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ABG ANALYSIS

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Anika Dahal
Anika Dahal

This document provides information about arterial blood gas (ABG) analysis, including: - ABG analysis measures blood pH, partial pressures of oxygen and carbon dioxide, and calculates bicarbonate levels. It is useful for evaluating respiratory, metabolic and renal function. - The procedure involves puncturing an artery with a needle to draw blood into a syringe. Precautions must be taken to avoid complications and ensure proper sample handling for analysis. - ABG values are interpreted using the Tic-Tac-Toe method to determine if any acid-base imbalances exist and their respiratory or metabolic origin. This allows clinicians to evaluate treatment for critically ill patients.

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ABG ANALYSIS ANIKA DAHAL LECTURER
INTRODUCTION An arterial blood gas measurement provides valuable information about the blood pH and the partial pressures of arterial carbon dioxide (PaCO2) and oxygen (PaO2). Most analysers calculate serum bicarbonate (HCO3 -) and the base excess. Some analysers also measure electrolytes, haemoglobin, glucose, lactate, and other analytes.
Arterial blood gas is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood
The relatively low incidence of major complications, its ability to be performed at bed side, and its rapid analysis make it an important tool to direct and redirect the treatment of the patient esp in patient who are critically ill to determine gas exchange levels in the blood related to respiratory, metabolic and renal function.
DEFINITION It is a procedure to measure the partial pressure of oxygen and carbondioxide (CO2) gases and the pH (Hydrogen ion concentration) in arterial blood.
PURPOSE To evaluate the acid base level in the blood To diagnose and evaluate respiratory disease To assess the integrity of the ventilator control system To evaluate the efficiency of pulmonary gaseous exchange To monitor the respiratory therapy
INDICATION Critically ill or deteriorate unexpectedlyfor example, because of sepsis or multiorgan failure Uncontrolled diabetes mellitus Identification of metabolic, respiratory and acid base disorder
Assessment of the response to therapeutic interventions such as mechanical ventilation in a patient with respiratory failure The significance change in ventilator mode or FiO2 Any sign of respiratory distress After the extubation
CONTRAINDICATION Local infection or distorted anatomy at the potential puncture site Severe coagulopathy Anticoagulation therapy with warfarin, heparin and derivatives
EQUIPMENT Disposable syringe, 2ml with swab. needle no. 22/23 Heparin injection Methylated spirit swab Ice pack
PRECAUTION Syringe should be heparinized before sample is collected; clotting should be avoided The syringe should be free from air both before and after sample is collected For transportation the syringe should be capped, place on ice pack, and immediately sent for the laboratory analysis
ABG ANALYSIS
PROCEDURE 1. Explain the procedure to the patient 2. Take the vital signs Hyperthermia and hypothermia influence 02 release from hemoglobin. 2 . Wash hands 3. Assemble equipments on bed side 4. Put on gloves 5. Assemble needle to syringe a. keep needle sterile b. eject excess heparin and air bubbles, if using syringe with liquid heparin.
6. Palpate the radial ,brachial or femoral artery Select Site Palpate the right and left radials arterial pulse and visualize the course of the artery Pick strongest pulse a. Radial artery is always the first choice and should be used because of it provides collateral circulation - if radial pulse weak on right, move to left - if pulse on left weak, then try brachial Note: If puncturing the radial artery,perform allen test to determine if collateral circulation is present
ALLEN TEST
ALLEN TEST
POSITIVE RESULTS
b. Brachial used as alternative site c. Femoral is the last choice in normal situations 7. For the radial site ,place a small towel roll under the patients wrist
9.The needle is at a 45 to 60 degree angle to the skin surface and is advanced in to the artery . 1o. once the artery is punctured ,arterial pressure will push up the hub of the syringe and a pulsating flow of blood will fill the syringe
ABG ANALYSIS
ABG ANALYSIS
10. After blood is obtained ,withdraw the needle and apply firm pressure over the puncture with a dry sponge 11. Remove air bubbles from syringe and needle use safety syringe system for closure 12. Place the capped syringe in the container of ice
