A nurse is taking ABG sample through the radial artery. During the procedure, a vein is pricked instead of an artery. What would be the expected and first response of the nursing officer?

Appeared in: NORCET 5 mains

Explanation

Accidentally puncturing a vein causes blood to leak into the surrounding subcutaneous tissue, which is the definition of a hematoma.
The immediate priority in any situation involving active bleeding from a vessel puncture is to achieve hemostasis (stop the bleeding).
Applying firm, direct pressure to the site is the standard and correct first-line intervention to control bleeding and limit the size of the hematoma.

Option B: A venous blood sample is not appropriate for ABG analysis because its gas concentrations (O2, CO2) and pH are different from arterial blood, leading to incorrect diagnosis and treatment.
Option C: This is a subsequent action, not the first response. The immediate priority is to manage the complication at the initial puncture site to ensure patient safety.
Option D: Documentation is crucial but always follows immediate patient care. The principle is to treat the patient first, then document the event and interventions.

Clinical Relevance

Nursing practice connection: Knowing Complications of ABG sampling and immediate nursing management helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to differentiate between an arterial and venous puncture. Arterial blood is bright red and pulsates from the needle hub, while venous blood is dark red and flows steadily.
A large hematoma can cause significant pain and potentially compress adjacent nerves (like the median nerve in the wrist), leading to neurological symptoms. Prompt pressure minimizes this risk.
What if? If the nurse successfully drew arterial blood but the patient is on anticoagulant therapy (e.g., warfarin, heparin), the nurse must apply firm pressure for a longer duration, typically 10-15 minutes, and monitor the site more frequently for any signs of re-bleeding or hematoma formation.

How to Approach the Question

First, identify the core clinical event: an error occurred during a procedure (a vein was punctured instead of an artery).
Next, recognize that the question asks for two things: the expected complication and the first nursing action.
Analyze the immediate consequence of puncturing any blood vessel: bleeding. If blood leaks into tissue, it forms a hematoma.
Prioritize the necessary nursing actions. In any situation involving bleeding, the top priority is to stop it (achieve hemostasis).
Evaluate the options based on this priority. Applying pressure directly addresses the immediate problem of bleeding. Other actions like redrawing the sample or documenting are important but secondary.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 79-81

E6 textbook of Applied Biochemistry and Nutrition & DieteticsHarbans Lal (pp 26-464 of 479) p. 218-220

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