Kettering - Pulmonary Diagnostic Testing questions with || || || || || || ||
accurate detailed solutions || ||
arterial puncture ||
puncture of a peripheral artery to obtain an arterial blood sample for direct measurement of
|| || || || || || || || || || || || || || ||
pH, PaCO2, PaO2
|| ||
indications for arterial puncture || || ||
evaluation of the adequacy of a patients ventilation (PaCO2), oxygenation (PaO2) and/or
|| || || || || || || || || || || ||
acid base status (pH)
|| || ||
assess the need for therapeutic intervention (i.e., oxygen therapy, mechanical ventilation,
|| || || || || || || || || || ||
etc) and/or diagnostic evaluation (i.e., exercise desaturation)
|| || || || || ||
monitor the severity and progression of a documented disease process
|| || || || || || || || ||
there are three primary sites for obtaining an ABG
|| || || || || || || ||
radial
brachial
femoral - if BP is low (60/40)
|| || || || || ||
,the radial artery is the first choice in most patients because of its accessibility and collateral
|| || || || || || || || || || || || || || || ||
blood flow ||
the brachial artery is an appropriate alternative site
|| || || || || || ||
the femoral artery is the last choice
|| || || || || ||
the modified allens test
|| || ||
used to assess the collateral circulation in the hand prior to drawing a radial ABG
|| || || || || || || || || || || || || ||
a positive modified allen's test confirms that collateral blood flow is present
|| || || || || || || || || || ||
the hand should pink up within 1-2 seconds after releasing the ulnar artery
|| || || || || || || || || || || ||
if it does not - use another site
|| || || || || || ||
never attempt arterial punctures on patients with an indwelling dialysis shunt (radial or
|| || || || || || || || || || || || ||
brachial), use another site || || ||
only performed for radial ABGs, performed every single time
|| || || || || || || ||
ABG sampling hazards and problems
|| || || ||
disruption of blood flow - hematoma || || || || ||
clotting
,bleeding - hold pressure on site for a minimum of 5 mins or until bleeding stops
|| || || || || || || || || || || || || || ||
vessel spasm ||
tissue trauma - muscles, bone, nerves
|| || || || ||
anticoagulant therapy (heparin) - apply pressure to site longer
|| || || || || || || ||
air bubbles in ABG sample
|| || || ||
PaCO2 decreases toward 0 torr
|| || || ||
PaO2 increases or decreases toward 150 torr
|| || || || || ||
pH increases
||
improper cooling of ABG sample (sample not iced)
|| || || || || || ||
PaCO2 increases ||
PaO2 decreases
||
pH decreases
||
, too much liquid heparin in ABG sample
|| || || || || ||
PaCO2 decreases toward 0 || || ||
PaO2 increases or decreases towards room air (150 torr)
|| || || || || || || ||
pH decreases toward 7
|| || ||
capillary samples or heel sticks can also be used to obtain blood gas samples in infants
|| || || || || || || || || || || || || || ||
the site must be arterialized by wrapping it in a wet, warm cloth at 45C for 5-7 minutes
|| || || || || || || || || || || || || || || || ||
the heel is cleansed with alcohol and a lancet is used for the puncture and is done deep
|| || || || || || || || || || || || || || || || || ||
enough to allow for free flowing blood
|| || || || || ||
results will show a consistent correlation with arterial pH and PCO2
|| || || || || || || || || ||
PO2 values do not correlate well with actual arterial blood, this is especially true when the
|| || || || || || || || || || || || || || || ||
arterial PO2 is above 60 torr || || || || ||
capillary gases should not be used to monitor oxygen therapy, actual oxygen levels may be
|| || || || || || || || || || || || || || ||
either higher or lower than what is measured in capillary sample
|| || || || || || || || || ||
umbilical arterial lines are used for newborn babies
|| || || || || || ||
a catheter is inserted into the umbilical artery at the ut end of the umbilical cord, the safest
|| || || || || || || || || || || || || || || || || ||
place for the tip of the umbilical arterial catheter is at L-3, which is above the bifurcation of
|| || || || || || || || || || || || || || || || || ||
