Obtaining

An Arterial
Blood
Specimen
For Blood
Gas
Analysis

Pg.942
 TABLE 18-1 ARTERIAL BLOOD GAS:
NORMAL VALUES
PARAMETER NORMAL VALUES
pH 7.35-7.45
PaCo2 35-45 mmHg
HCO3 22-26 mEq/L
SaO2 Oxygen saturation ˃ 95%
PaO2 ˃ 80-100 mm Hg (normal value decreases with age;
subtract 1 mm Hg from 80 mm Hg for every year over 60 years
of age up to age 90 (Fischbach & Dunning, 2006)
 EQUIPMENT
 ABG kit, or heparinized self-filling
10-mL syringe with 22-G, 1-inch needle attached

 Airtight cap for hub of syringe

 2X2 gauze pad

 Band-Aid

 Antimicrobial swab, such as chlorhexidine

 EQUIPMENT
 Biohazard bag
 Appropriate label for specimen,
based on facility policy and procedure
 Cup or bag of ice
 Nonsterile gloves
 Additional PPE, as indicated
 Rolled towel
 ASSESSMENT
 Review the patient’s medical record and plan of care
for information about the NEED FOR AN ABG
SPECIMEN.
 Assess the patient’s CARDIAC STATUS, including
heart rate, blood pressure, and auscultation of heart
sounds.
 Also assess the patient’s RESPIRATORY STATUS,
including respiratory rate, excursion, lung sounds, and
use of oxygen, including the amount being used, if
ordered.
 ASSESSMENT
 Determine the adequacy of peripheral blood flow to the
extremity to be used by performing Allen’s test.
 If Allen’s test reveals no or little collateral circulation to the
hand, do not perform an arterial stick to that artery.
 Assess the patient’s radial pulse. If unable to palpate the radial
pulse, consider using the other wrist.

 Assess the patient’s understanding about the need for specimen

collection.
 Ask the patient if he or she has ever felt faint, sweaty, or
nauseated when having blood drawn.
  Acute Pain
 Risk for Injury
 Impaired Gas Exchange
NURSING  Ineffective Airway
DIAGNOSIS Clearance
 Anxiety
 Decreased Cardiac Output
 OUTCOME IDENTIFICATION AND PLANNING

The expected outcome to achieve is that the

blood sample is obtained from the artery
without damage to the artery.

Other outcomes that may be appropriate include

the following:
-the patient experiences minimal pain and
anxiety during the procedure, and
-the patient demonstrates an understanding of
the need for the ABG specimen.
 IMPLEMENTATION
ACTION RATIONALE
1. Gather the necessary supplies. Check Organization facilitates efficient performance of the
product EXPIRATION DATES. procedure.
Ensures proper functioning of equipment. Suctioning
Identify ordered arterial blood gas may change the oxygen saturation and is a
analysis. Check the chart to make sure temporary change not to be confused with baseline
for the patient.
the patient has not been suctioned Arterial puncture is a source of pain and discomfort.
within the past 15 minutes. Intradermal injection of lidocaine around the
Check facility policy and/or procedure for puncture site has been shown to decrease the
guidelines on administering LOCAL incidence and severity of localized pain when used
before arterial puncture (AACN, 2005; Hudson et al.,
ANESTHESIA for arterial punctures. 2006)
Administer anesthetic and allow sufficient
time for full effect before beginning
procedure.
2. Bring necessary equipment to the Bringing everything to the bedside conserves time
bedside stand or overbed table. and energy.
Arranging items nearby is convenient, saves time,
and avoids unnecessary stretching and twisting of
muscles on the part of the nurse. Organization
facilitates performance of tasks.
 IMPLEMENTATION
ACTION RATIONALE
3. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent the transmission of
microorganisms.
indicated. PPE is required based on transmission precautions.

