Have just come out of hospital again and whilst I was in all drs had trouble getting blood gases from me - each gas took 4 or 5 attempts. They kept saying that because I'd had a lot of gases done, that the arteries can become embolised and that is why it is now difficult. Has anybody else been told this? What happens if I continue to need gases done? Am currently being admitted monthly hypoxic and therefore needing regular gases whilst in.
Thanks
Sarah
You can ask them to put in an aterial line this eliminates them having to stab you regualrly. I have one every admission and although its very painful going in its worth it to aviod the reluar needles.
I had a very nice on call anaethitist who once gave me a small bit of local first and this did help alot.
not nice. On my last stay in costa had my gases done 9 times in all. just as was getting rid of bruises they came and gave me more was not impressed especially as they didn't always get it 1st time
After having rather painful experiences with ABGs, canulas etc my needle phobia has got worse.
For some reason obtaining ABGs is very difficult from me, on average it can take 6 doctors from resus and ITU to attempt a sample.Usually when Im in ITU/HDU they put in an arterial line in which is something I again found very painful and guess what lol it took 4 attempts last time. :s So yes usually if you need ABGs taken frequently an Arterial line will be put in.
in my local they only put arterial lines in if ur in hdu or itu not allowed on ward which is a pain as like you my wrists have packed up if not in hdu or itu they use my femoral (SP) artery in my groin area which isnt at all nice very painful ouch! but again ive had arterial lines in my feet cause wrists are rubbish. so as others have said ask for an arterial line if your hosp allows it on ward.
HI
What I cant understand is that if you are a child they ALWAYS use ""magic"" cream dont they?
SO why dont they use it in us adults It would make life so much easier OK so they will still ""dig"" but at least it would ""nicer"" going,Come to think of it I might suggest it next time I go The max amount of times to get it & venflons come to think of it is 20!!
Penny
Hi all,
Most of the time, if you are unwell enough to need a blood gas, it would not be sensible to safely wait the 15 - 20 mins for the 'magic cream' to take effect. In any case, the cream only anaesthetises the skin, and most of the pain from a blood gas comes from the 'digging around' to find the deeper artery, which often means inadvertently hitting the radial nerve (causes pins and needles type pain in your thumb and first finger) or the bone (causes a 'deep' ache that radiates up your arm).
If an anaesthetist is doing the gas (eg in ICU or if you are reviewed by ICU), you could ask them to inject a little local anaesthetic (lignocaine), if you are not allergic. This only takes a minute or so to take effect, and a lot of anaesthetists will do this as a matter of course anyway. It may make the gas slightly more difficult to do, as raising a bubble of anaesthetic under the skin might make the pulse more difficult to feel, but it should numb most of the pain from 'digging around' (although it may not help the nerve or bone pain as much). However, a lot of junior doctors and non-anaesthetists will not have the confidence or experience to use local anaesthetic.
Arterial lines are of course another possibility, although as mentioned most hospitals will only have them in HDU or ICU, as they do require a bit of training on the part of the nursing staff to safely look after them. They are basically a little bit like a very long, bendy cannula, which is put into the artery and then stitched into place. They tend to be quite painful going in, although local anaesthetic is used, but once they are in they avoid the need for constant stabbing. They are associated with a small amount of risk, for example of throwing off clots into your hand - this is small, but obviously has to be taken into account, so the doctors will not do one unless the benefit clearly outweighs the risk.
Do be assured that, however bad your radial arteries (in your wrists) have got, in an emergency they will get that gas somehow. They can use the brachial artery, at the elbow (slightly higher risk of causing significant problems if it clots, as it supplies the whole forearm) or the femoral artery at the top of the leg (less risk of significant clots because it is bigger). A 'femoral stab' is usually described by patients as being *less* painful than a radial one, because the artery is so big and easy to feel that there tends to be no digging around, just a straight in and out. It's not particularly pleasant, though, and it does involve lying at least semi-reclined, which is often difficult in an acute attack.
I usually have a lot of problems with this issue - my radial arteries are badly scarred from too many art lines and don't even have palpable pulses any more (always fun to watch people's faces when they try to take my pulse at the wrist and I don't have one!). They usually go for the brachial or femoral artery for the initial few gases, and the brachial or dorsalis pedis (on the top of the foot) for art lines.
I know it's pretty unpleasant and painful, especially if you have to have a lot of gases. Doctors will not do it unless its necessary, though, and they will not wish to needlessly cause you pain - they will try to minimise it as much as possible. It is worth asking about local anaesthetic. Other than that, not a lot I can suggest, I'm afraid... just one of those things we have to put up with! :-S
Anyway, hope this helps folks to understand some of the issues surrounding gases, and why doctors do it the way they do.
