RSPT 1311 EXAM 6 REVIEW QUESTIONS WITH 100% APPROVED ANSWERS, Exams of Medicine

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RSPT 1311 EXAM 6 REVIEW

QUESTIONS WITH 100% APPROVED

ANSWERS

What are the current safety requirements for protection of the therapist during drawing of an arterial blood gas (ABG) sample? •Gloves •Protective eyewear (goggles) What does a positive Allen test indicate? A patent ulnar artery Which artery is most often used for sampling of arterial blood in adults? Radial artery How would you interpret the following ABG findings: pH = 7.50, PaO2 = 60mmHg, PaCO2 = 30mmHg, and HCO3- = 24mEq/L? Acute respiratory alkalosis with mild hypoxemia Which condition is associated with an acute respiratory acidosis? Barbiturate intoxication What is the most probable cause of erratic pulse oximetry readings in a patient admitted after a motor vehicle accident with pale skin and weak pulse? Poor perfusion state Which factors can alter pulse oximetry readings? •Low perfusion states, such as hypovolemic shock •Methemoglobinemia What conditions could be responsible for a patient's P50 being 36mmHg? •Hypercarbia •Acute acidosis In which solution must the reference pH electrode be bathed to function effectively? Saturated potassium chloride What is the most likely cause of progressively increased PCO2 values in Levy- Jennings graphs?

Protein buildup on the electrode Which of the following is not an anion buffer? Organic calcium How often should laboratory instruments used in hospitals for blood sample testing undergo three-point calibrations according to CLIA standards? Daily Define quality control (QC) and quality assurance (QA) in blood gas analysis. Quality control involves analyzing control samples against defined limits and identifying problems, while quality assurance includes assessing the results of these measurements and specifying corrective actions. How would you calculate the patient's actual pAO2 given the measured pAO of 80mmHg at 35 degrees Celsius? 70mmHg What are the consequences of maintaining the temperature of the transcutaneous PO2 (PtcO2) probe at 48 degrees Celsius? Thermal injury Which calculated variable derived from transcutaneous monitoring has been shown to be an early marker of hypoperfusion and mortality? PtcO2/FIO Which test is indicated for detecting carbon monoxide poisoning? CO-oximetry What equipment should be used to measure the inspired O2 concentration accurately? A properly calibrated electrochemical O2 analyzer. What are the most common causes of O2 analyzer malfunction? Low batteries, sensor depletion, and electronic failure. Why are ABG results considered the "gold standard" of gas exchange analysis? ABG results help assess ventilation, acid-base balance, oxygenation, and the O2- carrying capacity of blood. Which artery is preferred for arterial blood sampling in adults, and what test is performed before puncture?

Radial artery; a modified Allen test to confirm collateral circulation. How long should a clinician wait after a change in treatment before sampling arterial blood from critically ill patients? 20 to 30 minutes. How can most pre-analytic blood gas errors be avoided? Ensuring that the sample was obtained anaerobically, properly anticoagulated, and promptly analyzed. What are the advantages and risks associated with indwelling peripheral artery, central venous, and PA catheters for blood sampling? Ready access for blood sampling and continuous pressure monitoring, but with increased risk for infection and thrombosis. What parameters are sometimes used to assess acid-base status in infants and children using capillary blood? Capillary blood pH and PCO2. What are the key competencies required by a clinician to perform blood gas analysis and hemoximetry accurately? Proficiency in procedures, preventive maintenance, troubleshooting, instrument calibration, and quality control. What does a blood gas analyzer measure using three separate electrodes? pH, PCO2, and PO2. How can clinicians ensure accurate blood gas results? Ensuring the sample is free of pre-analytic error and following the manufacturer's recommended analysis protocol. Describe the cycle involved in blood gas analysis quality control. Performance validation, preventive maintenance, automated calibration, calibration verification, internal statistical quality control, external proficiency testing, and thorough recordkeeping. What level of accuracy and precision can portable point-of-care blood gas analyzers achieve? Levels comparable to laboratory-based analyzers. What does transcutaneous blood gas monitoring provide? Continuous noninvasive analysis of gas exchange.

