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Lesson 11: Arterial Blood Collection (Order: Answers/Questions) With Complete Solutions MODIFIED ALLEN TEST Done prior to radial artery puncture/sample collection to determine if the ulnar artery is capable of providing collateral circulation to the hand. prior to radial artery puncture/sample collection when is the modified allen test done? to determine if the ulnar artery is capable of providing collateral circulation to the hand purpose of the modified allen test II-III-I-IV-V-VI modified allen test: procedure (arrange) I. Compress both arteries. II. Extend the patient's wrist over a rolled towel and ask the patient to form a tight fist. III. Locate the pulses of the radial and ulnar arteries on the palmar surface of the wrist by palpating with the second and third fingers, not the thumb, which has a pulse. IV. Have the patient open the fist and observe that the palm has become pale (blanched). Remember you are still compressing
the arteries. V. Release pressure on the ulnar artery (near the pinky) only and watch to see the color returns to the palm. This should occur within five seconds if the ulnar artery is functioning and capable of collateral circulation. VI. If color does not appear (negative Modified Allen Test), the radial artery must not be used. If the Modified Allen Test is positive, proceed by palpating the radial artery to determine its depth, direction, and size second and third fingers Locate the pulses of the radial and ulnar arteries on the palmar surface of the wrist by palpating with the? thumb has a pulse why not use thumb when palpating? blanched pale five seconds color returns to the palm, this should occur within ________ if the ulnar artery is functioning and capable of collateral circulation. radial artery must not be used If color does not appear (negative Modified Allen Test),
needle is slowly inserted __________ below the palpating finger at a _______ degree angle (bevel up) blood appears in the needle hub Needle is slowly advanced until? t t or f: Arterial pressure should cause blood to pump into the syringe needle may be slightly redirected ("swim") to attempt to hit the artery If blood doesn't appear, _________ on critically ill patients having anticoagulant therapy (coumadin/heparin) or thrombolytic therapy Arterial punctures often done on? more than 5 mins Application of pressure should be done for phlebotomist who applies the pressure after removal of needle? phlebotomist or patient? check if bleeding has stopped
applying pressure: After the 5 minutes, what do u do? continue for two minutes again. Repeat until bleeding has stopped. if bleeding has not stopped after applying pressure for 5 mins, what to do? t t or f: With the hand holding the syringe, expel any air immediately that has entered the sample. Activate the needle protection shield, remove the needle, and apply the luer cap, or insert the needle into a point-lock device. anticoagulant Rotate the syringe and mix the _________ with the entire sample LABEL When both hands are free, the needle is discarded in an appropriate container and the luer cap is applied to the hub of the syringe. __________!!! t t or f: completion of procedure Put in an ice-water bath
RADIAL ARTERY PUNCTURE PROCEDURE (PLS STUDY
IN NOTES THE STEPS R SO LONG HUHU T^T but ill still add qs regarding this) oxygen therapy, steady Obtain __________ information (if it's room air, etc) and ensure a ______ state. Heparinize, anesthesia, pre-anticoagulated specialized ______ a glass syringe and prepare the local _______ syringe if necessary. But ideally, you should have a ____________ plastic syringe. lidocaine what anesthetic is administered if necessary in radial artery puncture? 30-45, 10 to 15 radial artery puncture Insert needle (with your dominant hand), bevel up at a _____- degree angle, _______ mm below the palpating finger. t t or f: it would self-fill because of arterial pressure 3- Remove needle and apply pressure for ________ minutes.
pressure Remove needle while retaining _______. Luer Apply _____ device and mix syringe while retaining after bleeding has stopped when to label sample? 30 radial artery puncture has a window period of at least ______ minutes to process the sample anaerobic The sample should be under strict _______ conditions
- Improper amount of anticoagulant.
- Failure to analyze the sample in a timely manner.
- Collection of venous rather than arterial blood. Sample integrity is compromised by:
- Introduction of air into the sample
- Excessive pulling of the syringe plunger resulting in increased suction
- The presence of excess heparin in the syringe falsely lowers blood pH
- An inadequate amount of heparin resulting in a clotted sample.
Samples should be collected in _____- syringes f, not placed t or f: samples should be placed in ice bath it is over 30 minutes. when can samples be placed in ice bath? when lactic acid/lactate has been ordered with the ABG test, then samples should be iced immediately (exception) when to place samples on ice bath immediately
- hematoma
- arteriospasm
- vasovagal reaction
- thrombus formation
- hemorrhage
- infection ARTERIAL PUNCTURE COMPLICATIONS Hematoma More common in arterial puncture due to the increased pressure forces blood into the surrounding tissues
- Failure of phlebotomist to maintain pressure for 3-5 minutes.