4. Check the PATIENT’S IDENTIFICATION Identifying the patient ensures the right patient receives
the intervention and helps prevent errors. Explanation
AND CONFIRM THE PATIENT’S IDENTITY. facilitates cooperation and provides reassurance for
Tell the patient you need to collect an patient.
arterial blood sample, and EXPLAIN THE
PROCEDURE. Tell the patient that the Mars is full of iron
needle stick will cause some discomfort oxide dust, which
but that he or she must remain still during gives the planet its
theVENUS
procedure.
by reddish
by by cast
MERCURY
MARS

5. Close curtains around bed and close the Closing the door or curtain provides for patient privacy.
door to the room, if possible.
 ACTION
IMPLEMENTATION RATIONALE
6. Check specimen label with the patient’s identification Confirmation of patient identification information
bracelet. Label should include PATIENT’S NAME AND ensures the specimen is labeled correctly for the right
IDENTIFICATION NUMBER, TIME SPECIMEN WAS patient.
COLLECTED, ROUTE OF COLLECTION, IDENTIFICATION OF
PERSON OBTAINING THE SAMPLE, AMOUNT OF OXYGEN
THE PATIENT IS RECEIVING, AND ANY OTHER
INFORMATION REQUIRED BY AGENCY POLICY.

7. Provide for GOOD LIGHT. ARTIFICIAL LIGHT is Good lighting is necessary to perform the procedure
recommended. Place a TRASH RECEPTACLE properly. Having the trash receptacle in easy reach allows
within easy reach. for safe disposal of contaminated materials.

8. If the patient is on bed rest, ask him or her to Positioning the patient comfortably helps minimize
lie in a SUPINE POSITION, with the head slightly anxiety. Using a rolled towel under the wrist provides for
elevated and the arms at the sides. Ask the easy access to the insertion site.
ambulatory patient to SIT in a chair and support
the arm securely on an armrest or a table. Place
a WATERPROOF PAD under the site and a ROLLED
TOWEL under the wrist.
 ACTION RATIONALE
IMPLEMENTATION
9. PERFORM ALLEN’S TEST (FIGURE 1) BEFORE Allen’s testing assesses patency of the ulnar and radial
OBTAINING A SPECIMEN FROM THE RADIAL arteries.
ARTERY:
a. Have the patient CLENCH THE WRIST to minimize blood
flow into the hand.
A
b. Using your INDEX AND MIDDLE FINGERS, PRESS ON THE
RADIAL AND ULNAR ARTERIES (Figure 1A). Hold this position
for a few seconds.
c. Without removing your fingers from the arteries, ask the
patient to UNCLENCH THE FIST and hold the hand in a relaxed B
position (Figure 1B). The palm will be blanched because
pressure from your fingers has impaired the normal blood
flow. MERCURY
d. RELEASE PRESSURE ON THE ULNAR ARTERY (Figure 1C).
•Mercury is the
If the hand becomes flushed, which indicates that blood C closest planet to the
is filling the vessels, it is safe to proceed with the radial artery
puncture. This is considered a POSITIVE TEST. If the hand Sun and the
does not flush, perform the test on the other arm. smallest one
 ACTION RATIONALE

10. Put on UNSTERILE GLOVES. Locate the radial Gloves reduce transmission of microorganisms. If
artery and lightly palpate it for a strong pulse. you push too hard during palpation, the radial
artery will be obliterated and hard to palpate.

11. Clean the site with the antimicrobial swab. Site cleansing prevents potentially infectious skin
If using chlorhexidine, use a back-and-forth flora from being introduced into the vessel during
motion, applying friction for 30 seconds to the the procedure. Palpation after
site, or use the procedure recommended by cleansing contaminates the area.
the manufacturer. Allow the site to dry. After
disinfection, do not palpate the site unless
sterile gloves are worn.

12. Stabilize the hand with the wrist extended Stabilizing the hand and palpating the artery with
over the rolled towel, palm up. Palpate the artery one hand while holding the syringe in the other
above the puncture site with the index and middle provides better access to the
fingers of your nondominant artery. Palpating the area to be punctured would
hand while holding the syringe over the puncture contaminate the clean area.
site with your dominant hand. DO NOT DIRECTLY
TOUCH THE AREA TO BE PUNCTURED.
 ACTION RATIONALE

13. Hold the needle BEVEL UP AT A 45-DEGREE The proper angle of insertion ensures correct
angle at the site of maximal pulse impulse, with access to the artery. The artery is shallow and does
the shaft parallel to the path of the artery. (When not require a deeper angle to
puncturing the brachial artery, hold the needle at penetrate.
a 60-degree angle.)
14. Puncture the skin and arterial wall in one The blood should enter the syringe automatically
motion. Watch for blood backflow in the syringe due to arterial CONCLUSIONS
pressure.
(Figure 2). The pulsating blood will flow into the
syringe. Do not pull back on the plunger. FILL THE
SYRINGE TO THE 5-ML MARK.

