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Phlebotomy Ch.13: Lecture 1 (ABG testing (measure the gas exchange ability…
Phlebotomy Ch.13: Lecture 1
Arterial Blood collection
used to manage oxygen therapy, electrolytes, and acid-base balance; makes it different from venous blood
most often used to test for ABG's, ammonia, and lactic acid
more dangerous type to the patient than venous collection and should only be performed by trained persons
ABG testing
measure the gas exchange ability of lungs and the buffering capacity of blood
abnormal values indicate that body's tissues are not getting adequate oxygen-potentially life threatening condition
can cause COPD, lung cancer, shock, respiratory failure and diabetic coma
equipment: preheparinized gas impermeable plastic syringe (1-5ml in size)
needleless vary in size- 22g to 21g with 1 in to 1 and a 1/2 length with safety device for removal of the needle before sealing syringe to prevent gas loss
cleaning protocol can vary with same facilities using both alcohol and povidone or chlorhexidine
if use local anesthetics make sure the pt is not allergic
safety needle needed so it can be removed before sealing tip of syringe to prevent gas loss
transport container with crushed ice may be needed
bandage and a thermometer to take the pt temp if required
ABG Site Selection
arteries used should be near the surface and large enough to accept at least a 23G needle
should be able to have collateral circulation and be able to receive blood from one or more artery
site should not be inflamed, irritated, edematous, or proximal to a wound
Radial Artery
first choice for collecting
may be ahrd to find in pt with low cardiac output
can be checked for collateral flow
easily accessible and can be compressed against bones and ligaments after puncture to reduce hematoma
Brachial Artery
large artery in antecubital fossa located below the basilic
deep lying close to median nerve
in soft tissue making it hard to compress posing a high risk of hematoma and bleeding
type may be prohibited
femoral artery
large artery located in the groin
useful when cardiac output is low but has poor collateral circulation
should only be accessed by those with advanced training
presence with high risk of infec and possible dislodging of plaque from the arterial wall
Allen Test
extend pts wrist over a towel and have pt make a fist
locate radial and ulnar pulses and compress both arteries
Radial Artery Puncture
1, Prep pt and examine and complete form
if required take and record pts temp and respiration rate
record and verify any O2 therapy
pt should be in steady state for 30 minutes prior to test
Choose and prep site
perform and document the Allen Test
clean the site per facility protocol
if permitted inject local anesthetic and wait 1-2 minutes for it to work
Perform puncture
locate artery with non dominant hand
hold the syringe like a dart with the bevel tip pointed toward toward the arm
insert needle 5-10 mm distal the finger over the artery
watch for blood to pulsate into syringe indicating an artery; confirm by bright red color
Withdraw needle...
apply pressure for a minute or 5 if the pt is receiving a anticoagulant therapy
activate needle safety device- expel any air in the syringe- cap syringe with leur tip and roll the syringe to mix blood with heparin
Examine puncture site
check the site to make sure bleeding has stopped either at 5 or 15 minutes
clean site with alcohol to remove iodine if used then apply bandage
check for pulse distal to the site- if weak or absent contact nurse immed.