Arterial Blood Gas (ABG) Procedure R.A.N.D.Ranaweera BSc.(Hons)KDU MSc.N (Reading) Session Outline • To Understand the overview of ABG • To Understand how to prepare and perform the Procedure Indications to perform ABG / VBG • Respiratory Failure - Assessing the severity • Monitor ventilated patients – Assist in weaning • Any severe illness leads to metabolic acidosis – Heart Failure, Renal Failure, Liver Failure, Burns, Toxins, Sepsis • Response monitoring to the therapeutic interventions and mechanical ventilation Arterial Puncture Sites • Radial Artery (Most Common) • Femoral Artery • Brachial Artery • Dorsalis Pedis (Very Rare) • Arterial Line Can directly take sample ABG Procedure • Equipment – ABG Analyzer 1 ml syringe with Needle (Heparinize : 0.5ml & do not leave excess heparin within the syringe) 70% Alcohol wipe and Gauze (Plasters) Gloves and Cover Roll Equipment ABG Analyzer Heparin 1ml Syringe Gloves Alcohol wipe and gauze Plasters ABG Procedure • Musts to remember Syringe should have > 50% of blood Use only 3ml or less Syringe (25% lower value expectancy if 1ml sample taken to 10ml syringe) Should not contain air bubbles ( pO2 pCO2 ) Cold chain must be maintained (with in 10 minutes) ABG Procedure • Introduce you to the patient and Confirm the patient • Explain the Procedure • Indications to the site : NON-DOMINANT radial artery (most favorable) • Check for Contra-indications Coagulopathies, AV Fistula, Sepsis, Poor Collateral Circulation, Peripheral Vascular Disease (PVD) ABG Procedure • Perform Allan Test – Test done to determine the existence of Collateral Circulation from the Ulnar Artery if Thrombosis occur in the Radial Artery. • Locate patient NON-DOMINANT arm on a support / pillow • Keep the wrist extended for 30 degrees • Palpate patient’s Radial artery • Clean with alcohol and dry ABG Procedure • Insert needle on 45 degree angle with the maximum pulsation • Advance the needle until a blood flash back come to the needle • The syringe should self fill in a Pulsatile manner • Remove Syringe and apply high pressure over puncture site for 3-5 minutes and place a dressing • Thank patient for the support ABG Procedure • Final Steps Remove the ABG needle and discard safely Apply a needle & syringe must be without air bubbles Label the sample -Patient’s name and BHT, FiO2, PEEP, PS (if available) Dispose gloves and Clinical waste to Yellow bins and sharps to the sharps bin Wash Hands Analyze the sample as soon as possible (Maintain Cold Chain) WHY SHOULD NURSES MUST KNOW HOW TO PERFORM THIS PROCEDURE??? Question Time? THANK YOU ! Reference • Good, V.S., and Kirkwood, P.L.,(2016), Advanced Critical Care Nursing, 2 (234 - 245)
