| Knowledge |
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States Contraindications
and Relative Contraindications
of procedure.
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| Preparation |
| Clinical standards for procedures and interventions. |
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| Ensures the patient has no contraindications, circulatory disorders, or limb alerts. |
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| Confirms the diagnosis, coagulopathies, anticoagulant therapy. |
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| Identifies patient allergies if using local anesthetic. |
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| Assessment |
| Notes the current oxygen delivery device, FiO2, ventilator settings. |
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| Palpates pulses in both arms to determine the best puncture site, selecting the nondominant arm if possible. |
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| Performs a collateral circulation evaluation with Modified Allen Test; if negative, repeats on the other arm. |
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| Implementation |
| Prepares the puncture site by rubbing vigorously in a circular motion away from the puncture site with an antiseptic solution for at least 30 seconds; disinfects gloved fingers used for palpation. |
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| Administers an anesthetic if ordered. |
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| Ensures heparin coats the wall of the syringe, expels extra heparin if present. |
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| Sets plunger on self-venting syringe for required sample amount. |
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| Adjusts capping safety device upright in line with the bevel of the needle. |
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| Holds syringe at 45 degree angle with bevel up. |
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| Rests the puncturing hand against the patient's palm. |
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| Instructs the patient to relax their hand and not move arm during puncture. Informs patient before puncturing. |
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| Slowly inserts the needle between the second and third skin folds on the patientÂ’s wrist. |
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| Identifies a flash of arterial blood in the syringe confirming arterial access. If no flash is present, safely adjusts the needle angle by withdrawaling needle slightly without removing the bevel tip and redirecting. (No more than three redirects are permitted) |
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| Obtains the sample. Removes the needle and applies counter pressure while withdrawaling with sterile gauze. Holds pressure with sterile gauze for 3 to 5 minutes or minimum of 10 minutes if the patient has a bleeding disorder or uses anticoagulants. |
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| After holding pressure, inspects the puncture site for bleeding, swelling, discoloration, and return of pulse proximal and distal to the puncture site |
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| Secures the needle with a rubber stopper or automatic self-capping device and ensures the sharp is enclosed in a containment device without using hands. |
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| Immediately discards the sharp in an approved sharps container. |
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| Ensures an anaerobic sample; removes air bubbles with a venting device. |
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| Post-Intervention |
| Labels the sample and places it in a sealed biohazard container for transport. (Sample may require ice if delay in analysis is > 15 minutes) |
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| Documents the date, time, FiO2, puncture site, Allen test results, oxygen and ventilatory settings. |
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| Post-Intervention Management Steps |
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