Differentiate between oximetry, hemoximetry, and pulse oximetry. Oximetry measures blood Hb saturations using spectrophotometry; hemoximetry requires an arterial blood sample; pulse oximetry combines spectrophotometry with photoplethysmography for noninvasive measurement of blood Hb saturations. How close are pulse oximetry readings typically to those obtained by hemoximetry? Within +- 2% to 4%. What is capnometry, capnography, and how are they utilized in clinical settings? Capnometry measures CO2 in respiratory gases; capnography displays CO2 levels graphically, which can be used to assess trends in alveolar ventilation, detect esophageal intubation, and assess the effectiveness of resuscitative efforts. Explain the terms "repeatability of results" and "comparing the values with a known value" in the context of blood gas analysis. •Repeatability of results refers to the precision of the measurements, indicating how consistently the same result is obtained when the test is repeated. •Comparing the values with a known value is the process of assessing accuracy, which involves comparing the obtained measurements with a standard or reference value to determine how close they are. What is another term associated with errors of precision? Imprecision Define "systemic error" in the context of blood gas analysis. A trend or abrupt shift in data outside the limits, indicating a consistent deviation from the true value in the same direction. What is the importance of CLIA standards in blood gas analysis? CLIA standards are an important example of quality control, ensuring that laboratory instruments used for blood sample testing adhere to specific quality and accuracy standards. Describe how an electrochemical analyzer converts the number of O molecules (PO2) into a measurable reading. Oxygen molecules cross a membrane and enter an electrolyte solution. A chemical reaction occurs at the cathode (reduction of oxygen) and anode (oxidation of silver), causing current flow between electrodes. The amount of current reflects the quantity of oxygen molecules present. Name the two common types of electrochemical analyzers used.

Galvanic and polarographic analyzers. Explain the differences between galvanic and polarographic analyzers in terms of principle of operation and response time. •Galvanic analyzers use a gold anode and a lead cathode, generating current flow by the reduction of oxygen at the cathode. They operate without a polarizing voltage, resulting in slower response times compared to polarographic analyzers. •Polarographic analyzers utilize a silver anode and a platinum cathode, with current flow generated by a polarizing voltage. They typically offer faster response times due to the applied voltage. Describe the two-step process for calibrating an O2 analyzer. Calibrate oxygen to 100% and confirm to 21% air. What is considered the gold standard of gas exchange analysis, and what does this mean? Arterial Blood Gas (ABG) analysis; it means that ABGs serve as the benchmark against which other methods of gas exchange analysis are measured. List four reasons explaining why the radial artery is the preferred site for ABG sampling. •Near the surface and easy to palpate •Collateral circulation exists •Not close to any large veins •May be less painful Describe the modified Allen test and the definition of a positive result. The modified Allen test involves occluding both the radial and ulnar arteries, having the patient make a fist, then releasing the ulnar artery. A positive result is indicated by adequate collateral circulation, observed as the hand flushing within 10 seconds. Name four alternative sites for ABG sampling if the radial artery is unavailable or has a poor pulse. Brachial, femoral, dorsalis pedis, temporal (infants). How long should you wait after changing the FiO2 before performing an ABG on a patient with healthy lungs? What about a patient with COPD? Patients with healthy lungs reach steady state in 5 minutes. For COPD patients, it may take as long as 20 to 30 minutes. List four things you can do to avoid most preanalytical sampling errors. •Avoid venous admixture •Ensure an anticoagulated sample

