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| |Effective Date: June 5, 2014 |
| |
|Category: Clinical |
| |
|Title: Arterial Puncture Procedure (Blood Gas) |
| |
|Applies to: |
| |
|St. Peter’s Health Partners (SPHP) |
| |
|All SPHP Component Corporations |
| |
|The following SPHP Component Corporations: |
| |
|___St. Peter’s Hospital____ |
| |
|St. Peter’s Health Partners Medical Associates (SPHPMA) |
TABLE OF CONTENTS
PURPOSE 1
POLICY STATEMENTS 1
SCOPE OF AUTHORITY / COMPETENCY 1
PROCEDURE 2
Preparation 2
Specimen Collection 3
LINKS
Hand Hygiene
Patient Identification
Standard Precautions
Mosby's Nursing Skills - Arterial Puncture
NICU – Radial Arterial Puncture by RN
REFERENCES 4
Top of Form
PURPOSE
To outline the process of arterial puncture.
POLICY STATEMENTS
• A physician/provider order is required for all arterial punctures.
• If one Respiratory Therapist cannot get a sample after two attempts, another Respiratory Therapist should be asked to attempt the arterial puncture.
SCOPE OF AUTHORITY / COMPETENCY
Respiratory Therapist (*Physician/Provider Order Required)
All RT's should demonstrate competency in the procedure under supervision of an experienced RT preceptor or RT Manager.
PROCEDURE
Indications
• Evaluation of the adequacy of ventilatory, acid-base, oxygenation status, and the oxygen-carrying capacity of blood.
• The need to quantify a patient’s response to therapeutic interventions (e.g.: BiPAP, oxygen therapy, mechanical ventilator).
• Diagnostic evaluation (e.g.: oxygen therapy, exercise testing).
• Monitoring the severity and/or progression of a documented disease process.
Precautions/Complications
• Arterial puncture should not be performed through a lesion or distal to a surgical shunt (dialysis)
• Hematoma
• Arteriospasm
• Trauma to the vessel
• Pain
• Inadvertent needle stick (use only arterial sampling kit with proactive sheath needles)
Equipment Required
• Adults: Arterial Puncture Kit
• Infants and children: 1 mL heparinized arterial blood sampling syringe with vented cap, 23 or 25g butterfly needle, alcohol prep pad, betadine prep pad, 2x2 gauze, and band aid or paper tape.
• Laboratory Requisition slip
• Patient labels
• Biohazard specimen bag
• Ice (if specimen cannot be transported to the lab within 15 minutes of acquisition)
Preparation:
|Steps |Key Points |
|Verify physician/provider order |Order should state: |
| |Date of the order |
| |Time of the order |
| |If the specimen should be collected with the patient on a specific oxygen |
| |flow rate, ventilator settings, etc. |
| |Physician/provider name |
|Review coagulation studies i.e., ACT, PT, PTT, INR and/or |Normal coagulation studies decreases bleeding complications. |
|platelets. Check to see if patiet is on anticoagulant therapy. | |
| |Note: Patients on anticoagulant therapy may need extra time to hold site.|
|Check patient’s ID band & verify identity using 2 patient |To ensure test is performed on the correct patient. Patient Identification|
|identifiers. | |
|Explain procedure to patient. |Reduces anxiety. |
|Perform proper Hand Hygiene and don clean gloves. |Follow all appropriate infection control and universal precautions. |
| |Standard Precautions |
|Position patient for comfort. |Facilitates insertion. |
|Perform Modified Allen’s Test: |If patient fails the Modified Allen’s Test on one hand, perform Modified |
|Hold firm pressure on both radial and ulnar artery. |Allen’s Test on the opposite hand. |
|Have patient open and close the hand that pressure is applied. |If patient fails both Modified Allen’s Tests, proceed to assess brachial |
|Have patient open hand while releasing pressure on the ulnar |arteries only if test is critically warranted. |
|artery. | |
|After pressure on the ulnar artery is released, the hand should| |
|become pink within 6 seconds. | |
|Note: Effective collateral circulation may be assessed with | |
|Doppler device. | |
Specimen Collection:
