LESSON PLAN

ON
“Arterial Blood Gas analysis”

SUBMITTED TO :- SUBMITTED BY :-
Prof. Mrs. Sasmita Das Itismita Biswal
Associate Dean M.SC(Nsg) 1ST YEAR STUDENT
HOD, Medical-Surgical Nursing Obstetrics & Gynaecological Nursing
SUM NURSING COLLEGE,BBSR SUM NURSING COLLEGE,BBSR
SUBMITTED ON:-
Subject – Advance Nursing Practice
Topic – Arterial Blood Gas Analysis
Venue – Nursing Foundation Lab
Group – M Sc. nursing 1st year students
Date –
Time –
Size of the group – 24
Method of teaching – Demonstration & Lecture cum Discussion
Language – English
A.V aids used – Power Point presentation, Chart , Video demonstration, Hand Out
Name of the student teacher – Itismita Biswal
Name of the evaluator – Prof. Mrs. Sasmita Das
General objectives – After the completion of the class, the student will gain knowledge
regarding ABG analysis & it’s interpretation.
DURA SPECIFIC CONTENT TEACHERS LEARNERS A.V AIDS EVALUATIO
TION OBJECTIVES ACTIVITY ACTIVITY N
2 min. i) Introduction to the topic- Explaining Active
Introduction- The test measures the amount of Listening
oxygen and carbon dioxide in the blood is known
as blood gas analysis (ABG) test . It is used to
determine the PH of the blood and used to
determine how acidic or basic it is .

After the class ii) Announcement of the topic-

the students will Today my topic for demonstration is ABG
be able to- analysis .
2 min. 1) Define ABG Middle Part Asking Answering What is the
analysis questions questions meaning of
ABG analysis?
Meaning-
The test which provides a precise measurement
of the oxygen and carbon dioxide level in the
blood .

2 min. 2) List out the Purpose- Explaining Observing Powerpoint

Purpose of ABG  To assess the acid – base balance. with Powerpoint presentation
analysis  To assess the degree of oxygenation in Powerpoint presentation & showing
the blood . presentation understanding Purposes of
 To determine the management of acutely ABG analysis
ill patient.
 To determine the adequacy of alveolar
ventilation .
1.
3 min. 3) Enlist the INDICATION: Explaining Observing Powerpoint What are the
indication of with Powerpoint presentation indication for
ABG analysis.  1. Any respiratory distress/failure (acute or Powerpoint presentation & showing ABG analysis?
chronic) presentation understanding Indication of
 2. Chronic and restrictive Pulmonary disease arterial blood
 3. Any severe illness which could lead to an gas analysis
acidotic state e.g.
 Cardiac failure
 Liver failure
 Renal failure
 Hyperglycaemic state e.g. ketoacidosis
 Multiorgan failure
 Sepsis
 Burns
 Poisons/Toxins
 4. Assessment of response to interventions such
as ventilation
 5. Sleep disorders
 6. Central nervous system dysfunctions
 7. Cardiovascular disorders such as congestive
heart failure, Shunts and intracardiac atrial or
ventricular shunts or both.

3 min. 4) List down the Contraindications- Explaining Observing Hand Out What are the
contraindication with giving Hand out & showing contraindicatio
of ABG analysis Hand Out understanding Contraindicati n for ABG
Absolute contraindication-
on of arterial analysis?
blood gas
 1. Infection/lesion at the site analysis
 2. An abnormal modified Allen test
 3. Presence of Arteriovenous fistulas
  4. Known or suspected severe peripheral
vascular disease of the limb involved.

 Relative Contraindication-
 1. Severe Coagulopathy
 2.Anticoagulant therapy with warfarin, heparin.
 3. Use of thrombolytic agents, such as
streptokinase or tissue plasminogen activator.

3 min. 5) List down the Articles- Explaining Observing Powerpoint What are the
articles required  1 ml or 2 ml disposable syringe. with Powerpoint presentation articles
for ABG analysis  Disposable needle size 20guage Powerpoint presentation & showing required for
 Luer-lock for syringe presentation understanding articles ABG analysis?
 Heparin 1:1000 required for
 Alcohol swab ABG analysis
 Crushed ice in specimen bag
 Disposable gloves
 Arterial catheter for continuous pressure
monitoring
 Water proof pad

