NURSING PATIENT CARE POLICY & PROCEDURE
December 1, 2015
Nursing Manual (Red)
Policy #: 11.11AP
Title: Arterial Blood Specimen Drawing via
Direct Radial Artery Puncture (Adult and
To draw arterial blood specimens by direct radial artery puncture.
A. Arterial puncture (via radial access) will be performed in adult units by RNs, including
SOS nurses, who have completed the competency, or respiratory therapists who have
completed the competency for radial arterial puncture through Respiratory Care Services.
If these clinicians are not successful at obtaining the arterial blood gas (ABG) sample via
radial artery, the ordering provider should be notified to obtain the sample.
B. In pediatric units, arterial puncture is the responsibility of the physician or pediatric nurse
C. The pneumatic tube system should be used to transport the specimen. The specimen must
be received in the laboratory within 30 minutes of draw in order for results to be valid.
For questions, call Laboratory Client Services at 263-7060. In the event the pneumatic
tube system is down, unit-specific arrangements should be made to transport the
A. Blood gas syringe
B. 2% chlorhexidine prep applicator
C. 4x4 gauze pads
D. Needle, 22 gauge or smaller
E. Health Link generated lab requisition form (paper form for downtime)
F. Patient identification label
G. Personal protective equipment, as appropriate
H. Exam gloves
I. Adhesive bandage
J. If using analgesia, use:
a. Alcohol pad
b. Sterile gloves
c. Syringe with 29-31 gauge safety needle
d. 1% lidocaine without epinephrine (optional, recommended)
A. Print lab requisition.
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1. Document correct FiO2 on printed form, if different from provider-entered value.
B. Identify the patient using two forms of patient identification and explain procedure.
C. Identify radial site. Arterial puncture should be avoided in extremities affected by
fistulas, shunts, or prior surgical procedures.
D. Perform hygiene according to Hospital Administrative Policy 13.08, Hand Hygiene and
don clean gloves.
E. Perform the modified Allen’s test:
1. Palpate both radial and ulnar pulses.
2. Raise patient's hand to vertical position and direct patient to open and close hand
several times. If patient is unable to perform, clench the fist passively for the
3. With the patient’s fist clenched, occlude radial and ulnar arteries using the two
hand grasp. See Figure 1 below.
4. Instruct the patient to lower and open the hand.
5. Release the pressure over the ulnar artery and assess return of color to hand. Color
should return within 5-10 seconds (positive Allen's sign).
6. Artery is used only if Allen’s test is positive.
F. Assist with positioning of extremity selected for puncture. Position extremity straight on
a firm surface. Wrist may be supported with a rolled towel, producing a curve which will
bring the artery to the surface. Do not hyperextend the wrist since this can obliterate the
G. Cleanse site with 2% chlorhexidine prep applicator using back and forth motion while
applying friction for 30 seconds and allow to dry. Do not touch the puncture site after
disinfecting the area unless wearing sterile gloves.
H. Use of local anesthetic is recommended. Intradermal injection of 1% lidocaine without
epinephrine may be used to decrease pain. Follow delegation protocol 29, Analgesic
Techniques Prior to IV Catheter Insertion and Other Needle Related Procedures, for adult
1. Ascertain there is no known allergy to lidocaine (Xylocaine) or bupivacaine
(Marcaine). Lidocaine allergy is rare. Lidocaine can be administered to patients
with known allergy to procaine (Novocaine).
2. Obtain 1% lidocaine without epinephrine and syringe with 29-31 gauge safety
3. Aspirate before injecting. Do not inject into artery. Inject small wheal (0.2-0.3
mL) of lidocaine intradermally (bevel up, only 1/4 to 1/3 cm into skin) around the
artery puncture site.
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I. Remove syringe from package, pull back plunger to desired sample volume and attach
needle to syringe.
1. 1.5 mL of blood is the preferred volume; however 0.5 mL is the minimum
2. No additional specimen is necessary for lactate measurement.
J. Palpate and stabilize artery. Puncture is made on uncontaminated skin.
K. Holding syringe like a pencil, puncture skin with needle at a 30-60° angle, bevel up and
directed toward the heart. Insert gently and slowly into the artery.
1. When the artery is entered, the syringe will fill with blood. If blood fills the hub
of the needle and proceeds no further, a slight reposition of the needle may be
needed or a vein may have been punctured. Resistance may be felt when needle
contacts arterial wall.
2. If the puncture is unsuccessful, withdraw the needle to the skin level (do not
withdraw from the skin), angle slightly toward the artery, and re-advance.
L. When artery is entered, blood will fill the syringe to the pre-set volume. If syringe stops
filling before preset volume is obtained, cover central hole at end of plunger with gloved
thumb or tip cap and gently aspirate.
M. Withdraw needle and activate the safety shield with thumb by pushing it forward until an
audible click is heard. Immediately apply firm constant pressure to the puncture site,
using a 4x4 dressing, for at least five minutes or until hemostasis is established.
N. Cover the puncture site with an adhesive compression bandage once hemostasis is
achieved. Do NOT place dressing circumferentially around entire wrist.
O. Discard needle with engaged safety shield in sharps container, expel air from syringe,
attach syringe cap and immediately mix specimen for 5-10 seconds to evenly distribute
heparin and prevent clotting.
P. Label syringe at the patient bedside according to Clinical Laboratories Policy 1502.5.06,
Acceptance Policy for Specimen Identification.
Q. Verify the time and FiO2 printed on the requisition form is correct. If not, cross out and
insert actual value(s).
R. Send specimen to the laboratory immediately via pneumatic tube system. Specimens
received in the laboratory longer than 30 minutes after collection cannot be considered
valid for blood gas results.
V. UWHC CROSS REFERENCES
A. Clinical Laboratories Policy 1502.5.06, Acceptance Policy for Specimen Identification
B. Delegation Protocol 29, Analgesic Techniques Prior to IV Catheter Insertion and Other
Needle Related Procedures
C. Hospital Administrative Policy 13.08, Hand Hygiene
D. Respiratory Care Policy 3.26, Arterial Puncture
A. AACN (2011). AACN Procedure Manual for Critical Care (6th Ed.). Philadelphia, PA:
WB Saunders Co.
B. Huston, T. L., Dukes, S. F., & Reilly, K. (2006). Use of local anesthesia for arterial
punctures. American Journal of Critical Care, 15(6), 595-599.
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VII. REVIEWED BY
Assistant Director, Clinical Laboratories
Clinical Nurse Specialist, Pediatric Hematology & Oncology
Clinical Nurse Specialist, Pediatric Intensive Care Unit
Clinical Nurse Specialist, Trauma Life Support Center
Director, Respiratory Care Services
Nursing Patient Care Policy and Procedure Committee, November 2015
Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer