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Page 2 of 4 Setting
Sampling may be performed by trained health care personnel(6-8) in a
variety of settings including (but not limited to) hospitals, clinics, physician offices, extended care facilities, and the home.
however, because of the need for monitoring the femoral puncture
site for an extended period, femoral punctures should not be performed outside the hospital.
Personnel
Arterial blood sampling should be performed under the direction of a
physician specifically trained in laboratory medicine, pulmonary
medicine, anesthesia, or critical care. A recognized credential MD, DO,
CRTT, RRT, RN, RPFT, CPFT, MT, MLT, RCVT, CPT I, CPT II, or
equivalent is strongly recommended.
Frequency
The frequency with which sampling is repeated should depend on the
clinical status of the patient and the indication for performing the procedure.
NOTE: Repeated puncture of a single site increases the likelihood of hematoma,
scarring, or laceration of the artery. Care should be exercised to use alternate
sites for patients requiring multiple punctures. An indwelling catheter may
be indicated when multiple sampling is anticipated.
Puncture sites
Approved puncture sites include radial, dorsalis pedis, and brachial arteries. The brachial artery will not be used on patients in Children’s Hospital. In the Emergency Department, femoral artery is an approved puncture site. Brachial and femoral arteries should be reserved as a last option. The radial artery on non dominant hand is the ideal site for an arterial puncture for the following reasons:
• It is superficial and easily accessible.
• It is easily compressible with better control of bleeding.
• There is no nerve near by to worry about.
• The collateral arch with ulnar artery minimizes the risk of occlusion.
Anatomical Review
The radial artery runs along the lateral aspect of the volar forearm
deep to the superficial fascia. The artery runs between the styloid
process of the radius and the flexor carpi radialis tendon. The point
of maximum pulsation of the radial artery can usually be palpated just
proximal to the wrist.
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Research 
