From Sensa Core Technical Service

Product: ABG

Subject: Arterial blood gas sampling procedure.

Number:

Date: 28.03.2019

Arterial blood gas (ABG) sampling is a commonly performed procedure which allows
healthcare professionals to quickly obtain information on a patient’s respiratory status
(blood oxygen and carbon dioxide levels), as well as the patient’s acid-base
balance. Taking an arterial blood gas (ABG) involves using a needle and syringe to
directly sample blood from an artery (usually the radial artery). Below is a step by step
guide explaining how to take an arterial blood gas sample.

1) Introduction
 Wash hands.
 Introduce yourself.
 Confirm patient details:

A) Name/date of birth
B) Take note of whether the patient is requiring oxygen and record how much. (e.g.
FiO2 concentration or flow rate)

Check for any contraindications to ABG sampling:

 Absolute – Poor collateral circulation / peripheral vascular disease in the limb /

cellulitis surrounding the site / arteriovenous fistula.
 Relative – impaired coagulation (e.g. anticoagulation therapy / liver disease / low
platelets <50)
Explain procedure:
“I need to take a sample of blood from an artery in the wrist to assess the oxygen levels in
your circulation. It will be a little painful, but should hopefully only take a short amount
of time. The procedure does involve some risks which include bleeding, bruising, infection
and permanent damage to the artery.”
Gain consent:
“Do you understand everything I’ve said so far? Are you happy for me to go ahead?”

2) Modified Allen’s test

This test involves the assessment of the arterial supply to the hand.
A) Ask the patient to clench their fist.
B) Apply pressure over both the radial and ulnar artery to obstruct blood supply to the
hand.
C) Ask the patient to open their hand, which should now appear blanched (if not you
have not completely occluded the arteries with your fingers)
D) Remove pressure from the ulnar artery whilst maintaining pressure over the radial
artery.
E) If there is adequate blood supply from the ulnar artery, colour should return to the
entire hand within 5-15 seconds.
It should be noted that there is no evidence performing this test reduces the rate of
ischaemic complications of arterial sampling.

3) Gather equipment

 Arterial blood gas syringe ( dried (lyophilized) heparin)

 Needle (23G)
 Alcohol wipe – 70% isopropyl
 Gauze
 Tape
 Gloves
 Apron

4) Preparation
A) Position the patient’s arm preferably on a pillow for comfort with the wrist
extended (20-30°).
B) Prepare all the equipment in the equipment tray using an aseptic non touch technique.
C) Palpate the radial artery on the patient’s non-dominant hand (most pulsatile over the
lateral anterior aspect of the wrist).
D) Clean the site with an alcohol wipe for 30 seconds and allow to dry before
proceeding.
E) Wash hands again.
F) Done gloves and apron.
G) Prepare and administer lidocaine subcutaneously over the planned puncture
site (aspirate to ensure you are not in a blood vessel before injecting the local anaesthetic).
H) Allow at least 60 seconds for the local anesthetic to work.

I) Attach the needle to the ABG syringe, expel the heparin and pull the syringe plunger to
the required fill level (check with your local laboratory).

5) Taking the sample

A) Palpate the radial artery with your non-dominant hand’s index finger around 1cm
proximal to the planned puncture site (avoiding directly touching the planned puncture
site that you have just cleaned)
B) Warn the patient you are going to insert the needle
C) Holding the ABG syringe like a dart insert the ABG needle through the skin at an angle
of 45° over the point of maximal radial artery pulsation (which you identified
during palpation).
D) Advance the needle into the radial artery until you observe blood flashback into
the ABG syringe.
E) The syringe should then begin to self-fill in a pulsatile manner (do not pull back the
syringe plunger).
F) Once the required amount of blood has been collected remove the needle and apply
immediate firm pressure over the puncture site with some gauze.
G) Engage the needle safety guard.
F) Remove the ABG needle from the syringe and discard safely into a sharps bin.
H) Place a cap onto the ABG syringe and label the sample.
I) Yourself or a colleague should continue to apply firm pressure for 3-5 minutes to
reduce the risk of haematoma formation.

6) To complete the procedure

 Dress the puncture site.

 Thank the patient.
 Dispose gloves and equipment into an appropriate clinical waste bin.
 Wash hands.
 Take the ABG sample to be analysed as soon as possible after being taken, as delays
longer than 10 minutes can affect the accuracy of results.