Healthcare and Medicine Reference
In-Depth Information
Box 6.2 Equipment for arterial blood gas sampling
Biceps
Median nerve
Gloves (sterile for procedure, non-sterile for preparation)
Brachialis
Skin preparation solution (2% chlorhexidine in 70% isopropyl
Brachial artery
alcohol)
Cotton wool and tape
Medial epicondyle
Biceps tendon
Tray with sharps bin
Arterial blood gas syringe (and needle if not provided)
Bicipital aponeurosis
Brachioradialis
A patient label, and pen to write down their details including
the inspired oxygen concentration
Pronator
teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Attach a 21G or 23G needle to the syringe. A 21G needle is likely to
be required for femoral access.
Figure 6.3 Anatomy of the brachial artery. (From Faiz O, Moffat D. (2006)
Anatomy at a Glance , 2nd edn. Blackwell Publishing, Oxford,
with permission.)
Radial
Conduct Allen test (Box 6.1).
1
2
Position the wrist; you can use a towel, pillow or bag of fl uid to
extend the wrist (20-30°).
Feel for the pulse just proximal to the traverse skin crease at the
External oblique
aponeurosis
3
wrist (Figure 6.6a).
Clean the skin with antiseptic solution (2% chlorhexidine in 70%
4
Superficial ring
isopropyl alcohol) and put on sterile gloves (Figure 6.6b).
With the pulp of your fi ngers, assess the size, depth, direction and
5
Ilioinguinal nerve
point of maximum pulsation.
Holding the syringe like a pen bevel upwards, at 45° aim at the point
Femoral artery
and vein in
femoral sheath
6
Spermatic cord
Femoral canal
of maximum pulsation, in a proximal direction (Figure 6.6c).
Figure 6.4 Anatomy of the femoral artery. (From Faiz O, Moffat D. (2006)
Anatomy at a Glance , 2nd edn. Blackwell Publishing, Oxford,
with permission.)
Brachial
Position the arm so the medial aspect of the antecubital fossa is
1
easily accessible.
Clean the skin with antiseptic solution (as above) and don sterile
2
gloves.
Feel for the pulse, assessing size, depth, direction and point of
3
maximum pulsation.
Holding the syringe at 45° aim at the point of maximum pulsa-
4
tion, in a proximal direction.
Femoral
Make sure the patient is lying fl at.
1
2
Clean the skin with antiseptic solution (as above) and don sterile
gloves.
Place fi ngers on the femoral pulse.
3
4
Aim the needle at the point of maximum pulsation, distal to your
fi ngers at almost 90° to skin.
Slowly advance the needle whilst pulling back on the plunger
5
until fl ashback is achieved.
Figure 6.5 Equipment for arterial blood gas sampling.
All sites
When you enter the artery the needle should self-fi ll; if not keep
Step-by-step guide: arterial blood gas sampling
1
the needle still and pull back on the plunger.
Collect 1-2 mL of blood (Figure 6.6d).
Give a full explanation to the patient in simple terms and
ensure that they consent to the procedure.
Set up your trolley (Box 6.2; Figure 6.5).
2
3
Withdraw needle and compress with cotton wool.
Prepare your trolley as a sterile fi eld. Wear a plastic
4
Discard needle (into sharps bin), expel the air and place the cap
disposable apron and non-sterile gloves, and take alcohol
hand rub with you
on the end.
Invert several times and take swiftly to the ABG analyser.
5
 
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