This document outlines the procedure for arterial blood gas sampling, highlighting its indications, contraindications, and potential complications. It details the step-by-step process, including site selection (radial, femoral, brachial) and necessary equipment. Emphasis is placed on ensuring patient safety and minimizing the risk of complications during the procedure.

1. Arterial Blood Gas
Sampling
prepared by
Voon YW
Daaniyal
HKL Houseman teaching

2. INDICATIONS
• Identification of respiratory, metabolic, and mixed acid-base
disorders
• Assessment of the response to therapeutic interventions such as
mechanical ventilation in a patient with respiratory failure
• Determination of arterial respiratory gases during diagnostic
evaluations (eg, assessment of the need for home oxygen therapy
in patients with advanced chronic pulmonary disease)
• Quantification of oxyhemoglobin and dyshemoglobins (eg,
carboxyhemoglobin and methemoglobin)
• Procurement of a blood sample in an acute emergency setting
when venous sampling is not feasible

3. CONTRAINDICATIONS
• Absolute
• Abnormal modified allen test
• Local infection
• Distorted anatomy
• AV fistula or vascular graft
• Peripheral vascular disease
• Relative
• Coagulopathy
• Anticoagulation therapy
• Thrombolytic agent

4. COMPLICATIONS
• Vessel laceration -> Hemorrhage/Hematoma ->
compartment syndrome -> loss of extremity
• Air or Thrombus embolism -> Arterial occlusion ->
loss of extremity
• Arterial vasospasm -> ischemic -> loss of extremity
• Infection -> loss of extremity
• Vasovagal response
• Local pain
• damage to surrounding structure

5. PROCEDURE
1. Wash hand
2. Self intro
3. Clarify patient identity and obtain consent
4. Gathering equipment
a. 23G/25G needle
b. Syringe with heparin
c. Syringe cap
d. Alcohol swab
e. Gloves
f. Sharp bin

6. 5. Selection of puncture
site

7. Radial Artery
• medial to the
radial styloid
process
• lateral to the
flexor carpi
radialis
tendon,
• 2-3 cm
proximal to
the ventral
surface of the
wrist crease

8. Radial artery
• Superficial & easily accessible
• Has collateral *can do allen test to ensure there's
secure of blood flow, check coagulation status also
• puncture at 30-45 degree angle
• minimizes trauma to the vessel and allows smooth-
muscle fibers to occlude the puncture site after the
procedure

9. Femoral Artery
• midline between the
symphysis pubis and the
anterior superior iliac
crest,
• 2-4 cm distal to the
inguinal ligament.
• medial to the femoral
nerve and lateral to the
femoral vein
• assess the distal pulses of
the lower limb prior
• 60-90º angle
• recommended only in
inpatient setting

10. Brachial Artery
• medial epicondyle of the
humerus and the tendon of
the biceps brachii in the
antecubital fossa.
• in the groove between the
biceps and triceps tendons
• The basilic vein and the
brachial nerve are located in
close proximity
• approach at 45-60º angle
• depper, harder to identify and
achieving hemostassis
• small caliber vessel, does not
have extensive collateral
circulation
• a/w median nerve damage

11. Others
• Dorsal Pedis
Artery
• Ulnar Artery
• posterior tibial
Artery

12. 6. Compress for 5
minutes and monitor for
complication
*repeated arterial blood sampling increases risk of
complication, alternate puncture site should be considered

13. Thank you