Puncture pressure to blood gas analysis

Arterial blood obtained by percutaneous puncture of the brachial artery , radial or femoral .

Once collected , the blood can be sent to determine arterial blood gas .

Blood gas analysis is effective ventilation and blood pH measuring the partial pressure of oxygen ( PaO2 ) and carbon dioxide pressure ( PaCO2 ) . Blood pH indicates acid-base balance in the blood. PaO2 indicates the amount of O2 in the lungs transmit them to the blood , and PaCO2 indicate lung capacity to remove carbon dioxide . Can also measure blood gases and oxygen saturation concentration and bicarbonate values ​​. Usually , blood gas analysis is recommended in patients with obstructive lung disease , pulmonary edema, acute respiratory disorders , heart attack, pneumonia. It also harvested after cardiac surgery ( bypass sites ) resuscitation in case of cardiac arrest, prolonged intraoperative anesthesia , etc. . Before performing puncture radial Allen test is performed .

Allen test :

  •       is used to evaluate the blood flow to the hand . First you can feel its pulse on the radial and ulnar arteries , by compression of the face deep anterior forearm .
  •       patient is asked to make a fist , then firmly compress both arteries between the two police ;
  •       further , the patient will be asked to open his fist and palm will notice that dim ( all the while maintaining compression on arteries);
  •      will decompress the ulnar artery (maintain compression on the radial artery ) ulnar artery is patent if i will see normal color within 3-5 seconds hand .
  •      will decompress the radial artery ( ulnar artery compression is maintained ) if the radial artery is patent , will become red palm bloodstream in seconds.

By this process , the maintenance of the decompression paleness after occlusion of one of the arteries indicating the level.

Materials needed:

  •  2 ml or 5 ml syringe
  •     vial of heparin
  •     gloves
  •     fortified forest
  •     gauze compress ice bag ( buiotă )
  •     labels
  •     analysis request form
  •     adhesive bandage

Preparation of materials :
 be heparinizează syringe (opens vial of heparin and pull until you fill the syringe , then slowly drain the whole syringe , allowing heparin to ” wash ” the whole surface ) . Heparinisation syringe prevents blood clotting in the syringe. However , excess heparin syringe can alter the pH values ​​and blood PaO2 .

Harvesting:
 confirm the identity of the patient ( to avoid confusion and to never take another patient analysis )
 be communicated to the patient will be informed of the procedure and what is , to reduce anxiety and ensure cooperation to
 Wash hands and put gloves
 sits a rolled towel under the patient’s wrist to support its
 artery locate and palpate the pulse
 puncture site is desinfectează
 expect to disinfect dry place
 they palpate the artery index and middle finger of one hand while the other hand held syringe is chosen over the puncture site
 radial artery puncture , the needle is oriented at an angle of 30-45 degrees
 if brachial artery puncture will be oriented at an angle of 60 degrees
 they puncture the skin and arterial wall by a single motion
 syringe will automatically fill with blood
 after harvest compress pressed firmly until the bleeding stops (at least 5 min). If the patient is being treated with anticoagulants or clotting is the compression is maintained for 10-15 minutes . Avoid to ask the patient to keep the puncture site compression alone . If it fails to apply firm compression , it becomes a painful hematoma .
 will not have to check the syringe for air bubbles ( if he will be out carefully )
 shall be attached to the blood sample analysis request duly completed and will be sent to the laboratory in a container of ice
 will attach an adhesive bandage for bleeding to stop
 will monitor the patient’s vital signs to detect any movement disorders as: pallor , pain, drowsiness , tingling , bruising, bleeding at the puncture .

Special considerations :
 if the patient receives oxygen will wait at least 15 minutes when you start to receive it until harvest
 not discontinue use of oxygen during collection unless it specifically states otherwise . If you do not stop the administration of oxygen , specify the form and type of oxygen assay that patient receives
 If the patient is under oxygen and this will be specified on the application form analysis
 if the patient has just been put on ventilator will wait 20 min to harvest
 on the application form for laboratory analysis will be more specific patient temperature , the latest level of Hb, respiratory rate , and if the patient is ventilated additionally specify : fraction of inspired oxygen , ventilatory frequency
 there will be no more than 2 attempts to puncture the same place as it may damage the artery and radial nerve

complications :
 achieve periosteum can cause considerable pain patient
 needle perforating artery crossing the other wall ( less needle will be withdrawn until blood appears in the syringe)
 appearance of arterial spasm ( it will change to a smaller needle and try again

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