Chapter 013

Arterial Blood Collection
Chapter 13
Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

Learning Objectives
Lesson 13.1: Arterial Blood Collection
(Slide 1 of 3)
1. Explain how arterial blood differs from venous

blood.
2. Describe what is measured in arterial blood gas
(ABG) testing, and explain the significance of
abnormal results.
3. List the equipment needed to collect arterial blood,
and discuss the differences from routine
venipuncture equipment.
4. List the arteries that can be used for blood gas
collection, and describe the advantages and
disadvantages of each.
Learning Objectives
(Slide 2 of 3)
5. Explain the principle and procedure for testing

collateral circulation.
6. Define respiratory steady state, and list the steps
that should be taken to ensure that it exists when
blood is collected.
7. Describe the steps in ABG collection.
8. Discuss at least five complications that may occur
with arterial puncture.

Learning Objectives
(Slide 3 of 3)
9. List at least seven sample collection errors that

may affect ABG testing.
10. Describe capillary blood gas testing, including
uses, limitations, and procedure.

Composition of Arterial Blood
 Arterial blood is rich in both oxygen and

electrolytes; this is different from venous blood, in
which the levels of these substances vary,
depending on the metabolic activities of
surrounding tissues
 Arterial collection is most often used for testing
arterial blood gases (ABGs), ammonia, and lactic

acid

Arterial Blood Gas Testing
(Slide 1 of 2)
 The absolute amount of oxygen is expressed as the

partial pressure of oxygen (Po2)
 Similarly, the carbon dioxide level is expressed as
the partial pressure of carbon dioxide (Pco 2)

Arterial Blood Gas Testing
(Slide 2 of 2)
 ABGs measure the gas-exchange ability of the

lungs and the buffering capacity of the blood
 A lower-than-normal Po2 and a higher-than-
normal Pco2 indicate that gas exchange in the

lungs is impaired
 Abnormal values mean that the body’s tissues are
not getting adequate oxygen, a serious and

potentially life-threatening situation

Reference Range for ABG

Equipment for Arterial Puncture
(Slide 1 of 4)
 Arterial blood is collected in a syringe that has

been pretreated with heparin to prevent
coagulation
 Syringes must be either glass or gas-impermeable
plastic
 The volume of blood required determines the
syringe size; available syringe volumes range

from 1 to 5 mL
 The typical collection needle is usually 21 or 22
gauge, and 1 to 1½ inches long

(Slide 2 of 4)
 The risk of serious infection is greater with arterial

puncture than with venipuncture
 For this reason, both alcohol and povidone–iodine
or chlorhexidine are used to clean the site

 To lessen pain, 0.5 mL of lidocaine, a local
anesthetic, may be injected subcutaneously, using

a 25- to 26-gauge needle on a 1-mL syringe

(Slide 3 of 4)
 Arterial blood is under pressure and may spray out

of the puncture
 You need a fluid-resistant gown, face protection,
and gloves
 You also need a puncture-resistant container for
sharps
 The Luer tip covers the syringe top after you have
removed the needle

(Slide 4 of 4)
 Other equipment needed for arterial puncture

includes the following:
 A slurry of crushed ice/water
 Gauze pads
 Pressure bandages
 Thermometer (to take the patient’s temperature)
 Transport container

Site Selection
(Slide 1 of 6)
 Phlebotomists collect only from the radial or

brachial arteries; other collections require a
physician or other specially trained professional
 Other arteries that can be used include the femoral
and dorsalis pedis

Site Selection
(Slide 2 of 6)
 The artery used for collection must be located near

the skin surface and be large enough to accept at
least a 23-gauge needle
 In addition, the region distal to the collection site
should have collateral circulation, meaning that it

receives blood from more than one artery

Site Selection
(Slide 3 of 6)
 The radial artery, supplying the hand, is the artery

of choice
 Although it is smaller than either the brachial or
the femoral artery, it has good collateral

circulation and is easily accessible along the
thumb side of the wrist
 Its small size is a disadvantage in patients with
low cardiac output because it is hard to locate

Site Selection
(Slide 4 of 6)
 The brachial artery is large; therefore, it is easy to

palpate and puncture
 It is located in the antecubital fossa, below the
basilic vein and near the insertion of the biceps

muscle
 It has adequate collateral circulation, although not
as much as the radial artery

Site Selection
(Slide 5 of 6)
 The femoral artery is the largest artery used

 It is located in the groin area above the thigh,
lateral to the pubic bone

 The femoral is used when the previously
mentioned sites are not available for puncture

 Its large size and high volume make it useful when
cardiac output is low

 However, it has poor collateral circulation

Site Selection
(Slide 6 of 6)
 Alternative sites in adults include the dorsalis

pedis artery in the foot
 When puncturing the dorsalis pedis, the posterior
tibial must be checked for an adequate pulse

 In newborns who have difficulty breathing, blood
may be collected from both the umbilical artery

and the umbilical vein

Testing Collateral Circulation
 Modified Allen Test

 Extend the patient’s wrist over a towel, and have the
patient make a fist
 Locate pulses of both the ulnar and radial arteries, and
compress both arteries
 Have the patient open and close fist repeatedly
 Release the pressure from the ulnar artery
 Interpret the results

Respiratory Steady State
 Must be in this state before radial artery puncture

 Patient has received specified amount of oxygen
and has refrained from exercise for at least 30

minutes
 Maintain this state during collection
 Keep patient calm
 Make sure he or she is not experiencing
hyperventilation

