Welcome to the clinical skills video for arterial blood gas sampling from a radial artery.
Prior to any clinical procedure on a patient you must ensure that you have obtained verbal consent from the patient and explained the procedure thoroughly.
Ensure that you thoroughly wash your hands using the 11 stage technique. Once your hands are thoroughly dried you may start to prepare your equipment;
you require; A heparinised syringe
a blue needle
a sharps bin
sterile gauze
non sterile gloves
and a skin preparation wipe which must be 2% chlorhexidine
You must ensure that you wear the appropriate personal protective equipment, in this case non-sterile gloves and an apron.
Prior to assembling your tray you must ensure that the tray has been thoroughly cleaned with the appropriate alcohol wipes and dried thoroughly prior to opening the packages.
Prior to the procedure you must perform the Allen's test.
This involves asking the patient to make a fist, then occluding the radial and ulnar artery for about 30 seconds.
Then open the fist and the hand should appear blanched.
Pressure is then released from the ulnar artery and the colour should return to the hand within 5 to 15 seconds.
f the colour returns as described the test is considered normal.
If a colour fails to return the test is considered abnormal and we should not proceed with the ABG in that limb.
Then prepare all your equipment opening the gauze,
placing the needle on to the ABG syringe.
Ensuring that the top of the syringe is not discarded, as it will be needed later for processing the sample.
Prior to cleaning the skin you must locate the artery with the index and middle fingers of the non-dominant hand.
Once you have identified the site for insertion you may mark area or keep a finger in situ above the insertion site whilst cleaning the site so this will then mark the area.
The skin must then be thoroughly cleaned using a chlorhexidine wipe, or swap, for 30 seconds and allowed to drive 30 seconds. You must not re-palpate the area that has been cleaned.
Insert the needle at 30 to 45 degrees at the point of maximum palpation and advance it slowly until arterial blood pushes back in to the syringe.
The syringe should then fill under arterial pressure and may need an initial gentle aspiration.
Once you have obtained at least 0.7 mls of sample withdraw the needle smoothly, whilst applying a gauze swab with the non-dominant hand.
Dispose of the sharp appropriately and put the cap back onto the ABG syringe ensuring it is filled to the line ready for sampling.
Pressure must be exerted on the puncture site for at least 5 minutes after the sample. If the patient is able to, ask them to provide this pressure.
if not either yourself or another healthcare professional need to apply the pressure whilst somebody else goes and take the sample for being processed.
Once 5 minutes of pressure has been exerted check the wound and ensure that the patient is feeling ok and responding appropriate to the sample.
For analysis you will need:
a patient identifiable data (ideally a patient label with patients date of birth, name & hospital number)
the amount of oxygen that the patient is receiving (%)
where the samples comes from (ABG or VBG)
the temperature of the patient
In summary
Ensure they have prepared the patient and confirm that identity.
Wash your hands.
Assemble and prepare all equipment insuring an aseptic non touch technique (ANTT)
Perform that Allen's test.
Insert the needle 30 to 45 degrees.
Obtain at least 0.7 ml sample.
Dispose of a Sharps and equipment safely.
Apply pressure on the site for at least 5 minutes.
Ensure you have the correct information to process the samples (this includes patient identifiable data, temperature and their oxygen requirements).
Provide appropriate aftercare advice to the patient.
Ensuring adequate documentation is completed and the results of the ABG are acted upon.