Contraindications

(Note: Contraindications are absolute unless specified otherwise.)

1. Negative results of a modified Allen test (collateral circulation test) are indicative of inadequate blood supply to the hand and suggest the need to select another extremity as the site for puncture.
2. Arterial puncture should not be performed through a lesion or through or distal to a surgical shunt (e.g., as in a dialysis patient). If there is evidence of infection or peripheral vascular disease involving the selected limb, an alternate site should be selected.
3. Agreement is lacking regarding the puncture sites associated with a lesser likelihood of complications; however, because of the need for monitoring the femoral puncture site for an extended period, femoral punctures should not be performed outside the hospital.
4. A coagulopathy or medium-to-high-dose anticoagulation therapy (e.g., heparin or coumadin, streptokinase, and tissue plasminogen activator but not necessarily aspirin) may be a relative contraindication for arterial puncture.

Infection Control

Risk-reduction Practices:

1. Universal Precautions as published by the Centers for Disease Control and by directives issued by the Department of Labor concerning occupational exposure to blood-borne pathogens must be applied in all circumstances involving blood or blood contaminated collection devices. WEAR GLOVES.
2. Transporting sample should be done in manner consistent with O.S.H.A. regulations for handling of blood products. WEAR GLOVES.
3. Note that needle sticks are the most frequent source of transmission of blood-borne diseases in health care workers. GLOVES may not protect against needle stick, but WEAR GLOVES for other reasons.
4. Needles used for blood sampling should be re-sheathed only with a technique that utilizes a one-hand device or by careful insertion into a cork, rubber plug, or similar device that prevents the sharp point from being accessible.
5. Blood specimens, contaminated needles, and syringes must be disposed of in appropriate containers.

Patient Protection

Patient Identification

    Proper procedure for identifying patients includes at least two steps.

• Step one is to ask the patient to tell you her or his name. Be careful not to tell the patient who (s)he is by asking, "Are you Karen Jones?" The patient may be hearing impaired and agree to what you have said or asked, merely to be compliant.
• Step two is to ask the patient to tell you specifically her or his birthdate.

    The person drawing blood may be confident of proper patient identification by obtaining matching answers from both the stated name and birthdate as they correlate with the ABG request slip.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

    HIPAA is a consumer protection mechanism which for our purposes, essentially prevents casual discussion of ABG values associated with the patient's identity when such discussions are not essential to the patient's well being. Health care workers, all along the chain of care must be very careful to protect the rights of the patient. Serious fines or imprisonment could result from careless violation of HIPAA rules. A high degree of professionalism is required of the laboratorian. Professionalism includes protecting the patient's rights to medical information privacy.

Although more complicated that the above explanation, for brevity in this Web site, the reader is referred to the following Web site: Medical Privacy   (National Standards to Protect the Privacy of Personal Health Information)

(Remember to click Return when done)

Hazards of Arterial Puncture

1. Hematoma
2. Arterio-spasm¹
3. Air or clotted-blood emboli
4. Anaphylaxis from local anesthetic
5. Introduction of contagion at sampling site and consequent infection in the patient ² ; introduction of contagion to sampler by inadvertent needle "stick."
6. Hemorrhage
7. Trauma to the vessel
8. Arterial occlusion
9. Vaso-vagal response
10. Pain¹

The Two Best Risk Reduction Practices

1. "Modified Allen's Test" should be done on all patients where arterial sampling is to be done from the radial artery.
2. Universal, Blood-borne precautions should be taken in all circumstances

Return to Lesson 1 Directory

¹ Arterio-spasm may cause pain. Pain at needle puncture site is often reported. Generally, if pain occurs, it is for short duration. For pain persisting >24 hours, physician evaluation is recommended.
² Commonly acceptable skin cleansing products include Alcohol, Betadine Iodine, or Benzalkonium Chloride.