Em H
Thanks EmH
I was worrying about what they would do next if my wrists packed up - I don't have palpable pulses in my right wrist any more. Just one other question, in paediatrics we do fingerprick blood gases, obviously I know the values may be different than with an arterial sample but is this an option in adults?
Capillary blood gases from a fingerprick or the earlobe are often used in adults in out-patients or when 'well' to get a baseline or see how you are doing, but they are not accurate enough to be used in an emergency when you are unwell. Also, if you are very unwell, peripheral circulation will often not be as good, which would further reduce the accuracy and make it difficult to get an adequate sample.
It would be nice, though, wouldn't it?
Em
I miss being a kid now!
Wow! Magic Cream! I can still remember the smell of that stuff!
They lie- Those needles still hurt! 
hehehe
Why do the dr always say 'sharp scratch' before doing ABG or venflon? Surely extreme pain would be a better description and warning. Think my veins and arteries run and hide when hear that phrase.
I have found the femoral one less painful in the past , thought he jokes from the nurses as the Dr applied pressure on the femoral artery often distracted from the previous pain just experienced! LOL!
I don't have ABGs now unless I am confused, out of it of sats are lower than 90% - this is written on my protocol.
Kate
Seahorse - yeah, tis a bit of a silly thing to say, but saying something like ""Sorry, this is going to hurt like h*ll"" is more likely to make a patient run away screaming....!
Ive found the local anaesthetic injection to be painful too! So when they tried to obtain an ABG sample and I was still in pain they thought maybe its just the thought of the ABG which is making it difficult but it was actually stinging cos the local didnt help. :S
to be fair had 2 diff docs do them without me feeling thing on last admission. some task
they say sharp scratch because the men get upset if we say ""little prick"". sorry to lower the tone!
Owl will smile now when hear the phrase 'sharp stratch' will be thinking of little pricks and prehaps take my mind of the pain. If had enough puff would run away screaming however its said. Oh well surpose will just have to grin and put up with them.
A CSW at work did my gases a few weeks ago n he was fab didnt feel a thing and didnt even bruise had I of not seen him actually go in I would of said he just pretended!!! Had em done twice last night n the bloody killed n got HUGE bruise n lump on left wristwhich hurts a lot now!!! I hate em with a passion n so did the patient in nest bed to me twice they had to stop n she said u not bloody doing that gain u can just guess my gases LOL!! Had em doen 6 times on xmas day last year nice xmas present hey!!
I have regular gases too and always try to get them to do capillary ones as we do in paediatrics. They unfortunatly don't give an accurate po2 through. I have a bit of an adversion too them now but a doctor I worked with explained that good doctors always take a long time palpating the pulse before they insert the needle. I have certainly found this the case and its usuallt the most junior doctors but gues thats becaus ethey do more. I've had registras trying 4 or 5 times and fy1's suceeding 1st time. It's the digging around in your wrist that hurts so much.
tAKE CARE
SADWHEEZER
Having performed and received probably approximately the same number of blood gases (well, it feels like that, anyway!), I can say that there are a few ways that they can minimise the pain - palpating very carefully and making very sure where the pulse is helps, as does using a tiny orange needle - it takes longer to get enough blood with an orange needle but it does hurt less. Positioning the patient's arm on a pillow often helps too, especially as they (and I) usually have the salbutamol shakes.
At the end of the day, though, some people on some occasions will just be very difficult to get a gas from, and will need multiple attempts and 'digging around'. This will often be especially the case when someone's had multiple gases before. Doctors do try their best to do minimise the pain, but sometimes it's unavoidable.
Em
Hi there, a sensible (wow) reply too. I find that the local anaesthetic doesnt' help - makes it harder to do. I also don't like them using an orange needle- there is more chance it will clot or they will wiggle back out the artery I find, so I suppose each person is different.
Taking time to find the pulse is really important. I also find it easier to put a pillow under the wrist, and to extend the wrist as much as you can (bend it so that you are almost pushing the artery towards the needle!) - it seems to make it easier to find the artery - I noticed that as a student and always teach the students to do that now. I was amazed to find recently that I hadn't lost the knack - did my first abg in about 2 years and got it first time without the patient even noticing me do it, despite his complaints before hand - I used to be the JHO that the others would ask to do their difficult gases, but I wasn't so good at venflons! Can do them now though.
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