•Immediately expel air bubbles •Analyze within 15 minutes or place on ice What precaution should you take when handling any laboratory specimen? Wear gloves, avoid recapping, dispose of sharps properly, and double-bag blood for transport. If you wanted to measure actual hemoglobin saturation, what type of analyzer would be needed? Hemoximeter. What is the range of accuracy for most commercially available pulse oximeters? Typically, (+) or (-) 3-5%. Describe three noninvasive ways you can determine the reliability of a pulse oximeter at the bedside. •Assess perfusion at the monitoring site •Compare pulse oximeter heart rate to the actual rate •Evaluate waveform According to the AARC guidelines, what action should you take to verify the results when pulse oximetry is unreliable or does not confirm suspicions about the patient's clinical state? Obtain an ABG. What are the two most common errors committed during capillary sampling? Failure to warm the skin and squeezing the puncture site. What variables are reliable and unreliable in capillary sampling compared to arterial sampling? pH and PCO2 provide rough estimates, while PO2 is not valuable from a capillary sample. What are the primary advantages and disadvantages of transcutaneous gas monitoring over arterial sampling? •Advantages: Noninvasive and continuous monitoring. •Disadvantages: Poor correlation to gases in some cases (e.g., elderly), not useful in emergencies. When would you choose a pulse oximeter for monitoring an infant's oxygenation status over a transcutaneous monitor?

Pulse oximeters are preferable during short procedures, emergencies, or when immediate results are needed. When would the transcutaneous monitor be preferred over the pulse oximeter? In infants where hyperoxia is a concern, as saturation measured by the pulse oximeter may not be specific enough to monitor PO2. What are the normal values for end-tidal CO2 for healthy individuals, and how do they compare with values for arterial CO2? Approximately 35 to 43 mmHg (5% to 6%), which is approximately 1 to 5 mmHg less than arterial values. An end-tidal CO2 of "0" may indicate a serious problem. Name two life- threatening causes of a "0" value for end-tidal CO2. Cardiac arrest and esophageal intubation. While performing end-tidal CO2 measurements, you notice that the baseline does not return to "0" on inspiration. Interpret this result. Elevated baseline indicates rebreathing CO2, suggesting the presence of dead space in the circuit. While performing end-tidal CO2 measurements, you notice that no real plateau is reached. Give two possible interpretations of this result. Possible interpretations include COPD or ventilatory failure, or shock. What are the three most common causes of O2 analyzer malfunctions? Low batteries, sensor depletion, electronic failure. A respiratory therapist is preparing to perform pulse oximetry. Which of the following would be least beneficial for assessing the accuracy of the device? A. Checking the capillary refill time. B. Assessing skin color and temperature. C. Performing an Allen test on the patient. D. Assessing pulse rate. C. Performing an Allen test on the patient. Which of the following would you perform after obtaining an arterial blood gas sample? A. Remove air bubbles from the sample.

B. Mix the sample by rotating the syringe. C. Maintain site pressure for at least 1 minute. D. Add heparin to the sample. B. Mix the sample by rotating the syringe. A pulse oximeter is being used to monitor a patient who was rescued from a fire. The SpO2 is 90%; however, the patient is unconscious and shows signs of respiratory distress. What additional test should the RT recommend? A. CT scan B. Electrolyte measurement C. Co-oximetry D. Hemoglobin and hematocrit levels C. Co-oximetry A polarographic O2 analyzer fails to calibrate when exposed to 100% O2. The first action the respiratory therapist should take would be to A. Replace the battery. B. Replace the membrane. C. Replace the fuel cell. D. Try another O2 source. A. Replace the battery. An infant is placed on a transcutaneous O2 monitor. The TcPO2 is reading 40 mmHg less than the PaO2 obtained from an arterial sample. Which of the following could cause this problem? A. Improper calibration of the transcutaneous electrode B. Room air contamination of the transcutaneous electrode C. Inadequate heating of the skin at the electrode site D. Inadequate perfusion of the skin at the electrode site D. Inadequate perfusion of the skin at the electrode site Which of the following analyzers is calibrated to a value of zero when exposed to room air? A. Clark electrode

