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Ns. I Kadek Saputra, S.

Kep

Introduction

To take arterial blood from arterial line Assessment of arterial blood gases (ABG) reveals the ability of the lungs to exchange gases by measuring the partial pressures of oxygen (PO2) carbon dioxide (PCO2) and evaluates the pH of arterial blood Blood gases are ordered to evaluate :
Oxygenation Ventilation and the effectiveness of respiratory

therapy Acid-base level of the blood

NILAI NORMAL
Komponen
pH

Darah Arteri
7.40 (7.35-7.40)

Darah Vena
7.38 (7.33-7.43)

PO2 Saturasi O2
P CO2

80-100 mmHg 95% atau lebih


35-45 mmHg

34-49 mmHg 70%-75%


41-51 mmHg

HCO3Base excess :

22 26 mEq/L
-2 sampai +2

24 28 mEq/L
0 sampai 4

Monday, January 07, 2013

Intensive Care

Arterial blood samples

Are drawn from a peripheral artery


Radial artery Brachial artery Femoral artery

Nursing practice perform radial artery puncture and femoral artery puncture is usually performed only by an advanced practitioner (DeLaune, 2002) The syringe is then rotated to mix the blood with the heparin to prevent clotting

Arterial punctures should not be performed


If the client is hyperthermic Immediately after breathing and suctioning treatments Less than 20 to 30 minutes after oxygen therapy or ventilator setting Potter 2006

Arterial samples are also contraindicated in :


Anticoagulant therapy Clotting disorders Symptomatic peripheral vascular disease Negative Allen test

Allen test

Have client tight fist and rise hand above heart Apply direct pressure to both arterial and ulnar artery Have client lover hand and open hand Release pressure ulnar artery; observe color of fingers, thumb, and hand

Allens test result :


Flushing can be seen immediately if flow through ulnar artery is good. Allens test is positive, verifying ulnar artery alone is capable to providing blood supply to entire hand. Therefore radial artery can be used to for puncture If there is not flushing in 15 second, Allens test is negative, and this test should be repeated on other arm If both hand give negative result, another artery (femoral) need to chosen for puncture

Regardless of who performs the arterial puncture


Nurse is responsible for assessing the client for symptoms of bleeding or occlusion postpuncture Direct pressure must be applied to the puncture site until all bleeding has stopped, a minimum of 5 minutes Ensure that all bleeding has stopped before releasing the pressure

Symptoms of impaired circulation include


Numbness and tingling Bluish color Absence of a peripheral pulse

Procedure