Table of Contents
Introduction
- Wash hands
- Introduce self
- Patient’s name, DOB and wrist band
- Explain procedure and obtain consent
- Check for allergies (including chlorhexidine)
- Ask preferred (or non-dominant) arm
Preparation
- Wash hands
- Clean tray
- Gather equipment around tray (think through what you need in order)
Equipment list
- Gloves
- Alcohol 70%/chlorhexidine 2% skin-cleansing wipe
- Arterial blood gas kit
- Heparinised 1-3ml syringe with 23G needle
- Rubber cube or needle cover
- Cap for syringe
- Sterile gauze
- Tape
- Wash hands
- Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
- Put needle on syringe if not already attached
- Return to patient
Procedure
Modified Allen’s test
- Wash handsÂ
- Expose wrist and place a pillow beneath it
- Perform modified Allen’s test
- With patient’s palm facing upwards, occlude both radial and ulnar arteries
- Ask patient to open and close hand until the palm becomes pale, then ask them to hold it open
- Release the ulnar artery and time how long the hand takes to reperfuse (i.e. become pink again)
- If ≤10 seconds, continue with ABG
Preparation
- Firmly hyper-extend the patient’s wrist (ask them, or hold it down yourself)
- Palpate radial artery with index and middle fingers
- Wash hands
- Put on gloves
- Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds)
- Expel air from the heparinised syringe (only necessary for some ABG kits)
Sampling
- With the index and middle fingers of your non-dominant hand, re-palpate the artery just proximal to the point of insertion
- Holding the bevel of the needle as close to your non-dominant hand’s fingers as possible (without touching them), insert the needle (bevel up) into the site of pulsation, at 45˚ to the skin
- When blood enters the syringe, hold it still while it self-fills (no need to aspirate)
- Place gauze loosely over the puncture site while you remove the needle. Then apply pressure to the gauze once the needle is fully removed.
- Secure needle with rubber block or needle cover
- Maintain pressure over the gauze for 5 minutes. Check it has stopped bleeding before taping down the gauze.
To complete
- Thank patient and restore clothing
- Remove the needle from the syringe and dispose of it in the sharps bin
- Put the cap on the end of the syringe and expel the air
- Discard waste and clean tray; then discard gloves; wash hands
- Label the sample and take it to the blood gas machine or call the porters to collect it on ice
- Document procedure and results in patient’s notes with the patient’s FiO2 and temperature
Learn how to interpret the results too…
ABG interpretation is covered here!