Term
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Definition
| The presence of pus in the urine, typically from bacterial infection |
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Term
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Definition
| Inflammation of the urinary bladder. |
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Term
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Definition
| inflammation of the nephrons in the kidneys |
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Term
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Definition
| an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis |
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Term
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Definition
| refers to crystals found in the urine when performing a urine test. |
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Term
| Why is a microscopic exam of urine sediment important? |
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Definition
esp for recognizing dzs of the UT
- many abnormalities in a urine sample cannot be detected w/ reagent test strips or tablets but often more specific info may be obtained by observation of the urine sediment
- occas. an aid in dx systemic dz |
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Term
| . What are the best samples for sediment evaluation? |
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Definition
- morning samples
- samples collected after several hrs of water deprivation
- because these samples are more concentrated, the chances of finding formed elements are increased |
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Term
| List the procedure used to prepare the urine sample for sediment examination |
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Definition
1. pour ~ 10ml of the urine sample into a labeled conical centrifuge tube
2. centrifuge the sample for 3 – 6 min at 1000 to 2000 rpm
3. pour off the supernatant leaving ~ 0.5 to 1 ml in the tube
4. resuspend the sediment by flicking the tube with your fingers or gently mixing the sediment and supernatant with a pipette
5. transfer a drop of resuspended sediment near the end of a microscope slide with a transfer pipette and place a coverslip over it.
6. OPTIONAL – add 1 drop of Sedi-stain or new methylene blue to 1 drop of urine sediment on the other end of the microscope slide and place a coverslip over it |
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Term
| . List the steps for examining the urine sediment. |
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Definition
1. subdue the light of the microscope by partially closing the iris diaphragm
2. scan the entire unstained slide for the presence of large formed elements such as casts and clusters of cells
3. examine the entire specimen under the coverslip with the high power (40x) objective to indentify and quantify formed elements. Use the stained sediment as needed to confirm id of formed element
4. examine a minimum of 10 microscopic microscopic fields with the high power lens
5. record results. Report cells and bacteria in numbers/HPF and casts in numbers/LPF. The report can list either the avg # seen in 10 microscope fields or a range representing the lowest and highest # of each element seen in 10 microscope fields |
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Term
| What are 2 common stains used for staining sediment? |
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Definition
| Sedi-stain or new methylene blue |
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Term
| . List the elements seen under 10X objective |
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Definition
| Larger elements such as crystals, casts or aggregates of cells. Entire area under cover slip should be examined because casts tend to migrate toward the edge of the cover slip. Casts/crystals are id’d/reported as the # observed per LPF |
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Term
| List the elements seen under 40X objective |
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Definition
- 40x is needed to id most objects accurately, detect bacteria, and differentiate cell types
- minimum of 10 HPF should be observed
- Epithelial cells, RBCs and WBCs are reported as few, moderate, or many, and their morphologic characteristics (cocci, bacilli)
- Alternatively, elements can be reported as a range seen, Ex: 1 – 4 cells per high power field would indicate that nearly every microscopic field examined had at least one cell and some had as many as 4.
- Bacteria and crystals may also be semi-quantified using a scale of +1 - +4 |
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Term
| What are the different cells that can be seen in urine sediment? |
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Definition
Erythrocytes (RBCs)
Leukocytes (WBCs)
Epithelial cells
Squamous epithelial cells
Transitional Epithelial Cells
Renal Epi cells |
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Term
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Definition
- several diff appearances depending on the urine concentration, pH, and time elapsed between collection and exam
- in a fresh sample – RBCs are small, round, usually smooth edged, somewhat refractile, , and yellow or orange
- may be colorless if their hemoglobin has diffused during standing
- smaller than WBCs
- concentrated urine – RBCs shrink and crenate (ruffled edges, sl darker, may appear granular as a result of membrane irregulari
- dilute or alkaline urine, swell and may lyse
- swollen RBCs have smooth edges and are pale yellow or orange
- lysed RBCs, esp when resulting from marked alkalinity, often dissolve and cannot be found on mic exam.