B. Galvanic O2 analyzer C. Capnometer D. Geisler type of nitrogen analyzer C. Capnometer Which of the following would be most useful in assessing proper tube placement following endotracheal intubation? A. Transcutaneous monitoring B. Arterial blood gas analysis C. Pulse oximetry D. End-tidal CO2 monitoring D. End-tidal CO2 monitoring Complications of arterial puncture include all of the following except A. Pulmonary embolus B. Hematoma C. Infection D. Nerve damage A. Pulmonary embolus A galvanic O2 analyzer is being used as a check of the ventilator system to measure the delivered FiO2. The set FiO2 is 40%; however, the analyzer is reading 32%. Which of the following is the most likely cause of this discrepancy? A. The batteries in the analyzer need to be changed B. The electrode membrane has water condensation on its surface C. The analyzer needs to be calibrated D. The ventilator requires servicing B. The electrode membrane has water condensation on its surface Which of the following will affect the accuracy of pulse oximeter measurements (Select all that apply? A. Increased bilirubin levels

B. Decreased hematocrit levels C. Dark skin pigmentation D. Exposure to sunlight D. B (Decreased hematocrit levels), C (Dark skin pigmentation), and D (Exposure to sunlight) only An arterial blood gas sample is drawn from a patient who is breathing room air. Analysis reveals the following results: pH 7. PaCO2 35 mmHg PaO2 155 mmHg Which of the following best explains the results? A. Too much heparin was added to the sample B. An air bubble has contaminated the sample C. Analysis of the sample was delayed for more than 60 minutes D. The patient was hyperventilating during the puncture B. An air bubble has contaminated the sample Which of the following sites would be the best for continuous monitoring of exhaled carbon dioxide during mechanical ventilation? A. Exhalation valve B. Inspiratory side of the ventilator circuit C. Expiratory side of the ventilator circuit D. Endotracheal tube connector D. Endotracheal tube connector Which of the following is true concerning the use of a transcutaneous PO monitor? A. TcPO2 should be checked with arterial blood samples B. The skin temperature control should be maintained at 37 C C. The site should be changed every 24 hrs D. The low calibration point is determined using room air

A. TcPO2 should be checked with arterial blood samples How would you modify your technique if you had to perform ABGs on a patient receiving anticoagulants? You should hold the site longer, up to 20 minutes, and consider the use of a pressure dressing. Additionally, you should assess whether ABG is absolutely necessary or if a noninvasive method would work. Why can you use a capnometer during CPR but not a pulse oximeter? During CPR, capnometry can be used as it measures the exhaled CO2, indicating perfusion through the lungs during compressions. However, pulse oximetry requires perfusion, so it may be unreliable during CPR when there's poor blood pressure and circulation. What does blood gas analysis involve? •Blood gas analysis involves the assessment of arterial and mixed venous blood to evaluate oxygenation, ventilatory, and acid-base status. •Key variables measured include PaCO2, PaO2, pH, total hemoglobin concentration, oxyhemoglobin saturation, and dyshemoglobin saturations. Where can blood gas analysis be performed? Blood gas analysis can be performed in various settings, including hospital laboratories, emergency departments, clinics, physician's offices, operating rooms, and cardiac catheterization laboratories. What are the indications for blood gas analysis? •Indications for blood gas analysis include evaluating ventilatory, acid-base, and oxygenation status. •It is also used to assess response to therapeutic interventions, monitor disease severity and progression, and evaluate circulatory response. What are the contraindications for blood gas analysis? Contraindications include improperly functioning blood gas analyzers, improperly anticoagulated specimens, specimens with visible air bubbles, and inadequately labeled specimens. What are the possible hazards or complications associated with blood gas analysis? Possible hazards include infection transmission, inappropriate medical treatments based on incorrect results, cross-contamination, and patient misidentification. What are the limitations of blood gas analysis? •Technique limitations may lead to erroneous results, including sample clotting, contamination, and sample deterioration.

