ATS Pulmonary Function Laboratory Manual

chapter  15

2.1. Preferably short-bevel, 20- to 25-gauge needles with length from 5/8 to 1½ inch, (depending on sampling site) are acceptable for arterial puncture (1). 2.2. Smaller gauge needs (e.g., 25 gauge) may require gentle aspiration (4). 3. Anticoagulant 3.1. The choice and type of heparin depends on the specific analytes to be measured and the method analysis (1). 4. Antiseptic supplies (e.g. isopropanol sponges) are required for cleansing the puncture site (1). 5. Specimen label adequate for unique specimen identification (1) 6. Sterile gauze pads (1) 7. Engineered sharps: equipment with engineered sharps injury protections that allow for one-handed removal of the needle, or other suitable capping device for the blood specimen syringe or collection device (1) 8. Coolant (e.g., container of ice water or other coolant capable of maintaining a temperature of 1 to 5° C and large enough to allow for immersion of the barrel of the syringe or collection device if the specimen is not expected to be analyzed within 30 minutes [1]) 9. Disposal container: a puncture-resistant disposal container in which to place used needles and syringes (1) 10. Barrier protection: standard precautions need to be diligently followed to protect the health practitioner from biohazard infections. These Standard Precautions are accepted standards that are dictated by the Occupational Safety and Health Administration (OSHA), the Centers for Disease Control and Prevention (CDC), and all organizations that oversee best practices for laboratory safety. Standards include: hand washing, donning barrier protective clothing (e.g., gloves at minimum), and the avoidance of recapping needles.

Patient Preparation 1. Identify the patient using institutionally-approved process. 2. Validate the physician’s order. 2.1. Confirm absence of allergy to antiseptic (1). 3. Verify that any supplemental oxygen (O 2

) has been stable for ≥ 15 minutes prior to sampling.

4. Assess and verify stability of patient conditions which may influence results (e.g., body temperature, respiratory rate, ventilator settings, supplemental O 2 ). 5. Assess the patient for physical and developmental status to determine if special arrangements are required. If there is a language barrier, an interpreter is to be utilized. 6. Explain the procedure to the patient, answering any questions and attempting to allay any fears. 7. The patient may be either seated or supine for radial or brachial punctures. 8. Perform a modified Allen test to confirm presence or absence of radial artery occlusion. 8.1. The Allen test was originally described in 1929 for confirming the presence of radial artery occlusion (5). The modified Allen test is now used to assess collateral circulation to the hand (4). 8.2. Modified Allen test: ask patient to close fist tightly to force most of the blood from the hand. Apply pressure at wrist to compress and obstruct radial and ulnar arteries. Ask patient to unclench fist and then remove pressure from only the ulnar artery. Observe the inside of the palm for flushing of palm, fingers, and thumb for 15 seconds. Flushing within 15 seconds indicates a positive modified Allen test. Negative results must prompt assessment of alternative sites.

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