Blood test from artery, have you had this?

[crappypatient]

To check arterial blood gases? I find them really painful and wonder if others do.

Generally I'm not bad with needles and venous blood tests!

@countbackfromten how deep do you infiltrate down. Med reg here and scared I’ll end up giving intra arterial lidocaine! I always thought a superficial bleb would make little difference as going fairly deep.

To posters asking why we don’t always use local anaesthetic if you’re really unwell/weak pulse and have tiny arteries or huge bmi or other reason they’re hard to find then a big blob of local anaesthetic can make it harder. And if you’re a medic or surgeon and not an anaethetist then on the ward you’re unlikely to have access to ultrasound to help you or the training to do so!

I always try and be kind/gentle and feel bad doing them. It’s hard but when people squeal and wriggle it makes it ten times harder for me to get the sample and have it over with. I try to use local when I can as I’ve worked in ICU so I’m more comfortable with it now.

I get these regularly due to having Pulmonary Arterial Hypertension and they need to know my O2 levels.
I would say it all depends on who is taking it .. I have had horrendous attempts where I have passed out to ones who were so good I never felt a thing.
I really depends on the person doing the test .

Another anaesthetist here…medium sized blob of local near the surface and give it a good squish - seems to do the job. Needs a bit of time to work though. A ml of 1% lignocaine would be pretty unlikely to cause any harm though even if it did end up going intravascularly…it’s not unusual to inject that intravenously on purpose on induction of anaesthesia. (Don’t often have to use ultrasound for art lines/gases but always use local in conscious customers. The local means you can have a better dig around too if you don’t hit the spot first pass).

Yes, they’re generally more painful, although I’m used to them now. I have them regularly when I end up in hospital. In my local hospital , it’s very hit and miss as to how it goes. When I’m in the specialist respiratory hospital, it’s much better - they obviously have more opportunities to practice. Some doctors are better than others at it. I do try to be kind and let less experienced doctors have a go, otherwise they don’t get a chance to learn. But it depends how many I’ve already had and how bruised I am as to how many ‘goes’ I can tolerate.

@Medstudent12 even if you did accidentally inject some it won’t be enough to cause a problem! No where near at all a dose that will cause a problem, you definitely won’t be giving 3mg/kg by using a small volume of 1% lidocaine.

Superficial bleb and then continue going down - as deep as you feel is necessary.

I gently massage over the area to give the local some time to work which disperses the bleb and the deeper infiltration somewhat so it isn’t harder to feel. And if I am not confident I use an ultrasound (same as I do for arterial lines if hard to palpate). With the availability of US now it is a skill I think everyone should have - it isn’t difficult to learn and US cannulation makes a real difference!

Yes. I was fifteen and in A&E after having my first seizure. I was in and out of consciousness for hours. I remember coming to and this junior doctor asking if I was alright with needles. Then he took the blood. There was a nice big spurt when he took the needle out and I had a huge bruise for ages. It was awkward and it felt like a lot of pressure but it didn’t hurt as such.

Horrible.

I think from the replies it depends who’s taking it. I had an arterial blood gas test (on my wrist) in A&E and remember the doctor warning it would hurt and apologising, but it was fine, I remember thinking ‘is that it?!’. I hope you have a similar experience to mine.

I’m a doctor - they are far more painful than a cannula or venous blood test

Local should always be used, there’s really no excuse for it outside of an emergency.
We also take them far too often.

Bit more painful than normal bloods

I don’t know if I’m weird but I find local more unpleasant. A skilled dr doing an arterial blood gas isn’t a big deal to me and I’d rather not have local injected. Obviously it should be an option but I wondered if I was weird hating local anaesthetic injections!

I’ve had at least 6 for arterial gases, yes a bit painful but nothing too bad. The most painful was the tight band after an angiogram, my hand went dead!

I’m sorry you have to have these. I’m a nurse and phlebotomist and hate doing gases on conscious patients. Awfully painful, and if there was any other way to get this, we would do it, trust me.