Background Direct radial artery puncture (DRAP) is considered the gold standard procedure for arterial blood gas (ABG) sampling, but it is associated with significant pain. The current ‘BTS guidelines for oxygen use in adult patients’ recommend using local anaesthesia (LA) for all ABG sampling except in emergency situations. LA can be administered subcutaneously or topically.

Aims

1. To assess the attitudes towards LA for ABG sampling in a population of medical junior doctors (JD).

2. To assess the effectiveness of topical lidocaine cream for ABG sampling by DRAP for respiratory inpatients.

Methods

1. Firstly, we surveyed a population of JD working in our Hospital using an electronic survey platform (Surveymonkey®).

2. Secondly, a group of inpatients requiring ABG sampling were surveyed over two months whereby half received topical LA and half did not. The LA used was Denela® 5% cream (Lidocaine 2.5% + Prilocaine 2.5%) applied 10 to 15 min prior to DRAP. Pain associated with DRAP was assessed using a combination of the Wong-Baker FACES pain rating visual scale¹ and a visual analogue pain scale, both scoring the pain from 1 (“no pain”) to 6 (“worst pain”).

Results

1. 68 JD were contacted and 26 responses were received (shown in Table 1).

2. 56 DRAP were performed for ABG sampling, 50% received topical LA. The median (inter-quartile range) pain score was reduced with LA prior to DRAP (2.0 [1.8] “moderate pain”) compared to performing DRAP without LA (3.0 [4.0] “severe pain”), p < 0.008. The doctors reported insignificant interruption to their ward duties by using topical LA.

Conclusions Currently, LA is not used routinely as part of the ABG sampling by DRAP in our centre. Pain was significantly reduced with the use of LA when performing DRAP.

These data will help inform quality improvement projects designed to implement the usage of LA for ABG sampling using DRAP as per BTS recommendations.

Reference 1 Baker C. Orthopaedic Nursing 1987;6(1):11–2