Arterial puncture in pediatrics is an invasive procedure used to obtain arterial blood samples, most commonly for arterial blood gas (ABG) analysis, which helps assess oxygenation, ventilation, and acid-base status. It’s typically performed in critically ill neonates and children when precise respiratory or metabolic data is needed.
Indications
- Arterial blood gas (ABG) analysis
- Invasive blood pressure monitoring
- Oxygen saturation and pH
- Patient’s acid-base state.
- For accurate diagnosis of respiratory failure
Sites for Arterial Puncture
- Temporal artery
- Radial artery
- Brachial artery
- Femoral artery
- Deep heel puncture
- Indwelling arterial catheters
Equipment
A sterile tray containing:
- Heparinized syringe with 21- to 23-G
- needle
- Sterile swabs in a bowl
- Heparinized collection tubes betadine
- Spirit
- Kidney tray
- Pair of gloves
- Light source
Preparation
- Adequate circulation should be assessed before arterial puncture by observing capillary refill or performing Allen’s test (Fig. 3.3).
- Comfort the child before doing the procedure. Because crying, fear, and agitation also affect blood gas values.
- Explain the procedure to the parents.
- Apply local anesthesia (EMLA cream) well before the procedure to minimize the pain.
- No matter how or by whom specimen is collected, children fear loss of blood.
They mistakenly believe that blood taken from their body is threat to their lives.
Explaining that their body continuously produces blood provides them to measure of reassurance regarding this aspect of stress proving procedure.
Procedure
- Perform hand hygiene and don gloves.
- Prepare the site aseptically, employing spirit, iodine and spirit in that order.
- In the case of a radial puncture, the wrist is kept extended and the radial artery palpated, and left-hand fingers kept on it.
- Then the bevel facing upward, the needle is inserted little superior to the proximal skin crease inclined at an angle of 45° to the artery. At this the needle should be gradually withdrawn as gentle suction is maintained.
- If blood fails to flow into the syringe, another attempt should be made by pushing the needle again in either direction without withdrawing it from the skin.
- Once the sample of blood has been collected, the puncture site should be kept pressed for 5 minutes or more to safeguard against bleeding.
Post procedure Care
- The syringe/tube containing blood sample is sealed and preserved in ice.
- It must be carried to the laboratory for immediate blood gas analysis.
- Praise the child for cooperation.
- Watch for bleeding from the puncture site.
Nurse’s Responsibilities
- In the case of multiple samples of arterial blood are needed over a relatively shorter time, it is advisable to place an indwelling arterial line. Such a line would require to be continuously heparinized (1 U/mL saline; 3-5 mL/h) to safeguard against thrombosis.
- When the blood is drawn, a simple comment, such as just look how red it is, you are really making a lot of blood, gives assurance to the child.
- Institute pain reduction techniques to lessen the discomfort of the procedure.
Special Considerations
- Crying or agitation can alter blood gas values—calm the child beforehand.
- Avoid repeated punctures at the same site to prevent arterial spasm or thrombosis.
- Monitor for bleeding, hematoma, or distal ischemia.
- For frequent sampling, consider an indwelling arterial line with continuous heparin flush.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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