ABG Sampling (Radial Artery)

Start with WIPERS

Then ABG

1. Allen’s test (modified):

  • Exsanguination: Ask the patient to make tight fist for about 30 seconds
  • Occlusion: Occlude the radial and ulnar artery simultaneously with fingers
  • Release:
    • Fist: Hand must stay blanched, else occlusion pressure is not enough (restart the test)
    • Ulnar artery:
      • Reperfusion within 5-15 seconds: Negative Allen’s test (Good blood flow)
      • No reperfusion within 5-15 seconds: Positive Allen’s test (Circulation of ulna artery is not sufficient)

In case of Positive Allen’s test: DO NOT puncture radial artery

2. Bad things:

  • Allergy to LA
  • Absolute contraindications: Cellulitis, Peripheral vascular disease, Arteriovenous fistula, For local anesthesia (Allergy to LA)
  • Relative contraindications: Coagulopathy (including Anticoagulant use)

3. Gather equipment needed

Then Procedure

ABG sampling radial artery
“622.4 – Figure 4 – ABG sampling position – radial artery” by iem-student.org is licensed under CC BY-NC-SA 2.0.

1. Position:

  • Position the patient so that they are sitting or lying down comfortably, ideally with their wrist supported by a pillow.
  • Extend the wrist fully

2. Site preparation:

  • Don the non-sterile gloves
  • Identify site: Palpate the radial artery just proximal to the point of maximum pulsation with non-dominant hand
  • Sterilize the skin with an alcohol wipe and allow it to dry and do not re-palpate

3. Local anesthesia (skin): Offer the patient local anesthesia –

  • 25 G needle (orange) and 2 ml syringe
  • 1% lignocaine

4. ABG sampling:

  • Use 23 G needle (blue) and 2 ml syringe (heparinized with 0.1 ml 1:1000 heparin)
  • Hold the syringe like a pen with a dominant hand
  • Insert the needle at 45-60 degrees with the bevel facing upwards while palpating the artery with other hand
  • Advance the needle slowly until a flash of blood is seen in the needle hub
  • Collect 1-2 ml of arterial blood (bright red and fills quickly in pulsatile fashion)

5. Post sampling:

  • Discard the needle safely
  • Elevate the arm and apply firm pressure to puncture site for 5 minutes
  • Expel any air bubbles from syringe and seal it with a cap
  • Label the syringe (Patient details, FiO2, Body temperature)
  • Roll the syringe in the palms of your hands for 10 seconds (to ensure heparin mixing)
  • Send the sample within 15 minutes of collection for analysis

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