Can anyone give me pointers?

  1. My lab skill is taking an ABG from the Radial artery. I have no problems with the brachial artery, and i have a hard time hitting the radial. I can feel it by palpation, but out of the 2 i have tried, i only got one of them, and i refuse to stick a person twice because arterial puncture seems to be extremely uncomfortable, even when done by someone more experienced than myself.

    Does anyone have any good tricks? I have no problems reading the results, be it Metabolic, or Respiratory Alkalosis, or acidosis (that isnt hard), and rather it is compensated or not, I understand that perfectly, but getting the blood for the test is a little more difficult from the radial. Anything you have to offer I am willing to try. This is the first skill I have had trouble with, and its stressing me out a little.

    Thanks!
    BrandyBSN
    •  
  2. 16 Comments

  3. by   Q.
    Yikes Brandy - I've never taken ABG's - we usually leave that to our phelbotomists who have the skill, or the docs sometimes do it themselves - at least on our floor (Labor and Delivery)

    I'm sure someone on this board can help ya though.

    Good luck.
  4. by   thisnurse
    i cant help you either sorry to say.
    ive never even seen a nurse draw abg's, let alone do it myself.
    i think its great that youre learning but im wondering why...
    i suck at taking blood and starting ivs
  5. by   BrandyBSN
    I am not sure why we are learning, but it is a required skill for our critical care/Emergency nursing clinical rotation.

    Thanks for replying
    BrandyBSN
  6. by   CC NRSE
    Brandy, it just depends on where you work,..and your hospital policy. We too, on occasion, stick for ABG's (in critical care). Although,...this is not a common practice on the floor. I have also worked at a hospital that did not allow nurses to stick,..but only respiratory therapy. Only advice I have,...just like starting an IV,..practice,..practice,...practice!!!! Good luck!!
  7. by   Zee_RN
    Me either. Respiratory does all our ABGs, unless a femoral is required and then the physician or resident does it. While I sometimes feel like I missing out on learning a critical nursing skill, I am also grateful I don't have to do it. ABGs are very uncomfortable and can be very time-consuming on that hard-to-stick person.
  8. by   JJFROG
    I agree that they are quite close to the bone and it gives me the heebie jeebies when I hear the scrape of needle on bone but usually always get the draw. Also, they usually are not as deep as one thinks they are. I also find that the more gentle I poke the needle in, the better luck I have! Also do not forget to check the pt's Allen's Test and document that you did it.
  9. by   kaycee
    I think it's easier if you place a rolled wash cloth or small towel under the wrist, it props it up and the artery is easier to find.
    You go in at a different angle then venipuncture. I believe it would be 90 degrees if I remember my Trig right, or maybe slightly less, it's hard to describe. Once you feel the artery with your finger leave it there and being careful not to stick yourself put the needle in right below your finger. Actually 1 out of 2 is not bad at all. And as already said, with anything is takes practice.
    Good luck.
  10. by   jayna
    Put trust in your self that you will suceed in sticking the needle there, it works for me. When i m about to do the procedure i have to put all trust in myself that i will suceed..(but remember don't tired yourself before doing this particular procedure)....
    believe me it works...i can close my eyes when puting ivi or ABG' in very fat person or small babies, because i trust my instinct..
    Good luck all,
  11. by   cmggriff
    Brandy,
    This was once my best thing. I could get ABG's when no one else could. This is how I did it.
    Be sure to hyper extend the patient's wrist, this puts the Artery
    as close to the surface as it can get. locate the artery with the index finger of your nondominant hand. Center the pulse in the center of your finger. As you insert the needle you should almost hit yur finger. Good luck Gary
  12. by   hoolahan
    Jayna, I thought I was the only one! Sometimes I think to myself "Use the force Luke..." LOL! It really works!!

    Except for me with abg's! I suck at them, and traded jobs with other nurses not to do them. Actually had an RT tell me once, as she was digging and digging that needle in, "It really doesn't hurt the pt much..." Bull!! I have seen them wincing in pain.

    One tip, remember to take the dynamap off in the arm you want to stick! Learned that one the hard way, maybe why I have never been successful!
  13. by   BrandyBSN
    Thanks Everybody!

    BrandyBSN
  14. by   RNed
    Get a good anatomy book and study the underlying structures of the wrist. Practice feeling and visualizing those structures on your husband, boyfriend or girlfriend's wrist with the book turned correct for orientation. This is one of those things, I do not suggest you do by yourself because you need to reverse that visualization when you attempt the "stick" on the patient. So study it in the correct orientation as though you were actually doing it.

    Prior to sticking the patient attempt to feel and visualize their underlying structures in your head. Enter the needle at an approximate 80 or 90 degree angle. Advance the needle slowly thereafter. Remember not to place to much pressure on the artery from above as this can occlude the artery and might hinder blood return. Specially on the low b/p patients. At times, I have used my palpation finger to sorta "pin" the artery between my finger and the bone therefore securing the artery prior to sticking. Do easy patients first and then move to the swollen, edemous, low b/p, difficult sticks.

    Chart Allen's test and note distal warmth and color prior and after the stick. Practice and good luck.
    Last edit by RNed on Oct 17, '01

close
Can anyone give me pointers?