Arterial Puncture

Position: Raise the patient’s bed at an adequate height to allow for ease of procedure without hunching over. Put the bed rail down at the side from which you will be performing the procedure. Place the patient’s wrist in the supine position (palm facing the ceiling) and extend the hand at the wrist to bring the radial artery closer to the skin surface. You can use a rolled up towel/cloth to prop under the patient’s hand to keep them positioned throughout the procedure (See image below). Palpate for the radial artery pulse and find the point of maximum impulse (Refer to anatomy below). Once found, trace the pulse distally and medially to see which direction the artery runs. Note: Ensure you never leave the patient’s side with the bed rail down and the bed raised. If you have to leave the room for a second, return the bed to a lower position with the bed rail raised to avoid potential falls.

Prepare: Place the drape under the wrist to ensure blood does not get on the patient’s bed. Prep the needle by attaching the vacutainer to the end of the butterfly needle, ensuring needle safety tip is on during prep. Have the labs needed and gauze ready within reach. Put non sterile gloves on. Clean the pulse site with the alcohol pad or swabstick.

Puncture: With your nondominant index finger, palpate the site of maximum impulse previously identified. Then, use your middle finger of the same nondominant hand to track the pulse medially (towards the patient’s shoulders) identifying the direction within which the artery tracks. Using your dominant hand, take the butterfly needle. Removing the index finger from the point of maximal impulse, puncture the skin at the site at which your index finger marked. Puncture at a 30-45 degree angle aiming the needle towards your middle finger and thus in the same direction the artery is running. Advance the needle slowly until it fills with bright red pulsating blood. If no blood returns, withdraw the needle slowly until it's under the skin and reattempt.

Draw: Once blood returns, collect the labs by drawing them into the vacutainer tip. If collecting an arterial blood gas, expel the heparinized fluid right before blood collection, and pull back 1-2 cc into the now empty syringe either using the vacutainer tip or with the vacutainer removed by screwing the syringe directly onto the end of the butterfly needle.

Hemostasis: Once all labs are collected, slowly withdraw the needle and click the safety button to retract the needle. Apply pressure to the site with gauze until hemostasis is achieved.

Post-ABG care: Expel any air bubbles from the syringe. Attach the cap found in the ABG kit to the tip of the syringe. ABG’s typically need to be sent to the lab immediately given the likelihood of clotting. If you anticipate a delay, ensure the RN places the syringe in ice to prevent clotting. Dispose of all sharps in designated sharps container, and reposition the patient back to original bed position with the bed rail raised.