POLICY

Policy Area: PULMONARY DEPARTMENT

Policy Title: ARTERIAL BLOOD GAS EXTRACTION

Document Code: AS-PUL-0004 Revision No.:
1

Issue No.: Issue Date: Review Date: Page :

1 October 21,2021 October 21,2024 1 of 3

Issued to:
NSO Department

1. RATIONALE AND POLICY STATEMENT

To promote and ensure optimum safety for the patient during the performance
of an arterial puncture and to contribute to the accuracy of arterial blood gas
analysis.

2. RESPONSIBILITY
Respiratory Therapists & Pulmonary Nurses ensure the safety of the patients
while doing arterial blood gas and do proper observation after the procedure.

3. ABBREVIATIONS
ABG - Arterial Blood Gas
O2sat - Oxygen Saturation
FiO2 - Fraction of Inspired Oxygen
RTOD - Respiratory Therapist on Duty

4. DEFINITIONS
Arterial blood gases (ABG) test measures the acidity (pH) and the levels of
oxygen and carbon dioxide in the blood from an artery. This test is used to find
out how well your lungs are able to move oxygen into the blood and remove
carbon dioxide from the blood.

5. SCOPE OF THE POLICY

ABG are done in OPD, ER and in Wards.

6. POLICY STEPS
6.1 Review patient’s chart and evaluate the following;
6.1.1 Physician’s order (or enter a verbal order)
6.1.2 Patient history and current status
6.1.3 Medications
6.1.4 Previous Blood Samples if any
6.1.5 Prescribed FiO2
6.2 Introduce yourself and verify the patient’s name and date of birth.
6.3 Wash your hands.
6.4 Aseptically Prepare the equipment for arterial puncture:
6.4.1 Attach the needle to syringe
6.4.2 If using a syringe that is not heparinized, withdraw 0.05ml of heparin
6.4.3 Lubricate the barrel of the syringe
6.4.4 Expel the heparin and any air bubbles.
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Document Code: AS-PUL-0004 Page No.: 2 of 3

6.5 Excessive heparin may affect the accuracy of the blood gas and Ph values.
A volume of heparin of 0.05ml for 1ml of blood is recommended.
6.6 Select the puncture site. Commonly used sites for adult includes:
6.6.1 Radial Artery
6.6.2 Brachial Artery
6.6.3 Femoral Artery
6.7 Explain to the patient why he is receiving an arterial puncture. Relate it to
his injury or disease state.
6.8 Tell the patient that the procedure may be uncomfortable but that everything
will be done to alleviate the discomfort.
6.9 If the radial artery is the preferred site to be used for the puncture, perform
the Allen’s test for collateral circulation.
6.9.1 Palpate the radial and ulnar arteries.
6.9.2 Request the patient to make tight fist.
6.9.3 Occlude both radial and ulnar arteries.
6.9.4 Release the ulnar artery and verify a rapid color return to the blanched
area of the hand. The color should return within 10-15 seconds.
6.10 If a palpable pulse is not present or if there is a negative Allen’s test, a
brachial puncture can be performed.
6.11 Do hand washing or Don gloves then clean the site of the puncture with
the alcohol swab. The wrist is then slightly extended and the radial artery is
palpated. Severe extension of the wrist may obliterate the palpable pulse.
6.12 Place the patient and yourself in comfortable position.
6.13 Palpate the artery at two points to facilitate proper location of the site of
puncture.
6.14 While palpating the artery, Insert the needled syringe at an angle of 45
degrees, bevel facing upward, into the artery against the flow of blood. If the
brachial site is being punctured, the needle is inserted at a 60-degree angle.
6.15 While performing the puncture, avoid:
6.15.1 Repeated punctures (sewing machine punctures)
6.15.2 Deep punctured of the artery
6.15.3 Pulling the plunger of the syringe to withdraw blood quicker.
6.16 Penetrate the artery and obtain 1-3 mls of blood.
6.17 Let the pressure of the arterial blood fill the syringe. If the needle is
advanced through the artery, withdraw it slowly until blood begins to flow into
the syringe. If blood does not flow into the syringe and re-direction of the needle
is necessary.
6.18 Patients needing repeated arterial blood gases should have the blood
taken from alternating radial arteries if possible. When the volume of the sample
is adequate for analysis (approximately 0.5ml) withdraw the syringe and
immediately compress the site of the puncture with an alcohol swab or 2x2
swab for a period of at least five (5) minutes; ten (10) minutes for a brachial
puncture. A pressure bandage may be used once the bleeding is stopped.
6.19 If unsuccessful at obtaining the sample for any reason, the RTOD may
make one more attempt for a total of two attempts at obtaining an arterial blood
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sample. If the RTOD is unsuccessful with the second attempt, the RTOD will
not make another attempt and will defer the sampling to another RTOD.
6.20 Be sure the bleeding has stopped and no hematoma is developing before
releasing the compress. Air bubbles should be immediately expressed from the
sample without mixing.
6.21 discard the syringe and needle into a puncture-resistant leakproof (sharps)
container. Discard gauze, alcohol and iodine swabs into a waste container.
6.22 Record all pertinent conditions of the time of puncture that might have a
bearing on the results on the label. Examples would be respiratory rate, tidal
volume, minute volume, FiO2, and the site from which the blood was drawn.
6.23 Hand washing is a must after the procedure is done.
6.24 The results will be available 15-20 Minutes.

7. REFERENCE/S:

University of Texas Medical Branch Pulmonary Function Clinic

8. ATTACHMENT/S:
Not Applicable

9. DEVELOPMENT TEAM:
9.1 Brian Abner Recio, RN

9.2 Mary Joy Sy, RN RMT

10. APPROVAL:
Prepared By: Reviewed By: Approved By:

Brian Abner Recio, RN Edward Jeremy Miranda Grace M. Aba

Pulmonary Unit Head Ancillary Serviced Director President & CEO

11. REVISION HISTORY:

(This part is being update whenever a revision was made.)
Revision No. Revision Description
Original Original Document, No revision/s has been made.
12.
13. END OF DOCUMENT: