Only very brief notes for potential mistakes. As you can only learn by doing it so we avoid lengthy passages here.
Taking blood from A line
- calculate the volume of blood in advance. Confirm with nurse that blood taking is required now
- aseptic technique
- swab 10 seconds
- bring labels. Beware twins so check name + UB / HN number
- note arterial waveform, bruising over limbs before starting blood taking
- take dead space of 2ml
- recap since you will give back the blood, so ensure hygiene
- take the blood required
- give back blood so they don’t require transfusion so soon
- when giving back anything to the child always aspirate as a habit so you don’t inject bubbles. When aspiration or giving back ensure vertical syringe so air rises to the top
- when flushing, the key is not to do with flushing all of it. The purpose is just to make sure the blood in the line is flushed away. So look at the A line getting cleared as you flush
- rmb to unblock the a line when leaving. Check A line waveform.
- Others
- Don’t three way the wrong way. Make sure blood is entering the A line. So see where it is the blood being drawn or given back.
- take the blood slowly or else also can hemolyse
- when removing gown, do not 爆衫 as germs can spread. Release the knot first
iSTAT machine
- remember to close the lid
- using gravity when filling it to the line (tilt slightly)
- don’t overfill or it will fail
- routinely perform H’stix and then write the result on the iSTAT sheet
CBG
- use the web between the thumb and forefinger to hold the heel
- try not to squeeze when obtaining the blood to prevent hemolysis. Try flexing the ankle instead
- if they cry too much and hyperventilate then CO2, can be falsely low