Tips for drawing ABGs

Your question:   i'm a 1st year student and I was wondering if you could give me a few tips on drawing ABG's. I went 0-3 on drawing ABG'sduring clinicals thus far, putting the patients in pain with no results was pretty discouraging for me. Any tips/advice is appreciated, maybe teach me

different techniques that you've heard of if you can, thanks. 

My humble answer:  Okay, I'll give you the same tips someone gave me when I was in your shoes, having missed my first several ABGs.  I'm going to describe a radial artery poke, although drawing from the brachial and femeral arteries is relatively the same.  I give these same tips to every student I have to supervise with their first pokes.  

1. Have your syringe, bandaide, gauze pad and everything you need to use ready before you ever walk into the patients room.  When doing this make sure you set the syringe to 1cc because most new ones fill automatically once you hit the artery.  Also make sure the cap comes off easily.  If not, loosen it slightly.  Label the syringe. Have a rolled up towel ready too.  
2. Walk into the room and say, "Hi, I'm (your name)  from respiratory therapy.  I'm here to draw some blood from you."  Do not give out any further information. Do not say you have never succeeded before.  Do not say "It's going to hurt." Do not say, "It's going to be a big poke."  Do not say anything unless the patient asks a question, and answer it as briefly as you can.  I know this goes against contrary wisdom, but I find it works best this way, especially for students.  Don't say you are a student. If they figure it out, that's fine, but don't jump out and say it.  And don't lie, either.  That comes without saying, though.  Just be pithy in what you say is my point here.  
3. Put on gloves.  Make sure the rubber is very tight over the right pointer finger.  I usually rip off the rubber over this finger so I can feel the artery better, but your student policy may not allow this.  
4. Prepare the skin with betadine and alcohol.  (make sure to ask the patient if he's allergic to betadine.  I think newer studies say skip the betadine, but you have to follow your hospital policy). 
5. Get comfortable (sit, stand, kneel, or whatever) facing the patient.  
6. Feel for a pulse on the radial artery, as 90% of your ABGs will come from this spot.  If the pulse is week feel the pulse on the other hand.  Pick the one that is best.  If you're right handed you may want to choose the right radial artery if possible.  Once you gain confidence it won't matter which side you poke from. 
7. Either on the side of the bed next to the patient, or preferably on a table,  place a towel or pillow under the patient's wrist so that the wrist is cocked and the artery is easily accessible
8. Perform your Allen's Test if appropriate
9. Carefully uncap the syringe.  I'm right handed, so I hold the syringe like a pencil in my right hand and use my left hand to prep the artery
10. Feel the pulse again.  Choose a good spot to poke where the artery is most stable.  I preferably go as close to the fingers as I can because the artery is more stable here.  But use common sense.  
11. Use a two finger technique. Using the middle finger of my left hand, I tighten any loose skin over the groove the radial artery usually sits in.   This is especially important for elderly people who have loose saggy skin.  Of course you don't want to press down too hard as to cut off circulation. And you technically don't want to feel the pulse with this finger if you can help it.  
12. With my pointer finger of my left hand I feel for a pulse.  If the pulse is strong you should feel it easily. If you don't feel it, make sure you're not pressing too hard with your middle finger
13. If possible, arrange the needle so the bevel (opening at the tip of the syringe) is up.  I'm told this make the blood flow more easily into the syringe.  I'm not sure if this is true, yet I don't like to risk it. 
14. Insert the syringe at a 30 degree angle right under your pointer finger (do not go at a 90 degree angle). This was a key tip for me.  I usually get as close to my finger with the tip of the needle as I can over the bounding pulse.  Do not insert the syringe to the right or left of your finger, but right under it where you feel the pulse.  Some people do it other ways, but I find this works great. You should succeed 90% of the time.  Most students I recommend this to succeed their first time. (When you enter the syringe it should be at a 30 degree angle toward the patient, not away from the patient or toward you) 
15. Insert the syringe slowly until you get blood return.  Sometimes the artery is right at the surface and fills right away, sometimes it's deep (especially on overweight folks).  YOU MUST BE PATIENT.  
16. If you don't hit blood right away don't give up. Pull the needle back as far as you can without exiting the skin, and reinsert by aiming the needle to the right or left, wherever you think the pulse is strongest.  Insert the needle very slowly.  If you still don't hit blood, pull back and do the same in the other direction.  I know rules say you can only re-position the needle once, but I think it's okay to do this twice or even three times because you should go right and then left if needed.  However, use common sense. Actually, if you're a student you should follow whatever rules you were taught.  
17. DO NOT MOVE THE SYRINGE OR YOUR FINGERS THAT ARE SUPPORTING THE ARTERY UNTIL THE SYRINGE IS FILLED WITH BLOOD, OR THE FLOW OF BLOOD STOPS.  However, if you get a flash and flow stops, you may try slightly adjusting the tip of the needle a little deeper or out a little.  You may also try lifting up your fingers to see if your pressure was blocking blood flow.  This sometimes helps.  
18. Hold gauze over needle, pull out syringe, hold pressure until bleeding stops.  If person on blood thinner like coumadin you may have to hold up to five minutes.  If in DNC (clotting disorder) you may have to hold longer.  Some hospital policies state you should hold for five minutes, but I don't find this necessary for most people.  Usually 1-2 minutes will suffice.  However, use your better judgement here.  Sometimes other people can hold for you if you're in a hurry.
19. Place the Bandaide right over the balled up gauze.  
20. 13.  If you do not get blood, do not give up or feel discouraged.  Every person misses, and every person even goes into slumps.  So keep trying and you'll eventually be a pro at it.  
21. 14.  Do not place the ABG on ice unless you think it's going to be more than a half hour for it to be run.  I don't care what anyone says, ice dilutes the sample, especially in the newer plastic syringes.  

I'll see if I can find a video on you tube.  I think it would be better to see what I'm describing.  

Anyway, let me know if this helps.

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