Assisting in Arterial Puncture

Definition:
Assisting for collection of blood sample from an artery by performing an arterial
puncture.

Purposes:
1. For accurate assessment of acid base status.
2. For assessing the degree of oxygenation of blood and adequacy of alveolar ventilation.
3. For starting continuous arterial blood pressure monitoring in an emergency.

Articles:
1. 1 ml or 2ml disposable syringe.
2. Disposable needles size 20 gauge.
3. Luer lock for syringe.
4. Heparin 1:1000
5. Alcohol swab
6. Crushed ice in specimen bag/ ice pack.
7. Disposable gloves and disposable probes.
8. Arterial catheter for continuous pressure monitoring
9. Waterproof pad.

Procedure
Sr Nursing Actions Rationale
no
1. Identify the patient by asking the name and Helps in gaining cooperation.
explain the procedure.
2. Record patient’s inspired oxygen Degree of hypoxemia cannot be assessed
concentration (FiO2) set on the ventilator. without knowing the inspired oxygen
concentration
3. Check patient’s temperature Hypothermia and hyperthermia influence
O2 release from hemoglobin
4. Heparinize the 2ml syringe. This action coats the interior of the
syringe and prevents clotting.
5. Wash hands and don gloves. Prevents infection
6. Palpate the radial brachial femoral artery. The radial artery is preferred site of
puncture. Arterial puncture is performed
in areas where good pulse is palpable.
7. If radial artery is selected for puncture, Allen’s test is a simple method of
perform the Allen’s test. assessing collateral circulation in the hand
 a. Obliterate the radial and ulnar pulses
simultaneously by pressing on both
blood vessels at the wrist.
b. Ask patient to clench and unclench
fist until blanching of skin occurs.
c. Release pressure on ulnar artery
(while still compressing radial
artery) watch for return of skin color
within 15 seconds.
d. Obliterate the radial the ulnar pulses
simultaneously at the wrist.
e. Elevate patient’s hand above heart
and squeeze or compress hand until
blanching occurs
f. Lower patient’s hand while still
compressing the ulnar artery and
watch for return of skin color.
8. For radial puncture, place a small towel Makes artery more accessible.
under the patient’s wrist
9. Place waterproof pad under forearms Protects the bed linen
10. Feel along the course of radial artery and The wrist should be stabilized to allow for
palpate for maximum pulsation with the better control of the needle.
middle fingers and index fingers. Prevents entry of microorganisms.
Prepare the skin with germicide. The skin
and subcutaneous tissues may be infiltrated
with a local anesthetic agent.
11. The needle is at 30-60 degree angle to the The arterial will cause the syringe to be
radial or brachial artery and 60-90 degree filled within few seconds.
angle for femoral artery to the skin surface
and is advanced into the artery. Once the
artery is punctured, arterial pressure will
push up the piston of the syringe and
pulsating flow of the blood will fill the
syringe.
12. After blood is obtained, withdraw needle Significantly bleeding can occur because
and apply firm pressure over the puncture of the pressure in the artery.
site with dry sponge for 5 minutes
13. Remove air bubbles from syringe. Insert the Immediate capping of needle prevents
needle into the rubber stopper placed on the room air from mixing with blood
flat surface. Do not hold the rubber stopper. specimen. Holding rubber stopper in one
hand may lead to needle stick injury.
14. Place the capped syringe in the container of Icing the syringe will prevent false results.
ice/ on the ice pack.
15. Maintain firm pressure on the puncture site Firm pressure on the puncture site will
for 5 minutes. If the patient is on prevents further bleeding and hematoma
anticoagulant therapy, apply direct pressure formation.
 over puncture site for 10-15 minutes and
then apply a firm pressure dressing.
16. For patients requiring serial monitoring of
arterial blood, an arterial catheter is placed
in to the radial or femoral artery.
17. Send labeled, iced specimen to the
laboratory immediately with duly filled
request.
18. Palpate the pulse (distal to the puncture
site), inspect the puncture site and assess for
reduced temperature, cold, numbness,
tingling or discoloration.
19. Change ventilator settings, inspired oxygen
concentration or type and setting of
respiratory therapy equipment as indicated
by the results.
All connections should be tight to avoid
the disconnection and rapid blood loss.
The arterial line also allows for direct
blood pressure monitoring in critically ill
patients.
Blood gas analysis should be done as soon
as possible because PaO2 and PH can
change rapidly.
Hematoma and arterial thrombosis are
complications.
The PaCO2 results will determine whether
to maintain, increase or decrease the FiO2.
The PacO2 and Ph result will dictate if ant
changes are needed in tidal volume or rate
of patient’s ventilator.