How to take an ABG
Dr.Padma Prakash Gandhiraj MD (A&E), Dip A&E
Indication
To access the acid /base status
To access the oxygenation and ventilation
Contraindication
Underlying infection or burn at insertion site
Absent collateral circulation
Arterio-venous shunt
Reynauds disease
Coagulopathy
Informed consent
Introduces yourself to the patient.
Check his/her identity either verbally or by looking at his wrist band
Let the patient know he may experience slight pain .
Get verbal consent.
Choose the non dominant hand.
Arrange the things needed
Gloves
Iodine Swab
Alcohol Swab
2 ml or 3 ml syringe heparinised
Gauze
Bag of Ice
1% lidocaine (1-2mls) and syringe
Alans test
Alan's test will determine whether there is patent collateral circulation to the limb .To
perform Alan's test, palpate the radial and ulnar arteries. Ask the patient to make a
tight fist. While their hand is in a fist, put pressure on the radial and ulnar artery and
occlude the blood flow. The hand will turn pale. Open their fist and release the ulnar
artery. The hand should turn pink again
Prepare the area
Clean the area around the radial artery with the iodine swab. Start at the middle and
clean out in a circular motion. Let dry and wipe away with the alcohol swab.
Anesthetise the area (Optional)
Anesthetise the area with 1-2% lidocaine to produce a 2mm bleb under the skin.
Prepare the syringe
Load the syringe with 1 ml of heparin and then empty it completely without air.
Insert the needle
Palpate the artery and feel for a pulse. Roll your finger right up from the pulse and
insert the needle. Insert the needle at a 45 degree angle making sure the bevel is up.
Aim for the pulse, not the bone. Collect about 0.5 ml of blood.
Remove the needle
Gently and quickly remove the needle and at the same time put 2x2 gauze over the
over the incision. Press firmly for two-five minutes
Remove the air bubbles
Remove the air bubbles by gentle tapping in upright position. Place it in the ice bag
Complications
Bleeding
Hematoma
Arterial occlusion
Infection – arteritis /cellulitis
Embolisation