•Validation of results depends on adherence to established guidelines, quality control, and proficiency testing. How should the quality of blood gas tests and the validity of results be assessed? Quality assurance programs should ensure standardized procedures, personnel competency, documentation of results, and proper interpretation by qualified medical professionals. What resources are recommended for performing blood gas analysis? Recommended resources include automated or semi-automated pH-blood gas analyzers, spectrophotometers, protective gear, and quality control materials. What recommendations are made for blood gas analysis? •Recommendations include using blood gas analysis for evaluating ventilatory, acid- base, and oxygenation status, monitoring disease progression, and assessing the impact of dyshemoglobins. •Peripheral venous PO2 is not recommended as a substitute for arterial blood measurement, and venous PCO2 and pH should not substitute for arterial measurements. What are some common governing bodies for laboratories? •CAP (College of American Pathologists) •CLIA ' •Joint Commission of Accreditation of Healthcare Organizations (JCAHO) What federal regulations stipulate the requirements for laboratory personnel? Federal regulations outline requirements for laboratory personnel regarding levels of education and training. What are some general rules for labs regarding conduct? •No chewing gum •No eating •No putting on makeup •No contact with eyes (putting on contacts) What are some common terms used in quality control in laboratories? •Calibration •Two-point calibration •One-point calibration •Drift •Calibration verification •Statistical quality control •Mean •Standard deviation

•Coefficient of variation (CV) •Control charts •Point-of-care testing •Analytical errors •Pre-analytical errors •Post-analytical errors •Precision •Accuracy •Proficiency testing •Interinstrumental comparison •Tonometer •Reportable range What are the phases involved in the sampling of blood? Blood sampling involves three phases: •Pre-analytical phase •Analytical phase •Post-analytical phase What does the pre-analytical phase of blood sampling entail? •It involves blood collection and handling procedures prior to sample analysis. •Common errors include air contamination, venous admixture, excess anticoagulant, and continued blood metabolism, which can result in incorrect therapeutic decisions. What are some pre-analytic errors associated with arterial blood sampling? •Air contamination •Venous admixture •Excessive anticoagulant •Continued metabolism What effects do air contamination, venous admixture, excessive anticoagulant, and continued metabolism have on blood gas analysis? •Air contamination: Decreases PCO2, increases pH, increases PO •Venous admixture: Increases PCO2, raises pH, decreases PO •Excessive anticoagulant: Decreases PCO2, decreases pH, increases PO •Continued metabolism: Increases PCO2, decreases pH, decreases PO How can you recognize and avoid pre-analytic errors in arterial blood sampling? •Recognition and avoidance of pre-analytic errors:

• Recognize air contamination by visible bubbles and inconsistent results; avoid by expelling bubbles and sealing tubes quickly.

• Recognize venous admixture by lack of pulsations and inconsistent results; avoid by not aspirating, avoiding specific sites, and using appropriate needles.
• Recognize excessive anticoagulant by leftover liquid heparin and inconsistent results; avoid by ejecting excess heparin, using dry heparin, and collecting appropriate volumes.
• Recognize continued metabolism by time lag and inconsistent results; avoid by analyzing quickly and adhering to time limits. What should be done if there's a suspected delay in the analysis of arterial blood for more than 15 minutes? •Use a glass syringe and place the sample on ice to maintain accuracy. •If a plastic syringe was used and the delay exceeds 15 minutes, the sample should still be placed on ice. Plastic is permeable to O2 and CO2, leading to potentially higher values than the actual patient's. How can pre-analytical problems be avoided when collecting arterial blood? •Verify the patient's FiO2 and wait 20-30 minutes if there's been a recent change in ventilation. •Ensure the patient's armband is correctly verified. •Evacuate air bubbles from the sample before analysis. •Avoid excessive heparin use, especially if the sample will be used for electrolyte analysis; lithium heparin is preferred over sodium heparin. What are the key components of the analytical phase in blood gas analysis? •Analyzer calibration and calibration verification. •Actual sample testing. •Interpretation of results. •Quality control and proficiency testing. How can clots in samples be avoided during the analytical phase? Use a "clot catcher" to prevent aspiration of clots into the analyzer. What steps should be taken to ensure proper specimen labeling during the analytical phase? •Confirming device, flow or FiO2, and ventilation settings. •Including patient data such as heart rate, respiratory rate, and SpO2. •Clearly indicating the site of arterial puncture or arterial line draw. What should be done if the analyzer is calibrating when a sample needs to be analyzed? Do not interrupt the calibration process; wait a few minutes until it is finished. How is hyperthermia or hypothermia of the patient addressed during blood gas analysis?

