Page 52 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 37

✔ ANSWER
A
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Uncompensated respiratory acidosis. The pH is below 7.35, indicating you
have an acidosis. The pCO is elevated, indicating the acidosis is caused by the
2
lungs retaining CO . The patient has hypoxemia as the pO is below 80 and it
2 2
is severe. The HCO level is normal, indicating no compensation is being done
3
by the kidneys. The anion gap is normal (145 + 4) − (110 + 24) = 15. Prepare to
intubate this patient as he or she has severe acidosis and is severely hypoxic
and hypercarbic. You might also prepare BiPAP as an alternative to intubation
and steroids to help decrease inflammation.
Frequently, arterial blood gases can be done at the bedside using an ISTAT
machine. At other times, they need to be collected through an arterial line or
an arterial puncture. Instructions for performing these procedures follow.

H ? How To Do It—Collecting an ABG by

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Arterial Punctur
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ash hands and appl
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ing
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es acc
1. Wash hands and apply gloves according to facility policy.
2. Perform an Allen’s test by occluding both the radial and ulnar arteries and then
2. P e r f orm an Allen ’ s t est b y occluding bot h
the ulnar
he hand should turn
.

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releasing the ulnar. The hand should turn flesh toned within seconds. If the hand
eleasin
g
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er
y
as
t
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this
the
ar
still
whit
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is still white, do not use this artery as the dual blood supply to the hand might be
e
not
use
,
do
compromised if you do a radial stick. Consider using an alternate arterial site.
3. Palpate the radial artery to assess for maximum pulsation in this area.
4. Cleanse the area according to facility policy—either with iodophor prep or
alcohol, or both.
5. Using a prefilled, heparinized syringe, insert at a 45-degree angle into the radial
artery making an oblique puncture, which allows the muscle fiber to seal the
puncture as soon as the needle is withdrawn.
6. Obtain blood, remove the needle, and apply sterile gauze, keeping firm, con-
tinuous pressure over the site for at least 5 minutes.
7. Gently rotate the sample to mix heparin with the blood.
8. Send the iced specimen to the laboratory in a biohazard bag immediately or
attach to an ISTAT machine.
9. Document the Allen’s test results, the site of the sample, and any patient reac-
tions to the procedure.