Authors: Ibrahim I et al., Acad Emerg Med 2015 Mar 2;
Drawing ABGs with a 29-gauge insulin needle instead of a standard needle is less painful and has fewer complications but results in slightly more hemolysis.
While venous blood gas analysis has replaced arterial blood gas (ABG) analysis for many illnesses treated in the emergency department, arterial samples are still occasionally needed. Standard arterial blood gas kits typically contain 22- to 25-gauge needles. To assess whether smaller needles might decrease the pain of ABG draws, researchers conducted a randomized, controlled crossover trial in 50 healthy adult volunteers. ABGs were drawn from one arm with a standard 23-gauge needle and from the other arm with a smaller 29-gauge insulin needle in random order about 5 minutes apart.
Mean pain scores on a 100-mm visual analog scale (the primary outcome) were lower with insulin needles than standard needles (23 mm vs. 39 mm; mean difference, 15 mm). The rate of postprocedure complications also was lower with insulin needles (0% vs. 24%). Rates of hemolysis (31% vs. 12%) and mean potassium values (4.6 mmol/L vs. 4.2 mmol/L) were higher with insulin needles.
Comment
We rarely need ABG measurements (NEJM JW Emerg Med Dec 21 2005; [e-pub]and Ann Emerg Med 2005; 46:323; NEJM JW Emerg Med Sep 2003 and Acad Emerg Med 2003; 10:836). However, when we do, we should draw them with a smaller insulin needle with the understanding that the potassium level might be inaccurate.
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