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PMTP 2 - 3rd Shift > Unit 14 > Flashcards

Unit 14 Flashcards

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1
Q

T/F:
Arterial puncture is technically difficult and potentially more painful and hazardous than venipuncture

A

True

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2
Q

T/F:
Arterial specimens are used for routine blood
tests because arterial blood composition is more
consistent throughout the body than venous

A

False;
Arterial specimens are not normally used for routine blood tests, even though arterial blood composition is more consistent throughout the body than venous.

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3
Q

Primary application of arterial puncture

A

for arterial blood gas (ABG) analysis

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4
Q

Why is arterial blood the best specimen for evaluating respiratory function?

A

because of its normally high oxygen content and consistency of composition

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5
Q

Considerations in collecting and storage of ABG specimen

A

must be collected in anaerobic manner
must not be exposed to air
must be transported in ice-slush

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6
Q

COMMONLY MEASURED ARTERIAL BLOOD GAS
(ABG) ANALYTES

A

pH
PaO2
PaCO2
HCO3
O2 saturation
Base excess (or deficit)

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7
Q

PERSONNEL WHO PERFORM ARTERIAL PUNCTURE

A

o nurses
o medical technologists and technicians
o respiratory therapists
o emergency medical technicians
o level II phlebotomists

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8
Q

Phlebotomists who collect arterial specimens must have extensive training involving:

A

o theory
o demonstration of technique
o observation of the actual procedure
o performance of arterial puncture with supervision

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9
Q

CONSIDERATIONS FOR SITE SELECTION FOR ARTERIAL PUNCTURE

A

PRESENCE OF COLLATERAL CIRCULATION
ARTERY ACCESSIBILITY
SIZE OF THE ARTERY
TYPE OF TISSUE SURROUNDING THE PUNCTURE
SITE
ABSENCE OF SITE COMPLICATIONS

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10
Q

What is meant by collateral circulation?

A

means that the site is supplied with blood from more than one artery, so that circulation can be maintained if one vessel is obstructed or damaged

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11
Q

How can presence of collateral circulation be evaluated?

A

using a portable ultrasound instrument or
by performing modified Allen test

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12
Q

Considerations in site complications

A

No observance of:
inflammation
irritation
edema
hematoma
lesion or a wound
arterioventricular (AV) shunt in close proximity
a recent arterial puncture at the site

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13
Q

ARTERIAL PUNCTURE SITES

A

radial artery
brachial artery
femoral artery

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14
Q

The first choice and most commonly used site for arterial puncture

A

radial artery

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15
Q

Describe the location of radial and ulnar arteris

A

radial: thumb side of the wrist
ulnar: pinky side of the wrist

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16
Q

Advantages of performing arterial puncture on the radial artery

A

Presence of good collateral circulation
Easy to palpate
Less chance of hematoma formation
Reduced risk of accidentally puncturing a vein or
damaging a nerve

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17
Q

T/F:
The ulnar artery can be used for arterial specimen collection.

A

False

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18
Q

Disadvantages of performing arterial puncture on the radial artery

A

Considerable skill is required .
It may be difficult or impossible to locate on patients with hypovolemia (decreased blood volume) or low cardiac output.

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19
Q

The second choice for arterial puncture

A

brachial artery

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20
Q

Why is the brachial artery in children, especially infants, not commonly used according to CLSI?

A

because it is harder to palpate and lacks collateral circulation

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21
Q

Advantages of performing arterial puncture on the brachial artery

A

● Large and relatively easy to palpate and puncture
● Sometimes the preferred artery if a large volume of blood must be collected
● Has adequate collateral circulation (not as much as the radial artery)

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22
Q

Disadvantages of performing arterial puncture on the brachial artery

A

● Deeper and can be harder to palpate than the radial artery
● Lies close to the basilic vein
● Lies close to the median nerve
● Increased risk of hematoma formation following the procedure

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23
Q

The largest artery used for arterial puncture

A

Femoral artery

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24
Q

Who performs arterial puncture on femoral artery and in what type of situations is it performed?

A

Performed primarily by physicians and specially trained emergency room personnel and is generally used only in emergency situations or when no other site is available.

