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Radial ABG Procedure

Phlebotomy Procedures

Numerical OrderProcedure
1 Rationale Blood collection for arterial blood gas analysis using the radial artery.
2 Equipment Tincture of iodine solution or chlorhexidine gluconate
3 Equipment 0.5% to 1% lidocaine to numb site
4 Equipment Prefilled heparinized safety syringe, 1 to 5 mL (especially designed plastic syringe for collections for ABG analysis)
5 Equipment Collection w/a plastic syringe requires the sample to be transported at room temperature & analyzed within 30 mins. If analysis will occur after a 30 min delay from collection, collect the blood in a glass syringe & transport it in a slurry of ice water.
6 Equipment Safety needles (20- to 22-gauge, for collections for ABG analysis)
7 Equipment Safety needles (25- to 26-gauge, for lidocaine administration)
8 Equipment Safety syringe for lidocaine administration (1- or 2-mL plastic syringe)
9 Equipment Plastic bag or cup with crushed ice and water
10 Equipment Waterproof ink pen
11 Equipment Oxygen-measuring device to record bon laboratory requisition the oxygen concentration on patient receiving oxygen
12 Equipment Thermometer to record patient's temperature on laboratory requisition
13 Equipment Mask
14 Equipment Protective laboratory coat or smock.
15 Preparation Gather and organize the necessary equipment and supplies for a successful arterial puncture
16 Preparation Properly identify the patient and inform him or her of the arterial puncture procedure
17 Preparation Determine that the patient has been in a stable state for at least the previous 30 min (no respiratory changes)
18 Preparation Attempt to calm the patient before collecting the specimen if the patient appears anxious. The anxiety can lead to hyperventilation (rapid breathing) which can falsely alter ABG levels
19 Preparation Before proceeding, determine whether the patient is receiving anticoagulant therapy or is allergic to iodine or lidocaine, and record the patient's temperature, oxygen concentration from the respirator, & respiratory rate
20 Procedure Wash your hands; put on gloves, a facial mask, and a protective laboratory coat; and then palpate the radial artery in the forearm. The radial artery in the patient's nondominant hand is usually the best choice
21 Procedure With the forefinger or first two fingers, press at these sites to find the artery. Never use your thumb (has a pulse). Avoid any site that has a hematoma or that was previously used for an arterial puncture
22 Procedure Position the patient's arm with the wrist slightly extended and rotated. Check for adequate collateral circulation using the modified Allen test
23 Procedure Once the radial artery site is chosen, clean the area well with tincture of iodine or chlorhexidine. Do not touch the site after it is cleansed.
24 Procedure If the patient desires a local anesthetic, fill a 1-mL syringe with lidocaine and inject the lidocaine with the 25- to 26- gauge needle subcutaneously around the anticipated puncture site
25 Procedure No tourniquet is required because the artery has its own strong BP. Use a prefilled heparinized safety syringe (1 to 5 mL) with a needle to withdraw the sample
26Procedure Hold syringe/collection device like a dart. Pull skin taut w/a finger of the other hand over the artery, and pierce the pulsating artery at a high angle, usually 30°-45° against the bloodstream. Blood pulsates quickly into syringe under its own pressure.
27 Procedure When apprx 1mL of blood is collected, withdraw needle carefully to avoid bubbles. Apply gauze pressure at least 5min. If pt is receiving anticoagulant therapy (ie, Coumadin), gauze pressure 10-15mins.
28 Procedure Engage the safety syringe cover to cover the needle exposure, gently mix the blood in the syringe with the heparin, and label the syringe. Mix the blood gently by inverting the syringe at least 5x.
29 Procedure Before leaving the patient, clean the puncture site with an alcohol pad to remove the excess iodine or chlorhexidine solution; leave a pressure bandage on the site
30 Procedure If bleeding from the site persists, apply more manual pressure and ring for assistance from the patient's primary nurse. Never leave a patient who is bleeding, particularly after an arterial puncture
31 After the Procedure Notify the primary nurse after an arterial puncture is performed so that the area may be checked frequently for deep or superficial bleeding
32 After the Procedure Discard blood-soaked gauze pads, contaminated items, and gowns or gloves used in isolation rooms in approximate biohazardous waste containers
33 After the Procedure Dispose of gowns and gloves that are not from isolation rooms in the appropriate containers
34 After the Procedure Wash or sanitize your hands
35 After the Procedure Thank the patient for cooperating and depart with all specimens and all remaining supplies. Do not leave anything at the patient's bedside
36 After the Procedure Deliver the blood specimen with the laboratory test to the laboratory immediately
Created by: DenmarkH0ttie
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