13. Maintain firm pressure on the puncture site for 5 minutes 14. If the patient is on anticoagulant medication ,apply direct pressure over puncture site for 10-15 minute and then apply a firm pressure dressing
POST PUNCTURE
COMPONENTS OF THE ABG Pao2 =The partial pressure of oxygen that is dissolved in arterial blood 80-100 mm Hg. HCO3- = The calculated value of the amount of bicarbonate in the blood 22 26 mmol/L PCO2= The amount of carbon dioxide dissolved in arterial blood 35 45 mmHg pH= Measurement of acidity or alkalinity, based on the hydrogen (H+) 7.35 7.45 SAO2 =The arterial oxygen saturation >95%
NORMAL ARTERIAL AND VENOUS BLOOD GAS VALUES Parameter Arterial Venous pH 7.35-7.45 7.35-7.45 Paco2 35-45mmhg 40-45mmhg Bicarbonate(HCO3) 22-26 mEq/L( MMOL/L) 22-26 mEq pao2 80-100 mmhg 40-50 mmhg Oxygen saturation 96-100% 60-85%
ACID BASE DISORDER Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
DEFINITIONS Metabolic acidosis Metabolic acidosis is a clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen ion or a loss of bicarbonate Metabolic alkalosis Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+
RESPIRATORY ACIDOSIS Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg. It may be either acute or chronic. Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 levels and thus elevated carbonic acid (H2CO3) levels
RESPIRATORY ALKALOSIS Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg. As with respiratory acidosis, acute and chronic conditions can occur. Respiratory alkalosis is always due to hyperventilation, which causes excessive blowing off of CO2 and, hence, a decrease in the plasma carbonic acid concentration.
ABG ANALYSIS
INTERPRETATIONS 1.Blood Ph(7.35-7.45) -high indicates alkalosis -Low indicates acidosis 2.Paco2(35-45mmhg) >45mmhg-respiratory acidosis <45mmhg-respiratory alkalosis
3.Pao2 (80-100 mmhg) The partial pressure of o2 that is dissolved in arterial blood 4.Hco3 (22-26meq/lit) The calculated value of the amount of bicarbonate in the blood stream. 5.Base excess (-2 to +2meq/l) >+3= metabolic alkalosis <-3=metabolic acidosis 6.Sao2(95%-100%)
ABG ANALYSIS
INTERPRETATION BY TIC TAC TOE METHOD
1. Know the normal values Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3.
2. Determine if pH is under acidosis or alkalosis Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to keep pH in balance. pH level below 7.35 is acidosis pH level above 7.45 is alkalosis
ABG ANALYSIS
3. Determine if acid-base is respiratory or metabolic Next thing you need to determine is whether the acid base is Respiratory or Metabolic. paCO2 = Respiratory HCO3 = Metabolic
4. Remember ROME Still, it all boils down to mnemonics. The mnemonic RO-ME. Respiratory Opposite When pH is up, PaCO2 is down = Alkalosis When pH is down, PaCO2 is up = Acidosis Metabolic Equal When pH is up, HCO3 is up = Alkalosis When pH is down, HCO3 is down = Acidosis
5. Tic-Tac-Toe And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do is make a blank chart similar to this:
ABG ANALYSIS
6. Mark the Chart Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample problem: pH: 7.26, paCO2: 32, HCO3: 18 Using the normal values reference chart in the first step, determine where the values should be under in the tic-tac-toe.
In the given example, the solution is as follows: pH of 7.26 is LOW = ACID so place pH under Acid paCO2 of 32 is LOW = BASE so place paCO2 under Base HCO3 of 18 is LOW = ACID so place HCO3 under Acid
ABG ANALYSIS
7. Match it up In this step, determine at which column matches up with the pH. In the given example, HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so this example implies Metabolic Acidosis.
ABG ANALYSIS
8. Determine compensation The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated. Heres the trick:
If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .
By applying the steps above, interpret the following ABGs: pH:7.44, PaCO2: 30, HCO3: 21 pH is NORMAL = NORMAL so place pH under Normal PaCO2 is LOW = BASE so place PaCO2 under Base HCO3 is LOW = ACID so place HCO3 under Acid
*Since the acidity of the blood is determined by the value of the pH, determine whether the normal pH is SLIGHTLY ACIDIC or SLIGHTLY BASIC. In this example, pH is NORMAL but SLIGHTLY BASIC therefore it is ALKALOSIS. In this case PaCO2 goes with pH. PaCO2 is considered Respiratory (shown in step 3), and both are under Basic, so this example implies Respiratory Alkalosis. The HCO3 is also abnormal. When pH is NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates FULL COMPENSATION.
