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Changes from previous version (not Insertion of rationale for informed consent.
applicable if this is a new guideline, enter
Advice re the avoidance of potential hazards related to
below if extensive): the procedure.
Minimal changes to procedure guideline.
Summary of evidence base this British Thoracic Society (2017) Guideline for emergency
guideline has been created from: oxygen use in adults in healthcare and emergency
settings. Danckers, M & Fried, ED (2013) Arterial Blood
Gas Sampling.
This guideline has been registered with the trust. However, clinical guidelines are
guidelines only. The interpretation and application of clinical guidelines will remain the
responsibility of the individual clinician. If in doubt contact a senior colleague or expert.
Caution is advised when using guidelines after the review date or outside of the Trust.
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Contents
Page
Number
Acknowledgments 3
Introduction & Rationale for Guideline 3
Best Practice 3
Indications for ABG Sampling 4
Role Specific ABG Sampling 5
Contraindications 5
Technical Considerations 5
Procedure for Radial Artery Puncture 6
Modified Allen’s Test 6
Practitioners who can undertake this Guideline 7
Accountability 7
Informed Consent 7
Hazards/Cautions 8
Infection Control 9
Equipment List 9
Documentation 9
Performing an Arterial Blood Gas 10-13
References 14
2
Acknowledgements
Best Practice
Arterial blood gases should be used for assessing respiratory failure in
Critically Ill Patients or those with Shock or Hypotension (Systolic blood
pressure <90mmHg) (British Thoracic Society, 2017).
3
Indications for ABG Sampling
Any patient with risk factors for hypercapnic respiratory failure who
develops acute breathlessness, deteriorating oxygen saturation or
drowsiness or other symptoms of CO2 retention.
Any other evidence from the patient’s medical condition that would
indicate that blood gas results would be useful in the patient’s
management (e.g. an unexpected change in EWS)
The results of ABG sampling only reflect the physiological state of the
patient at the time of sampling – it is important they are correlated with
the evolving clinical scenario and changes in a patient’s treatment
(Danckers & Fried, 2013).
4
Role specific ABG sampling
Contra-Indications
Arteriovenous fistula
Severe coagulopathy
Technical Considerations
ABG sampling may be difficult to perform in patients who are un-cooperative
or where pulses cannot be easily identified e.g. cognitive impairment/tremors.
The amount of subcutaneous fat in obese patients may limit access to the
sample area & obscure anatomical landmarks (Danckers & Fried, 2013)
5
Procedure for Radial Artery Puncture
The radial artery is the one most often used in practice in the acute care
setting because of easy access and the fact that the artery is superficial
and easily palpated. Prior to any attempt at arterial puncture the
practitioner must perform the Modified Allen’s Test (WHO, 2010)
6
Practitioners who can undertake this Guideline
Accountability
Designated practitioners should ensure that in fulfilling this role they are
working within the guidance set out by their regulatory body.eg. The
Code of Members' Professional Values and Behaviour (CSP 2011) or
The Code for nurses and midwives (NMC, 2015).
Informed Consent
Consent is valid if given voluntarily and by an appropriately informed
person who has the capacity to consent to the intervention in question.
7
Hazards / Cautions
8
Infection Control
Equipment List
Documentation
9
Performing an Arterial Blood Gas
ACTION RATIONALE
10
7 Inspect and assess the tissues and To identify any areas of
anatomical structures surrounding excoriation/infection, poor perfusion
the intended sampling site or other puncture sites. If any of
these are present the site should
not be used (Weinstein and Plumer,
2007).
11
14 Apply sterile gloves, take care not
to touch the puncture site after
cleaning
12
21 Expel any air bubbles from the
syringe, and cap the arterial
syringe.
13
References
The Royal Marsden NHS Trust (2015) The Royal Marsden Manual of
Clinical Nursing Procedures. 9th Ed. [Online] Available at:
http://www.rmmonline.co.uk/manual/c10-fea-0054 Accessed 15.10.15
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