Reducing pain associated with arterial punctures for blood gas analysis.

Arterial punctures for arterial blood gases (ABGs) analysis are described as the most painful laboratory procedure and are performed without the benefit of pain management. This study originated from one nurse's concern about the level of pain her hospitalized patients endured when she drew their ABGs. A review of the literature found that ABG pain relief has not been studied in hospitalized patients. Therefore, this study explored the question "Can the pain of arterial blood gas draws be reduced through the use of infiltration with a local anesthetic agent?" This study compared the pain scores of 40 hospitalized patients who received either no intervention or one of three analgesic interventions (infiltration of 0.7 ml 1% lidocaine, 0.7 ml buffered 1% lidocaine, or 0.7 ml of bacteriostatic saline at the arterial puncture site). Results showed that, although lidocaine and buffered lidocaine are effective in reducing the pain associated with the arterial puncture, plain lidocaine was the only intervention in which the pain rating score for the overall experience was significantly diminished. This study is limited by partial randomization, small sample size, and patient duress; however, it provides a foundation for further nursing research that explores methods to reduce the pain associated with this very painful procedure. Future studies should be directed at larger, diverse populations, multiple operators, and comparison of interventions to topical analgesics and nonpharmacological measures.

Demonstrating the effectiveness of an online, computer-based learning module for arterial blood gas analysis.

PURPOSE/OBJECTIVES: To determine the effectiveness of a computer-based learning module specific to arterial blood gas (ABG) interpretation. DESIGN: A pretest and posttest design was used to assess staff nurses' ability to interpret ABGs before and after engaging in a computer-based module. SETTING: Two community hospitals in northern Illinois. SAMPLE: Fifty-eight staff nurses completed the online learning module and the pretest and posttest measures. METHODS: Subjects consented to participate and completed a pretest measure of their knowledge of ABG interpretation. Subjects participated in a computer-based learning module on ABG interpretation and then completed a posttest. FINDINGS: Staff nurses' knowledge increased significantly after viewing the computer-based learning module (t = 6.3; P < .001). This improvement was irrespective of experience or department. CONCLUSIONS AND IMPLICATIONS: Computer-based, online learning has emerged as a means of providing continuing education to nurses. Such a teaching strategy helps to overcome barriers pertinent to traditional classroom settings.

Arterial blood gas analysis. 2: compensatory mechanisms.

This is the second of a two-part unit discussing arterial blood gas (ABG) analysis. Part 1 outlined background information on ABG reports and focused on a systematic approach to ABG analysis. This part examines the physiology of the various lines of defence in the body and explores the concept of compensation. A step-by-step guide to interpretation and examples of uncomplicated ABGs are available in the Portfolio Pages for this unit at nursingtimes.net, as well as further practice examples relevant to this part of the unit.

Nurse-led arterial blood gas sampling for patients.

Following the introduction of new guidelines in February 2006, assessments for long-term oxygen therapy are now being undertaken by respiratory nurse specialists. The key skill required is arterial blood gas sampling. This has traditionally been the role of the doctor, however by using an education and training package along with a competency-based assessment, nurses can now perform this extended role. Sarah Dodds and Graham Williamson describe a competency-based education and training programme for nurses to carry out this procedure.

From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery.

Nurses working in perianesthesia care areas use discharge scoring criteria to complete patient assessments and ensure patient readiness for discharge or transfer to the next phase of recovery. However, all discharge criteria have both advantages and disadvantages. Comparative studies on the reliability of the different discharge criteria in use are extremely limited. As the acuity of our aging population increases, as well as the number of annual surgeries performed on an outpatient basis, it is most timely to ensure that we are following evidence-based discharge criteria.

Harmonization of practice among different groups of caregivers: a guideline on arterial blood gas utilization.

