OUTLINE

I. Overview of Arterial Puncture

II. Sites and Criteria Used for Arterial Puncture
III. Arterial Blood Gas Specimen Collection

I. OVERVIEW OF ARTERIAL PUNCTURE

• The arterial puncture is used to collect blood specimen for arterial
blood gas analysis to manage cardiopulmonary disorders and
maintain the acid-base balance of the body.
• The arterial blood is the ideal specimen for respiratory function
evaluation due to the consistency of its composition and high
oxygen content.
• The phlebotomist should have a thorough understanding of the
collection procedure to minimize pain and maintain the accuracy of
the results since it is more technically challenging and hazardous
than venipuncture.

● Health workers who collect arterial specimens should have

extensive skills and knowledge on the performance of the
procedure, and should undergo periodic evaluation
● These personnel include nurses, medical technologists and
technicians, respiratory therapists, emergency medical
technicians and Level II phlebotomists

II. SITE AND CRITERIA USED FOR ARTERIAL

PUNCTURE
● The following criteria are used in selecting the site for an arterial
puncture:
→ There is a collateral circulation, or the site gets its blood
supply from more than one artery. The potential site can be
evaluated by using a portable ultrasound instrument or by
modified Allen test
→ The artery should be accessible and large in size so that the
puncture is easy
Figure 1. Radial Artery Blood Gas Collection → The surrounding tissue of the puncture site should have little
risk of being injured during the procedure. The area should also
help in keeping the artery from rolling and the pressure can be
ARTERIAL BLOOD GAS (ABG)
applied easily in the area after the procedure
● The evaluation of the arterial blood gas is performed to
→ The area should be free from inflammation, irritation, edema,
diagnose respiratory disorders.
hematoma, lesion, and wound. There should be no
● Testing provides information about:
arteriovenous (AV) shunt near the site or there is no recent
→ Oxygenation
arterial puncture
→ Ventilation
● Other sites that can be used for arterial puncture include the
→ Acid-Base Balance
scalp and hair for infants and the dorsalis pedis arteries for
● All of which aids in the management of diseases
adults
→ The accuracy of results is easily affected by pre- analytical
errors. For this reason, proper assessment of the patient and
collection and handling procedures should be strictly followed