- Decreased elasticity in the arteries of older people. It is weak/fragile and has the tendency to collapse. If it collapses, blood leaks which leads to hematoma
causes of hematoma Arteriospasm Temporary constriction of an artery in response to pain. collection of samples and prevents oxygen from reaching the tissues Closure of artery prevents? gangrene Closure of artery may result to? necrosis gangrene may lead to? t t or f:gangrene may result. May lead to necrosis. That is the importance of collateral circulation compensating for a damaged artery. Vasovagal Reaction Results in a sudden loss of consciousness. Stimulation of the vagus nerve from stress/pain โ vasodilation โ drop in BP (hypotension) โ Loss of consciousness. Pathophysiology of vasovagal reaction: hypotension
brachial artery is located near the _______ vein t t or f: Be alert for the presence of bright red blood that pulsates into the syringe t t or f: The sample submitted to the lab and the collection of arterial blood must be noted on the requisition form. t t or f:Do not perform arterial puncture unless properly equipped with specialized training. air or capillary blood to enter the sample Excessive pulling on the syringe plunger can cause? it should always be in an anaerobic state or environment Air entry is a big no no because? rechecked Patient assessment information may be included on the requisition form but should be _______ at this time 15- If anesthesia is given, it wears off in _____ minutes venous blood
Blood that does not pulse into the syringe and appears dark rather than bright red may be ______ t t or f: Again, apply firm pressure for at least 3-5 minutes. One hand must hold pressure on the puncture site during the 3- minute duration electrolytes Samples that will have __________ performed cannot be placed on ice f, never t or f: hesitate to report anything unusual observed while performing an arterial pressure venous blood normal values for most laboratory tests are true t or f: arterial blood collection is more uncomfortable and dangerous and obviously more painful blood gas evaluation or ABG arterial blood collection is specifically for? I - III - IV - V
responsible for the collection of arterial blood arterial blood gases Test the ability of the lungs to provide oxygen to the blood and to remove carbon dioxide from the blood and exhale it critically ill Usually patients requiring blood gas analysis are often ____________ as soon as possible arterial blood gases must be released? respiratory ; metabolic ABG can be ____ or _______ in origin. I - II - III - IV - V - VII As ABG can be be respiratory or metabolic in origin, it specifies on: I. chronic obstructive pulmonary diseases (COPD) II. cardiac and respiratory failure III. lung cancer IV. severe shock V. open heart surgery and respiratory distress syndrome (RDS) in premature infants
VI. congenital artery disease VII. diabetic coma partial pressure of oxygen (PO2) measures pressure of O2 dissolved in the blood partial pressure of oxygen (PO2) tells how well O2 moves from the lungs into the blood 75-100 mmHg normal values for PO partial pressure pf carbon dioxide (PCO2) measures the pressure of CO2 dissolved in the blood partial pressure pf carbon dioxide (PCO2) tells how well CO2 moves out of the lungs 35-45 mmHg normal value for PCO pH measures the acidity or the alkalinity of the blood 7.35-7. normal value for pH pH
blood gas analyzer ; syringe
- to protect specimen from room air contact specimens are introduced directly into the _______ from the ______ to ________. true (t or f): for arterial blood collection, the blood collected from the syringe is fed to the machine already instead of transferring it to the tubes I - III arterial blood collection kit: I. pre-anticoagulated syringe II. syringe III. hypodermic needles with safety shields and tight fitting cap for the luer tip heparin anticoagulant usually present in the pre-anticoagulated syringe 30 mins ; luer tip after the needle is removed, and you're about to feed it within ______. you can cover it with this ____. to protect it from air why should u cover with a luer tip after removing the needle?
freely moving plungers containing an anticoagulant syringes are recommended with? 1-5 mL syringe sizes may range from? true t or f: syringe size must not be larger than the volume of sample blood true t or f: when feeding blood to the machine, it doesn't really need that much volume bc you'd only collect around less than 3 mL of blood why is 1-5 mL the syringe size? II - 3 Based on the size and depth of the artery selected, needle sizes ranges from _____ and are_____ inches long I. 21-25 g II. 20-25 g III. 21.5 - 24.5 g
- 2/3 to 1 1/2 inches long