Radial Artery Puncture
(Slide 1 of 6)
 Prepare the patient, and examine and complete the

requisition form
 Take the patient’s temperature and respiration rate and
record them on the requisition form if required by your
facility’s protocol
 The patient should be in a respiratory steady state,
meaning that he or she has received the specified
amount of oxygen and has refrained from exercise for
at least 30 minutes

(Slide 2 of 6)
 Choose and prepare the site

 Perform the modified Allen test to assess collateral
circulation in the hand
 If the result is positive, proceed
 Fully extend the arm, with the anterior surface facing
upward
 Palpate for the artery with either the middle or the
index finger to locate the greatest maximum pulsation

(Slide 3 of 6)
 Perform the puncture

 Cleanse the fingers of your nondominant hand and
place them over the area where the needle should enter
the artery, using the index finger and middle finger of
your nondominant hand to stabilize the artery
 Hold the syringe like a dart with your dominant hand,
with the needle tip pointed bevel up toward the upper
arm
 As the needle is inserted into the artery, blood should
appear in the hub

(Slide 4 of 6)
 Withdraw the needle, apply pressure, and ice the

syringe
 Withdraw the needle with your dominant hand
 With your nondominant hand, apply direct pressure to
the site with a folded gauze square
 Hold it for at least 5 minutes
 Meanwhile, with the hand holding the syringe, depress
the plunger slightly, if necessary, to expel any air that
may have entered the needle

(Slide 5 of 6)
 Examine the puncture site

 After 5 minutes (or 15 minutes for patients on
anticoagulant therapy), check the site to ensure that the
bleeding has stopped
 A number of medications increase bleeding times,
including anticoagulants (e.g., heparin and warfarin)
and thrombolytics (e.g., tissue plasminogen activator,
streptokinase, and urokinase)

(Slide 6 of 6)
 Label and deliver the specimen to the laboratory

 Dispose of the needle in the sharps container
 Label the specimen with a waterproof pen
 Deliver the specimen to the laboratory immediately

Arterial Puncture Complications
(Slide 1 of 2)
 Arteriospasm, the spontaneous constriction of an

artery in response to pain
 Embolism, or blood vessel obstruction, due to an
air bubble or dislodged clot in the artery

 Hematoma, resulting from inadequate pressure on
the site

Arterial Puncture Complications
(Slide 2 of 2)
 Hemorrhage
 Infection, from skin contaminants
 Lightheadedness, nausea, or fainting.
 Nerve damage, caused by inadvertent contact with
a nerve
 Severe pain
 Thrombosis, or clot formation, within the artery

Sampling Errors
 The most significant source of error is failure to

deliver the sample to the laboratory immediately
or to properly store the sample on ice if delivery
will be delayed
 Blood cells continue to respire after collection,
and this may cause considerable changes in the

analyte values, including Po2, Pco2, and pH
 Samples collected in a plastic syringe are not iced,
and must be analyzed within 30 minutes of

collection

Specimen Rejection
 Air bubbles in the specimen

 Clotting
 Failure to ice the specimen
 Improper or absent labeling
 Inadequate volume of specimen for the test
 Too long a delay in delivering the specimen to the
laboratory
 Use of the wrong syringe

Capillary Blood Gas Testing
(Slide 1 of 2)
 Capillary blood gas (CBG) testing is an

alternative to ABG testing when arterial
collection is not possible or is not recommended
 Capillary blood is not as desirable a specimen for
blood gas testing because it is a mixture of blood

from the capillaries, venules, and arterioles and is
mixed with tissue fluid

Capillary Blood Gas Testing
(Slide 2 of 2)
 Clean the site with the appropriate antiseptic swab,

using the antiseptic required by your institution
 Collect the sample in a heparinized glass pipet
 Fill the tube completely with blood so that no air
bubbles remain
 Mix well using the magnet and flea, and transport
the specimen to the laboratory on ice

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Arterial Blood Collection

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

1. Explain how arterial blood differs from venous

5. Explain the principle and procedure for testing

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 3

9. List at least seven sample collection errors that

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 4

 Arterial blood is rich in both oxygen and

arterial blood gases (ABGs), ammonia, and lactic

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 5

 The absolute amount of oxygen is expressed as the

the partial pressure of carbon dioxide (Pco 2)

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 6

 ABGs measure the gas-exchange ability of the

normal Pco2 indicate that gas exchange in the

not getting adequate oxygen, a serious and

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 7

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 8

 Arterial blood is collected in a syringe that has

syringe size; available syringe volumes range

gauge, and 1 to 1½ inches long

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 9

 The risk of serious infection is greater with arterial

or chlorhexidine are used to clean the site

anesthetic, may be injected subcutaneously, using

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 10

 Arterial blood is under pressure and may spray out

removed the needle

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 11

 Other equipment needed for arterial puncture

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 12

 Phlebotomists collect only from the radial or

and dorsalis pedis

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 13

 The artery used for collection must be located near

should have collateral circulation, meaning that it

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 16

 The radial artery, supplying the hand, is the artery

the femoral artery, it has good collateral

low cardiac output because it is hard to locate

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 17

 The brachial artery is large; therefore, it is easy to

basilic vein and near the insertion of the biceps

as much as the radial artery

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 18

 The femoral artery is the largest artery used

lateral to the pubic bone

mentioned sites are not available for puncture

cardiac output is low

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 19

 Alternative sites in adults include the dorsalis

tibial must be checked for an adequate pulse

may be collected from both the umbilical artery

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 20

 Modified Allen Test

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 21

 Must be in this state before radial artery puncture

and has refrained from exercise for at least 30

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 22

 Prepare the patient, and examine and complete the

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 23

 Choose and prepare the site

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 24

 Perform the puncture