Input the patient's temperature into the analyzer to ensure accuracy. What distinguishes a point-of-care analyzer from a central lab analyzer? •Point-of-care analyzers are portable and allow bedside testing. •They use cartridges for calibration and analysis, with small sample volumes and immediate results. What values can be directly measured by the electrodes in blood gas analyzers? •pH (acid/base balance). •PCO2 (pressure of carbon dioxide). •PO2 (pressure of oxygen). What is proficiency testing, and why is it required? •Proficiency testing involves analyzing specimens of unknown values from an external source, ensuring accuracy in laboratory testing. •It is mandated by the Clinical Laboratory Amendments of 1988 (CLIA'88) and performed a minimum of three times a year. How is calibration verified in blood gas analyzers? •Calibration verification is conducted using control media with a range of three different levels. •It must be performed at least every 24 hours, after any maintenance, or if the analyzer's accuracy is in question. What corrective actions should be taken for random and bias errors in analyzers? •For random errors, reanalyze the control sample after performing a two-point calibration. •For bias errors, troubleshoot the contributing factors and continue corrective actions until an acceptable calibration is achieved. What are the main components involved in calibration of blood gas analyzers? •Calibration involves adjusting the offset (zeroing) and gain (slope) of the analyzer. •It can be performed as either a one-point or two-point calibration. How are reports handled during the post-analytical phase? •Reports must be placed in the patient's chart. •If values are outside normal limits (panic values), they must be reported to the attending physician and nurse, with an additional person notified. •If a sample value exceeds the machine's calibration range, report the highest calibrated value. What are the methods of obtaining arterial blood gases (ABG)?

•Puncture •Arterial Line •Capillary Why is ABG analysis recommended for assessing oxygenation, ventilation, and acid-base balance? •To evaluate ventilation (PaCO2) •To evaluate oxygenation (PaO2) •To evaluate acid-base balance (pH, PaCO2, and HCO3) •To assess response to therapy •To monitor severity and progression of a documented disease What are the clinical indications for ABG analysis? •Sudden, unexplained dyspnea •Cyanosis •Abnormal breath sounds •Severe unexplained tachypnea •Heavy use of accessory muscles •Changes in ventilatory settings •CPR •Diffuse infiltrates on CXR What are the potential complications of arterial blood gas sampling? •Hematoma •Loss of limb •Infection •Bleeding •Thrombosis •Pain •Peripheral nerve damage •Arteriospasms •Air or clot emboli •Trauma to vessel •Arterial occlusion •Vasovagal response •Anxiety When should arterial puncture be avoided? •Negative Allen's test •Lesion at the puncture site •Arm with a dialysis shunt •Arm with removed lymph nodes •Evidence of infection What precautions should be taken during arterial puncture?