the aorta but below the renal arteries
|| || || || || ||
accurate detailed solutions || ||
arterial puncture ||
puncture of a peripheral artery to obtain an arterial blood sample for direct measurement of
|| || || || || || || || || || || || || || ||
pH, PaCO2, PaO2
|| ||
indications for arterial puncture || || ||
evaluation of the adequacy of a patients ventilation (PaCO2), oxygenation (PaO2) and/or
|| || || || || || || || || || || ||
acid base status (pH)
|| || ||
assess the need for therapeutic intervention (i.e., oxygen therapy, mechanical ventilation,
|| || || || || || || || || || ||
etc) and/or diagnostic evaluation (i.e., exercise desaturation)
|| || || || || ||
monitor the severity and progression of a documented disease process
|| || || || || || || || ||
there are three primary sites for obtaining an ABG
|| || || || || || || ||
radial
brachial
femoral - if BP is low (60/40)
|| || || || || ||
,the radial artery is the first choice in most patients because of its accessibility and collateral
|| || || || || || || || || || || || || || || ||
blood flow ||
the brachial artery is an appropriate alternative site
|| || || || || || ||
the femoral artery is the last choice
|| || || || || ||
the modified allens test
|| || ||
used to assess the collateral circulation in the hand prior to drawing a radial ABG
|| || || || || || || || || || || || || ||
a positive modified allen's test confirms that collateral blood flow is present
|| || || || || || || || || || ||
the hand should pink up within 1-2 seconds after releasing the ulnar artery
|| || || || || || || || || || || ||
if it does not - use another site
|| || || || || || ||
never attempt arterial punctures on patients with an indwelling dialysis shunt (radial or
|| || || || || || || || || || || || ||
brachial), use another site || || ||
only performed for radial ABGs, performed every single time
|| || || || || || || ||
ABG sampling hazards and problems
|| || || ||
disruption of blood flow - hematoma || || || || ||
clotting
,bleeding - hold pressure on site for a minimum of 5 mins or until bleeding stops
|| || || || || || || || || || || || || || ||
vessel spasm ||
tissue trauma - muscles, bone, nerves
|| || || || ||
anticoagulant therapy (heparin) - apply pressure to site longer
|| || || || || || || ||
air bubbles in ABG sample
|| || || ||
PaCO2 decreases toward 0 torr
|| || || ||
PaO2 increases or decreases toward 150 torr
|| || || || || ||
pH increases
||
improper cooling of ABG sample (sample not iced)
|| || || || || || ||
PaCO2 increases ||
PaO2 decreases
||
pH decreases
||
, too much liquid heparin in ABG sample
|| || || || || ||
PaCO2 decreases toward 0 || || ||
PaO2 increases or decreases towards room air (150 torr)
|| || || || || || || ||
pH decreases toward 7
|| || ||
capillary samples or heel sticks can also be used to obtain blood gas samples in infants
|| || || || || || || || || || || || || || ||
the site must be arterialized by wrapping it in a wet, warm cloth at 45C for 5-7 minutes
|| || || || || || || || || || || || || || || || ||
the heel is cleansed with alcohol and a lancet is used for the puncture and is done deep
|| || || || || || || || || || || || || || || || || ||
enough to allow for free flowing blood
|| || || || || ||
results will show a consistent correlation with arterial pH and PCO2
|| || || || || || || || || ||
PO2 values do not correlate well with actual arterial blood, this is especially true when the
|| || || || || || || || || || || || || || || ||
arterial PO2 is above 60 torr || || || || ||
capillary gases should not be used to monitor oxygen therapy, actual oxygen levels may be
|| || || || || || || || || || || || || || ||
either higher or lower than what is measured in capillary sample
|| || || || || || || || || ||
umbilical arterial lines are used for newborn babies
|| || || || || || ||
a catheter is inserted into the umbilical artery at the ut end of the umbilical cord, the safest
|| || || || || || || || || || || || || || || || || ||
place for the tip of the umbilical arterial catheter is at L-3, which is above the bifurcation of
|| || || || || || || || || || || || || || || || || ||
the aorta but below the renal arteries
|| || || || || ||
