Procedure: Arterial Blood Gases (ABG)

Casebank Combined
1

Who you are:
You are FY2 in A&E department

Who the patient is:
Peter Fey, 49-year-old male who has been previously diagnosed with COPD has now presented with shortness of breath.

Other information:
Your consultant has asked you to take an ABG sample from the patient

What you must do:
Take focused history, do the relevant procedure, and manage the patient accordingly

History Taking:

  • Start the station well (I can see from my notes that you are here as you have been having some shortness of breath.)
    – Check if the patient is on oxygen already
  • IPS:
    – Pick up on non-verbal cues (if the patient is looking is SOB) -
    – Build Rapport.
  • Why? & Why?
    – My consultant has asked me to take a sample to test for the level of gases of your blood.
  • Take focused History relevant only to your procedure
    – Ask about any chest pain.
    – Ask about fever.
    – Any cough.
    – Ask about compliance to medications for COPD.
  • Red flags - features of respiratory distress
  • MMA
    – Medical Conditions (specify any bleeding disorder) -
    – Medications (specify any blood thinner)

You might have to explain how ABG is different from venous sampling

Patient preparation:

Patient:

  • Benefit ( I would like to take a blood sample from you in order to check your blood gases and O2 level in your blood.
  • Risk: It could be painful, but if you feel uncomfortable at any time let me know.
  • Explain: explain exactly what you are going to do: (I will be inserting a thin needle into one of the blood vessels (veins/ arteries) of your (forearm/ wrist).
  • It will feel like a sharp scratch, but I will be as quick and gentle as possible

Doctor:

  • Position : Can you please straighten your elbow/ wrist for me.
  • Exposure: Can you please roll up your sleeves for me.
  • Please be observant. (Notice whether the patient has short sleeves, or has rolled up the sleeves already, and comment on it accordingly).

Both:

  • Privacy: I will ensure your privacy.
  • Chaperon: Blood procedures do not require a chaperone.
  • Consent: Do I have your consent to proceed.
  • Ask about any arm soreness and any arm preference.
  • Do not forget to inform the patient that if you fail, you may need to repeat the procedure.

Procedure:

  • Perform the modified Allen’s test:
    – I’m going to check the blood supply of your hands
    – Ask the patient to make a fist and then (on the mannequin), press with each hand on radial and ulnar arteries
    – Ask the patient to release the fist, and release the ulnar artery
    – If the reperfusion time is less than 7 seconds, I will continue with the procedure.

  • Collect your equipment:
    –1 Alcohol swab
    – ABG Needle (with the stopper)
    – Cotton piece

  • Prepare your equipment in your clean area, then put them on your tray:
    – Partially open the alcohol swab
    – Loosen up the cap slightly and keep it aside ready for the procedure.
    – Keep the green stopper in the tray.

  • Gloves: Assume you are wearing gloves

  • Feel the artery

  • Clean Prick Collect
    – Locate the Radial pulse by palpating over the artery using 3 fingers of your left hand (index, middle and ring fingers). If you do not feel the pulse inform the examiner, as the mannequin has a palpable pulse in
    the exam. Simply say: “I can’t feel the Radial pulse.”
    – Sterilize the area: Put 3 fingers of your left hand over the Radial artery.
    – Then remove only your middle finger (backwards) and clean the area using an alcohol swab with a single stroke. Keep that hand fixed.
    – With the other hand, remove the cap to reveal the needle, and discard the cap. Then warn the patient and prick at a degree between 45 to 90 degrees holding the needle like a pen.
    – Keep the needle fixed and secure all the time.
    – Once inside the artery, the syringe should begin to self-fill. The arterial pressure will cause the blood to fill the syringe automatically. Do not pull the plunger.

  • Cotton and Label
    – Withdraw the needle carefully. Once the needle is out, press the cotton down firmly on the puncture site, and ask the patient to do so for at least 5 minutes.
    – Lock the protective needle sleeve by pushing it down against the table.
    –Do not use your hand to lock the protective needle sleeve. Remove the needle from the syringe and discard it into the sharps bin.
    – Apply the stopper onto the syringe.

  • Verbalize labeling the sample with the patient’s details (Mention oxygen saturation) and verbalize sending it to the ABG machine by yourself immediately.

Management

  • Keep in the observation unit
  • Take the patient’s observations including the O2 saturation
  • Treatment: Oxygen

Safety net

  • about the procedure itself (any bleeding, swelling or soreness)
  • about the patient’s general condition (chest pain, cough, fever,…)
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