Chapter 11. Arterial Puncture

• • 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.

Absolute

• • Allen test indicates that collateral circulation is compromised.

  • Circulatory defects.

  • Sampling area is infected.

Relative

• • Coagulation abnormalities, such as hypercoagulability or hypocoagulability.

  • Patient has disease associated with hypercoagulability or hypocoagulability.

  • Hematoma at site.

  • Anatomic abnormalities in limb.

• • 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.

• • Ischemia.

  • Hematoma.

• • 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.

• • 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.

• • 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.

Radial Artery

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

• • 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.

Femoral Artery

• • 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).

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