Blood Gas Analysis

Definition
Blood gas analysis, also called arterial blood gas (ABG) analysis, is a test which measures the amounts of oxygen and carbon dioxide in the blood, as well as the acidity (pH) of the blood.

Purpose
An ABG analysis evaluates how effectively the lungs are delivering oxygen to the blood and how efficiently they are eliminating carbon dioxide from it. The test also indicates how well the lungs and kidneys are interacting to maintain normal blood pH (acid-base balance). Blood gas studies are usually done to assess respiratory disease and other conditions that may affect the lungs, and to manage patients receiving oxygen therapy (respiratory therapy). In addition, the acid-base component of the test provides information on kidney function.

Description
Blood gas analysis is performed on blood from an artery. It measures the partial pressures of oxygen and carbon dioxide in the blood, as well as oxygen content, oxygen saturation, bicarbonate content, and blood pH. Oxygen in the lungs is carried to the tissues through the bloodstream, but only a small amount of this oxygen can actually dissolve in arterial blood. How much dissolves depends on the partial pressure of the oxygen (the pressure that the gas exerts on the walls of the arteries). Therefore, testing the partial pressure of oxygen is actually measuring how much oxygen the lungs are delivering to the blood. Carbon dioxide is released into the blood as a by-product of cell metabolism. The partial carbon dioxide pressure indicates how well the lungs are eliminating this carbon dioxide. The remainder of oxygen that is not dissolved in the blood combines with hemoglobin, a proteiniron compound found in the red blood cells. The oxygen content measurement in an ABG analysis indicates how much oxygen is combined with the hemoglobin. A related value is the oxygen saturation, which compares the amount of oxygen actually combined with hemoglobin to the total amount of oxygen that the hemoglobin is capable of combining with.

Key terms
Acid-base balance The condition that exists when the body's carbonic acidbicarbonate buffer system is in equilibrium, helping to maintain the blood pH at a normal level of 7.35-7.45. Hemoglobin A proteiniron compound in red blood cells that functions primarily in carrying oxygen from the lungs to the tissues of the body. pH A measure of the acidity of a solution. Normal blood pH ranges from 7.35-7.45. Carbon dioxide dissolves more readily in the blood than oxygen does, primarily forming bicarbonate and smaller amounts of carbonic acid. When present in normal amounts, the ratio of carbonic acid to bicarbonate creates an acid-base balance in the blood, helping to keep the pH at a level where the body's cellular functions are most

efficient. The lungs and kidneys both participate in maintaining the carbonic acidbicarbonate balance. The lungs control the carbonic acid level and the kidneys regulate the bicarbonate. If either organ is not functioning properly, an acid-base imbalance can result. Determination of bicarbonate and pH levels, then, aids in diagnosing the cause of abnormal blood gas values. The procedure The blood sample is obtained by arterial puncture (usually in the wrist, although it could be in the groin or arm) or from an arterial line already in place. If a puncture is needed, the skin over the artery is cleaned with an antiseptic. A technician then collects the blood with a small sterile needle attached to a disposable syringe. The patient may feel a brief throbbing or cramping at the site of the puncture. After the blood is drawn, the sample must be transported to the laboratory as soon as possible for analysis.

Preparation
There are no special preparations. Patients have no restrictions on drinking or eating before the test. If the patient is receiving oxygen, the oxygen concentration must remain the same for 20 minutes before the test; if the test is to be taken without oxygen, the gas must be turned off for 20 minutes before the test is taken. The patient should breathe normally during the test.

Aftercare
After the blood has been taken, the technician or the patient applies pressure to the puncture site for 10-15 minutes to stop the bleeding, and then places a dressing over the puncture.The patient should rest quietly while applying the pressure to the puncture site. Health care workers will observe the patient for signs of bleeding or circulation problems

Risks
Risks are very low when the test is done correctly. Risks include bleeding or bruising at the site, or delayed bleeding from the site. Very rarely, there may be a problem with circulation in the puncture area.

