Goal: The blood sample is obtained from the artery without damage to the artery.
1. Gather the necessary supplies. Check product expiration dates. Identify ordered arterial blood gas analysis. Check the chart to make sure the patient has not been suctioned within the past 15 minutes. Check facility policy and/or procedure for guidelines on administering local anesthesia for arterial punctures. Administer anesthetic and allow sufficient time for full effect before beginning procedure (American Association of Critical Care Nurses [AACN], 2005; Hudson, et al., 2006).
2. Bring necessary equipment to the bedside stand or overbed table.
3. Perform hand hygiene and put on PPE, if indicated.
4. Check the patient’s identification and confirm the patient’s identity. Tell the patient you need to collect an arterialblood sample, and explain the procedure. Tell the patient that the needlestick will cause some discomfort but that he or she must remain still during the procedure.
5. Close curtains around bed and close the door to the room, if possible.
6. Check specimen label with the patient’s identification bracelet. Label should include patient’s name and identification number, time specimen was collected, route of collection, identification of person obtaining the sample, amount of oxygen the patient is receiving, and any other information required by agency policy.
7. Provide for good light. Artificial light is recommended. Place a trash receptacle within easy reach.
8. If the patient is on bed rest, ask him or her to lie in a supine position, with the head slightly elevated and the arms at the sides. Ask the ambulatory patient to sit in a chair and support the arm securely on an armrest or a table. Place a waterproof pad under the site and a rolled towel under the wrist.
9. Perform Allen’s test before obtaining a specimen from the radial artery:
a. Have the patient clench the wrist to minimize blood flow into the hand.
b. Using your index and middle fingers, press on the radial and ulnar arteries. Hold this position for a few seconds.
c. Without removing your fingers from the arteries, ask the patient to unclench the fist and hold the hand in a relaxed position. The palm will be blanched because pressure from your fingers has impaired the normal blood flow.
d. Release pressure on the ulnar artery. If the hand becomes flushed, which indicates that blood is filling the vessels, it is safe to proceed with the radial artery puncture. This is considered a positive test. If the hand does not flush, perform the test on the other arm.
10. Put on unsterile gloves. Locate the radial artery and lightly palpate it for a strong pulse.
11. Clean the site with the antimicrobial swab. If using chlorhexidine, use a back-and-forth motion, applying friction for 30 seconds to the site, or use the procedure recommended by the manufacturer. Allow the site to dry. After disinfection, do not palpate the site unless sterile gloves are worn.
12. Stabilize the hand with the wrist extended over the rolled towel, palm up. Palpate the artery above the puncture site with the index and middle fingers of your nondominant hand while holding the syringe over the puncture site with your dominant hand. Do not directly touch the area to be punctured.
13. Hold the needle bevel up at a 45-degree angle at the site of maximal pulse impulse, with the shaft parallel to the path of the artery. (When puncturing the brachial artery, hold the needle at a 60-degree angle.)
14. Puncture the skin and arterial wall in one motion. Watch for blood backflow in the syringe. The pulsating blood will flow into the syringe. Do not pull back on the plunger. Fill the syringe to the 5-mL mark.
15. After collecting the sample, withdraw the syringe while your nondominant hand is beginning to place pressure proximal to the insertion site with the 2 2 gauze. Press a gauze pad firmly over the puncture site until the bleeding stops at least 5 minutes. If the patient is receiving anticoagulant therapy or has a blood dyscrasia, apply pressure for 10 to 15 minutes; if necessary, ask a coworker to hold the gauze pad in place while you prepare the sample for transport to the laboratory, but do not ask the patient to hold the pad.
16. When the bleeding stops and the appropriate time has lapsed, apply a small adhesive bandage or small pressure dressing (fold a 2 2 gauze into fourths and firmly apply tape, stretching the skin tight).
17. Once the sample is obtained, check the syringe for air bubbles. If any appear, remove them by holding the syringe upright and slowly ejecting some of the blood onto a 2 2 gauze pad.
18. Engage the needle guard and remove the needle. Place the airtight cap on the syringe. Gently rotate the syringe to ensure that heparin is well distributed. Do not shake. Insert the syringe into a cup or bag of ice.
19. Place label on the syringe per facility policy. Place iced syringe in plastic, sealable biohazard bag.
20. Discard the needle in sharps container. Remove gloves and perform hand hygiene.
21. Remove other PPE, if used. Perform hand hygiene.
22. Transport the specimen to the laboratory immediately.
Subscribe to:
Post Comments (Atom)
0 comments:
Post a Comment