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Interventions 2 (RESP 319) > Mod 3 ABGs and CBGs > Flashcards

Mod 3 ABGs and CBGs Flashcards

1
Q

Indications for ABG

A
  • Evaluate CO2 or O2 needs
  • Alterations to pH status
  • Check Pt. conditions and response to therapy
  • Get a gas q24h if Pt. is well at the min.
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2
Q

What Assessments help determine if a ABG is needed?

A
  • initiation, change, or discontinuation of therapy
  • abnormalities from other tests (like x-rays)
  • history and physical indicators (onset of SOB or smoking)
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3
Q

Main contraindications for ABG

A
  • Arterial graft located @ puncture site
  • failing a bilateral negative modified allen’s test (check to see if there is collateral circulation)
  • Pt. on any anti coagulation/thrombolytic disorder or medication
  • Pt. refuses to coop
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4
Q

What are some relative conditions where ABGs shouldn’t be performed?

A

Pt with Raymond’s disease, fibroses arteries, or a large hematoma site

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5
Q

how do you mitigate a hematoma when performing a ABG?

A
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6
Q

What are 6 hazards of ABGs to Pts?

A
  1. hematoma/hemmorhage
  2. infection
  3. thrombosis
  4. arterial spasm
  5. laceration of blood vessels/nerves
  6. pain
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7
Q

hazards to staff when performing a ABG?

A

blood borne infections

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8
Q

Normal value for platelets?

A

Normal platelet count = 150 - 400 x 10E9/L

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9
Q

INR value ranges?

A

Normal value 0.9 - 1.1

Critical values > 5

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10
Q

what is activated partial thromboplastin time (aPTT)

A

time for blood to clot/blood to return?

edit need to confirm

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11
Q

What are 3 lab assessment values we assess from ABGs?

A
  1. Primary and secondary hemostasis (platelet count and INR)
  2. aPTT
  3. Fibrinogen (factor I in coagulation cascade)
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12
Q

What is the difference between a Primary and secondary hemostasis lab assessment ?

A

Primary observes platelet count

Secondary observes INR

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13
Q

What is thrombocytopenia

A

Decreased platelet counts

  • causes bleeding into the tissues, bruising, and slow blood clotting after injury.
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14
Q

Causes of thrombocytopenia?

A
  • Aplastic anemia (when the body stops making blood cells)
  • some immune diseases, blood clotting disorders, inherited disorders or bleeding disorders.
  • pregnancy.
  • medications.
  • cancers, such as leukaemia, or cancer treatments including chemotherapy.
  • Infection in the bone marrow.
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15
Q

what platelet count range is a high risk of spontaneous bleeding?

A

platelet count < 10 x10E9/L

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16
Q

key elements of a ABG

A
  1. pre assessment
  2. informers consent
  3. perform ABG
  4. Label and analysis
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17
Q

what things should you think about when performing an ABG

A

is the Pt. on O2? is it @ RA?

edit look up more info on this

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18
Q

How do you assess INR?

A

Assess extrinsic and common coagulation pathways

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19
Q

Causes of high INR?

A
  1. Warfarin
  2. Liver disease
  3. cephalosporin antibiotics
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20
Q

what are some causes of prolonged partial thromboplastin time (PTT)?

A

Heparin and clotting factor deficiencies

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21
Q

Fibrinogen normal value

A

Norm: 1.6 - 4.1 g/L

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22
Q

critical low value for fibronogin?

A

less than or equal to 1 g/L

23
Q

what size syringes are used for ABG?

A

23 or 25 gauge needles for radial pokes

  • they’re vented and heparnized
  • heparinized prevents the blood from clotting
24
Q

what is the procedure for a radial puncture?

A
  1. Verify order & Pt. Check lab results
  2. Examine site perform SpO2, check therapy
  3. Perform Allens test
  4. Clean site, allow to dry
  5. palpate site and notify Pt. prior to puncture
  6. puncture @ 30-45 degree angle
  7. Apply pressure as needle withdrawn
  8. vent air, make sharp safe, agitate sample
  9. Hold pressure until no bleeding (5 mins or longer)
25
Q

need to know radial muscles

A
26
Q

Indications for CBG

A

Used as an alt access in infants and small children.

