blood gases

**SKM-NURSIEPOOH, BSN, RN** · Mar 1, 2008

hiya b eyes!

try the following sites:medineplus, nytimes, student

bmj.com, & madsci.com . hope these sites help ya.

cheers :cheers:,

moe

cccnurse · Mar 1, 2008

I have seen several different ways to draw ABG's I'll try to explain how I was taught to draw ABG's by a very respected Pediatric Intensivist, I almost never miss (not that I'm the best by no means) it's just this way seems to work.

First locate a good Radial pulse. (don't forget to check your Ulnar pulse)

Once you find a good pulse point your index finger of your non dominant hand toward the palm of your patients hand and locate the pulse again.

Place a towel roll under the patients wrist and slightly hyper extend the hand. you don't need much... Just enough to hold slight traction.

Take your time while feeling the pulse and try to visualize a straight line through your finger where you feel the pulse, and to where the Patients pulse originates.

Hold the ABG needle directly over your finger nail where you visualized the line... pull your finger back (proximal to the patient) and insert the ABG needle slowly just passed the tip of your finger. Watch the hub for flash, when you start to get flash stop and let the syringe fill to 1ml. (don't forget to run your syringe plunger back and forth once and have your plunger at 1-1.5 ml first)

Keep your finger on the patient to be able to recheck the pulse if you go all the way to the radius and didn't hit your target, this way you can slightly retract the needle and re-visualize the target and take another go.

My biggest advise is to take your time... take a deep breath and have confidence in yourself. When I raced dirtbikes in the woods the best advise I received from an old veteran was... Sometimes slower is faster.

Good luck, you will be ok.

PageRespiratory! · Mar 1, 2008

Can anyone give me any advice on how to draw blood gases...any helpful hints. Our lab is capable, most of them, but there are times when the tech is unable to get the stick and wants me to do it, but I never have and be honest, don't know how.
Don't know what I would do without you guys to go to...:redbeathe
b eyes

>

I'm sure the links provided will give you some good info, but I'll add some from my experience. The radial artery is the safest spot to perform an arterial stick. The ulnar artery usually will supply enough collateral blood flow to supply the hand if the radial artery becomes occluded. In order to test for sufficient collateral flow, you must first perform the modified Allens test. With both thumbs, occlude both the radial and ulnar artery while the Pt makes a fist. Hold for about 60 seconds and the release the ulnar artery. While still occluding the radial, test for sufficient capillary refill in the digital tips. Do this before you even open the blood gas kit. If collateral flow is good, find the spot where pulse seems strongest, usually the more distal, the closer to the surface the artery, usually:D. Palpate the pulse and like cccnurse explained imagine a straight line (Thats how I do it anyway) with the needle on a 45 degree angle, and the bevel facing the oncoming flow, go for it. Don't try to reposition the needle while in to deep, you'll increase the risk of slashing the artery. I usually withdraw untill just below the surface, reposition and then advance. I hope this "quick and dirty" version helps. Is this in the ER? Do you have a respiratory dept.?

jmgrn65, RN · Mar 1, 2008

We have to go thru competencies to draw blood gases. lab doesn't do them either RT does them on the floor generally and ICU nurses do them. I don't know about ED I would imagine the nurses do thier as well. OP gave really good advice but I was always taught that the radial should not be the first attempt the risk is greater. Go for the AC.

I was taught to feel for the pulse and then spread my first two fingers leaving the spot with the pulse in the middle and then going for it. but I find the method the first op mentioned easiest.

PageRespiratory! · Mar 1, 2008

We have to go thru competencies to draw blood gases. lab doesn't do them either RT does them on the floor generally and ICU nurses do them. I don't know about ED I would imagine the nurses do thier as well. OP gave really good advice but I was always taught that the radial should not be the first attempt the risk is greater. Go for the AC.
I was taught to feel for the pulse and then spread my first two fingers leaving the spot with the pulse in the middle and then going for it. but I find the method the first op mentioned easiest.

>

I'm assuming by AC, you mean the brachial artery. There is far more risk involved by drawing from the brachial then the radial. The radial artery should be the first attempt.

webbiedebbie · Mar 1, 2008

Guess it's been awhile for me...When I was in ER, only the Nurse could do them. Then respiratory was doing them. Didn't know lab techs could do them now.

b eyes · Mar 1, 2008

Guess it's been awhile for me...When I was in ER, only the Nurse could do them. Then respiratory was doing them. Didn't know lab techs could do them now.

With training , lab techs can do them.

b eyes

alkaleidi · Mar 4, 2008

Can anyone give me any advice on how to draw blood gases...any helpful hints. Our lab is capable, most of them, but there are times when the tech is unable to get the stick and wants me to do it, but I never have and be honest, don't know how.
Don't know what I would do without you guys to go to...:redbeathe
b eyes

You can find videos of actual ABG sticks on google or YouTube... :) They might help, if it helps you to see a procedure from start to finish.

rgroyer1RNBSN, BSN, RN · Mar 5, 2008

Ive done them alot and my er and sicu nurses do them too, Ive always done the radial stick without a problem, heck when we place an a-line in sicu we always go for the radial, I think ive did the brachial one time.