Arterial Puncture

ARTERIAL PUNCTURE
 It is collected anaerobically by directly Arterial puncture sites

puncturing n artery with a sharp short
bevelled hypodermic needle or winged  Criteria for selection:
infusion set attached to a syringe or other  How large and accessible the artery
collection device. is
 Presence of collateral circulation
 It is an ideal specimen for many analyses
 Should not be inflamed, irritated or
because its composition is consistent
edematous
throughout the body, whereas the
composition of venous blood varies relative  Radial artery
to the metabolic needs of the areas of the  Brachial artery
body it serves.  Femoral artery
 The puncture is technically difficult to Radial Artery
perform and potentially more painful and
hazardous to the patient than venipuncture.  The first choice and the most common site
 Not used for routine test.  Locate in the thumb site of the wrist
 For evaluation of Arterial blood gas  Most accessible though smaller
 It can also aid in the determination of
poisoning (carboxyhemaglobinemia or
methemoglobinemia)
 And in the measurement of lactate
concentration
To assess:
 Respiratory status. Assess oxygenation and

ventilation Advantages
 Acid base balance
 Phlebotomy. If venous route is unavailable/  presence of collateral circulation (supplied
inaccessible with blood from more than one artery)
 less chance of hematoma formation
Contraindications:
Disadvantages
 Overlying infection or burn at insertion site
 Absent collateral circulation  skill is required to puncture it successful
 Severe atherosclerosis owing to its small size and difficult to locate
 Coagulopathy
Brachial Artery
Personnel who perform arterial puncture
 The second choice for arterial puncture
 Paramedical course  It is located in the medical anterior aspect of
 RMTs, RNs, phlebotomist, the antecubital fossa near the insertion of
emergency technicians the biceps muscle
 Physician
1
Advantages
 Large and easily palpated and punctured
Disadvantages
 Poor collateral circulation

 Increased risk of infection because of the
site difficulty in achieving aseptic technique
because of the presence of pubic hair
Other sites:
Advantages  Include the scalp and umbilical arteries in
 It is large and easy to palpitate and puncture infants and the dorsalis pedis arteries of the
adult.
 With adequate collateral circulation
 The phlebotomist is not trained to perform
Disadvantage arterial punctures at this site including
catheters and other indwelling devices
 It is deeper than the radial artery
 It is close to a large vein (basilic) ABGs
 It is close to a median nerve and increase
 It is used in the diagnosis and management
risk of hematoma
of respiratory diseases
Femoral artery  It provides valuable information about the
patient oxygenation, ventilation and acid-
 The largest artery used for arterial puncture base balance and in the management of
 It is located superficially in the groin, lateral electrolyte and acid-base balance in patients
to the pubic bone and performed primarily with disorders such as diabetes.
by the physician.
 It is sometimes the only site where arterial ABGs specimen collection
sampling is possible
 Test requisition- current body temperature
 Femoral artery lies close to femoral vein respiratory rate and ventilation status at the
time of collection
 Equipment and supplies- PPE, heparinised
syringes, ABG prepackage kits
 Patient identification and preparation
procedures
 Identification and assessment
 Steady state- no exercise,
sunctioning or respirator for at least
20-30 mins before obtaining blood
gases
 Administration of local anesthetic
2
Modified Allen Test provide an accurate measurement of
resting pH and Pco2
 An easy way to assess collateral circulation  Next, draw heparin into a glass syringe.
before collecting a blood specimen from the Rinse the syringe with the heparin and then
radial artery empty the syringe. Kits nowadays have pre-
 Positive- the hand flushes pink r heparinized syringes, in which case skip this
return to normal color within 15 step.
seconds
 The small amount of heparin left in the
 Negative- the hand does not flush
needle and syringe is sufficient.
pink or return to normal color within
15 seconds Before needle insertion:
Sampling kit  The artery generally tends to be slippery,

especially when it is elongated by
 3 pieces
arteriosclerosis.
 Orange air ball or cube. Used to
 Stretching stabilizes the vessel. Let the
expel excess air from the syringe
patient rest his arm on a table, with his hand
 Black cap for syringe used for
projecting beyond the edge. Dorsiflex the
transport
wrist be gently pressing down on the hand.
 3 cc heparinised syringe with needle
 This maneuver stretches and stabilizes he
inserted
vessel.
Radial ABG Procedure 3. Insert the needle- as holding a dart, relax the
hand, insert it bevel up at 30-45 degree
1. Position the arm facing up and wrist angle (femoral requires 90 degree angle)
supported and extended at an approximate approximately 5-10mm distal to the index
30 degree angle to stretch and fix the tissue finger.
over the firm ligaments and bone of the 4. Advanced the needle into the artery-
wrist directing it toward the artery just under the
2. Clean the site finger. When the artery is pierced, a “flash”
Optional step of blood will appear in the hub of the needle.
 When the flash appears, stop
 Draw 2% xylocaine into a syringe. Infiltrate advancing the needle. Do not pull
the skin and the area around the radial artery back on the syringe plunger. The
with this local anesthetic. blood will continue to pump into the
 The use of local anesthetic for arterial syringe unless a needle smaller than
puncture is not universal. This proposed 23 is used., in which case a gentle
reasons for the use of local anesthetic are: pull on the plunger may be required.
 To avoid pain  Hold the syringe very steady until
 The concern of the pain induced the desired amount of blood is
hyperventilation or apnea could alter collected.
the results of blood gases 5. Withdraw the needle and apply pressure
 This issue was specifically studied 6. Remove air cap syringe and mix specimen
and the results indicate that an 7. Check site
unanesthesized arterial puncture does
3
8. Wrap up procedure- label, dispose, remove
and thank your patient
Transportation and handling
 Should be analyzed within 30 mins

 Specimens for electrolyte testing in addition
to ABG evaluation should not be cooled
because cooling affects potassium levels
Hazards and complications associated with arterial

puncture
 Arteriospasm or irritation cause by needle

penetration of the artery muscle, or even
patient anxiety, can cause reflex constriction
of the artery
 Infection- any procedure resulting in
violation of the patient’s defense
mechanisms can result in infection. Clearly,
improper site preparation and/or improper
procedure technique can result in
subcutaneous infection.
 Discomfort
 Hematoma
 Numbness
 Thrombus formation
 Syncope
 Bleeding causing hematoma
Sampling errors
 Air bubbles
 Delay in analysis
 Improper mixing
 Improper syringe
 Venous puncture instead of arterial puncture
 Clotted specimens

Arterial Puncture

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ARTERIAL PUNCTURE

 It is collected anaerobically by directly Arterial puncture sites

 Respiratory status. Assess oxygenation and

 Large and easily palpated and punctured

 Poor collateral circulation

Sampling kit  The artery generally tends to be slippery,

Transportation and handling

 Should be analyzed within 30 mins

Hazards and complications associated with arterial

 Arteriospasm or irritation cause by needle

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