Quality improvement programs based on guidelines should change practice and reduce intraindividual and interindividual variations as well as variations between groups of caregivers. We analyzed a quality improvement program in 3 groups of caregivers. The groups modified differently their practice. Less experienced caregivers modified their practice the most, joining the more experienced professionals. This harmonization was achieved only during the last consolidation period. The analysis of practice could identify the quality of the implementation process and the group on which attention should be focused when such a quality improvement program is undertaken.

An audit of the patient's experience of arterial blood gas testing.

Arterial puncture is the most common method used to obtain a sample for the measurement of arterial blood gases (ABGs) and is essential to guide the prescription of long-term oxygen therapy (LTOT) in patients with chronic hypoxic lung disease. However, this procedure is often reported by patients as a painful and unpleasant experience, which to date has not been explored. This audit specifically examines the subjective views of a small group of patients (n = 41) who are receiving LTOT who have experienced repeated ABGs. Results demonstrated that 49% (n = 20) were poorly informed regarding what the procedure involved, almost half the patients 49% (n = 20) recalled pain levels of 5 and above on a visual analogue scale and 66% (n = 27) were totally unaware that the test could make a considerable difference to their treatment. While highlighting the deficits in current practice locally, this audit concludes that the respiratory nurse specialist is in an ideal position to implement changes to improve the patient's experience of chronic disease management.

Interpretation of arterial blood gases: a clinical guide for nurses.

Arterial blood gas analysis has become an essential skill for all healthcare practitioners. It provides important information with regard to adequacy of ventilation, oxygen delivery to the tissues and acid-base balance. Although each patient's clinical presentation will be judged individually, situations that warrant analysis of a blood gas sample include respiratory compromise, post-cardiorespiratory arrest, evaluation of interventions such as oxygen therapy, respiratory support and as a baseline before surgery. This article reviews the different parameters that are measured by various machines, with a focus on basic measurement of arterial blood gases. These include partial pressure of carbon dioxide in arterial blood (PaCO(2)), partial pressure of oxygen in arterial blood (PaO(2)), bicarbonate levels (HC0(3)(-)) in arterial blood and base excess/deficit. The physiology of acid-base balance is reviewed and the causes and presentation of the four acid-base disturbances is described. A systematic method to aid arterial blood interpretation is identified, together with discussion regarding the importance of interpreting PaO(2) readings in relation to the amount of inspired oxygen a patient is receiving (FiO(2)), the practice of temperate correction and the relationship between standardized and actual bicarbonate readings.

Arterial blood gas analysis.

With increasing use of arterial blood gas analysis in various ward and other hospital settings to aid medical diagnosis and management, nurses who can interpret results are often able to initiate earlier interventions and understand the reasons for medical interventions. This article enables nurses to interpret such results.

Evaluating arterial blood gas results.

Previously in this Clinical Update series we examined how the body regulates acids and bases. If information about acid-base balance is to be useful, we need to know how to interpret arterial blood gases (ABGs) so we can intervene rapidly when the body is unable to restore a normal acid-base balance in the face of an overwhelming derangement.

Blood gas analysis: a study of blood loss in intensive care.

This paper describes a quantitative study conducted on an intensive care unit in the north of England. It involved the collection of data from the existing records of 65 patients consecutively sampled from a predetermined date provided that they stayed more than 24 hours and had an arterial line in situ. As patient records were used, ethical approval was not necessary. The objectives of the study were to quantify the mean number of blood gas samples taken per patient and estimate the mean blood loss resulting from this, including discard volume. Limitations include reliance on records and lack of an economic evaluation. The results show that blood loss in this study was greater than that reported elsewhere. Patients who were ventilated for 24 hours or more had a statistically significant greater blood loss when compared to those who were not (P < 0.001). A subgroup of patients undergoing renal replacement therapy had the greatest blood loss (mean 55.18 ml per day). This loss was statistically significant when compared to patients not in acute renal failure (P=0.007). When patients undergoing multiple therapies normally associated with increased sampling were compared to patients not receiving such therapies, there was no statistically significant difference in blood loss. The need to change current nursing practice to reduce iatrogenic anaemia is emphasized.