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 ARTERIAL PUNCTURE SITES
● The most commonly used site located in the thumb side of the
wrist
Advantages
→ Good collateral circulation from the radial and ulnar arteries
→ Easy to palpate
→ Less chance of hematoma formation post-collection
Disadvantages
→ Necessitates considerable skills to puncture because it is
small in size
→Difficult to locate in patients with hypovolemia or low cardiac
output
→ Arteries of the arm and hand
BRACHIAL ARTERY
● • Located in the Medial Anterior of the Antecubital Fossa
Advantages
→ Relatively easy to puncture and palpate due to size
→ Sometimes the preferred artery for a large volume of blood
→ Adequate collateral circulation (but not as good as radial)
Disadvantages
→ Deeper and can be harder to palpate the radial artery
→ Lies close to basilic vein; risk of mistakenly puncturing it
→ Lies close to the median nerve; risk of pain and nerve
damage
→ Increased risk of hematoma formation
FEMORAL ARTERY
● Located in the groin lateral to the pubic bone
Advantages
→ Large, easily palpated and punctured
→ Sometimes the only site where arterial sampling is possible
Disadvantages
→ Poor collateral circulation
→ Lies close to the femoral vein; increased risk of mistakes in
puncturing
→ Increased risk of infection because of location and pubic hair
→ Risk of dislodging plaque build-up from inner artery walls
→ Requires extended monitoring for hematoma formation
III. ARTERIAL BLOOD GAS SPECIMEN COLLECTION
● The following specimen collection equipment and supplies must
be ready before the procedure:
o Antiseptic for site cleaning
o Local anesthetic to numb the site (optional)
o Sharp, short-bevel hypodermic needle with safety feature
o 1-5mL self-filling syringe
o Luer-tip normal or bubble removal cap to cover the end of
the needle after needle removal
o Coolant (when applicable) to maintain the temperature of the
specimen
o 2x2 inch gauze squares to hold pressure
o Self-adhering gauze bandage to wrap the site
o Identification and labeling materials
o Puncture-resistant sharps container for proper disposal
PATIENT PREPARATION
● As part of the standard procedure, the identity of the patient is
confirmed before the start of the test.
● The blood drawer should also explain the procedure to the
patient and get his/her expressed consent to proceed.
PMLS Special Procedure - Arterial Puncture
● The patient should be resting in a comfortable position lying in
bed or seated on a chair) for at least 5 minutes or until the
breathing of the patient becomes stable.
● The collection conditions must be documented in the test
requisition.
● Additional verification includes whether the patient is on
anticoagulant therapy or has any allergies to anesthesia,
specifically if local anesthesia will be administered.
● • The patient should be stable or in steady state for 20 to 30
minutes before the test is performed. As a rule, the collection
shall not be performed until the patient has reached the
required condition, but emergency situations are considered an
exception.
● To determine if the patient has collateral circulation, the
modified Allen test is performed prior to collection.
● The modified Allen test procedure is as follows:
→ Request the patient to make a tight fist.
→ Apply pressure on the wrist using the middle and index
fingers of both hands. Simultaneously compress the patient's
radial and ulnar arteries.
→ While maintaining the pressure, ask the patient to open
his/her hand slowly.
→ Start lowering the patient's hand and release the pressure on
the ulnar artery only.
→ Evaluate the results: (+) if the hand flushes pink and (-) if the
hand does not flush pink.
→ Record the results on the test requisition.
PREPARING AND ADMINISTERING LOCAL ANESTHETIC
● The administration of local anesthesia prevents adverse
reactions from young patients who are afraid of the procedure.
It is one way of preventing vasoconstriction.
● The doctor's order is presented before anesthesia is used.
However, since thin-walled needles are used during the
procedure, the use of local anesthesia is no longer necessary.
● Listed below are the steps in the preparation and administration
of local anesthesia:
→ Ask the patient for a history of allergic reactions to anesthetic
or its derivatives.
→ Follow hand hygiene and wear gloves.
→ Attach the safety needle to the syringe.
→ Clean stopper of the anesthetic bottle using isopropyl alcohol
wipes.
→ Insert needle through the bottle stopper to withdraw the
anesthetic.
→ Replace needle cap and keep the syringe in a horizontal
position.
→ Clean the site and air-dry.
→ Insert needle into the puncture site at a 10-degree angle.
→ Pull back the plunger slightly.
→ Slowly expel contents into the skin. It should form a raised
wheal.
→ Wait for about 2 minutes before continuing with the arterial
puncture.
→ Note the anesthetic application on the test requisition.
RADIAL ARTERIAL BLOOD GAS PRODUCER
● The phlebotomist may proceed with the puncture of the radial
artery if there is collateral circulation.
● The steps in obtaining using the ABG specimen using the radial
artery through the use of the syringe are as follows:
→ Review the accession test request for completeness.
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 → Approach and identify the patient., Explain the procedure → Processing exceeded optimal time, which is within 10
clearly. minutes from collection.
→ Ask for any sensitivity to latex and other substances. → The sample was not mixed properly or immediately.
→ Assess if the patient is in a steady state. Verity collection → Syringe was used improperly
requirements and record information. → Venous blood was obtained by mistake:
→ Observe proper hand hygiene and wear gloves. → Improper anticoagulant was used
→ Verify collateral circulation by modified Allen test or use an → Incorrect volume of heparin was used.
ultrasonic flow indicator.
→ Position the arm, palm up, and wrist extended to CRITERIA FOR REJECTION OF ABG SPECIMEN
approximately a 30-degree angle. ● The laboratory personnel will reject the ABG specimen that has
→ Use the index finger to locate the radial artery. been submitted for analysis using the following
Clean the site. criteria:
→Administer local anesthetic if ordered. → Air bubbles are found in the specimen.
→ Assemble the ABG equipment. Clean the gloved → The specimen has clotted.
non-dominant finger.
→ Pick up the equipment, Remove the cap and inspect the
needle.
→ Relocate the radial artery by placing the non-dominant index
finger Over the vein. Gently worn the patient of the Imminent
puncture to avoid startle reflex.
→ Insert needle at a 30- to 45-degree angle. Slowly direct it
toward the pulse and stop when a flash of blood appears.
→ Let the syringe fill to a proper level.
→ Place the gauze and remove the needle. Activate the safety
feature and apply pressure on the site.
→ Remove and discard the syringe needle in the sharps
container.
→ Expel air bubbles. Cap the syringe and mix thoroughly. Label
the Specimen with the necessary information.
→ Check the patient's arm for swelling or bruising. Apply a
pressure bandage.
→ Dispose of used and contaminated materials properly.
Remove gloves and sanitize hands as a precaution.
→ Thank the patient courteously. Transport the specimen to the
laboratory immediately.

HAZARDS AND COMPLICATIONS OF ARTERIAL PUNCTURE

● The arterial puncture is an invasive procedure. There are
hazards and complications that are associated with the
performance of the procedure. Proper technique is followed to
avoid complications but still some conditions cannot be
avoided.
● Listed below are some examples:
→ Arteriospasm-involuntary contraction of the artery.
→ Artery Damage- results from repeated punctures on the
same site.
→ Discomfort can be avoided by using local anesthesia as
ordered by the physician.
→ Infection-observe proper preparation in the pre- analytical
phase
→ Hematoma - avoid multiple punctures on a single site.
→ Numbness- should be addressed and reported immediately
to the nurse or physician.
→ Thrombus formation- must be reported to the nurse or
physician immediately.
→ Vasovagal response- remove the needle, activate the safety
device, maintain pressure over the site, and follow the syncope
procedure.

SAMPLING ERROS
● The integrity of the blood sample and the accuracy of the test
are compromised when:
→ Air bubbles were not expelled from the sample.

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