Arterial blood gas demonstration

[Nadrealis]

I've had ABG's done over 30 times. I recently had a double lung transplant and let me tell you it's pretty rare for someone to hit the artery on the first try. Only a truly seasoned practitioner or doctor becomes good at it. Hell, one of the doc's at my recent admission missed 7 times. It literally feels like your arm is breaking. I hope I never have to get one again.

[21phleb]

You suck! I think he should be the one being trained.

[drumaboy200]

he should've got it the first time!

[Chrisjaldin]

what analyzer would you recomend? which one takes 30 to 40sec to measure??!

[tumejorpose]

When you withdraw the needle while searching for the radial artery, due you completely withdraw it or only withdraw a little while keeping the needle tip still under the skin?

[2006kcl]

thanks for the demo. I'm struggling taking the cap off the needle, Ive tried it on 2 ABG packs, and the cap doesnt come off unless i hold onto the end of the needle (a key part?) to pull it off. is this happening with other people? thanks

[KTinNYC]

@2006kcl Yep it happens to everyone, depending on the pack. Just put it back on.

[margaretgoodwyn1]

I enjoyed your video but since when do you touch the needle on top of the syringe? I think this is all wrong and should not be taught as a needle stick injury is likely by using these out of date techniques

[1958boomergirl]

I was watching this video just now, and I didn't see the doctor/instructor using any numbing medicine prior to this demo at all. I've never had an ABG done, but still---what is up with the "no local anesthetic" policy? :(

[sefik66]

Did you guys used Lidocaine before the procedure to num the area since it can be quite painful for the patient?

[AngelOne11]

@nessajack What you have to do is not be nervous. Go in slowly at an angle after you feel for the pulse. Don't push it too fast and as he said go round the site several times until you get it. I got mine from the first insert ever; not to brag or anything ;)

[muhammad159]

you can't pull the needle out and then in again. You'll fail an OSCE if you do that! You have to keep the needle in and try and find the Radial artery or pull out and get a new needle.

[Yixian99]

@muhammad159 There's a big difference between what you need to do to pass and OSCE and what is really needed in real life

[MedicalEducator]

Thanks SteveTube - there is more completely free videos/podcasts/questions like this at medicaleducator.co.uk/student/­login/signup.php , why not give us a go today?

[SteveTube939]

Wonderful! Thanks ever so much for the technique review. I'm ready to give it another go now.

[melenia1]

@nessajack

me2

[edwardiansnow]

thanks, this is a great video

[SilverDragon24]

@nessajack I'm a student in respiratory therapy.. and omg let me tell you I had a hard time getting it as well! My problem was that where I thought I felt the artery with my index finger wasn't actually where it really was.. the first time I got it I was sooo happy.. and now I know where to go when I feel the pulse

[purple1449]

I had this done several years ago and can say it's the most painful thing ever.

Dr fished about in my wrist for ages and eventually gave up. It took two nurses to hold my arms to stop me pulling them away (and I'm usually stoic - I am now needle phobic - hence looking this up to try and overcome my phobia).

He didn't even try the artery in my groin. which makes me wonder if I needed the test in the first place.

Note to Drs & Med students - if this test is not neccesery DON'T do it.

[obugirl04]

@purple1449 I agree- I passed out and had a seizure after having this done.

[cutseypoo777]

@purple1449 I hear you. I've had an ABG done 3 different times, & it hurt like mad each time. In fact, the last time I had an ABG done, I had to get stuck twice! Just two words... Never again. I never want a stinkin ABG done if I can help it. Peace.

[nadasj]

I think you should prepare the skin by wiping it by iodine in circular motion then use alcohol swap .. you are invading an artery .. in this case the risk for infection is high .

moreover in case of air bubbles inside the syringe this will effect on the result so you should use rubber stopper ..

[pajto3]

I agree about the box.

[MedicalEducator]

Box is now moved - cheers.

[StarChildElven]

you cant really see whats going on due to the box at the bottom of the screen. Also, if you miss you are supposed to pull out all the way, not keep the needle in and move it around... unless he did pull out all the way, idk it was hard to see. other than that it was a helpful

[MedicalEducator]

Hi, sorry about that - we have moved the box!

[rfrnet]

what's with the blue advertising field over the main course of action? idiots didn't think this one through.

[MedicalEducator]

Sorry - we have moved the box!

[di55illu5ioned]

I suffer with chronic/acute pancreatitis and thought I'd have a look to see why they do blood gases when I go into hospital. This guy pulls out when he misses at first and seems to have difficulty getting it second time round! As it is quite painful I'm surpised the student didnt "chin" him! Scared me, I cringe everytime I think agout it!

[saxophoneman23]

That looks quite uncomfortable:P

[MPHILLIPS89]

OH MY GOD!!! Are you kidding me?? Who is this guy?? Poor patient!!

[yodelania8]

OMG!! That is not the correct angle for a radial ABG should be 30 - 45 degree, also you don't torture your patients by searching the artery once the needle is inside. If you are a good RT you will do it by palpation or anatomically PRN, for me this is easier than venipuncture.

PS: I can;t believe that this is an MD, no way!!

[zcheeseolly]

5:43 watch as the patient pulls his arm away from the doctor, seemingly in anger.

[yodelania8]

LOL

[saxophoneman23]

He does quite a distinct movement :P

[AngelOne11]

@zcheeseolly Good observation. This guy must be a doc because docs usually are not good with needles :)

[TheCh0pper]

I felt uneasy watching this video as it brought back some painful memories of when I was in hospital due to DKA, ketoacidosis.

I had 10 of these blood gas samples done to me and they really do hurt a LOT!

