Effective Date: February 20, 2014
Category: Clinical
Title: NICU – Radial Arterial Puncture by RN
Applies to:
St. Peter’s Health Partners (SPHP)
All SPHP Component Corporations
The following SPHP Component Corporations:
___St. Peter’s Hospital – NICU_____
St. Peter’s Health Partners Medical Associates (SPHPMA)
TABLE OF CONTENTS
PURPOSE ..................................................................................................................................................... 1
POLICY STATEMENTS ............................................................................................................................. 1
SCOPE OF AUTHORITY / COMPETENCY.............................................................................................. 2
PROCEDURE ............................................................................................................................................... 2
LINKS
Patient Identification
Arterial Puncture (Blood Gas)
REFERENCES ............................................................................................................................................. 3
PURPOSE
To define the professional nurse’s role in performing arterial punctures.
To obtain an adequate supply of arterial blood for blood gas analysis and to obtain routine laboratory tests
when venous and capillary sampling are not suitable or obtainable.
POLICY STATEMENTS
Arterial punctures are performed to obtain blood for blood gas analysis and when blood is needed and
venous or capillary blood samples cannot be obtained.
1. Performed only with order from physician/provider
2. Identification of patient using two forms of identification
3. Assess for pain and utilize comfort measures
4. Follow procedure for performing arterial puncture
5. Performed by nurses who have completed the arterial puncture competency
6. The nurse shall not make more that two attempts to obtain the blood. Notify the on-call
physician/provider if unsuccessful.
7. Arterial punctures are not indicated for routine blood drawing.
Title: NICU – Radial Arterial Puncture by RN
Effective Date: February 20, 2014
Page 2 of 3
8. Document in the patient record.
SCOPE OF AUTHORITY / COMPETENCY
Arterial Puncture Certified RN, (* Physician/Provider Order Required)
EQUIPMENT LIST
1. Sterile 23g Butterfly Needle
2. 2x2 Gauze
3. Appropriate syringes
4. Skin Antiseptic
5. Sterile gloves
PROCEDURE
1. Identify infant per hospital policy on Patient Identification
2. Obtain physician/provider order
3. Assemble necessary equipment and don gloves (hand hygiene)
4. Assess for pain and utilize comfort measures
5. Perform modified Allen’s test for collateral supply
 Elevate infant’s hand
 Occlude both radial and ulnar arteries at wrist
 Massage palm toward wrist
 Release occlusion of the ulnar artery only
 Look for color to return to the hand in six seconds or less indicating adequate collateral
supply
6. Extend wrist in supine position
7. Locate artery by palpation
8. Clean area with antiseptic. Allow to dry.
9. Have an assistant available to attach syringe(s), collect the blood and transfer it to the tubes.
10. Insert the needle at an appropriate angle with the bevel up, facing the flow of blood. Penetrate the
skin first and then puncture artery to minimize trauma to vessel. In most cases, the blood will
flow into the syringe with minimal aspiration. If it does not flow, insert the needle further.
Slowly withdraw the needle, at the same time gently aspirating the syringe to the point at which
blood appears. Hold the needle steady. To prevent tearing of the artery, do not allow
unnecessary movements of the arm or the equipment. Use fresh needle and repeat skin
preparation if withdrawal from skin is necessary.
11. After collecting specimen, withdraw the needle and immediately apply pressure to the puncture
site with a 2x2 gauze. Maintain pressure for at least 5 minutes to insure complete hemostasis.
12. Dispose of needle in appropriate sharps container.
13. Distribute blood to appropriate lab tube(s).
14. Document in the patient record:
 Time specimen collected
 Amount of blood, if appropriate
 Site from which blood was drawn
 Test(s) performed
 Infant’s tolerance of procedure
15. Observe puncture site for adequate capillary refill, cooler and temperature of the extremity and
potential hematoma formation.
16. Remove antiseptic with a saline pad.
Title: NICU – Radial Arterial Puncture by RN
Effective Date: February 20, 2014
Page 3 of 3
REFERENCES
Atlas of Procedures in Neonatolgy. MacDonald M., Ramasethu J. 2007, 5th Edition, Lippincott Williams
& Wilkins. Philadelphia, PA, 2012.
Neonatology Management, Procedures, On_Call Problems, Disease, and Drugs. Gommela, T.,
Cunningham, D., Eyal, G. 2009 McGraw-Hill Companies, Inc. USA.
Approving Official: CNO; CMO
Effective Date: February 20, 2014
Key Sponsor: NICU Level 4 RN
Reviewed By: NICU Operations Manager; Director of Women’s &
Children’s Services; Perinatal/Neonatal CNE; Chief of Neonatology;
SPH Policy Council
Search Terms: nicu, arterial puncture, neonatal, blood, blood gas,
venous, transillumination
Replaces: NICU – Radial Arterial Puncture by RN, 5/12
Original Date: 6/11
Reviewed/Revised Date: 5/12; 2/6/14
*Reviewed, No Revisions
**Revised without Full Review