A+Acute Medical TakeUK Acute Medicine Clinical Guide
Clinical evidenceNICE · Specialist guidance · UpToDate
Current languageEnglish
Works on Safari and Chrome for macOS and iPhone/iPad, Chrome on Android, and Chrome, Edge or Firefox on Windows. If in-page translation is blocked, Enter automatically opens the compatible translated version. Linked guidance, websites and PDFs follow the selected language where supported. Verify clinical meaning against the English source.

STAND-ALONE BEDSIDE PROCEDURE PATHWAY

Arterial blood gas sampling

Arterial oxygenation, ventilation and acid–base sampling with rapid analysis
Radial arterial blood gas sampling from circulation assessment through compression and prompt analysis
1Assess2Prepare3Sample4Expel air + mix5Compress + analyse

Indications

  • Precise PaO₂/oxygenation assessment or suspected respiratory failure
  • Ventilation decisions in severe acute respiratory or metabolic illness
  • Serial assessment when the result will change immediate management

Stop / escalate

  • Inadequate collateral circulation/local vascular compromise or infection at site
  • AV fistula/graft or limb with vascular restrictions
  • Clinically important bleeding risk requires experienced operator/alternative plan

Illustrated step sequence

1Record FiO₂/device, ventilation settings, temperature and sampling time
2Explain; assess radial artery/collateral circulation per local policy; hand hygiene/PPE
3Use 1% lidocaine 0.5–1 mL SC unless contraindicated; allow effect
4Pre-heparinised syringe, bevel-up arterial puncture; allow spontaneous fill without aspiration
5Expel air, cap, gently mix, label and analyse immediately; firm pressure at least 5 minutes—longer if bleeding risk

Samples / technical essentials

  • pH, PaCO₂, PaO₂ and calculated bicarbonate/base excess
  • Lactate, co-oximetry and electrolytes depend on analyser and clinical question
  • Use VBG when adequate for the question; VBG does not replace arterial PaO₂

Aftercare and complications

  • Check haemostasis, distal perfusion, pain and haematoma
  • Interpret with oxygen delivery, respiratory rate/work, clinical trajectory and previous gas
  • Escalate severe hypoxaemia, rising PaCO₂ with fatigue, marked acidaemia, dangerous electrolytes or rising lactate with shock

Supervised clinician education. Use the current local checklist, competency standard, consent policy, infection-control procedure and escalation route. This pathway does not certify procedural competence.

Other bedside procedures

Lumbar puncture→Abdominal paracentesis→Blood cultures→Chest-drain insertion→Venepuncture→