- Normally, urine sediment contains fewer than 2 to 3 RBCs/HPF |
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Term
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Definition
– larger than erythocytes and smaller than renal epithelial cells
– spherical, can appear as a dull gray or greenish-yellow color
– ID’d in urine sediment by their characteristic granules or by lobulations of the nucleus
– Appearance is due to the fact that most WBCs in urine are neutrophils, which contain a lg # of granules
– Few are found in the urine of animals w/o urinary or genital tract dz.
– Shrink in concentrated urine and swell in dilute urine
– Usually in low #s in urine (0 to 1/hpf)
– More than 2 to 3/hpf indicates an inflammatory process somewhere in the urinary or genital tracts (excessive WBCs in urine is pyuria)
– Pyuria is indicative of an inflammatory or infxs process such as nephritis, pyelonephritis, cystitis, urethritis, or ureteritis
– Urine with increased #s of leukpcytes should be cultured for bacteria even if organisms not observed by microscopic exam |
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Term
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Definition
- a few are considered normal, result of normal sloughing
- marked increase indicates inflammation
- 3 types epi cell found in urine are squamous, transitional, and renal
- differentiation of trans from renal is often difficult. In these cases, reporting the cells as nonsquamous epi cells is ok |
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Term
| Squamous epithelial cells |
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Definition
- derived from distal urethra, vagina, vulva, or prepuce
- occas found in voided samples
- not usually considered significant
- flat, thin cells with homogenous appearance, largest cells found in urine sed
- often straight edges and distinct corners, sometimes curl or fold
- may show small, round nucleus
- not normally found in samples from cysto or cath |
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Term
| Transitional Epithelial Cells |
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Definition
- come from the bladder, ureters, renal pelvis, and proximal urethra
- usually round but may be pear shaped or caudate
- granular, small nucleus, larger than WBCs
- low #s (0 to 1/hpf) may be found in sed due to sloughing of old cells
- increased #s suggest cystitis or pyelonephritis
- also may be seen if cath was used to obtain samples |
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Term
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Definition
- smallest epi cells in urine
- orig in renal tubules, only sl. Larger than WBCs, often confused w/ WBC
- generally round and contain a large nucleus and nongranular or finely granular cytoplasm
- rarely found (o to 1/hpf) |
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Term
| . How are RBCs and WBCs recorded? |
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Definition
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Term
| What are the 3 types of epithelial cells found in urinary sediment? |
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Definition
Squamous
Transitional
renal |
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Term
| Define and describe “crenated RBC” and what causes this |
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Definition
| Multiple small projections evenly spaced over the cell circumference; an artifact from immersion in hypertonic fluid |
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Term
| Is urine from the bladder normally sterile? |
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Definition
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Term
| What are casts composed of? |
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Definition
- cylindrical structures composed mainly of mucoprotein (the Tamm-Horsefall mucoprotein)
- mucoprotein is secreted by epithelial cells lining the loops of Henle, the distal tubules and the collecting ducts
- factors resp for the precipitation of this mucoprotein not fully understood but may relate to concentration and pH of urine in these areas
commonly-held theory is that cellular, granular, and waxy casts represent different stages of degeneration of cells in a cast. The appearance of a cast observed in a urine sediment depends largely upon the length of time it remained in situ in the tubules prior to being shed into the urine, as well as where it forms in the tubules. A cast recognizable as "cellular", for example, was shed shortly after it was formed. A waxy cast, in contrast, was retained longer in the tubular system prior to being released |
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Term
| . Where are casts formed? |
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Definition
| Casts may form in the presence or absence of cells in the tubular lumen. If cells (epithelial cells, WBC) are present as a cast forms, they may adhere to, and subsequently be surrounded by, the fibrillar protein network. |
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Term
| 17. Casts may be dissolved or disrupted by what? |
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Definition
| casts are unstable in urine and are prone to dissolution with time, especially in dilute and/or alkaline urine |
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Term
| How are crystals reported? |
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Definition
| Occasional, moderate or many or as +1 to +4 |
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Term
| What crystals can be found in acidic urine? |
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Definition
Amorphous urates
Bilirubin
Cystine
Leucine
Tyrosine
Uric acid |
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Term
| . What crystals can be found in alkaline urine? |
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Definition
Amorphous phosphate
Calcium carbonate
Triple phosphate |
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Term
| 20. What factors influence the types and numbers of urinary crystals in a given sample? |
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Definition
| Urine pH, concentration and temp, and the solubility of the elements |
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Term
| What are some of the most common laboratory results seen in animals with antifreeze toxicity? |
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Definition
Several findings in the biochemical profile may be associated with ethylene glycol toxicosis, including azotemia, hyperphosphatemia, hyperkalemia, severe hypocalcemia, metabolic acidosis, increased anion gap, isosthenuria, and aciduria with or without glucosuria or proteinuria.
