Resp Care Tech 1 Test 6
When preparing the puncture site for an ABG, cleanse are over puncture site with what?
disinfectant swab
How often should proficiency be run on machines?
every 6 months
How often should calibration be run on machines?
every month
When preparing a syringe be sure to do what with the excess heparin?
expel it, heparin left in the hub of the needle is plenty
When palpating the arterial artery what is used to get the maximum impulse?
finger tips
Safety guidelines for drawing an ABG would include?
goggles (cord gases) wash your hands after drawing a sample wearing gloves
When a pt is on a vent, when any changes are made to the vent, how long after the change should an ABG recheck be done?
half an hr
The femoral artery may be the only site to stick for an ABG in some cases such as?
hypovolemia hypotension low cardiac output
What type of pt is it difficult to distinguish an arterial blood sample from a venous sample due to color?
hypoxic pt
What important information will the collection of an ABG provide?
important information for decision making in the management of the pt requiring oxygen or ventilator support
What is the disadvantage of a radial blood draw for ABG?
it is a small target
What are the disadvantages of a brachial artery blood draw for an ABG?
it is close to both a large vein and a nerve no collateral circulation
Pt's with cardiopulmonary arrest, hypovolemia, hypotension or low cardiac output often have low _______________. Samples from these pt's usually have to be _______________.
pressures; aspirated
What is heparin used for?
prevent coagulation
What are the unknown controls in quality control in terms of machine calibration?
profiency
What are disadvantages of a blood draw from the femoral artery?
proximity to a major vein and lack of collateral circulation, also it is very deep
What all information should be a on a blood sample label?
pt's name, room/bed #, specify oxygen concentration & vent status
Program designed to monitor the performance of blood gas laboratories for insuring that data is reported correctly and accurate.
quality control
What is the preferred site for obtaining an ABG?
radial
What is located in the wrist on the thumb side close to the surface of the skin?
radial artery
As part of quality control, all three levels of blood gas control are measured, in the event the control(s) are out of range it must be what?
repeated, or the machine will be put out of service, until back into range
Oxygen dissociation curve with decreased affinity shifts which way? What happens to pH, PCO2 & temp?
right increased (H+) decreased pH increased PCO2 increased temp increased 2,3 DPG fetal hemoglobin
Why is it important to get bubbles out of the blood sample drawn during an ABG?
room air contains enough oxygen that it can diffuse into the sample, increasing the PaO2 or if the PaO2 is greater than 160 mm it can decrease the PaO2.
What does calibration mean?
setting up an instrument to generate a certain result
What is the best anticoagulant to use in arterial blood gas sampling?
sodium heparin
In the Levy-Jennings Chart, the distance from the mean is measured in what?
standard deviations (SD)
If a therapist believes there is a problem with the blood gas analyzer, she/he should:
take out of service & follow manufacturing guidelines
When running a blood gas sample it is important to perform a _________________ correction in order to prevent blood sample reporting errors.
temperature
The site where the brachial artery is commonly punctured is at the elbow in what?
the anticubital fossa
What is the major advantage of performing arterial puncture at the radial artery?
the safety afforded by the presence of collateral circulation
What is the basic goal of quality control?
to assure that the testing site is reporting results that correspond to the correct or expected values. Ex: If a pt has a pH of 7.43, the testing site should be able to reproduce this result within a certain range.
Proficiency testing uses ________ type of samples and can be compared to national results that should be ______________.
unknown samples and should be reproducible
What position should the needle be to draw an ABG?
upstream with bevel up
Blood gases are tested to determine what?
whether to change current therapy or to maintain it
What could happen if you walk out of a pt's room without the label on the vial?
you could be asked to redraw the blood
What is the accurate amount of heparin that should be in syringe to ensure blood does not coagulate?
0.1 mL heparin per 1 mL whole blood
What amount is considered a sufficient sample volume?
1-1.5 mL
Explain the procedure for the modified allen's test.
1. occlude both radial and ulnar arteries. 2. hold pt's hand higher than the heart. 3. have pt open and close hand rapidly several times. 4. release the pressure on the ulnar side. 5. the hand should flush pink within 15 seconds. 6. if it does, the test is positive and the ulnar artery is supplying sufficient blood flow. 7. if it does not try the other hand.
Arterial Line Sampling Procedure
1. verify physician's order 2. verify oxygen concentration 3. gather appr. equipment: latex gloves, eye protection, 5 mL syringe, blood gas analysis, sodium heparin, syringe gas or stopper and ice slush 4. wash your hands 5. don latex gloves prior to pt contact 6. explain the procedure & position the pt 7. assemble & prepare the equipment 8. turning off monitoring alarms (bower's says dont) 9. open the sampling port, removing the cap aspetically 10. attach a disposable syringe 11. turn the stopcock to fill the syringe and draw 3 mL of blood 12. attach the heparinized blood gas syringe 13. open the stopcock and draw a sufficient sample 14. close the stopcock and remove syringe 15. expel any air from the sample 16. cap and ice the sample 17. flush the sampling port w/ heparin, using flush control 18. clean up the area and dispose of 3 mL blood sampled collected before the blood gas (waste) 19. reset the alarms & observe the monitor for the correct wave form 20. label and transport the sample 21. record the procedure on the chart
Normal PO2 in the alveoli?
100-104 mmHg
If ___ ______________ elapses before the blood sample is analyzed, the results can change dramatically.
15 minutes
What strength of heparin usually used?
1:10,000
QC records including problem and corrective action are to be kept in the testing areas for how long?
2 years
How long should pressure be applied to the artery once the needle has been removed?
