UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Pediatric Arterial Line Sampling
Policy 7.3.42
Page 1 of 4
Pediatric Arterial Line Sampling
Effective:
Reviewed:
Formulated: 10/79
11/07/94
5/31/05
Pediatric Arterial Line Sampling
Purpose
To standardize the proper method of obtaining blood samples from an arterial
catheter.
Scope
Respiratory Care Services provides appropriate training for all practitioners
withdrawing blood Samples to meet minimum criteria.
Accountability
Only those specially trained (Nursing Staff, Respiratory Care Service staff
member and House Officers) may enter the line for purposes of obtaining
blood specimens.
Special Training
The practitioner will have a complete understanding of the entire procedure
with an awareness of indications, contraindications and complications of such
a procedure. He/She will be able to demonstrate the proper technique for
entry under supervision. After completing the certification policy as approved
by the Program Manager, Respiratory Care Service, his/her name will be
added to the roster of those eligible to do the procedure by the Program
Manager, Respiratory Care Service, as maintained in the Policy and
Procedure Manual.
Physician's
Order
Arterial Blood Gases and laboratory work will be drawn as ordered by M.D.
or as a component for routine procedure or ventilator protocol.
Indications
 Arterial lines are entered for removal of blood, for monitoring of
laboratory work and arterial blood gases.
 Arterial lines are entered for the administration of I.V. fluids and
medications.
Contraindications
Signs of complications (i.e.: leg blanching, discoloration, decreased
peripheral pulses, improper position of catheter) indicating that infusion or
withdrawal through the catheter may cause or further decrease circulation to
an extremity.
A pediatric patient with an already depleted blood volume.
Goals
The therapist will be able to properly remove appropriate amount of blood for
studies without complications.
Equipment

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

3cc sterile dry syringe for clearing line
1cc pre-heparinized sterile syringe
1cc syringe for drawing lab work
1cc syringe of normal saline for flush (This syringe is placed on the
stopcock at the beginning of each shift).
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Pediatric Arterial Line Sampling
Policy 7.3.42
Page 2 of 4
Pediatric Arterial Line Sampling
Effective:
Reviewed:
Formulated: 10/79
11/07/94
5/31/05
Procedure
Step
Action
1
Identify patient and verify physician order.
2
Evaluate patient on feasibility of drawing ABG.
 ABG's should be drawn 20-30 minutes after each
ventilator change.
 ABG's should not be drawn until 20 minutes after any
procedure (suction, CPT, feeding, etc.)
 General appearance should be assessed and a clinical
decision made as to the necessity for the ABG.
3
Wash hands and assemble equipment.
4
Check position of stopcock, making sure it is closed to the
flush syringe.
5
Remove flush syringe, cap and set aside.
6
Place 3 cc drying syringe on stopcock. Turn stopcock off to
I.V. fluids.
7
Draw back 2-21/2 cc of blood to clear line to obtain an
uncontaminated blood sample.
8
One-fourth turn stopcock off. Remove syringe, cap and set
aside. To prevent blood loss and to prevent infection.
9
Place 0.3 cc for ABG in pre-heparinized TB syringe on
stopcock. Turn stopcock off to I.V. fluids and draw blood
sample needed.
10
Remove cap from the syringe of blood drawn earlier to
clear the line. Replace this into stopcock.
11
One-fourth turn stopcock and remove sample syringe.
For ABG's prepare for transport -Remove air bubbles and ice sample.
For laboratory -Place in appropriate vacutainer and label.
12
Remove cap from the syringe of blood drawn earlier to
clear the line. Replace this into stopcock.
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Pediatric Arterial Line Sampling
Policy 7.3.42
Page 3 of 4
Pediatric Arterial Line Sampling
Effective:
Reviewed:
Formulated: 10/79
11/07/94
5/31/05
Procedure
Continued
Step
Action
12
Remove cap from the syringe of blood drawn earlier to
clear the line. Replace this into stopcock.
13
Turn stopcock off to I.V. fluids, draw slightly back on
syringe and flick to remove air bubbles. Then slowly
reinfuse blood. Observe line to make sure no air or clots
are infused.
14
One-fourth turn stopcock OFF, remove syringe. Remove
cap from flushing syringe, place in stopcock.
15
Turn stopcock off to I.V. fluids, draw back slightly on
syringe and flick any air bubbles to top, using as little flush
as possible to clear line of blood. Return stopcock off to
flush syringe, leaving I.V. open.
16
Make sure all connections are tightly secure and that the
stopcock is open to I.V. infusions.
17
Observe line for any air bubbles, and observe patient for
any adverse reaction to the procedure: Leg blanching,
discoloration, decreased pulses due to infusion of emboli
may occur.
18
Wash hands.
19
Chart the amount of blood withdrawn, keeping a running
total. The amount of flush solution used will be added to
cumulative total of fluid intake. To maintain accurate
intake of all fluid infused over a 24-hour period. Infants
with a 10% body weight blood loss need to have
withdrawn blood returned.
Assessment
of Outcome
Obtaining the blood sample needed without complications occurring.
Documentation
Chart on RCS Flow sheet, treatment card per RCS Policies # 7.1.1 and #
7.1.2 and on the nursing flow sheet.
Continued next page
UTMB RESPIRATORY CARE SERVICES
PROCEDURE - Pediatric Arterial Line Sampling
Policy 7.3.42
Page 4 of 4
Pediatric Arterial Line Sampling
Effective:
Reviewed:
Formulated: 10/79
Safety
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11/07/94
5/31/05
The umbilical arterial catheter should be maintained as a sterile infusion
line. Good hand washing technique is IMPERATIVE.
The arterial line should be observed at all times to maintain a closed
system to:
Prevent loss of blood
Prevent loss of I.V. fluids
Prevent air embolisms.
Maintain patency of line.
Infection
Control
Follow procedures as outlined Healthcare Epidemiology Policies and
Procedures: #2.24 Respiratory Care Services.
http://www.utmb.edu/policy/hcepidem/search/02-24.pdf
References
AARC Clinical Practice Guidelines; Sampling For Arterial Blood Gas
Analysis. Respiratory Care. 1992; 37:913-917.
Behrman, Kliegman & Jenson Nelson Textbook of Pediatrics, 17th Edition
2004
Michael P Czervinske, RRT and Sherry L Barnhart, AS, RRT Perinatal and
Pediatric Respiratory Care, 2nd Edition W. B. Saunders 2003
Wilkins & Stoller Neonatal and Pediatric Respiratory Care Section Egan's
Fundamentals of Respiratory Care, 8th Edition 2003
Suddaby EC, Sourbeer MO. Drawing pediatric arterial blood gases. Critical
Care Nurse. 1990; 10:28-31.