ABG ANALYSIS
THANK YOU

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ABG ANALYSIS

  • 2. INTRODUCTION An arterial blood gas measurement provides valuable information about the blood pH and the partial pressures of arterial carbon dioxide (PaCO2) and oxygen (PaO2). Most analysers calculate serum bicarbonate (HCO3 -) and the base excess. Some analysers also measure electrolytes, haemoglobin, glucose, lactate, and other analytes.
  • 3. Arterial blood gas is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood
  • 4. The relatively low incidence of major complications, its ability to be performed at bed side, and its rapid analysis make it an important tool to direct and redirect the treatment of the patient esp in patient who are critically ill to determine gas exchange levels in the blood related to respiratory, metabolic and renal function.
  • 5. DEFINITION It is a procedure to measure the partial pressure of oxygen and carbondioxide (CO2) gases and the pH (Hydrogen ion concentration) in arterial blood.
  • 6. PURPOSE To evaluate the acid base level in the blood To diagnose and evaluate respiratory disease To assess the integrity of the ventilator control system To evaluate the efficiency of pulmonary gaseous exchange To monitor the respiratory therapy
  • 7. INDICATION Critically ill or deteriorate unexpectedlyfor example, because of sepsis or multiorgan failure Uncontrolled diabetes mellitus Identification of metabolic, respiratory and acid base disorder
  • 8. Assessment of the response to therapeutic interventions such as mechanical ventilation in a patient with respiratory failure The significance change in ventilator mode or FiO2 Any sign of respiratory distress After the extubation
  • 9. CONTRAINDICATION Local infection or distorted anatomy at the potential puncture site Severe coagulopathy Anticoagulation therapy with warfarin, heparin and derivatives
  • 10. EQUIPMENT Disposable syringe, 2ml with swab. needle no. 22/23 Heparin injection Methylated spirit swab Ice pack
  • 11. PRECAUTION Syringe should be heparinized before sample is collected; clotting should be avoided The syringe should be free from air both before and after sample is collected For transportation the syringe should be capped, place on ice pack, and immediately sent for the laboratory analysis
  • 13. PROCEDURE 1. Explain the procedure to the patient 2. Take the vital signs Hyperthermia and hypothermia influence 02 release from hemoglobin. 2 . Wash hands 3. Assemble equipments on bed side 4. Put on gloves 5. Assemble needle to syringe a. keep needle sterile b. eject excess heparin and air bubbles, if using syringe with liquid heparin.
  • 14. 6. Palpate the radial ,brachial or femoral artery Select Site Palpate the right and left radials arterial pulse and visualize the course of the artery Pick strongest pulse a. Radial artery is always the first choice and should be used because of it provides collateral circulation - if radial pulse weak on right, move to left - if pulse on left weak, then try brachial Note: If puncturing the radial artery,perform allen test to determine if collateral circulation is present
  • 18. b. Brachial used as alternative site c. Femoral is the last choice in normal situations 7. For the radial site ,place a small towel roll under the patients wrist
  • 19. 9.The needle is at a 45 to 60 degree angle to the skin surface and is advanced in to the artery . 1o. once the artery is punctured ,arterial pressure will push up the hub of the syringe and a pulsating flow of blood will fill the syringe
  • 22. 10. After blood is obtained ,withdraw the needle and apply firm pressure over the puncture with a dry sponge 11. Remove air bubbles from syringe and needle use safety syringe system for closure 12. Place the capped syringe in the container of ice
  • 23. 13. Maintain firm pressure on the puncture site for 5 minutes 14. If the patient is on anticoagulant medication ,apply direct pressure over puncture site for 10-15 minute and then apply a firm pressure dressing
  • 25. COMPONENTS OF THE ABG Pao2 =The partial pressure of oxygen that is dissolved in arterial blood 80-100 mm Hg. HCO3- = The calculated value of the amount of bicarbonate in the blood 22 26 mmol/L PCO2= The amount of carbon dioxide dissolved in arterial blood 35 45 mmHg pH= Measurement of acidity or alkalinity, based on the hydrogen (H+) 7.35 7.45 SAO2 =The arterial oxygen saturation >95%
