COLLECTION - ARTERIAL BLOOD GAS
punctures are the responsibility of Medical Technologist,
Medical Laboratory Technicians and Technical Assistant III's
authorized by training and competency to perform the procedure.
OF BLOOD COLLECTION SITE:
are three main arterial sites on each side of the body, which
are easily accessible for arterial puncture. Two of these sites
are available to laboratory personnel- the brachial artery immediately
above the crease of the elbow and, more preferably, the radial
artery at its site of most palpable pulsation in the wrist.
The third is the femoral artery - laboratory personnel are
not authorized to use this site. The patient's physician
may use the femoral artery or other sites.
patient's nurse may draw specimens through an arterial line.
without an arterial line, laboratory personnel may be requested
to draw an arterialized capillary specimen by heel stick.
store blood samples for later analysis, place the syringe in
ice. Blood gas values may change within five to ten minutes
if the sample remains at room temperature.
the specimen on ice maintains the temperature at 1° to 5°C which
will stabilize the specimen and provide reliable results for
one to two hours. However, it is best that analysis of the sample
be performed as soon as possible.
reagents and test materials for this test are stored at the
analyzer at room temperature. Pulsator Plus arterial blood collection
kits Ref # G1542 are ordered from Sims Poretx Co. as needed
heparin (0.5 mL)
needle (23 gauge, preferably)
physician order; if appropriate, call the floor to verify
that specified conditions in the order have been met.
blood gas kit at patient bedside.
plastic bag with ice.
needle to syringe and mix heparin in the syringe, completely
the syringe upright, pull the plunger back and forth to
distribute the dry heparin.
the patient and explain the procedure, including discomfort
that might be expected (throbbing pain when the needle reaches
the artery, possibly shooting pains to the fingers and thumb).
via nasal canal = 21 (arm. air) + (4 x #l liters).
via mask - percent O2 set at valve on mask
or near humidifier (if you cant find it, ask the
the Allen Test
radial and ulnar pulses at the wrist as the patient opens
and closes fist until his palm blanches.
pressure on the ulnar artery only, and watch for
flushing of the hand (return of color within 5 seconds
indicates sufficient collateral circulation).
For the unconscious patient - raise the hand above
the heart level and squeeze until it blanches. Block
radial and ulnar arteries and lower hand. Release
pressure on ulnar and observe for flushing.
either case, if the Allen Test fails, arterial puncture
must not be performed and ordering physician notified.
the patient comfortably, with the arm fully extended and
anterior surface upward. With middle and/or index finger,
palpate the artery, locating the area of maximum pulsation.
the area thoroughly with an alcohol sponge. Prep fingers
used to palpate the artery. Cleanse the puncture site a
forefinger and middle of your free hand to stabilize the
artery, hold the syringe as you would a pencil at an angle
between 45° and 90°, bevel up. Arterial pressure will push
blood into the syringe.
collecting 2-3 mL of blood, remove needle and immediately
apply pressure to the puncture site. Maintain pressure a
minimum of two minutes (3-5 minutes is preferable).
If the patient is on anticoagulant therapy, apply pressure
for 15 minutes and apply a pressure dressing.
syringe, being sure to remove air bubbles. Rotate sealed
syringe to mix blood with heparin.
syringe, put on ice, and transport to lab immediately. Recheck
puncture site before leaving.
Puncture Technique: Infants & Children
minimize anxiety of other children within close proximity,
perform in a treatment room.
the aid of sufficient personnel to provide for patient immobilization.
a heparinized tuberculin syringe. For greater maneuverability,
a butterfly may be substituted for the conventional needle.
REMEMBER: A plastic syringe will not provide arterial
return alone; pressure must be applied.
this site only if neither radial is satisfactory.
patients arm (palm up) with elbow straight.
pulse above the brachial fascia at the elbow, but within
one inch of the elbow.
this site, the median nerve is very close to the artery.
this site, the artery is more difficult to stabilize.
site and prep fingers as for radial puncture.
puncture at an angle of about 90°, avoiding veins that might
be superimposed on the artery.
collection, apply pressure. Do not leave patient until you
are sure bleeding has stopped.
Capillary Sample Collection Technique:
capillary bed 5-10 minutes; vasodialation increases blood
flow to near arterial rate.
heel pad, ear lobe, and fingertip.
full heparinized capillary tubes, excluding air bubbles.
both ends of tube.
on ice and transport to the lab immediately.
NOTES: Authorization process for all personnel is as follows:
observe three (3) arterial punctures performed by an
at least three (3) arterial punctures under supervision
of an authorized technologist.
by pathologist for proficiency; competency report to
be presented to pathologist after completion of orientation
or annual competency.
samples anaerobically, without introducing air bubbles
in the syringe and cap the syringe. If bubbles develop
during sample collection, remove them immediately.
capillary samples in heparinized capillary tubes. Cap
the tube on both ends.
Do not use other common anticoagulants, such as EDTA, citrates,
or oxalates, since they markedly alter the pH. Because of the
high gas solubility of paraffin hydrocarbons, avoid the use
of grease or mineral oil lubricants.
James, 1983. Grants Atlas of Anatomy, 8th
Ed., Williams and Wilkins. Baltimore. (plates 6-68,
Joseph S. and Griese, Roger W., 1976. Clinical Chemistry:
Principles and Procedures, 4th Ed., Little, Brown
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Gordon, 1981. Neonatology, 2nd Ed., J.B. Lippincott
Co., Philadelphia. p. 420.
Gas Manager Model 1312; pH/Blood Gas Analyzer - Operators
Manual, Instrumentation Laboratory, Inc., Lexington,
Israel and Henry, John B., 1974. Todd Sanford Clinical
Diagnosis by Laboratory Methods. W.B. Saunders Co.,
Susan. and Francis, Sally A., 1981. Pediatric Diagnostic
Procedures, John Wiley and sons, New York. pp. 91-92.
Clarence A., Ed, 1977. Pulmonary Medicine, J.B.
Lippincott Co., Philadelphia. pp. 124-127.
Alex and Szabo, LaVerne. 1979. Clinical Chemistry
Interpretation and Techniques. Lea and Febiger.
Philadelphia. pp. 124-127.
Pat and Stevens, June. Step by Step Through an Arterial
Stick. RN, 1981, October. pp. 46-50.
Siew Jyu, M.D. 1983, Personal Communication. NHMH, Wilmington,