•Use authorized needle capping device •Do not remove the capping device •Use a single-handed scoop method for capping What is the purpose of Allen's Test in arterial puncture? •To check for collateral circulation •Positive test indicates adequate collateral circulation What equipment and supplies are needed for ABG sampling? •Standard precautions barrier protection •Anticoagulant •Syringe and needle •Local anesthetic •Isopropyl alcohol or povidone-iodine swabs •Sterile gauze squares, tape, bandages •Puncture-resistant container •Ice slush (if needed) What steps should be taken prior to arterial puncture? •Confirm patient's condition and medical history •Gather necessary equipment •Wash hands and don barrier protection •Explain the procedure to the patient What is the procedure for arterial puncture? •Perform Allen's test •Position patient's wrist •Cleanse the puncture site •Inject local anesthetic •Heparinize the syringe •Insert the needle and collect blood •Apply pressure and bandage the site •Expel air bubbles and cap the syringe •Mix the sample and transport it How can you confirm if a good arterial blood sample has been obtained? •Pulsatile flow into the syringe •Bright red blood observed •Presence of a "flash" upon needle insertion, indicating arterial puncture What are capillary blood gas samples used for? •Capillary samples are used in neonates or infants instead of arterial punctures. •They are useful in assessing pH and PaCO2 but not reliable for assessing PO2. When should capillary blood gas sampling not be performed?

•Capillary sampling should not be performed when an accurate assessment of oxygenation is needed. •It's not recommended for neonates less than 24 hours old, or in certain areas like the posterior curvature of the heel, fingers of neonates, inflamed, swollen, or edematous tissues, among others. What are the indications for capillary blood gas sampling? •When arterial access is unavailable but an arterial blood gas analysis is needed. •When less invasive methods would not provide accurate readings. •To assess a patient following a change in therapy or change in status, or to monitor the severity and progression of a disease. What complications can arise from capillary blood gas sampling? Complications may include osteomyelitis, infection, burns, hematoma, nerve damage, bruising, scarring, tibial artery laceration, pain, bleeding, and inappropriate management due to relying on capillary PO2 values. What is the procedure for obtaining a capillary blood gas sample? •Gather equipment including a heel warmer, alcohol, lancet, heparinized capillary tube, sterile gauze, 'flea' and magnet, and end caps. •Select a highly vascularized area with good perfusion, warm the site with a heel warmer, clean the site, puncture the heel, allow blood to flow into the capillary tube without squeezing, cap both ends of the tube if icing the sample is necessary, and follow the procedure for analysis. What is arterial cannulation, and when is it indicated? •Arterial cannulation involves inserting a catheter into an artery for blood gas and pressure monitoring purposes. •It is indicated when continuous blood pressure monitoring or frequent blood draws are needed over several days. What are the complications associated with arterial lines? •Hemorrhage •Severe vascular occlusion •Clot formation •Gangrene •Infection (risk increases if the catheter is in place for more than 4 days) •Loss of limb How do you correct damped pressure tracings in arterial lines? Check for occlusion of the catheter, catheter tip resting against the vessel wall, clot in the transducer or stopcock, or air bubbles in the line. Correct the issue accordingly. What causes abnormally high or low readings in arterial lines, and how can they be addressed?

Improper calibration or transducer position can cause these readings. Adjust the transducer position so that it is level with the patient's heart. What is the purpose of the Allen test in arterial cannulation? The Allen test assesses collateral circulation, particularly in the radial artery, to ensure adequate blood flow before arterial cannulation. What is a stopcock, and how is it used in arterial line sampling? A stopcock is a valve used to turn on or off different ports. In arterial line sampling, it is positioned to control the flow of blood into the syringe for sampling or flushing. What should be assessed daily in patients with arterial lines, and when should the catheter be removed? Daily assessment should include checking the catheter site for inflammation, assessing distal extremities for ischemia, and limiting cannulation to 4-5 days at one site. The catheter should be removed for distal ischemia, local infection, persistently damped pressure tracing, or difficulty with blood withdrawal. What is the procedure for arterial line sampling using a three-way stopcock? First, ensure adequate flush is present in the bag, then draw and discard blood to clear the sample line. Withdraw the required blood sample, then clear the lines again. Finally, verify that the pressure tracing returns to its previous state.