Some of the most common laboratory findings are isosthenuria, metabolic acidosis, and increased anion gap. Metabolic acidosis may occur within three hours of ingestion of the toxin. The toxic metabolites of ethylene glycol, along with lactic acid accumulation, lead to acidosis. Glycolate is the major contributor to the metabolic acidosis |
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Term
| 2. What crystals may be detected in the urine sediment with antifreeze toxicity? |
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Definition
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Term
| How long after ingestion of ethylene glycol are crystals detected in the urine? |
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Definition
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Term
| How do these crystals form? |
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Definition
| Renal tubular damage due to the presence of toxic metabolites of ethylene glycol is primarily responsible for renal failure at this stage of toxicosis.1 The presence of oxalate leads to crystal formation within the renal tubules. Once oxalate is formed by the metabolism of ethylene glycol, it combines with calcium in the blood to form calcium oxalate. As the kidney attempts to filter the newly formed calcium oxalate from the blood, the pH of the renal tubule is decreased thereby causing the precipitation of calcium oxalate crystals.1 The formation of these crystals contributes to renal impairment, but their overall contribution is small. |
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Term
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Definition
| A urolith is a polycrystalline concretion found in the urinary tract, containing primarily inorganic crystalloids and a small amount of organic matrix. Uroliths have an organized and regular pattern of crystal deposition on the organic matrix. Uroliths are also called calculi or stones |
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Term
| What are the 3 primary factors which contribute to urolith formation? |
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Definition
There are 3 primary factors which contribute to urolith formation:
• supersaturation of urine with minerals leading to crystalluria. Urine may be supersaturated with crystals due to increased dietary intake of those crystals, reduced solubility of crystals due to pH, concentrated urine enhancing crystal concentration or congenital abnormalities resulting in the presence of abnormal crystals in the urine
• delayed passage of crystals through the urinary tract. Crystal elimination may be delayed due to adherence of crystals to damaged mucosa, stationary foreign bodies (i.e., suture), sludging in an atonic bladder, or in a urachal diverticulum. A calculus of one mineral type may act as a stationary foreign body upon which minerals of a different type may deposit .
• reduction of normally present inhibitors of crystal growth and aggregation (i.e. citrate, pyrophosphates). |
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Term
| 5. List some of the clinical signs seen in an animal with urolithiasis. |
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Definition
The clinical presentation of an animal with urolithiasis depends upon the location of the uroliths. Uroliths can lodge in the urethra of the male dog, but rarely lodge in the urethra of bitches as the female urethra is shorter and more distensible. Uroliths usually lodge at the two narrowest regions of the male urethra; the caudal aspect of os penis and the point at which the urethra curves around the ischium of the pelvis (called the ischial arch). The urethra is less distensible in these two locations and uroliths will result in partial or total obstruction. Clinical signs associated with urethral obstruction may include:
• frequent attempts to urinate producing small amounts of urine
• straining to urinate (stranguria or dysuria)
• inability to urinate (anuria) if the obstruction is complete
• incontinence. The animal may unconsciously dribble urine past a partial obstruction
• hematuria
• cver-distended urinary bladder
• rupture of the urinary bladder resulting in ascites
• signs of postrenal uremia
Cystic calculi (bladder location) result in signs including:
• dysuria/stranguria
• hematuria
• pollakiuria
• the bladder is small due to the frequent voiding but lack of obstruction
• systemic signs are usually absent
Renal or ureteral calculi may result in the following signs:
• abdominal pain
• hematuria
• hydronephrosis causing renal enlargement may occur if the calculus obstructs urine flow
• systemic signs of anorexia, depression and fever may occur if a UTI accompanies the calculus
Animals with bladder or renal calculi may be asymptomatic. |
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Term
. What are the 2 most common mineral types seen in canine uroliths?
