Blood Gases and CPAP || with 100% Error-free Answers.
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Blood Gases and CPAP
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Blood Gases And CPAP
What are the three ways to sample arterial blood from an infant? correct answers Umbilical arterial line (UA), arterialized capillary sample (heel stick), and peripheral artery puncture/line (radial, brachial, temporal, post tibial)
What does placing a UA involve? correct answers It involves pla...
Blood Gases and CPAP || with 100% Error-free Answers.
What are the three ways to sample arterial blood from an infant? correct answers Umbilical
arterial line (UA), arterialized capillary sample (heel stick), and peripheral artery puncture/line
(radial, brachial, temporal, post tibial)
What does placing a UA involve? correct answers It involves placing a catheter in the UA at the
cut end of the umbilical cord (limited to newborns)
the catheter is cut to a predetermined length so the tip is either at the high position of T7- T8 or
in the low position of L3-L4
What is the T7-T8 position? correct answers The high position associated with hypertension
What is the L3-L4 position? correct answers The low position associated with perfusion defects
to the lower extremities
However, this is usually above the bifurcation of the aorta & below the renal arteries
What technique is used for ABG draw from a UA line? correct answers - A sterile syringe is
used to remove dead space fluid & some blood from the UA catheter (Saved and replaced after
the procedure)
- Then, a second sterile heparin coated syringe is used to remove the sample (usually .2-1cc)
-The first syringe is reattached & pulled back to aspirate any air from the sampling port (tap the
syringe to bring air to the top & slowly begin to infuse the dead space fluid & blood back into the
line.
DO NOT let air enter the arterial line
-Roll the sample to mix the heparin with the blood
-Label, and run immediately in ISTAT
What precautions are there to UA sampling? correct answers Transfusion may be needed for
infants who have frequent samples drawn
Remember: a 2,000gm infant only has 200cc's of blood
Accurate records need to be kept of blood volumes withdrawn
What does a UA sample not reflect? correct answers It is postductal so it does not reflect the O2
supplying the eyes and head
So, if you increase the FiO2 in response to low PO2 (caused by a ductal shunt) you may be
increasing the arterial blood supply that affects the head and eyes to a dangerous level
What do you do if a right to left shunt is suspected through a PDA? correct answers A right
radial artery gas should be drawn simultaneously with a UAC sample.
-Compare the two PaO2's
The right radial is preductal & in the presence of a ductal shunt it will reflect a higher O2 tension
than the post ductal UAC sample (15-20mmHg difference)
Complications that can occur with UA lines: correct answers Air embolism or
thromboembolism, hemorrhage, organ necrosis (NEC) due to hypertonic infusion, vasospasm
, What is the difference between an air embolism and a thromboembolism? correct answers An air
embolism is undissolved matter, present in lymphs and blood
A thromboembolism occludes and causes infarcts
How to perform a arterialized capillary stick: correct answers A warm wet cloth is placed on the
site for 3-7 minutes at 45 degrees C ("arterialized")
the heel is cleaned with alcohol and punctured with a lancet, blood should flow freely & is
collected by a capillary tube
DO NOT squeeze the heel ! this will alter the results & may cause damage to the heel
Why is "arterializing" the heel important? correct answers Warming the puncture site serves to
accelerate the blood flow through the peripheral vascular bed & reduces the difference between
the arterial and venous gas pressure
What values are reliable with a capillary blood gas? correct answers Used to measure pH and
PaCO2, with good results
PaO2 DO NOT correlate well with actual arterial blood
Capillary gases should not be used for what? correct answers to monitor oxygen therapy
Advantages to CBG's: correct answers Provides the safest and least invasive technique
Provides the least risk of infection or embolism
Can be repeated frequently
Disadvantages to CBG's: correct answers Not reliable for older infants or children
PO2 may not reflect arterial trends
Crying or pain alters values
Not recommended for patients with decreased peripheral blood flow
What are the possible complications from CBG? correct answers Increased WOB and possible
fatigue, calcified heel nodes (osteochondritis, osteomyelitis), bone spurs for deep punctures,
nerve damage, cellulitis and infection, bruising (from squeezig or milking the foot), infliction of
pain
Osteochondritis: correct answers Cartilage or bone in a joint is inflamed. A joint condition in
which bone underneath the cartilage of a joint dies due to lack of blood flow.
Osteomyelitis: correct answers infection and inflammation of the bone or bone marrow
Bone spur: correct answers A bone spur is an outgrowth of bone that can occur along the edges
of a bone. It is also called an osteophyte.
When and how are peripheral catheters used? correct answers Indicated when a UAC is not
possible
It involves percutaneous puncture of the artery
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