RESULTS
FIGURE 2. Observing blood flow into syringe.
 ACTION RATIONALE
15. After collecting the sample, withdraw the syringe while If insufficient pressure is applied, a large,
your non-dominant hand is beginning to place pressure painful hematoma may
proximal to the insertion site with the 2 X 2 gauze. Press a form, hindering future arterial puncture at
gauze pad firmly over the puncture site until the bleeding the site.
stops—at least 5 minutes.
If the patient is receiving ANTICOAGULANT THERAPY or
has a blood dyscrasia, APPLY PRESSURE FOR 10 TO 15
MINUTES; if necessary, ask a coworker to hold the gauze
pad in place while you prepare the sample for transport to
the laboratory, but do not ask the patient to hold the pad.

16. When the bleeding stops and the appropriate time has Applying a dressing also prevents arterial
lapsed, APPLY A SMALL ADHESIVE BANDAGE OR SMALL hemorrhage and extravasation into the
PRESSURE DRESSING (FOLD A 2 X 2 GAUZE INTO FOURTHS surrounding tissue, which can cause a
AND FIRMLY APPLY TAPE, STRETCHING THE SKIN TIGHT). hematoma.
 ACTION RATIONALE

17. Once the sample is obtained, check the Air bubbles can affect the laboratory
syringe for air bubbles. If any appear, remove values.
them by holding the syringe upright and slowly
ejecting some of the blood onto a 2 X 2 gauze
pad.

18. Engage the needle guard and remove the Engaging the needle guard prevents
needle. Place the airtight cap on the syringe. accidental needle stick injury.
Gently rotate the syringe to ensure that heparin Using an airtight cap prevents the sample
is well distributed. Do not shake. Insert the from leaking and keeps air out of the
syringe into a cup or bag of ice. syringe, because blood will continue to
absorb oxygen and will give a false
reading if allowed to have contact with air.
Heparin prevents blood from clotting. Ice
prevents the blood from degrading.
Vigorous shaking may cause hemolysis.
 ACTION RATIONALE
19. Place LABEL on the syringe per facility Labeling ensures specimen is the correct one for the
policy. Place the iced syringe in a plastic, right patient. Packaging the specimen in a biohazard
sealable BIOHAZARD BAG. bag prevents the person transporting the samples
from coming in contact with blood.
20. Discard the needle in sharps container. Proper disposal of equipment prevents accidental
Remove gloves and perform hand hygiene. injury and reduces transmission of microorganisms.
Removing gloves properly reduces the risk for
infection transmission and contamination of other
items. Hand hygiene reduces transmission of
microorganisms.
21. Remove other PPE, if used. Perform Removing PPE properly reduces the risk for infection
hand hygiene. transmission and contamination of other items.
Hand hygiene reduces the transmission of
microorganisms.
22. Transport the specimen to the Timely transport ensures accurate results.
laboratory immediately.
 EVALUATION
The expected outcome is met when an arterial blood
specimen is obtained, and the patient reports
minimal pain during the procedure. In addition, the
site remains free of injury, without evidence of
hematoma formation, and the patient verbalizes
the rationale for the specimen collection.
 Results of Allen’s test
RESULTS
 Time the sample was drawn
 Arterial puncture site
 Amount of time pressure was applied JUPITER to the site to
controlMARS bleeding. It’s the biggest planet in
the Solar System
 Typeisand amount of oxygen therapy that the
Despite being red, Mars
a cold place
patient was receiving
 Pulse oximetry values, respiratory rate, respiratory
effort, and;
 Any other significant assessments.
 Sample Documentation
1/16/22 1245H Allen’s test positive. ABG obtained using R
radial artery. Pressure applied to site for 5 minutes.
Patient receiving 3 L/NC oxygen, pulse oximetry 94%,
respirations even/ unlabored, respiratory rate 18 breaths
per minute, patient denies dyspnea.

—C. Bausler, RN