Normal results
Normal blood gas values are as follows:

partial pressure of oxygen (PaO2): 75-100 mm Hg partial pressure of carbon dioxide (PaCO2): 35-45 mm Hg oxygen content (O2CT): 15-23% oxygen saturation (SaO2): 94-100% bicarbonate (HCO3): 22-26 mEq/liter pH: 7.35-7.45

Abnormal results

Values that differ from those listed above may indicate respiratory, metabolic, or kidney disease. These results also may be abnormal if the patient has experienced trauma that may affect breathing (especially head and neck injuries). Disorders, such as anemia, that affect the oxygen-carrying capacity of blood, can produce an abnormally low oxygen content value.

Arterial Blood Gases

An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood. As blood passes through your lungs, oxygen moves into the blood while carbon dioxide moves out of the blood into the lungs. An ABG test uses blood drawn from an artery, where the oxygen and carbon dioxide levels can be measured before they enter body tissues. An ABG measures:

Partial pressure of oxygen (PaO2). This measures the pressure of oxygen dissolved in the blood and how well oxygen is able to move from the airspace of the lungs into the blood. Partial pressure of carbon dioxide (PaCO2). This measures how much carbon dioxide is dissolved in the blood and how well carbon dioxide is able to move out of the body. pH. The pH measures hydrogen ions (H+) in blood. The pH of blood is usually between 7.35 and 7.45. A pH of less than 7.0 is called acid and a pH greater than 7.0 is called basic (alkaline). So blood is slightly basic. Bicarbonate (HCO3). Bicarbonate is a chemical (buffer) that keeps the pH of blood from becoming too acidic or too basic. Oxygen content (O2CT) and oxygen saturation (O2Sat) values. O2 content measures the amount of oxygen in the blood. Oxygen saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen (O2).

Blood for an ABG test is taken from an artery. Most other blood tests are done on a sample of blood taken from a vein, after the blood has already passed through the body's tissues where the oxygen is used up and carbon dioxide is produced.

Why It Is Done
An arterial blood gas (ABG) test is done to:

Check for severe breathing problems and lung diseases, such as asthma, cystic fibrosis, or chronic obstructive pulmonary disease (COPD). See how well treatment for lung diseases is working. Find out if you need extra oxygen or help with breathing (mechanical ventilation).

Find out if you are receiving the right amount of oxygen when you are using oxygen in the hospital. Measure the acid-base level in the blood of people who have heart failure, kidney failure, uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose.

Results
An arterial blood gas (ABG) test measures the acidity (pH) and levels of oxygen and carbon dioxide in the blood. Normal The normal values listed here-called a reference range-are just a guide. These ranges vary from lab to lab and depend upon the elevation above sea level. Your lab may have a different range for whats normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab. Results are usually available right away. Arterial blood gases (at sea level and breathing room air) Partial pressure of oxygen (PaO2): Partial pressure of carbon dioxide (PaCO2): pH: Bicarbonate (HCO3): Oxygen content (O2CT): Oxygen saturation (O2Sat): Greater than 80 mm Hg (greater than 10.6 kPa) 35-45 mm Hg (4.6-5.9 kPa) 7.35-7.45 23-30 mEq/L (23-30 mmol/L) 15-22 mL per 100 mL of blood (6.69.7 mmol/L) 95%-100% (0.95-1.00)

The concentration of oxygen being breathed, called the fraction of inhaled oxygen (FiO2), is also usually reported. This is only useful if you are receiving oxygen therapy from a tank or are on a ventilator. Many conditions can change blood gas levels. Your doctor will talk with you about any abnormal results that may be related to your symptoms and past health.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include the following:

You have a fever or an abnormally low body temperature (hypothermia). You have a disease that affects how much oxygen is carried in your blood, such as severe anemia or polycythemia. You smoke just before the test or breathe secondhand smoke, carbon monoxide, or certain paint or varnish removers in closed or poorly ventilated areas.

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