Tests for:

  • pH
  • PaCO2
  • PO2 (SpO2 is more useful) why?*
27
Q

What is a CBG?

A

capillary blood gas

28
Q

what drugs would affect hemoptysis?

A
  1. Anticoagulants (heparin, vitamin K)
  2. Thrombolytics (streptase, retavase, activate)
  3. Platelet Inhibitors (aggrexnox, plavix, intergrilin, ASA)
29
Q

What are the 4 normal lab values needed for a ABG?

A
  1. Platelet count of 150-400x10E9
  2. INR of 0.9-1.1
  3. aPTT of 27-37 seconds
  4. Fibrinogen of 1.6-4.1 g/L
30
Q

Advantages of a radial artery

A
  1. collateral circulation
  2. easily accessible
  3. easy to palpate, stabilize, and puncture
  4. Not close to any major nerves
31
Q

Disadvantages of radial arteries

A
  1. More likely to spasm than the fermoal
  2. Radial vein is located on each side of the radial artery, makes it possible to draw a venous sample
32
Q

The radial artery will not likely spasm if what condition is present?

A

The ulnar flow is present

33
Q

What is a modified allen’s test?

A

A test before drawing a ABG, it tests for collateral circulation (if the ulnar and radial are present)

34
Q

What is the minimum length of time to hold pressure on puncture site after ABG is drawn?

A

5 minutes

35
Q

What are calgary lab services standards for cleaning a site?

A
  1. use 70% isopropyl alcohol to pre-cleanse site for 30 seconds
  2. Use 2% chlorhexidine w/70% isopropyl alcohol. to cleanse site for 30 seconds prior to puncturing skin
  3. Allow to dry, min 1 minute. (ideally -> 2 mins)
36
Q

what are the advantages of Brachial Artery Sampling?

A
  1. Less subjective to low pressure/flow problems (bc its close to heart)
  2. Brachial artery is large and easy to palpate
  3. Distal aspect of the humerus is easily accessible
37
Q

Disadvantages of Brachial Arterial Sampling

A
  1. No real collateral circulation
  2. Deeply located under the bicep brachii muscle
  3. is close to the artery, meaning a miss can be painful.
38
Q

what is the recommended needle size for a brachial sample?

A

23G x 1 inch, 25G x 5/8 inch

39
Q

What angle should you insert a needle for the brachial artery?

A

60-90

40
Q

When would you perform a femoral arterial sample?

A

A last resort when BP is too low for a more peripheral sample to be obtained.

41
Q

Needle choice for a Femoral artery sample?

A

22G X 1 ¼”, 21G X 1½”, 18G X 1½’

Textbook is 21 and 18 tho

42
Q

What angle should be used for a Femoral artery sample?

A

90

43
Q

Need to add info on this, from slide 37

A
44
Q

For Femoral arterial samples, what are the preferred needle choices?

A
  • [22G x 1 ¼”]
  • [21G X 1½”]
  • [18G X 1½’]
  • Longer as needed to go deeper, larger as artery is larger.
45
Q

After gathering a arterial sampling, how long should you apply pressure?

A

A min of 5 mins, longer if needed.

46
Q

Which demographic would a CBG used for?

A

Infants and small children

47
Q

Why would you use CBGs?

A
  • ABG analysis is needed but no access to arterial site
  • non invasive monitor readings are abnormal (SpO2)
  • Access initiation or change to therapy
48
Q

List the structures of the following figure:
- Wrist anatomy

A

Tip:
- yellow = nerves
- grey = tendons
- Red = arteries

49
Q

List the structures of the following figure:

  • Forearm Anatomy
A
50
Q

List the structures of the following:

  • Upper arm
A
51
Q

List the structures of the following figure:

  • Forearm Anatomy
A
52
Q

List the structures of the following figure:

  • Forearm Anatomy
A
53
Q

List the structures of the following figure:

  • Forearm Anatomy
A

Interventions 2 (RESP 319) (25 decks)

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