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25
Advantages of performing arterial puncture on femoral artery
● Large and easily palpated and punctured ● Sometimes the only site where arterial sampling is possible
26
Disadvantages of performing arterial puncture on femoral artery
● Has poor collateral circulation ● Lies close to the femoral vein ● Increased risk of infection and difficulty in achieving aseptic technique ● Possibility of dislodging plaque buildup from the inner artery walls of older patients ● Requires extended monitoring for hematoma formation or hemorrhage after puncture
27
Other sites for arterial puncture In Infants: In Adults:
● In infants: Scalp, Umbilical arteries ● In adults: Dorsalis pedis arteries – center of the dorsal area of the foot (center)
28
Information documented prior to ABG specimen collection
o current body temperature o respiratory rate o ventilation status o fraction of inspired oxygen (FiO2) o prescribed flow rate in liters per minute (L/M)
29
Needle gauge for radial ABG collection
typically 22-gauge or smaller
30
Why should we not use needles that have gauges that are too large or too small for ABG specimen collection?
Larger-diameter needles: may be too large to access the artery. Smaller needles: (e.g., 25-gauge) can increase the chance of producing bubbles during the draw and specimen hemolysis.
31
Syringe for ABG specimen: heparinized or non-heparinized?
heparinized
32
T/F: In preparing patient for ABG specimen collection, it should be determined whether or not the patient is on anticoagulant therapy. If an anesthetic is to be used, it should be confirmed that the patient is not allergic to it.
Both true
33
Steady state of the patient: No exercise, suctioning, or respirator changes for at least ___-___ minutes before the blood gas specimen is obtained
20-30
34
Test that determines if the patient has collateral circulation before arterial puncture is performed
Modified Allen Test
35
Modified Allen Test (perform arterial puncture or not) Positive result: Negative result:
Positive result: perform arterial puncture Negative result: do not perform arterial puncture; notify nurse or physician
36
Which fingers are used in performing modified Allen test?
index and middle fingers of both hands
37
In performing modified Allen test, release pressure on which artery only?
ulnar artery
38
Describe the appearance of the hand for positive modified allen test result.
The hand flushes pink or returns to normal color within 15 seconds.
39
Describe the appearance of the hand for negative modified allen test result
The hand does not flush pink or return to normal color within 15 seconds.
40
In addition to minimizing or preventing patient reactions, local anesthesia may also prevent _____________.
vasoconstriction
41
recommended local anesthetic for ABG collection
1% lidocaine without epinephrine
42
volume of lidocaine adequate to be administered for most adult applications
0.25 mL to 0.5 mL
43
T/F: You should clean the stopper of the anesthetic bottle with an isopropyl alcohol wipe.
True
44
Insert the needle of the anesthetic syringe into the skin over the proposed arterial puncture site at an angle of approximately ___ degrees.
10
45
After administering local anesthetic, wait __-__ minutes before proceeding with arterial puncture.
1-2
46
Why should we avoid hyperextension of the wrist prior to arterial specimen collection?
it can eliminate a palpable pulse
47
How should you hold the syringe in performing arterial puncture?
The syringe is held in the dominant hand as if holding a dart.
48
A needle inserted at a ___-___ degree angle, ___-___ millimeters distal to the finger that is over the pulse; it should contact the artery directly under that finger
30- to 45- 5 to 10
49
T/F: If the blood normally fills the syringe under its own power, it is an indication that the specimen is venous blood
False; arterial blood
50
Why should you expel air bubbles, cap syringe, mix?
● Air bubbles in the specimen can affect test results and must be expelled . ● The specimen must be capped to maintain anaerobic conditions, mixed thoroughly by inversion or rotating to prevent clotting.
51
HAZARDS AND COMPLICATIONS OF ARTERIAL PUNCTURE
ARTERIOSPASM ARTERY DAMAGE DISCOMFORT INFECTION HEMATOMA NUMBNESS THROMBUS FORMATION VASOVAGAL RESPONSE
52
Pain or irritation caused by needle penetration of the artery muscle and even patient anxiety can cause a reflex (involuntary) contraction of the artery
Arteriospasm
53
Repeated punctures at the same site can damage the vessel, resulting in swelling, which can lead to partial or complete blockage of the vessel.
Artery damage
54
Usually minor and temporary hazard/ complication generally associated with arterial puncture, even with use of a local anesthetic
Discomfort
55
can result from improper site preparation, contamination of the site prior to specimen collection, or choosing a site where inflammation or infection is present.
Localized infection
56
Blood is under considerable pressure in arteries and initially more likely to leak from an arterial puncture site than a venipuncture site.
Hematoma
57
The probability of hematoma formation is greatest in (older or younger?) patients. Why?
greatest in older patients, because arterial elasticity normally decreases with age, and in patients receiving anticoagulant therapy
58
can be a sign of impaired circulation or nerve irritation or damage due to an error in technique, such as improper redirection of the needle when the artery is missed
Numbness
59
Can result from injury to the intima or inner wall of the artery
Thrombus or clot formation
60
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 during arterial puncture
Vasovagal response
61
SAMPLING ERRORS IN ARTERIAL SPECIMEN COLLECTION
AIR BUBBLES DELAY IN ANALYSIS IMPROPER MIXING IMPROPER SYRINGE OBTAINING VENOUS BLOOD BY MISTAKE USE OF IMPROPER ANTICOAGULANT USE OF TOO MUCH OR TOO LITTLE HEPARIN
62
If the specimen remains at room temperature for more than 30 minutes, what parameters can be compromised?
pH blood gas glucose
63
Optimal time of analysis is within ___ minutes of collection.
10
64
Inadequate or delayed mixing of the sample can lead to ________, making the sample unacceptable for testing.
clotting
65
T/F: Regular plastic syringes are used for ABG specimen collection.
False; The use of regular plastic syringes will lead to erroneous values. Use only syringes especially designed for ABG procedures or ABG kits.
66
arterial blood color venous blood color
arterial: bright-red venous: bluish-red
67
The best way to be certain that a specimen is arterial is?
if the blood pulses into the syringe
68
accepted anticoagulant for blood gas specimens
Heparin
69
T/F: Oxalates, EDTA, and citrates can be used as alternative anticoagulants for arterial specimen.
False; Oxalates, EDTA, and citrates may alter results, especially pH.
70
Too much heparin in the syringe can result in ________ of the specimen. Too little heparin can result in ________ of the specimen.
acidosis clotting

PMTP 2 - 3rd Shift (5 decks)

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