Ivan Zamorano

Acupunture Treatment

ABG Palpation and Targeting Sal Technique 102919

ABG Palpation and Targeting   Sal Technique 102919

Hello I’m Sal Sanders. It will be my pleasure to
demonstrate an alternative technique for palpating and targeting the radial
artery during arterial blood gas sampling. This is very important because
having an arterial puncture procedure done is uncomfortable enough if you
manage to get the sample on the very first attempt and in some cases if you
have difficulty properly palpating and making that initial approach you may
need multiple attempts to get that sample. Most of the procedures for
arterial blood gas punctures will show the palpation being done with two
fingers and the puncture being done just prior to the finger here some will have two fingers to start with
and again the fingers perpendicular to the artery which is running this way
down the arm some will have demonstrated with lifting one finger just prior to
the puncture the technique that I’m going to demonstrate is a slightly
different technique that I call the S.A.L. technique so before we get started with
the model itself I’m just gonna put some tubing with
red colored fluid in here on top of the model so you can kind of get the idea of
what we’re doing with this S.A.L. technique and it would be nice if people’s radial
arteries did lie on top of the skin and you can just see them this easily but
that would take all the fun out of this really so when you’re palpating the
radial artery you’re gonna roll your fingers slightly from side to side again
the finger is single finger technique aligned with the radio artery and you’re
gonna roll your finger from side to side so that you can feel the curvature of
that artery and wherever you feel the pulse to be the strongest align the
center of your fingernail with that pulse point so this should be the center
of the artery and then you’re going to take your needle and aim it towards the
middle of your finger there at the center of your fingernail and make the
puncture just before your finger by aligning it with the center of your
finger you should be able to hit the center of that artery get your needle
into the lumen of that vessel and obtain an adequate arterial sample even if you
should miss by a tiny bit you’ll probably still hit the artery itself and
be able to obtain an adequate sample that’s one of the beauties of making
sure that you’re aligned with the center of the the artery you have a little bit
of room for error so again take your time palpate the artery make sure you
can visualize where you want to stick roll your fingers side to side align the
middle of your finger with the strongest pulse point
and then use that as an aiming point for your needle when you make your initial
puncture and puncture just prior to your finger obtaining an adequate sample
that’s really all there is to it and that stands for single finger aligned
linearly so the finger aligned linearly with the artery the artery running in
this direction the finger being placed here and then slowly rocked the finger
back and forth until you can actually feel the curvature of that artery feel
where the pulse is the highest and this should be the center of the artery and
then once you’ve located that line up the center of your fingernail with that
point where the pulse is strongest which should be the place where the you’re at
the center of the artery and then make your puncture at a 45 degree angle just
before your finger you don’t want to stick your finger during the procedure pretty simple I used to show this
technique to students who were having difficulty getting arterial blood
samples and the technique helped their performance quite a bit but those were
just anecdotal observations on my part so Dr. Colwell and I decided to see what
would happen if we taught people who are just learning this technique from the
start not just the folks who are having difficulty perhaps doing targeting that
artery and hitting it using the traditional techniques so that’s the
purpose of this video and the purpose of the research project that you’re
currently involved in so again traditional techniques would have the
fingers perpendicular to the artery and in this case the the whole feeling of
where that pulse is at least in my opinion is spread out over a much
broader part of the finger whereas with the S.A.L. technique when you’re aligned
linearly with the artery you can palpate right on the tip of your finger there
line it up with the center of your fingernail and it makes it much easier
to go ahead in and hit that artery on the first attempt

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