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  • • Collection of arterial blood for blood gas analysis to manage cardiopulmonary disorders and maintain acid-base balance.

    • Collection of arterial blood when unable to sample venous blood to help manage fluid and electrolyte imbalance.

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Absolute

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  • • Allen test indicates that collateral circulation is compromised.

    • Circulatory defects.

    • Sampling area is infected.

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Relative

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  • • Coagulation abnormalities, such as hypercoagulability or hypocoagulability.

    • Patient has disease associated with hypercoagulability or hypocoagulability.

    • Hematoma at site.

    • Anatomic abnormalities in limb.

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• Caution: All equipment must be latex free.
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  • • Gloves.

    • 23-gauge or smaller butterfly needle.

    • 1-mL heparinized syringe for blood gas sampling.

    • Syringes for blood sampling.

    • Disinfectant (povidone-iodine, chlorhexidine, and alcohol) swabs.

    • Sterile gauze pads.

    • Topical anesthetic.

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  • • Ischemia.

    • Hematoma.

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  • • Use smallest gauge needle to minimize arterial trauma.

    • Hold pressure over puncture to prevent hematoma formation and bleeding.

    • The radial artery and the femoral artery are the preferred sites for arterial puncture.

    • If the pulse is hard to palpate, use Doppler and mark the location.

    • In small infants, the radial artery may be located by transillumination.

    • The Allen test involves the following:

    • • Localizing and assessing the radial pulse.

      • Encircling the patient’s wrist with your hand and elevating the hand.

      • Applying occlusive pressure on the radial and the ulnar arteries.

      • Releasing the ulnar artery and continuing to apply occlusive pressure on the radial artery.

      • Monitoring palmar blush.

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  • • Introduce yourself to the patient and parents.

    • Explain the procedure to the patient (if appropriate) and the parents.

    • Choose site of puncture.

    • Apply topical anesthetic to the site.

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  • • Position the patient with the puncture site within easy reach.

    • Have an assistant gently immobilize the extremity.

    • If using the femoral artery, open the femoral joint by elevating it over a rolled up towel.

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Radial Artery

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  • • The palmar arch is composed of the radial and ulnar arteries and connecting palmar arteries (Figure 11–1).

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  • • The radial artery is located at the wrist proximal to the head of the radius.

    • In most patients, collateral circulation is dependent on an intact ulnar artery.

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Femoral Artery

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  • • The femoral artery is located below the inguinal ligament over the femoral gutter halfway between the pubic symphysis and the anterior superior iliac spine (Figure 11–2).

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  • • The femoral artery lies in the gutter lateral to the femoral vein.

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