right arterial puncture is required to
obtain arterial blood.
For analysis of ph and blood gas values
in trauma victims or patients with cardiopulmonary
abnormality,
three sites are available for obtaining arterial blood.
The radio artery.
Break your artery and femoral artery.
The radio artery is preferred since it is easily
accessible and it's puncture causes few
complications.
The radio artery and nerve pass along the radio side
of the forearm from the elbow to the wrist.
The site for puncture is at the distal portion of the
radius because it is close to the surface centers away
from any major nerves.
The break your artery must be used when radio pulses
are faint when approaching the break your
artery in the anti cubicle fossa.
Care must be taken to avoid the owner and radial
nerves.
The femoral artery should be used only when the other
sites are unavailable,
such as with severe trauma or when it is the
only detectable pulse.
The site for a femoral artery puncture is in the
femoral triangle.
The artery lies in between the femoral vein
and nerve and can easily be detected by
palpitating a sartorius muscle and the inguinal
ligament and stepping off from either of these two
points into the triangle.
Great care must be taken to avoid damaging either the
vein or the nerve.
Either a three or five millimeter glass or plastic
syringe.
With lure lock is used.
Glass syringes are easier to handle because the plunger
moves more freely in the barrel,
making it easier to detect pulsating arterial
blood,
the plastic syringes more available.
Less expensive and offers reliable
results If the blood sample is analyzed quickly
to avoid diffusion through the plastic.
Other equipment for arterial puncture includes
alcohol swabs for prepping the skin,
sodium heparin for coating the barrel and plunger.
Come on A
23 or 20 five gauge needle.
Gauze patches,
rubber hub,
which is placed on the lure lock
and a basin of ice.
An arterial blood gas sample pack contain the
necessary equipment can also be used
before the puncture,
prepare the glass or plastic syringe by wetting the
barrel with Approximately .25 CCS of
heparin.
Do not draw air into the syringe and inject it
into the heparin bottle.
This procedure may alter the results of the blood gas
analysis,
gently pull and rotate the plunger back until the
barrel is coated and eject the remaining solution.
It is not necessary to leave Heparin in either the glass or
plastic syringe
to carry out radio artery puncture,
extend the wrist,
palm up a small towel may be
placed under the risk to aid an extension.
Next Locate a point for puncture
approximately two cm proximal to the second wrist.
Crease
palpate the skin to locate the pulse.
It is important to palpate across the risk to
locate the area of strongest pulse.
Follow the artery along its route to help
visualize the anatomy.
Prep the area with alcohol and relocate the
artery with a single palpitating finger
holding the syringe like a pencil,
advance The needle at an approximately
45 degree angle Bevel up.
If there is difficulty in obtaining the sample,
you may have to advance the needle further as the
artery maybe deeper than expected,
or rotate the syringes the bevel of the needle
maybe against the wall of the artery.
If the artery has rolled to the side,
withdraw the needle slightly and advance it
when using a glass syringe with a freely moving
plunger entry into the artery will result
in automatic filling of the syringe by way of the arterial
blood pressure with a plastic
syringe,
the blood will have to be aspirated
because a small gauge needle will cause slow filling into
the barrel.
Aspiration of even the glass syringe may be
necessary to collect the sample.
The following live sequence will show a radio artery
puncture in a clinical setting.
To inject a small amount of pain.
The patient should first be given an explanation of the
procedure to make the patient
more comfortable.
A local anesthetic such as 1% Zilla
cane can be used
locate the artery and inject zilla,
Kane,
subcutaneous lee in this area.
Following an alcohol prep.
Yeah.
Okay.
A little stick
pull back on the needle to make sure you are not in the
vein before injecting the solution.
Right
A glass syringes prepared by placing a number
23 or 25 gauge needle on the lure
lock and drawing in a small amount of heparin to
coat the barrel and plunger
prep the wrist and relocate the artery.
Hold the bowel of the syringe like a pencil with a
needle bevel up with a quick
smooth motion entered the skin at approximately
a 40 five degree angle,
gradually advance the needle until you enter the lumen of the
artery.
Okay,
allow a small amount of blood to enter the syringe.
The pulse,
little movement of the blood will assure you that you
have entered the artery,
stabilize the needle and pull back gently
on the plunger to help fill the syringe
222 and one half milliliters of blood is adequate
for analysis.
Be ready with your free hand to compress the artery with a dry
gauze square as you withdraw the needle,
we move the needle from the lure lock,
making sure that there are no air bubbles in the sample
and place a rubber lure tip cap on the
syringe.
Place the sample in ice,
apply pressure on the Artery until all surface
bleeding has stopped.
This is usually 3-5 minutes.
A plastic syringe may be used to collect the sample when no
glass syringes available.
Greater care must be taken in locating the artery by
palpitation since the barrel of the syringe will not move
freely in response to arterial blood
prep the selected area and enter the skin.
Yeah.
Okay,
mm hmm.
Mhm.
Pull back gently on the plunger to collect the sample
preparation for lab analysis is the same as with the
glass syringe,
a lot of people will break through the scanner.
Okay.
Yeah.
Okay well hold on.
In cases of severe trauma,
the femoral artery may be the only site where a pulse can be
found because of the close proximity of
the vein and nerve is important to locate the artery
and bracketed between the forefinger and middle finger.
The needle is then positioned between the fingers.
Use a glass syringe and hold it at a more nearly right
angle than for a radio puncture.
The following scene shows ephemeral puncture in a trauma
situation
following palpitation
and location of the artery prepped the area with alcohol.
Hold the needle at a more nearly right
angle than for a radio puncture and aim it into
the clearly felt pulse.
Following the collection of the sample.
The syringe is sealed and iced because of the
larger size of this artery,
it is necessary to apply pressure for a greater length of
time,
usually five to 10 minutes.
In summary the steps of the procedure are
prepare the syringe by wetting the bow with heparin,
palpate the area to locate the artery
prepped the area with alcohol.
Hold the syringe like a pencil at a 45°
angle and advance the needle slowly until you
enter the artery
observed pulsar tile blood in the hub of the needle or in
the syringe
stabilize the needle and pull back gently on the
plunger.
Okay compress the artery.
Following withdrawal of the needle,
remove any air bubbles and seal the syringe.
Place the sample on ice,
continue compression of the artery until all surface
bleeding has stopped.