arterial procedures

Question 1

this is more consistent throughout the body than the venous blood

Answer 1

arterial blood composition

Question 2

it is technically difficult and potentially more painful and hazardous than venipuncture

Answer 2

arterial puncture

Question 3

what is the pri reason for performing arterial puncture

Answer 3

to obtain arterial blood gas specimens
To evaluate respiratory functions
normally high O2 content
consistency of composition

Question 4

personnel who perform arterial puncture what are the hazards and complications of arterial puncture

Answer 4

physicians
medical technologist and technicians
nurses
respiratory therapists
emergency medical technicians
level II phlebotomist

Question 5

The first Choice, second choice for artery collection

Answer 5

First choice - radial artery
preferred and most common
located underside of the wrist on the thumb side

Second choice - brachial artery
located in the medial anterior aspect of the antecubital fossa near the attachment of the biceps muscle

Question 6

The largest artery used for arterial puncture

Answer 6

Femoral artery
located superficially in the groin,, lateral to the pubic bone
for physicians and emergency room personnel - used only in emergency situations or no other site is available

Question 7

What might happen as femoral artery lies close to the femoral vein

Answer 7

may be
inadvertently punctured and result in the collection of a venous specimen instead of an arterial one

Question 8

Hazards and complications of arterial puncture

Answer 8

● Arteriospasm
● Artery damage
● Discomfort
● Infection
● Hematoma
● Numbness
● Thrombus formation
● Vasovagal response

Question 9

true or false:
personnel who perform ABG testing are designated level I or level II depending on their formal education

Answer 9

true - level II personnel supervises personnel I

Question 10

it is the primary site-selection criterion for arterial puncture

Answer 10

collateral circulation

Question 11

how can the collateral circulation be evaluated

Answer 11

using portable ultrasound instrument
for radial artery - modified allen test
- if +ve test, result =ulnar artery is freely open and able to supply blood hence can perform on radial artery. vice versa

Question 12

what are the 3 main sites where arteries are accessed for specimen collection

Answer 12

underside of the wrist
antecubital area of the arm
the groin

Question 13

this artery is usually off limits and why

Answer 13

ulnar artery
- if the radial artery is accidentally damaged the ulnar artery will supply blood to the hand

Question 14

advantages and disadvantages of radial artery

Answer 14

advantage:
good collateral circulation (biggest advantages)
ez to palpate cos lies normally close to the skin
less chance of hematoma formation
reduce risk of accidental puncturing a vein or nerve cos no adjacent

disadvantage:
considerable skils bcs of small veins
difficult cos of hypovolemia

Question 15

what happens if the ulnar artery is weak

Answer 15

do not puncture at the radial artery

Question 16

advantages and disadvantages of brachial artery

Answer 16

advantages:
to collect ABG
large and ez to locate and palpate
preferred artery if large volume
less painful than radial artery puncture

disadvantages:
no direct collateral circulation
deep and harder to puncture
difficult to palpate on obese
near median nerve
increased risk of hematoma formation

Question 17

advantages and disadvantages of femoral artery

Answer 17

advantages:
collect ABGs
large and ez palpated and punctured
sometimes the only site where arterial sampling is possible (hypovolemic, low cardiac output, during cardiac resuscitation)

disadvantages:
poor collateral circulation
close to the femoral vein
infection and difficulty in achieving aseptic technique
extended monitoring for hematoma formation

Question 18

other site for arterial puncture:

Answer 18

infants:
scalp
umbilical
posterior tibial artery

adults:
dorsalis pedis

Question 19

some examples of ABG evaluation in diagnosis and management of respiratory disorders

Answer 19

lung disease: provide info abt
- oxygenation ventilation
- acid-base balance

diabetes, other metabolic disorders, critically ill patients, injured patients
- management of electrolyte
- acid-base balance

Question 20

commonly measured arterial blood gas analytes

Answer 20

table 14-1

Question 21

FiO2

Answer 21

fraction of inspired oxygen, which for room is 0.21
prescribed flow rate in liters per minute (L/M)

Question 22

what are some of the specimen collection equipment and supplies

Answer 22

safety needle
special heparinized syringe
cap to cover the syringe

to maintain anaerobic conditions

Question 23

why are ABG specimens are collected in syringes than tubes

Answer 23

evacuated tube presence can affect test results

Question 24

antiseptics used

Answer 24

isopropanol or chlorhexidine sponges or pads

Question 25

local anesthetic

Answer 25

1% lidocaine w/o epinephrine

Question 26

type of syringe used

Answer 26

1 or 2 ml plastic syringe with a 25 or 26 gauge to 5/8 inches long

Question 27

what position should the patient be

Answer 27

relaxed in a comfy position lying in bed or seated comfy on a chair for a minimum of 5min or until breathing has stabilized

Question 28

how long shld the patient be in a steady state and why

Answer 28

20-30 min before the blood gas specimen is obtained steady state: current body temp breathing pattern conc. of oxygen inhaled affect the amt of O2 AND CO2 in the blood

Question 29

what happens when the patient is unable to make a fist

Answer 29

the hand can be held abv heart lvl for 30-60 sec

Question 30

what signifies the temporary blockage of ulnar and radial artery

Answer 30

blanched appearance

Question 31

positive and negative allen test result

Answer 31

+ve: the hand flushes pink or returns to normal color within 15sec -ve: opp - means that the patient does not have collateral circulation

Question 32

needle insertion angle

Answer 32

45 degree femoral - 90 degree, approx 5-10 mm dista to the index finger

Question 33

hat happens if you recheck the site after 3-5 min and saw that there is bleeding, swelling, bruising

Answer 33

reapply pressure for additional 2 min notify nurse or physician if bleeding has not stopped after the additional 2 min

Question 34

pain or irritation caused by needle penetration of the artery muscle and even patient anxiety can cause a reflex contraction of the artery

Answer 34

arteriospasm

Question 35

repeated puncture at the same site resulting in swelling which can lead to partial or complete occlusion

Answer 35

artery damage

Question 36

this is usually associated with with arterial puncture, even with the use of local anesthetic

Answer 36

discomfort - may indicate nerve involvement

Question 37

blood is under considerable pressure in arteries and is initially more likely to leak form an arterial puncture site than a venipuncture site

Answer 37

hematoma

Question 38

it can result from improper site preparation, contamination of the site before specimen collection

Answer 38

infection

Question 39

it can be a sign of impaired circulation or nerve irritation or damage due to an error in technique

Answer 39

numbness - immediately inform nurse or physician

Question 40

injury to the intima or inner wall of the artery

Answer 40

thrombus formation

Question 41

it is the source which may cause a clot, thrombus or ___

Answer 41

embolus (circulating undissolved matter) embolism (obstruction of a blood vessel by an embolus)

Question 42

faintness or loss of consciousness related to hypotension caused by a nervous system response (increased vagus nerve activity) or abrupt pain or trauma can occur

Answer 42

vasovagal response

Question 43

factors that can affect the integrity of a blood gas sample and lead to erroneous results

Answer 43

air bubbles delay in analysis improper mixing improper yringe obtain venous blood by mistake use of improper anticoagulant use too much or too little heparin