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Local Anesthesia
The use of local anesthetic for arterial puncture is not universal. The
proposed reasons for the use of local anesthetic are:
To avoid pain
The concern that the pain induced hyperventilation or apnea could alter
the results of blood gases
This issue was specifically studied and the results indicate that an
unanesthetized arterial puncture does provide an accurate measurement
of resting pH and Pco2.
Hence, the only reason to use local anesthetic is to avoid pain to the
patient. If you are proficient, the first stick can be tried without the
anesthetic. I strongly recommend the use of local anesthetic for
beginners.
The syringe has to be heparinized to prevent clotting. It is important to
have the right amount of heparin in the syringe. Too much or too little can
alter the results.
Necessary equipment:
• Protective eye wear
• Gloves
• Iodine swab
• Alcohol swab
• Two by two gauze
• ABG sampling kit is recommended to preserve the integrity of the
sample
• bag with ice, in which sample will be send to lab
Procedure
Before beginning of a procedure be sure to wash your hands using proper
washing technique and follow universal precautions in this procedure.
We begin the procedure with performing Allen test, to be sure that
collateral circulation is an appropriate. Before beginning the actual
procedure it is a good idea to make sure the patient is seated
comfortably. He should rest his arm on a pillow in front of him, palm
facing up. This position is necessary to perform the procedure and is
the most comfortable for the patient. Try to hyperextend patient’s hand.
NOTE: The artery generally tends to be slippery, especially when it is
elongated by arteriosclerosis. Stretching stabilizes the vessel. Let the patient
rest his arm on a table, with his hand projecting beyond the edge. Dorsiflex
the wrist be gently pressing down on the hand. This maneuver stretches and
stabilizes the vessel.
First, we need to palpate by three fingers radial artery, than, on opposite
site, the ulnar artery, which can’t be palpated, but we have to palpate
area closest to ulnar artery. Than, we should ask patient to make a fist
the tighter he or she can. Now I’m going to occlude both arteries and
than I’m asking patient to release fist, I’m realizing my grasp from
ulnar artery. Normally, within 5 second pale palm turns pink,
showing good collateral circulation. With this patient we have good
blood return and you’re OK to proceed arterial puncture procedure.
Clean area with iodine swab.
NOTE: Cleaning from center to periphery by circular motion.
You should allow area to dry, than you should wipe away iodine with
alcohol swap, again allowing skin to dry and now, you can open
ABG kit, which consist, from 3 parts. First peace is sponge cube to expel
excessive air from syringe. Second, is black cap, to go over syringe to
transport to lab, and last, heparinized syringe with needle attach.
Slightly pull plunger back to be sure, that plunger is not stocked and
blood can flow inside of syringe from pulsating artery.
Remove cap, making sure that you’re seeing bevel. Don’t forget bevel
must be up when inserting facing flow of blood.
NOTE: If you wish to use local anesthesia- draw 2% xylocaine into a syringe.
Infiltrate the skin and the area around the radial artery with this local anesthetic.
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Research 
