ATS Pulmonary Function Laboratory Manual

chapter  2

Competency Assessment Resource Material Percutaneous Collection of Arterial Blood Theory and General Information 1. Lists at least three concerns or contraindications to performing an arterial puncture. a. Negative results of Allen test indicating reduced patency of ulnar artery

b. Arterial puncture should not be performed through a lesion or through or distal to a surgical shunt. c. Anticoagulation therapy does not necessarily contraindicate arterial puncture but may require special precautions (e.g., compression of the site for extended period). d. Clotting disorders 2. Lists at least three hazards of an arterial puncture: a. Hematoma b. Arteriospasm (reflex constriction of artery) c. Thrombosis or embolism d. Fainting (vasovagal response) e. Allergic reaction to antiseptic solutions or local anesthetics (“caines”) Introduces self, identifies patient either by asking the patient to state or spell his/her first and last names, and date of birth, and verify the information against ID band and/or requisition. Explains the procedure to the patient, asks if he/she has an allergy to iodine or lidocaine (if applicable), and asks/verifies if he/she is taking anticoagulant medication. 2. If patient is on supplemental O 2 , verifies flow rate and/or concentration using appropriate device (e.g., calibrated meter). 3. Selects site for puncture and performs Allen test (if using radial artery). a. Radial artery is site of choice, but brachial artery is a reasonable alternative. b. Allen test 1) Have patient make a tight fist to expel blood while technician applies pressure to the radial and ulnar arteries. 2) The patient opens and closes hand several times. 3) The patient opens the hand, and the technician releases pressure on the ulnar artery. 4) If color fails to return quickly to the palm and fingers within 15 seconds, ulnar artery obstruction is indicated and another site should be selected. 4. Uses appropriate barrier protection. a. Dons gloves and other protection (e.g., eye goggles), if applicable. 5. Cleanses area with iodine and alcohol. a. Adequately scrubs site to ensure aseptic conditions. 6. Properly administers local anesthetic (if applicable). a. Verifies patient does not have a “caine” allergy. b. Injects 1% or 2% lidocaine without epinephrine into and under the skin, creating a wheal. Implementation 1.

17