|Steps |Key Points |
|Place patient’s arm palm up. |Facilitates artery position. |
|Place patient’s arm on wrist support. |May need to hyper-extend wrist. |
|Don clean gloves. |Follow all appropriate infection control and universal precautions. |
| |Standard Precautions |
|Prepare site with betadine solution/alcohol. |Allow each agent to dry before going to next step. |
|Locate artery using non-dominate hand |Palpate artery with index and middle fingers. |
| | |
| |Note: May use Doppler device to assist in locating artery in conditions |
| |of severe hypotension. |
|Slowly perform puncture at approx. 45( angle. |Proper angle facilitates successful procedure. |
|Look for flash in needle hub and hold steady until syringe |Note: Approximately 0.5 mL of blood is needed for testing. |
|fills. | |
|Withdraw syringe and immediately close the safety cap. Apply |Hold pressure no less than 5 minutes. |
|firm pressure to site. |Assure that bleeding has stopped. |
| |If bleeding persists continue to hold pressure and dress with a pressure |
| |bandage. |
|Remove closed needle and place vented cap on syringe. Press on |To expel air bubbles. |
|the plunger until blood fills the gap in syringe hub and cap. | |
|Gently roll sample to mix the heparin with the blood. |To prevent clot formation. |
|Place patient label on specimen & complete laboratory |Verify correct label and requisition slip. |
|requisition slip. | |
| |Note: Make sure to include the patient’s temperature if less than 36.11( |
| |C (97( F) or greater than 38.33( C (101(F). |
| | |
| |Proper specimen labeling includes: |
| |Label affixed to the specimen with: |
| |patient name |
| |DOB |
| |collectors initials |
| |date & time of collection |
| |ABG requisition slip, filled in completely, inclusive of: |
| |patient name |
| |DOB |
| |specimen type |
| |collection site |
| |O2 / ventilation mode and applicable settings |
| |Modified Allen’s test if applicable |
| |collectors initials |
| |date & time of collection |
|Send specimen to the Blood Gas Lab for analysis. |Place the specimen on ice if it cannot be transported to the lab within 15|
| |minutes of acquisition |
REPORTABLE CONDITIONS TO PHYSICIAN/PROVIDER
• Any adverse events associated with procedure.
• Inability to successfully obtain sample.
DOCUMENTATION
Laboratory requisition slip:
• Patient name & date of birth
• Specimen type (arterial, mixed venous, venous)
• Specimen draw site
• FiO2
• Mode of ventilation/oxygenation and related settings
• Time & date of collection
• RT’s initials
Specimen label/Patient label:
• Time & date of collection
• RT’s initials
Progress notes section of patient chart:
• Adverse events, patient refusal, or inability to obtain a sample & notification of physician/provider
• Results of the Modified Allen’s Test
REFERENCES
American Association for Respiratory Care. (2012). Clinical Practice Guideline: Sampling for arterial blood gas analysis. Retrieved on May 15, 2012 from
Brzezinski M, Luisetti T, London MJ. (2009) Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthesia & Analgesia, 109(6):1763-81.
Mosby’s Nursing Skills (2011) Skill – Arterial Puncture
Shelly P. D., Hillmer, M.D., and Ferri, M. (2011) Arterial Puncture for Blood Gas Analysis. New England Journal of Medicine, 364:e7.
| | | |
|Approving Official: CNO; CMO | |Effective Date: June 5, 2014 |
| | | |
|Key Sponsor: Respiratory Therapy Manager | | |
| | |Original Date: 9/99 |
|Reviewed By: Director of Patient Therapies; chief of Pulmonary Medicine; Respiratory | |Reviewed/Revised Date: 9/02; 1/03; 10/08; 2/09; 5/12; 6/5/14|
|Therapists; SPH Policy Council | | |
| | |*Reviewed, No Revisions |
| | |**Revised without Full Review |
| | | |
|Search Terms: Arterial puncture, coagulation, Allen’s Test, ABG, oxygen, CO, Respiratory | | |
|Therapy | | |
| |
|Replaces: Arterial Puncture Procedure (Blood Gas), 5/12 |
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