3 min. 6) Enemurate Site of arterial puncture- Explaining Observing Power Point What are the
the sites of  Brachial artery with Powerpoint presentation sites used for
arterial puncture  Femoral artery Powerpoint presentation & showing sites arterial
 Radial artery presentation understanding of arterial puncture?
 Ulnar nerve puncture
 Median nerve
3 min. 7) Explain the Client and Environment Preparation: Explaining Observing Power Point How to
Preparation of 1. Explain the procedure to the client thoroughly. with Powerpoint presentation Prepare Client
Client and 2. Place the Client in comfortable position. Powerpoint presentation & showing and
Environment for 3. Before a radial artery puncture is executed or presentation understanding Preparation environment
Procedure a arterial line is inserted, allen test is performed of client and before
to ensure adequate circulation of blood to the environment Procedure?
hand. for Procedure
4. Prepare ice and heparinized syringe.
5. Instruct the client about the arterial puncture,
it is painful.
6. If the client is anxious, hyperventilation may
occur, giving false reading because CO2 is blown
off.
7 min. 8) Describe the Procedure- Explaining Observation Video How you can
procedure NURSING ACTIONS RATIONALE with doing & Active demonstratio draw the
1. Identify the It helps in obtaining demonstarti participation in n showing arterial blood?
patient by asking co – operation of on and discussion Procedure of
name and explain patient. Showing a Arterial Blood
the procedure. Video draw
2. Check the body Demonstrati
temperature. Hypo/hyperthermia on
influences o2 release
in hemoglobin.
3. Heparinize the
2ml syringe and It helps in preventing
then hold it in the clotting of blood
upright position in the syringe.
and expel excess
heparin and air
bubbles.
4. Hand washing and It helps to prevent
 then wear the infections.
gloves.
5. radial, brachial, The arterial puncture
femoral artery is is to be performed in
to be palpated . the areas where
pulsation is good .

6. After selection of Allen test is simple

site, allen’s test is method for assessing
to be performed. circulation at hand.
Impedes arterial
blood flow in the
hand.
a.The patient is asked
to clench and Identify ulnar artery
unclenched first untill alone is capable of
blanching occurs. supplying blood to
the hand while radial
The occluded.
b. The radial and
ulner artery to be Identify radial artery
obliterated alone is capable of
simultaneously at the supplying blood to
wrist. the hand while ulnar
artery is occluded.
C.Elevate patient’s
hand above heart and
sweeze or compress
hand untill blanching
occurs .Lower
patient’s hand while
still compressing the
ulnar artery and
watch for return of
the skin colour.

7. For radial
puncture a small To prevent soiling of
towel is put under linen and allow the
the hand along better control over
with water proof the needle .
pad.

8. The radial artery It allows better

to be palpated for control of needle.
maximum
pulsation with
middle and index
finger.
9. The skin is rubbed It prevents entry of
with alcohol swab micro – organism.
. The arterial pressure
10. The needle is at will cause the syringe
45-60o angle to to be filled within few
the surface of the seconds.
skin and inserted
into artery once
artery is
punctured.The
arterial pressure
 will push up the
piston of syringe
and pulsating flow
of the blood will The significant
fill the syringe. bleeding can occur
11. After the blood is because of arterial
obtained , pressure .
withdrawn needle
and apply firm
pressure over
punctured site
with dry sponge Immediate copping
for 5 minutes . prevents room air
12. Remove air from mixing with
bubbles from blood stream.
syringe and
needle and insert
needle stopper Icing the syringe
placed on the flat prevents false results.
surface. The firm pressure on
13. The capped the punctured site
syringe placed in prevents further
the container of bleeding.
ice.
14. Maintain firm
pressure on
punctured site for
5 minutes .if
patient is on anti ABG analysis to be
coagulant therapy done as soon as
and apply direct possible because PH,
 pressure over Pao2 change rapidly .
punctured site for Hematoma and
10 to 15 minutes. arterial thrombosis
15. Send labeled ice are complicated .
specimen to
laboratory
immediately with
duly filled request.
16. The pulse
palpated ,
punctured site to
be inspected for
decreased
temperature, cold
, numbness,
tingling or
discolouration.

4 min. 9) Explain the Special Consideration- Lecture cum Active listening What are the
Special 1. To protect the client from injury during discussion & take part in special
consideration for diagnostic Procedure. discussion consideration
the Procedure 2. Before radial puncture, the Allen test should to be taken for
be performed to ascertain adequate ulnar the
circulation. procedure?
3. If the critically ill clients have femoral or
arterial catheter system, blood specimen should
drawn from there.
4. Excessive amounts of heparin or an air bubble
in the syringe will cause inaccurate results.
3 min. 10) Student will After care- Lecture cum Active listening What are the
able to modify 1. Immediately after the needle is withdraw, discussion & take part in after care of
their behavior exert pressure on the arterial site for a minimum discussion arterial Blood
with knowledge of 5 minutes. draw?
of after care. 2. If the client is taking anticoagulants, Pressure
on the site should be maintained for for atleast
10 minutes.
3. Wash hand
4. Record the procedure.
5. Send the specimen to intensive care
unit/emergency department where ABG
machine is available, with proper labeling.
6. Report all scientific finding
7. All disposable waste disposed into appropriate
bio-medical waste bin
8. Disinfect all non-disposable equipment used
and store appropriately.
3 min. 11) Describe the Complications- Explaining Observing Powerpoint What are the
complications i) Arterial Occlusion from hematoma formation with Powerpoint presentation complication
or thrombosis. Powerpoint presentation & showing may develop
ii) Bleeding. understanding complication during arterial
iii) Infection. of arterial blood draw?
blood draw
4 min. 12) List down Normal value and abnormal values- Explaining Observing Powerpoint What are the
the normal & (PH)- Normal:7.35 – 7.45 , Acidemia : <7.35, with Powerpoint presentation normal and
abnormal values Alkaemia:>7.45. Powerpoint presentation & showing abnormal
(PaCO2)- Normal:35-45mmHg, Respiratory understanding normal & values of
acidosis:> 45mmHg, Respiratory abnormal blood?
alkalosis:<35mmHg. values of
(HCO3)- Normal:22-26meq/l, Metabolic acidosis: blood
<22meq/l, Metabolic alkalosis:>26meq/l
 (PaO2)-Normal:80-100 mm hg , o2 saturation:96-
100%

