Effect of palmar warming versus transient ulnar compression on the success rate of arterial puncture in critically ill patients

Abstract

: Background: Difficulty of ABG punctures results in increased workloads and lost time in congested emergency rooms. Palmar warming of radial artery and transient ulnar artery compression are methods generally used to grease radial perforation and drop number of failures at the first attempt of arterial perforation. The aim of the study: was to evaluate the effect of palmar warming versus transient ulnar compression on success rate of arterial puncture in critically ill patients. Materials and Method: Research Design: A quasi experimental design was implemented in this study. Setting: This study was performed at the general ICU of Damanhur Medical Institute. Sample: A convenience sample of 25 critical care nurses and 150 patients were enrolled in this study. Instrument: Two instruments were used to accomplish this study. Tool I: Nurses , characteristics and competence for performing arterial punctures tool. Tool II: Patients' characteristics and success rate of arterial punctures tool. Method: studied patients were divided into two groups: palm warming (group I) and transient ulnar compression group (group II). Patients who were assigned to the palm warming experimental group were inherited an air-activated heat pack to bridle in their hand for palmar warming before arterial puncture for 5-10 minutes. Patients who were assigned to the ulnar compression experimental group were subjected to manual pressure by the nurse's finger at the level of the wrist joint in Guyon's canal as long as the arterial sample was drawn, and the compression did not stop until the completion of the arterial sample. Results: It was found that the mean of arterial puncture trials in palm warming trials was lower than the mean of ulnar compression group with significant difference. The mean number of arterial puncture trials in the palm warming group for the patients whose systolic blood pressure ranged from 110–≥120 was significantly higher than the mean number of arterial puncture trials for the patients whose systolic blood pressure was less than 90. On the other hand, there was a significant negative correlation between the mean number of arterial puncture trials in palm warming groups and both of systolic, diastolic and, mean blood pressure measurement. Conclusion: Using palmar warming is more effective for a successful arterial puncture. There is a need for further study to combine palmar warming and ulnar compression, especially for patients with blood pressure less than 50 mmhg.