Name:
HPIM 21e (Video CP05-1) - 17670478
Description:
HPIM 21e (Video CP05-1) - 17670478
Thumbnail URL:
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Duration:
T00H10M59S
Embed URL:
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https://asa1cadmoremedia.blob.core.windows.net/asset-e4090865-9ad0-4014-acaf-7bb7777f6cec/HPIM2019e-2028485e-012920Clinical20Procedure20Tutorial3F20Pe.mov
Upload Date:
2022-03-18T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Segment:1 Introduction.
I'm Dr. Christian Becker from Mount Sinai Medical Center in New York. This instructional video will review the indications, contraindications, techniques and potential complications in the performance of percutaneous arterial blood gas sampling.
Segment:2 Indications.
The indications for percutaneous arterial blood gas sampling include, most commonly, the measurement of arterial oxygen tension, arterial carbon dioxide tension, and arterial acidity.
And less frequently, in patients with a clinical suspicion, co-oximetry for measurement of oxyhemoglobin saturation, carboxyhemoglobin levels and methemoglobin levels.
Segment:3 Contraindications.
The common contraindications relative and absolute for percutaneous arterial blood gas sampling are lack of collateral circulation, local skin infections and/or lymph edema, coagulopathy, severe atherosclerosis, and goals of care inconsistent with performance of invasive procedures.
Less common contraindications relative and absolute are local or generalized acral hypoperfusion, arterial thrombosis, Raynaud's phenomenon, thrombangiitis obliterans, and vascular anomalies in the same extremity.
Segment:4 Equipment.
The equipment required for performing the percutaneous arterial blood gas sampling are skin cleanser, antiseptic or chlorhexidine swabs, optionally and for selected patients, a 25 gauge to 30 gauge needle and one cc syringe with 1% lidocaine may be used for local anesthesia, ABG kit including 22 gauge to 25 gauge needle and heparinized syringe system, one cc to 3 cc, or separate 22 gauge, 225 gauge needle and manually heparin coded one cc to three cc syringe.
And sterile gauze and Bandaid.
Segment:5 Preparation.
Preparation for performing the percutaneous arterial blood gas sampling is to check indications and contraindications. Choose the optimal site depending on patient specifics. Check pulses and acral profusion distal to planned puncture. Perform the Allen test or Modified Allen test for planned radial artery puncture, perform compression testing of the dorsalis pedis artery with assessment of nail bed profusion of the first digit on the same foot for dorsalis pedis artery puncture.
Be aware of all vascular abnormalities or modifications like AV fistulae or grafts as well as bypasses or stenosis and vascular lesions. Principally accessible sites are radial artery, brachial artery, axillary artery, femoral artery, and dorsalis pedis artery. Avoid the femoral artery location if possible due to higher contamination and infection risk.
Segment:6 Procedures Overview.
But it may be the last site of palpable arterial pulses in severely hypotensive patients. In obese patients, a longer needle, such as a 19 gauge to 21 gauge needle may be needed for the femoral artery. Ensure a quiet environment, limiting distractions with good lighting. Explain the procedure to conscious patients to reassure them and avoid hyperventilation.
For the radial artery site, supinate the arm. Extend the wrist and support this position by placing a towel or similar soft object beneath the extended wrist. You may use an arm-board. For the brachial and axillary artery sites, abduct and flex the arm at around 90 degrees. For the femoral artery site, place a pillow under the ipsilateral hip.
This will provide a slight extension of the hip to optimally expose the inguinal area. In obese patients, the abdominal pannus may need to be held or taped out of the way. Cleanse and disinfect the skin with antiseptic and sterilely prep the area. If desired by the patient, a local anesthetic may be injected intradermally prior to arterial puncture to reduce the discomfort associated with arterial puncture.
Most patients defer on this option because it means an additional, albeit less painful, needle stick.
Segment:7 Step-by-Step Procedure.
Become familiar with the specific ABG kits available at your procedure location. Ultrasound guidance may be used in addition to palpation, or when palpation is difficult to guide arterial puncture. When using ultrasound, take great care not to contaminate the disinfected intended skin puncture site with the non-sterile ultrasound probe.
Check for functionality of all pieces of equipment, break the seal of the heparinized syringe to ensure easy movement of syringe plunger. Leave small empty volume in the syringe. While feeling the arterial pulse with the non-dominant hand, or observing the femoral artery non-compressible pulsations laterally to the compressible femoral vein, or the axillary artery pulsations in the axilla on ultrasound.
Advance the needle slowly with the dominant hand towards the projected or palpated pulse, or ultrasonographic projection of the artery at a 45 to 60 degree angle. Observe spontaneous arterial pulsatile filling of the syringe or butterfly tubing. Adjust the needle position if needed. Manual pulling of the plunger is not usually necessary to fill the syringe directly attached to the puncture needle.
It may be needed with the butterfly tubing system. Withdraw the needle when the desired amount of blood is present in the syringe, generally one to three cc's. Remember that very small amounts of blood can be below the requirements of the analytic equipment and can cause directed measurement errors due to disproportionate heparin INAUDIBLE mixture. Compress the site with sterile gauze immediately after needle removal for an appropriate duration to avoid hematoma formation.
Press firmly to not only overcome venous but arterial pressure. Remove air bubbles from the sample. Place the sample on ice and analyze in a timely fashion.
Segment:8 Potential Complications.
Complications are rare from an ABG but include hematoma at the site, retroperitoneal hematoma at a femoral artery site, arterial spasm, arterial wall damage, acral limb ischemia and necrosis, arterial thrombosis and embolism, brachial plexopathy of the axillary artery, median nerve damage of the brachial artery, and peripheral neuropathy of the radial artery.
Segment:9 Summary.
Percutaneous arterial blood gas sampling is indicated for measurements of arterial oxygen tension, arterial carbon dioxide tension and arterial acidity. There are several contraindications and potential complications. It is important to be aware of individual patient characteristics. It is also important to evaluate collateral circulation for the radial and dorsalis pedis sites. Carefully select the most suitable percutaneous arterial puncture site based on the patient's anatomic characteristics.
Reassure the patient about the procedure. It is essential to optimally position the patient to minimize their discomfort and to follow strict aseptic precautions. Sufficient manual compression of the puncture site is important to prevent hematoma. Cooling the sample on ice and analyzing it in a timely fashion reduces directed measurement errors. Thank you for watching this Harrison's procedure video.
Segment:10 References.
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