What do you need to perform before doing a percutaneous punture of the radial artery or dorsalid pidas artery?
Allen's Test
What size needle is used for adults?
23-25 gauge
What size needle is used for infants?
25-26 guage
Where is the artery sample obtained in the infant?
scalp
What should be used to prep the puncture sight?
70% isopropanol
What should be in the syringe prior to puntuce of the artery and abtaining the sample?
Sodium or Heparin
To alleviate possible pain and pt. anxiety, what can be used as a local anethetic?
1% Lidocaine
Why is the blood drawn anaerobically?
to prevent contamination by room air
If you are going to take a capillary blood gas sample from an infants' heel or earlobe, what should you do first?
Warm the area to increase perfusion
In an adult, when drawing blood from an A-Line, how much should be removed and discarded before drawing the sample?
1-2mL
How quickly should un-iced specimens be analyzed?
within 5 minutes
What are the erroneous results you might get from not analyzing the sample in time?
reduction in PaO2 and rise in PaCO2
After drawing the sample from the A-Line, why do you flush the line?
To prevent coagulation
Why does the erroneous results happen?
Blood cells remain metabolically active in vitro
What type of pt's would particularly have a problem with erroneous results?
High White Blood Cell Count
What represents unuversal neutrality?
pH 7.00
How cold should the blood sample be chilled?
Below 5 degrees C
Blood can contain how many types of hemoglobin?
6
What three electrodes does a typical blood gas monitor have?
pH, PaCO2, PaO2
Most commercially available co-oximeters provide measurements for how many types of hemoglobin?
4
pH is a shorthand way of expressing the hydrogen ion activity of solutions? T or F
T
What types of hemoglobin do co-oximeters typically measure?
O2Hb, HHb, HbCO, and metHb
O2Hb and HHb are measured with a pulse oximeter, using red light at 660nm and IR light at 940nm. Which absorbs more light?
O2Hb
O2Hb and HbCO have similar absorbtion coefficients for red light or IR light?
Red light
Significant levels of HbCO will lead to?
Overestimation of SpO2
metHb absorbs?
Both IR and red light
Do pulse-oximeters report fractional or functional hemoglobin saturation?
Functional
What is the best way to deal with inaccurate readings due to low perfusion when using a pulse-ox?
reposition to an area of higher perfusion
If enough metHb is present to dominate all pulsatile absorption, the pulse-ox will measure a red-IR ratio of 1:1, corresponding to an SpO2 of?
85%
Regarding non-COPD patients, a PaCO2 greater than ________ would equate to ventilatory failure.
50mmHg
Moderate hypoxemia
40-60mmHg
Regarding COPD patients, acute ventilatory failure is said to exist if the PaCO2 is well above 50 mmHg and the pH is below?
7.30
The preceding hypoxemia levels were based on a pt. under 60 years of age. For mild and moderate hypoxemia in pt;s over 60, for each year of age over 60 you would?
Subtract 1 mmHg to the limits
Mild hypoxemia?
60-80mmHg
A PaO2 of 40 mmHg indicates severe hypoxemia in any pt. at any age: T or F?
T
The most common iatrogenic blood gas abnormality in the hospital is?
Metabolic Alkalosis
Severe hypoxemia?
<40 mmHg
What are some causes of metabolic acidosis?
Diarrhea, Methanol ingestion, and Diabetes mellitus