4 min 13) List down Abnormal sign indicate certain medical Explaining Observing Chart showing
certain medical condition:- with chart Chart & certain
condition Blood PH HCO3 Paco2 condition understanding
Common causesmedical
Less than Low Low Metabolic abnormalities
Kidney failure, shock,
7.4 acidosis diabetic ketoacidosis
High High Chronic vomiting ,
Greater Metabolic hypokalemia
than 7.4 alkalosis
Lung disease , COPD,
High High Respiratory Pneumonia
acidosis
Less than Breathing to fast , pain,
7.4 anxiety

Greater Low Respiratory

than 7.4 Low alkalosis
3 min. 14)Explain the Strength – Explaining Observing Power Point
methods of Methods of testing the procedure- with Powerpoint presentation
testing the Powerpoint presentation & showing
procedure presentation understanding methods of
testing the
procedure.
Modern, blood-gas analyzer. This device is
capable of reporting pH,PCO2, pO2, SatO2, Na+,
K+, Cl−, Ca2+, Hemoglobin The machine used for
analysis aspirates this blood from the syringe and
measures the PH and partial pressure of oxygen
and carbon dioxide. The bicarbonate
concentration is also calculated. These results
are usually available for interpretation within five
minutes.

Two methods have been used in medicine in the

analysis of blood gas of patients in hypothermia:
pH-stat method and alpha-stat method. Recent
studies suggest that the α-stat method is
superior.

 pH-stat: The pH and other ABG results are

measured at the patient's actual
temperature. The goal is to maintain a pH
of 7.40 and the arterial carbon dioxide
tension (paCO2) at 5.3 kPa (40 mmHg) at
the actual patient temperature. It is
necessary to add CO2 to the oxygenator
to accomplish this goal.
 α-stat (alpha-stat): The pH and other ABG
results are measured at 37 °C, despite the
patient's actual temperature. The goal is
to maintain the arterial carbon dioxide
tension at 5.3 kPa (40mmHg) and the pH
at 7.40 when measured at +37 °C.
 Both the pH-stat and alpha-stat strategies have
theoretical disadvantages. α-stat method is the
method of choice for optimal myocardial
function.

3 min. 15) Enumerate 1. Arterial blood gases are frequently ordered by Explaining Observing Power Point
the recent emergency medicine, intensivist, with Power Powerpoint presentation
changes in ABG anesthesiology and pulmonology physicians, but point presentation & showing
analysis may also be needed in other clinical settings. presentation understanding recent
2. Alcohol swab is recommended before skin changes in
puncture . ABG analysis.
2. The ABL90 Flex is a blood gas analyzer
from Radiometer America Inc, that is designed to
provide laboratory quality blood gas results at
the point-of-care for 17 parameters, including
blood gas, oximetry, and electrolytes.
3. The Stat Profile Prime from Nova Biomedical,
launched globally in 2013, is a blood gas analyzer
designed for critical care testing and is intended
to provide actionable, lab-quality results in 60
seconds.
4. The epoc Blood Analysis System by Alere is a
wireless solution for the testing of electrolytes,
blood gas, and metabolites.
5. The article “Assessing Tissue Oxygenation”
(June 2002:22–40) contains a comprehensive
overview of arterial blood gas analysis, routinely
add an additional step in the analysis of arterial
blood gases to determine if another primary
acid-base process is present.
3 min. 16) Explain the Anatomy – Positioning given according to site of Lecture cum Active listening What are the
scientific arterial Puncture discussion & take part in scientific
principle Physics – The pressure with which blood flows. discussion Principles
involved in this Chemistry – Interpretation of Blood gas values. involved in this
procedure Microbiology – Site cleaning with alcohol swab Procedure?
for maintenance of asepsis.
Psychology- Provide psychological support to
patient.

3 min. 17) Summerizing

the topic End part
i)Summarization Summerizing Active listening
the topic
What is the
importance of
ii)Feedback Asking Answering performing
questions questions allen test
before ABG
analysis?
2 min. 18) Concluding Conclusion- ABG analysis helps the doctor to Concluding Active listening
the topic determine the normal / abnormal functioning of the topic
the lungs and kidney . This ABG analysis helps to
diagnose the critical disease condition

BIBLIOGRAPHY-
1. Clement I, Basic concepts of Nursing Procedure, 2 nd Edition(2013), Jaypee Brothers Medical Publishers (p) Ltd,, Page nos.(281-
283)

2. Jacob Annamma, R Rekha & Tarachand Jadhav Sonali, Clinical Nursing Procedure: The Art of Nursing Practice, 3rd Edition(2015),
Jaypee Brothers Medical Publishers (p) Ltd, Page nos.(369-371)