2-5 minutes (bower's says at least 1 min)
Normal values for blood gas bicarbonate levels?
22-26 mEq/L
What gauge needle is used for arterial puncture in the adult?
23 gauge
When doing a blood gas on a pt receiving oxygen be sure that they are on the correct FiO2 for at least how long before obtaining sample?
30 minutes
Normal levels of PCO2 in arterial blood?
35-45 torr
To minimize the angle between the needle an radial artery the RT should stick at what angle?
45 degree angle
When performing a radial arterial puncture, the puncture should be made at what angle to the skin?
45 degrees
When performing a brachial arterial puncture, the puncture should be made at what angle to the skin?
60 degrees
When performing a femoral arterial puncture, the puncture should be made at what angle to the skin?
90 degrees
Normal SaO2 range?
95-100 %
What is a useful diagnostic test used for clinical assessment of ventilation, acid base status and oxygenation?
Arterial blood gas analysis
PO2 electrode
Clark
T/F: A doctor's order is not required to stick the femoral artery.
False
T/F: During a code, a femoral artery stick will pulsate blood into the syringe.
False
T/F: When withdrawing needle, it is not important to maintain the 45 degree angle.
False
Why do we use an A-line, its purpose and function?
For pt's who are expected to require numerous ABG/acid-base analyses, indwelling arterial catheters are generally placed to avoid subjecting the pt to multiple punctures.
A graph that quality control data is plotted on to give a visual indication whether a laboratory test is working well.
Levy-Jennings Chart
A quality control tool that plots sample results as a function of standard deviation is the?
Levy-Jennings plot chart
The severinghaus electrode measures what?
PCO2
If an air bubble is present in the syringe what will it cause the PCO2 to do?
PCO2 will try to get to zero
ABG is drawn from a pt who has a temp of 38.5 Celsius. If the temp isn't corrected what will happen?
PO2 and PCO2 higher than actual, pH is lower
A pt has a known PO2 120 torr and ABG sample is exposed to room air, what will happen to the PO2, PCO2 and pH?
PO2 and pH go up and CO2 goes down
T/F: A modified allen's test should be done prior to arterial puncture to determine the adequacy of circulation supplied by the ulnar artery.
True
T/F: If anticoagulants are not used properly it will alter the pH of arterial blood.
True
T/F: QC records should be available for review at all times.
True
T/F: Use stand precautions when recapping a need, remove air bubbles from sample, expel excess air and caps syringe in an ice bath.
True
ph electrode
Sanz
PCO2 electrode
Severinghaus
Mixed venous blood, obtained from the pulmonary artery via a ____________-____________ catheter, is used to determine what?
Swan-Ganz O2 delivery to the tissues
More than .1 mL heparin per 1 mL of whole blood will cause you pH, PaO2 and PaCO2 to do what?
acidosis in the blood sample pH down PaO2 up or down toward 160 PaCO2 down toward 0
Level 1 blood gas control
acidosis range
What are 3 hazards of arterial lines?
air emboli infection loss of line (decannulation)
Level 3 blood gas control
alkalosis range
An ____________ sample will tend to cause the plunger of the syringe to pulsate as the samples fill the barrel.
arterial
What 4 physiologic parameters does an ABG monitor?
arterial oxygenation: PaO2 alveolar ventilation: PaCO2 acid-base status: pH O2 delivery to tissue PvO2
Why are arterial samples used?
because the values reflect the pt's total cardiopulmonary status
What happens to a blood sample if their is a delay in sample time?
blood contains living cells w/their own metabolism, these cells will continue to consume oxygen, nutrients, produce acids & CO2 even after being withdrawn from the body. The results can dramatically change.
QC testing is performed after what 6 things?
calibration of an instrument any electronic instrument maintenance instrument parts replacement new reagent or QC material lot number is used unexpected pt results improper storage or handling of reagents is suspected
What does the modified Allens test used for?
collateral circulation
Proficiency testing provides a method to evaluate the quality of testing performed by?
comparing test results to a group
What is the advantage of a brachial artery blood draw for an ABG?
its size is large & easily palpated
Oxygen dissociation curve with increased affinity shifts which way? What happens to pH, PCO2 & temp?
left decreased (H+) or increased pH decreased PCO2 decreased temp decreased 2,3 DPG
What are the known controls in quality control in terms of machine calibration?
level 1, 2 & 3
What are the two types of heparin?
lithium sodium heparin
Explain process of preparing syringe.
maintain asepsis aspirates heparin solution coats internal syringe surface/barrel expels excess heparin from syringe
Level 2 blood gas control
normal range
Level 2 blood gas controls measure what range for monthly calibration?
normal range
How often are blood Gas controls normally run through all blood gas analyzers?
once a month
The Pc02 electrode is a modified __________ electrode.
pH
What two factors can be used to differentiate between venous and arterial blood?
pH & PaCO2
If an ABG is left on the table/counter what might the results be?
pH down PaO2 down PaCO2 up
If the RT did not adjust the temp and the pt had an increased temp, what might the ABG results be? what happens to the shift?
pH down PaO2 up PaCO2 up right shift
If the RT did not adjust the temp and the pt had a decreased temp, what might the ABG results be? what happens to the shift?
pH up PaO2 down PaCO2 down left shift
Calibration verification consists of.......
performing the test on the analyzer using at least three solutions of known concentration
Laboratories performing measurement of blood, pH, PcO2 and P02 should hold a what?
permit and be accredited by CLIA
ABG samples held longer than 15 minutes should be?
placed on ice
What are the components of an A-line?
pressure infusor heparinized saline monitor transducer pressure gauge A-line tubing stopcock
