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Arterial Puncture (3.26)

Arterial Puncture (3.26) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Patient Assessment

3.26




3.26 Arterial Puncture
Category: UWHC Clinical Policy
Effective Date: March 1, 2016
Version: Revision
Section: Respiratory Care Services – Patient Assessment

I. PURPOSE

Arterial blood gases are drawn to evaluate the adequacy of ventilatory, acid-base, and oxygenation status.

II. CONTRAINDICATIONS

A. Negative results of an Allen test.
B. Puncture should not be performed through a lesion or distal to a surgical shunt
(e.g. a fistula in a dialysis patient).

III. POLICY

A. The responsibility of performing arterial punctures on adult patients is determined by the patient’s unit.
B. Registered nurses who have completed the competency for arterial puncture through Nursing Staff
Development may perform arterial punctures.
C. Arterial puncture (via radial access) will be performed by respiratory therapists who have completed the
competency for radial arterial puncture through Respiratory Care Services. Please refer to the ABG
evaluation related link.
D. If two punctures are performed and a sample is not obtained, the ordering physician must be notified.

IV. EQUIPMENT

A. A sterile 20-23 gauge short beveled needle with needle guard (smaller needles may cause less pain,
however, they may be inappropriately flexible and/or cause hemolysis).
B. Alcohol Prep Isopropyl Alcohol 70% and /or Chlorhexidine Gluconate 2% is used for
disinfecting the skin.
C. Arterial Blood Sampler Kit (pre-heparinized plastic syringe that includes Luer cap).
D. Sterile 4 x 4's.

V. PROCEDURE

A. Review and acknowledge the physicians order.
B. Review the patient’s chart as necessary.
C. Print laboratory requisition via Health Link
D. Identify the patient using two forms of patient identification, and explain the procedure.
E. Wash hands thoroughly.
F. Put on eye wear and gloves for all ABG's and follow isolation precautions as indicated.
G. Air bubbles left in the syringe will cause errant results (pH increased, pCO2 decreased, and PO2 will
increase if FiO2 = 0.21).
H. Perform Allen’s test.
I. Cleanse the injection site with Alcohol Prep Isopropyl Alcohol 70% and/or Chlorhexidine Gluconate
2%.The operator disinfects their fingers with the same prep.
J. Attach the needle to the syringe and remove the needle sheath.
K. Preset plunger to desired volume (minimum 1 ml),
L. Relocate the artery using two fingers on top of it to feel the pulsation; separate the fingers and use the
other hand to again locate the artery.
M. Quickly puncture the skin on top of the artery with the needle at a 45-60 degree and directed with
the bevel up toward a palpable pulsation.



1. Redirection is sometimes necessary; retract needle (do not exit from skin), redirect and re-
advance as before. If the needle is removed from the skin, it is to be changed to assure it is not
blocked by a clot or other tissue as well as a precaution to reduce infection hazard.
2. When the artery is entered, the syringe will fill with blood. If blood fills hub of the needle and
proceeds no further, a slight reposition of the needle may be needed or a vein may have been
punctured.
N. Apply firm constant pressure to the puncture site with a 4 x 4 dressing for a full 5 minutes or longer,
depending on clotting time and patient's condition, after the needle is removed. A pressure bandage could
be helpful in cases requiring pressure over longer periods.
O. Remove the needle from the syringe:
1. Carefully snap needle guard into place. Remove from syringe at hub. Discard needle in an
appropriate receptacle. Samples with needles still attached will be refused.
2. Remove air from the syringe. The specimen must be free of air bubbles since the blood will
equalize with the atmospheric pressure. Foam in the sample can invalidate results.
3. Place the cap on the syringe.
4. Rotate the specimen in the syringe for 5 seconds to evenly distribute heparin and prevent
clotting.
P. Correctly label syringe at the patient bedside
1. The syringe must be labeled in the presence of the patient, comparing the patient labels and the
other form to the patient ID band.
2. Use the “buddy system” to double check that the patient’s label matches the patient and that
the label is securely affixed to the syringe. A “buddy” can be an RT, RN, NA or MD
3. The label must be legible.
4. Verify the time and FiO2 printed on the requisition form is correct. If not, cross out and insert
actual value(s).
5. The labeled syringe and matching requisition form must be sent to the laboratory in a sealed
biohazard bag with form placed in the outside pouch.
6. The Laboratory will not accept syringes with label attached to plunger or syringes with needles
on them.
Q. Place the specimen in a clear baggie and put into a hazard bag found in the tube system and send to the
laboratory immediately.
R. If unable to obtain arterial blood gas after two attempts, contact ordering provider for further instructions.

VI. REFERENCES

A. ABG Evaluation Related Link
B. AARC Clinical Practice Guidelines: Arterial Blood Gas Sampling
C. Nursing Policy & Procedure #11.11: Arterial Blood Specimen Drawing.


Approved by Director and Medical Director of Respiratory Care.
A copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].