  • 26. NORMAL ARTERIAL AND VENOUS BLOOD GAS VALUES Parameter Arterial Venous pH 7.35-7.45 7.35-7.45 Paco2 35-45mmhg 40-45mmhg Bicarbonate(HCO3) 22-26 mEq/L( MMOL/L) 22-26 mEq pao2 80-100 mmhg 40-50 mmhg Oxygen saturation 96-100% 60-85%
  • 27. ACID BASE DISORDER Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
  • 28. DEFINITIONS Metabolic acidosis Metabolic acidosis is a clinical disturbance characterized by a low pH (increased H+ concentration) and a low plasma bicarbonate concentration. It can be produced by a gain of hydrogen ion or a loss of bicarbonate Metabolic alkalosis Metabolic alkalosis is a clinical disturbance characterized by a high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of H+
  • 29. RESPIRATORY ACIDOSIS Respiratory acidosis is a clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 42 mm Hg. It may be either acute or chronic. Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2 levels and thus elevated carbonic acid (H2CO3) levels
  • 30. RESPIRATORY ALKALOSIS Respiratory alkalosis is a clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mm Hg. As with respiratory acidosis, acute and chronic conditions can occur. Respiratory alkalosis is always due to hyperventilation, which causes excessive blowing off of CO2 and, hence, a decrease in the plasma carbonic acid concentration.
  • 32. INTERPRETATIONS 1.Blood Ph(7.35-7.45) -high indicates alkalosis -Low indicates acidosis 2.Paco2(35-45mmhg) >45mmhg-respiratory acidosis <45mmhg-respiratory alkalosis
  • 33. 3.Pao2 (80-100 mmhg) The partial pressure of o2 that is dissolved in arterial blood 4.Hco3 (22-26meq/lit) The calculated value of the amount of bicarbonate in the blood stream. 5.Base excess (-2 to +2meq/l) >+3= metabolic alkalosis <-3=metabolic acidosis 6.Sao2(95%-100%)
  • 36. 1. Know the normal values Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3.
  • 37. 2. Determine if pH is under acidosis or alkalosis Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to keep pH in balance. pH level below 7.35 is acidosis pH level above 7.45 is alkalosis
  • 39. 3. Determine if acid-base is respiratory or metabolic Next thing you need to determine is whether the acid base is Respiratory or Metabolic. paCO2 = Respiratory HCO3 = Metabolic
  • 40. 4. Remember ROME Still, it all boils down to mnemonics. The mnemonic RO-ME. Respiratory Opposite When pH is up, PaCO2 is down = Alkalosis When pH is down, PaCO2 is up = Acidosis Metabolic Equal When pH is up, HCO3 is up = Alkalosis When pH is down, HCO3 is down = Acidosis
  • 41. 5. Tic-Tac-Toe And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do is make a blank chart similar to this:
  • 43. 6. Mark the Chart Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample problem: pH: 7.26, paCO2: 32, HCO3: 18 Using the normal values reference chart in the first step, determine where the values should be under in the tic-tac-toe.
  • 44. In the given example, the solution is as follows: pH of 7.26 is LOW = ACID so place pH under Acid paCO2 of 32 is LOW = BASE so place paCO2 under Base HCO3 of 18 is LOW = ACID so place HCO3 under Acid
  • 46. 7. Match it up In this step, determine at which column matches up with the pH. In the given example, HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so this example implies Metabolic Acidosis.
  • 48. 8. Determine compensation The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated. Heres the trick:
  • 49. If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .
  • 50. By applying the steps above, interpret the following ABGs: pH:7.44, PaCO2: 30, HCO3: 21 pH is NORMAL = NORMAL so place pH under Normal PaCO2 is LOW = BASE so place PaCO2 under Base HCO3 is LOW = ACID so place HCO3 under Acid
  • 51. *Since the acidity of the blood is determined by the value of the pH, determine whether the normal pH is SLIGHTLY ACIDIC or SLIGHTLY BASIC. In this example, pH is NORMAL but SLIGHTLY BASIC therefore it is ALKALOSIS. In this case PaCO2 goes with pH. PaCO2 is considered Respiratory (shown in step 3), and both are under Basic, so this example implies Respiratory Alkalosis. The HCO3 is also abnormal. When pH is NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates FULL COMPENSATION.