Normal blood samples are not a problem, but the blood gas one is enough to make a grown man cry.

I dont recall any bleeding however..just lots of pain lol

[deathtothepast]

it's painful as hell

[girlytubegirl]

unsterilized..... i would even if they don't mandate it to be sterilized! educational tho, i have a few months until i have to do this in school.... thanks for the video

[Daisy72762]

it is more painful than an IV,because it goes deeper into the arm around the nerves!!!

[vegancarnivore89]

it is painful I had 10 of them taken over the last 3 days :(

[joaoangelo26]

r u an RT? coz if u r, u shouldnt have done it that way! so unsterile! i bet u dont even know how to interpret the results...

answer this one

fio2: RA

ph: 7.41

pc02: 45.8

po2: 100.2

hc03: 23

Be: +2

o2sat: 97.3%

now... interpret.. ^^

[Miurator]

es un chapuzaaaaas, a estado tanto tiempo haciendo el canelo que me a dolido asta a mi y encima le a echo sangrar, aparte a tenido k desviar la vista de el brazo es un chapuzaaaaas

[sammysd2005]

OMG I start my first clinical rotation tommorrow and im so nervous. Lol. Thats what I'm scared of, to miss the artery!! Lol

[yrangelion]

i had one of these done yesterday coz i have pneumonia, the Dr missed the first time with me it's not the end of the world and it probs happens to the most eperienced Dr at some point too, hope your rotation isn't going that bad xx

[AichaBlueSky]

omg how did he manage to get that guy to agree to this! looks painful

[cutseypoo777]

Ugh! I've had a couple ABG's done on a couple different occasions, and they HURT! They are more painful than the more prevalent venipuncture. The last time I had an ABG done, I had to be stuck twice because the nurse missed my artery.

[talfonso4]

I missed 3 times during my try

[breatheasy4u]

also.. It's ok to redirect in the same "plane" but you do have to keep in mind that the tip of the needle is sharp and you are slicing up the inside of the wrist in the process. And yes, squirted was a drastic word but for those who might be using this video as an educational source, they should be aware of the risks. Maybe on the next video you should say "Don't try this at home kids"

[breatheasy4u]

ok ok.. House?? seriously? James.. I believe that you are qualified to do what you do.. but THIS example was not a great one. I don't know the "rules" in the UK, but here in the US we are taught that you can potentially expose your patient to bacteria (infection) if you remove the needle past the bevel (which is also the ONLY time you will see blood unless you have completly finished and removed the needle) As for math.. a patients artery can move and is not exactly 2mm at all times.

[lizalicef]

In the UK ABG sampling is not currently a sterile procedure as there is not felt to be sufficient evidence of infections gleaned from the procedure to warrant performing it sterile. It is a 'clean' procedure, like venepuncture. I found the video pretty good as ABGs are difficult to do and I thought the potential problems were addressed nicely.

[breatheasy4u]

This was NOT the proper way to perform an ABG. Please DO NOT use this as a learning tool. Learn FROM it.

When doing an ABG, you can only redirect the needle IF the bevel DOES NOT COME OUT! He pulled too far and that is why you saw blood. (not suppose to happen) Also, only redirect at the same angle.

This man could have exposed the subject to bacteria. Also, the artery has a lot of pressure and blood could have potentially squirted out everywhere. (not good)

[medicaleducatorJames]

Thanks!Points form your post...

1.) Its a video demonstration promoting our website. Its not designed to teach you how to do the thing *s*

2.) If you redirect the needle at the same angle then you will go back in at the same angle and therefore again not hit the artery

3.) The artery does have "a lot of pressure" (124mmHg in this case). Blood could not and did not "squirt everywhere" because the needle did not initially go into the artery. The bleeding is from the puncture wound itself.

[medicaleducatorJames]

A tip is to cover the site with a sterile dressing as you remove the needle.4.)The artery is approximately 2mm below the surface of the skin and the bevel on a needle is approximately 1mm in diameter! You need to do the maths. These things happen, this is clinical medicine. Dont you watch 'House'? *S*

5.) When you put needles in people they generally bleed. Blood is not a sign of "infection". Same goes for arthro/para/thoracocentesis

Thanks for the comments anyway,

James, Medical Educator Team

[kd4imu]

I refuse to have a battle of wits with the unarmed.... Medication usually isn't administered through an arterial stick..

[aminhumeida]

Thanks James for the effort to educate people.

[kd4imu]

This guy is stupid. Move a needle around under the skin is very painful.

[medicaleducatorJames]

Thanks Kd!

You cant please all the people all the time~s~

The trick is not to withdraw the needle under the skin. You should advance and withdraw in the same plain, withdrawing and then retrying.

Trust me I've had enough practice including:

Working in some of the busiest admissions/ surgical/medical/intensive care units in the UK.

James

Medical Educator Team

[melinty]

he has to move around the skin because its very hard to hit the artery (its called fishing!).. and yes, an ARTERIAL blood gas is painful to start with.. *duh!*

[kd4imu]

I know what is it is called, I had a nurse go "fishing" for twenty minutes to start the IV before my last surgery. More than a minute or so of this would draw a nasty reaction from me.

[melinty]

hahhahahahah... you're funny... apparently IV's are only done via venous.. not artery.. and it doesnt hurt.. speaking from experience.

[medicaleducatorJames]

You're right Melinty,

Almost All the medications given via a drip are given IV.

The technique can be used for either arterial or venous access. The term IV actually means "intra venous" and as such by definition IV's are given by this route.

It is confusing though for patients and some staff. You can have an arterial line put in (an A line) but this is normally used just to monitor the patients condition.