What should the phlebotomist do next? 2. What might be affecting the pulse? 3. How might the patient have contributed to the problem? 4. How might the phlebotomist’s technique have contributed to the problem? 5.  Can the phlebotomist be certain that the specimen is arterial?

A phlebotomist has a requisition to collect an ABG specimen from a patient in the cardiac care unit (CCU). The phlebotomist identifies the patient and records the required requisition information. The patient has an IV in the left arm in the area of the wrist, so the phlebotomist chooses the right arm. The patient is having difficulty breathing and appears quite restless and agitated. The phlebotomist performs the modified Allen test. The result is positive. The phlebotomist attempts puncture of the radial artery. The patient moves his arm as the needle is inserted and it misses the artery. The phlebotomist redirects the needle several times and finally hits the artery. The blood pulses into the syringe but is dark reddish-blue in color. The phlebotomist completes the draw, removes the needle, holds pressure over the site, and at same time activates the needle safety device, removes the needle, and caps the syringe, being careful not to introduce air bubbles into it. After holding pressure for 5 minutes, the phlebotomist checks the pulse distal to the site. The pulse is barely discernible.

1.  What should the phlebotomist do next?

2. What might be affecting the pulse?

3. How might the patient have contributed to the problem?

4. How might the phlebotomist’s technique have contributed to the problem?

5.  Can the phlebotomist be certain that the specimen is arterial?