In feline uroliths? |
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Definition
Canine uroliths
- struvite
- calcium oxalate
Feline uroliths
- calcium oxalate
- struvite |
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Term
| What may be seen on a urinalysis performed on a patient suffering from urolithiasis? |
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Definition
- hematuria
- pyuria due to inflammation or infection
- proteinuria from blood or inflammation or infection (secretory/post glomerular proteinuria)
- crystalluria
- bacteria if UTI is present
- isothenuria may be present if concurrent pyelonephritis led to renal dysfunction.
Isosthenuria may also reflect an under lying dz that led to stone formation such as liver dz which may result in urate uroliths and dilute urine |
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Term
| What factors promote development of struvite uroliths? |
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Definition
- alkaline urine
- increased mineral formation
- concentrated urine
- genetic predisposition |
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Term
| What role does a bacterial infection play in the formation of uroliths? |
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Definition
UTI with urease producing bacteria (urease catalyzes the conversion of urea to ammonia) results in alkaline urine and increases the concentration of ammonium ion in urine
Staph, proteus, and ureaplasma are urease producing bacteria. Most, but not all dogs w/ struvite uroliths have a UTI
Experimentally produced urinary tract infxns have resulted in struvite calculi formations in 2 – 8 wks (avg 4.5 wks) |
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Term
| What dog breed is predisposed to development of urate uroliths? |
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Definition
| Dalmations are homozygous for a recessive trait which predisposes them to development f urate calculi. Defect results in impaired ability of mepatocytes to take up uric acid. The hepatocytes are responsible for the conversion of uric acid to allontoin. If the hepatocytes cannot take up uric acid, the concentration of uric acid is increased in the blood. Additionally, Dals have impaired renal proximal tubular absorption of uric acid leading to increased levels of uric acid in urine. It is possible that non-Dalmation dogs which form urate uroliths are also h/z for this trait. |
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Term
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Definition
| It is a disease of the urinary tract that is sometimes related to the buildup of crystals, leading to inflammation of the lining of the urinary bladder and urethra. In many cases there is no crystal buildup, so dietary changes will be unhelpful |
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Term
| What are the causes of FLUTD? |
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Definition
| Diets, UTIs, Feline idiopathic cystitis, (high pH [alkaline] greater chance for struvite crystals, low pH [acidic] calcium oxalate crystals) and many more |
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Term
| What factors predispose a cat to FLUTD? |
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Definition
Middle-aged overweight cats that get little exercise, use an indoor litter box, have restricted access outside and eat a dry diet.
Environmental factors, such as interactions w/ owners, multi-cat households, and changes in routine may also increase risk
In a significant number of cases no cause can be determined. The name of the disease in this case is called idiopathic FLUTD. Idiopathic means that a cause cannot be identified at this time. |
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Term
| List some of the symptoms. |
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Definition
1. Straining to urinate.
2. Frequent and/or prolonged attempts to urinate.
3. Crying out while urinating.
4. Excessive licking of the genital area.
5. Urinating outside the litter box.
6. Blood in the urine. |
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Term
| are some typical results of a urinalysis from a cat with FLUTD? |
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Definition
Blood in urine
No bacteria seen
Typical culture – no growth after 48 hours
MIC – minimum inhibitory concentration – the amt of abx needed to kill a bacteria |
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Term
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Definition
| minimum inhibitory concentration – the amt of abx needed to kill a bacteria |
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Term
| . In animals with crystalluria, what are the 2 most common crystals seen? |
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Definition
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Term
| Steps for drawing an Arterial Blood Gas Sampling |
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Definition
1. “wash” the syringe w/ sodium heparin
2. identify and prep the collection site
3. isolate femoral artery between 2 fingers
4. insert the needle bevel up and direct it into the artery at the appropriate angle to the skin
5. aspirate the sample, and remove the needle from the skin
6. ensure the restrainer holds pressure on the puncture site for 5 min
7. remove air bubbles from the syringe and insert the needle into a cork or rubber stopper
8. place the sample ice if analysis is not run immediately |
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