Background BTS guidance for Emergency Oxygen Use recommends that local anaesthesia should be used for all routine arterial blood gas (ABG) sampling . Intradermal and/or subcutaneous local anaesthetic (LA) via small gauge needle has been shown to reduce pain associated with the procedure by more than half . We aimed to quantify the prevalence of this practise and ascertain potential barriers.
Methods 160 FY1 doctors with at least eight months working experience, from five hospitals in London were given a ten-item anonymised questionnaire to measure practise and opinions regarding local anaesthesia before ABG sampling.
Results All 115 respondents (72% response rate) performed ABG sampling regularly, with 84% doing so at least weekly.
Only 27% of respondents had ever used intradermal and/or subcutaneous LA before ABG sampling, although only 5% did this regularly.
The commonest needles used were 25 gauge (orange) (49%), 28 gauge (insulin needle) (18%), and 23 gauge (blue) (16%).
70% of respondents had never used LA of any kind for ABG sampling. Topical LA use was rare.
14% of respondents had never heard of LA used for ABG sampling; 24% were unfamiliar with how to do it; 14% believed it was potentially dangerous; 34% claimed not to have time, 21% believed that LA would not reduce the overall pain of the procedure (Figure 1).
Allen’s test was usually perfomed by only 25% of doctors before ABG sampling.
Only 30% of respondents believed using LA would lead to less repeated ABG sampling attempts.
93% of respondents had never personally been sampled for an ABG, although 44% would prefer LA to be used on them.
Conclusion The regular use of local anaesthesia before ABG sampling among FY1 doctors is rare. Awareness of the technique is poor, and education is needed. Prominence and promotion in teaching sessions and local guidelines, along with quick access to supplies is likely to help to prevent unnecessary pain in unwell patients.
O’Driscoll, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008; 63 (Suppl VI):vi1–vi73.
Giner J, Casan P, Belda J, et al., Pain during arterial puncture. Chest 1996; 110:1443–5.