1. prepared by: Salwa Maghrabi Teacher Assistant Nursing Department Arterial Blood Gases

2. Outlines  Definition of the arterial blood gases.  Indications of the arterial blood gases.  Contraindications and cautions of the arterial blood gases.  The deferent between the artery and vein.  Procedure of the arterial blood gases.  Preparation phase.  Performance phase.  Complications.  Patient teaching.

3. Objectives  Identify the arterial blood gases.  Mention the indications of arterial blood gases.  List and understand the contraindication and cautions of the arterial blood gases.  Discuss the variations between the artery and the vein.  Count the arterial puncture site.  Apply the procedures.  Enumerate the complications of the arterial blood gases.  List the teaching patient guide.

5. Definition are diagnostic tests performed on blood taken from an artery which contains oxygen and carbon dioxide and others elements.  Arterial blood gases (ABGs) : are diagnostic tests performed on blood taken from an artery which contains oxygen and carbon dioxide and others elements.

6. Indications 1- Evaluate acute respiratory distress and assist in determine therapeutic interventions. 2- Evaluate the effectiveness of respiratory intervention.

7. Cont’ Indications 3- Document the existence and severity of a problem with oxygenation or carbon dioxide exchange. 4- Analyze acid – base balance.

8. Contraindications and Cautions 1- Previous surgery in the artery 2- Patient with anticoagulant or with known coagulopathy. 3- Skin infection or damage of the skin. 4- Decrease collateral circulation.

9. Cont’ Contraindications and Cautions 5- Sever atherosclerosis 6- Serious injury to the extremity. 7- Fibrinolytic therapy. 8- Patient with femoral graft or cellulites

10. Cont’ Contraindications and Cautions 9- Patients who have had a cardiac catheterization via the brachial rout or who have sclerotic vessels.

11. The different between the artery and the vein VeinArtery Veins carry blood toward the heart. Arteries receive the blood from the heart. In veins the blood is not under great pressure, hence it flows more slowly.and smoothly Blood is under great pressure in arteries; hence it lows fast. Veins have relatively thin and slightly muscular walls. Arteries have thick and elastic muscular walls.

12. Cont’ The different between the artery and the vein VeinArtery In the vein there is internal valve. Arteries have no valves. Dark red in color.Fresh red in color.

13. Arterial Puncture sites Redial artery, Brachial artery Femoral artery

14. Equipment  Syringe (1-3 ml size ).  20- 25 G needle with a clear hub.  Syringe cap.  Antiseptic pledgets.  Heparin 1:1000  Gauze dressing.  Ice container.  Local anesthetic.

16. The procedure Preparation phase : 1- Patient explication. 2- prepare equipment. 3- Hand washing. 4- select the puncture site on the base of the clinical situation, how rapidly sample must be obtained, and the circulatory status of the patient.

17. Cont’ preparation phase 5- if redial artery is chosen, performing modified Allen’s test is optional :  Elevate the patient arm for several second.  Have the patient to open and close the fist for several times.

18. Cont’ Allen’s test

19. Cont’ preparation phase 6- position the extremity  Radial : stabilize the wrist over a small towel.  Brachial : place a rolled towel under the patient elbow while hyperextending the elbow.  Femoral : rotate the leg slightly outward.

20. Cont’ the procedure Performance phase : 1- prepare the syringe ( if not preheparinized ). 2- Palpate the pulse and determine the point of maximal impulse. 3- Local anesthesia may be useful in anxious patient.

21. Cont’ performance phase 4- clean the over lying skin with antiseptic solution. 5- Use the index finger of your free hand to palpate the arterial pulse just proximal to the puncture site. 6- grasp the needle as if holding a pencil, direct the needle with bevel up, and puncture the skin slowly.

22. Cont’ performance phase 7- When the blood appears stop advance the needle and allow the blood to flow freely into the syringe. 8- Obtain a sample of 1 to 2 ml, remove the needle from the artery, immediately apply the direct pressure to the puncture site with dry gauze for 2 to 3 minute. a) Prepare the blood sample for the laboratory by immediately expelling the air bubbles.

23. Cont’ performance phase b) Activate the needle stick safety device and remove the needle. c) Label the syringe.

24. Complications  Bleeding, hematoma, thrombosis formation.  Nerve injury.  Avoiding arterial puncture in patient who take anticoagulant medication.  If the air bubbles are not removed from the sample, the PO2 can increase and yield inaccurate test result.  The blood sample may clot if the heparin and the blood not mixed adequately.

25. Patient teaching 1- Do not rub the puncture site. 2- Report any bleeding, numbness or tingling following the arterial puncture.

26. Reference  http://copd.about.com/od/glossaryofcopdterms/g /abgs.htm http://copd.about.com/od/glossaryofcopdterms/g /abgs.htm  http://www.blurtit.com/q747973.html http://www.blurtit.com/q747973.html