ST. PETER’S HOSPITAL LABORATORY
St. Peter’s Hospital
SPECIMEN ACQUISITION - ARTERIAL BLOOD GASES - ARTERIAL PUNCTURE
PROCEDURE:
1.Bring all equipment to patient’s room.
2.Obtain requisition at Nursing Station.
3.Check patient’s chart to confirm physician’s order.
4.Check patient’s identification band to ensure that blood is being obtained from the correct patient.
5.Explain the purpose of the arterial puncture to the patient and answer any questions the patient may have.
6.Choose the site of puncture; ensure that patient has no present or previous vascular, neurological, or dermal condition at the puncture site which would produce complications; check for good pulses and/or collateral circulation.
a.Radial Artery - Should be the first site chosen because nerve and vein injury or inadvertent venous sampling is unusual at this site. Ensure good collateral circulation through the ulnar artery by PERFORMING AN ALLEN TEST.
b.Brachial Artery - If good pulses and/or good collateral circulation are not present in the radial artery, then proceed to the brachial artery at the antecubital fossa. This artery is usually readily palpable; arterial spasm may be less common than at the wrist, but if plaque embolism, spasm, or hematoma do occur, the likelihood of complications are higher than with a Radial Puncture.
c.Femoral Artery - Should be chosen only if the Radial and Brachial sites are not feasible.
7.Wash hands and follow all appropriate Infection Control and Universal Precautions after opening the kit.
8.Set plunger to desired sample size (cc.., cc., etc.).
a.For femoral puncture, remove 23 gauge needle and place 20 or 21 gauge 1/2" needle on arterial sampler.
b.For punctures on children, remove 23 gauge needle and place 25 gauge 1/2" needle on arterial sampler.
9.Place gloves on hands.
10.Prep the site by:
a.scrubbing the puncture site first with alcohol pad, and
b.placing second alcohol pad on puncture site and cleaning outward in a circular motion.
c.Wipe off fingers to be used to palpate artery, with the back side of the second alcohol pad.
11.Dab excess alcohol from site with sterile 2" x 2" gauze pad.
12.Palpate artery with one finger.
13.Insert needle into artery at approximately a 30 to 40 degree angle with bevel up and allow blood to flow until the volume established in #8 is completely filled.
14.Withdraw needle from site once sample is obtained and immediately apply pressure to puncture site with sterile2" x 2" gauze.
15.Check sample for air bubbles and expel any that are present in the sample. Direct needle into rubber stopper, shake/roll sample vigorously to mix the heparin with the blood, and label the syringe while firmly compressing the puncture site for a minimum of five minutes routinely, and ten minutes for patients on anticoagulation therapy. Remove used needle and place plastic outlet cap on syringe tip. Discard used and unused needles into sharps container in patient’s room.
16.Check puncture site for hematoma after compression for five minutes. If puncture wound is still bleeding, reapply pressure until artery is sealed.
17.Blood gases should be sent to the lab immediately via the pneumatic tube system. (Otherwise, samples must be placed in ice water slurry if they cannot be transported to the lab within 15 minutes after acquisition.)
18.Enter on the Blood Gas Requisition:
a.Date and time drawn
b.Therapist’s initials or last name which drew sample
c.Pertinent vent settings.
d.Type of specimen - venous, arterial, etc.
e.Patient’s temperature if less than 97ºº or greater than 101ºF.
19.If one therapist cannot get a sample after two attempts, another THERAPIST should be asked to attempt the arterial puncture.
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Blood Gas Arterial Puncture
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