BLOOD GAS ANALYSIS

Hermanto
1608437716
 INTRODUCTION
In the evaluation of the critically ill patient,
the blood gas status plays a key role.

Evaluation of blood gas parameters can be

divided into subgroups of oxygen status,
related metabolic parameters and acid-base
status.

The body maintains normal blood pH (pH =

7.4) to maintain homeostasis
 TYPE OF SAMPLES
Arterial samples
Arterial samples can be collected either by
arterial puncture or by aspiration from an
indwelling arterial catheter. Both methods
have advantages and disadvantages.
Arterial Puncture Arterial Line
Advantage Less risk of bias than Easy to obtain
arterial-line and samples because of
capillaries if performed indwelling line
correctly Not painful to the
Can be carried out in patient
an emergency situation Elimination of risk
No catheter needed associated with
Requires less blood multiple punctures
volume than catheter
sampling
 TYPE OF SAMPLES
Arterial samples
Arterial Puncture
Disdvantage Painful to the patient,
hyperventilation can
potentially change blood
gas values
It can be difficult to locate
arteries
Risk of complications for
the patient, not always
advisable to perform
arterial puncture
User safety risk of
needle stick accidents
Requires
trained/authorized
personnel
Arterial Line
Risk of infection with
invasive catheter
Risk of clotting leading to
thromboses or emboli
Risk of anemia because
too much blood is
removed (typically 5 6
mL per sample including
waste)
Risk of locally diminished
or blocked blood flow
leading to necrosis
Risk of air contamination
from catheter
connections, etc.
Risk of dilution errors if
catheter is flushed
insufficiently
 TYPE OF SAMPLES
Capillary samples
Capillary samples are often used for blood
gas analysis, especially in neonatal and
pediatric intensive care. However, this
method has to be used with caution as
several potential errors exist.
 TYPE OF SAMPLES
V enous samples
Peripheral venous samples are not
recommended for blood gas analysis as they
provide little or no information on the general
status of the patient.
Samples obtained from central venous
catheters can be used to evaluate mixed
venous oxygen status. Misleading results can
however be obtained if the sample is
collected primarily from either the superior or
the inferior vascular beds, or if cardiac left-to-
right shunt on arterial level is present.
 Function of ABG
ABG has several functions:
1. To know the acid base balance.
2. Evaluate ventilation through pH measurements, partial
pressure for oxygen (PaO2), and partial pressure for
carbon dioxide (PaCO2).
3. To know the amount of oxygen delivered by the lungs
through the blood shown by PaO2.
4. To know lung capacity in eliminating carbon dioxide shown
by PaCO2.
5. To know the amount of bicarbonate.
ABG indication

Patient with:
COPD
Pulmonal edema
ARDS
Miocard infarct
Pneumonia
Post op. of coronary artery bypass
Cardiac arrest resuscitation
Arterial target
A. radialis
A. brachialis
A. femoralis
A. tibialis
A.dorsalis pedis
 ARTERIAL OXYGEN STATUS
Based on documented physiology, the parameters
related to the arterial oxygen status can be divided into
three groups: oxygen uptake, oxygen transport, and
oxygen release.
Oxygen uptake in the lungs depends primarily on:
The alveolar oxygen tension, which is primarily
influenced by the ambient pressure, the FO2 (I) and,
though much less, by pCO2(a).
The degree of intra- and extrapulmonary shunting
(FShunt).
The diffusion capacity of the lung tissue.
 STEPS IN ACIDS BASE
CLASSIFICATION

1. pH Classification
2. PaCO2 Classification
3. Metabolic Classification
4. Compensation Evaluation
5. Complete Acid-Base Classification
 pH Classification

Classification pH
Normal 7.35-7.45
Acidosis < 7.35
Alkalosis >7.45
 Classification of Laboratory
Respiratory Acid-Base Component

Classification PaCO2 (mmHg)

Normal Resp.Component 35-45
Respiratory Acidosis >45
Respiratory Alkalosis <35
 Classification of Laboratory
Metabolic Acid-Base Component

Classification BE HCO3
Normal Metab.Component 02 242
Metabolic Acidosis < -2 <22
Metabolic Alkalosis > +2 >26
Steps
Look at the pH normal,
acidosis, alkalosis
Look at the PaCO2 or BE,
find the one as suitable as pH
PaCO2 respiratory as
primary proccess
BE metabolic as primary
proccess
If one component is Primary
proccess look at another
component:
opposite compensated proccess
Same way with pH double proccess
normal yet or no compensated proccess
ACIDOSIS ALKALOSIS
7,35 pH 7,45
45 PaCO2 35
-2 BE +2
22 HCO3 26
 pH : 7.28, PaCO2 : 40, BE : -10

ACIDOSIS ALKALOSIS

7.28 7,35 pH 7,45

45 PaCO
40 2 35
-10 -2 BE +2
22 HCO3 26

Metabolic acidosis without compensated

 pH : 7.32, PaCO2 : 55, BE : +1

ACIDOSIS ALKALOSIS
7.32 7,35 pH 7,45
55 45 PaCO2 35
-2 +1
BE +2
22 HCO3 26

Respiratory acidosis without compensated

 pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;

ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,50
45 PaCO2 35 30
-2 BE +2
22 HCO3 26
Respiratory alkalosis without
compensated
 pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;

ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,55
45 PaCO2 35 30
-2 BE +2 +5
22 HCO3 26

Respiratory and metabolic alkalosis

(double proccess)
Steps in Evaluation and Classification of
Acid-Base Compensation

1. Evaluate for the presence of compensation

2. Determine the probable primary problem
3. Classify the degree of compensation
 Determination of the
primary problem

pH 7.40-7.45 Alkalosis is primary

Acidosis is compensatory

pH 7.35-7.40 Acidosis is primary,

Alkalosis is compensatory
 Classification of degree of
Compensation

pH Degree of compensation
7.35-7.45 Complete
<7.35 Partial
>7.45 Partial
 pH : 7,48 ; PaCO2 : 30 ; BE : -6 ;

ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,48
45 PaCO2 35 30
-6 -2 BE +2
22 HCO3 26
Respiratory alkalosis with partial
compensated
 pH : 7.32, PaCO2 : 30, BE : -10

ACIDOSIS ALKALOSIS
7.32 7,35 pH 7,45
45 PaCO2 35 30
-10 -2 BE +2
22 HCO3 26

Metabolic acidosis with partial

compensated
 pH : 7.38, PaCO2 : 30, BE : -10

ACIDOSIS ALKALOSIS
7,35 7,38
pH 7,45
45 PaCO2 35 30
-10 -2 BE +2
22 HCO3 26

Metabolic acidosis with complete

compensated
 pH : 7,43 ; PaCO2 : 30 ; BE : -6 ;

ACIDOSIS ALKALOSIS
7,35 pH7,43 7,45
45 PaCO2 35 30
-6 -2 BE +2
22 HCO3 26
Respiratory alkalosis with complete
compensated
 Respiratory acidosis:
Acidosis caused by respiratory disorders,
characterized by increased pCO2 or partial
pressure for CO2 in the blood
Cause:
1. Affect to respiratory center directly :
Narcotics, barbiturat, trauma,degenerative tumor, infection
(ensefalitis, meningitis), coma etc

2. A condition that affect to respiratory system:

Lung fibrosis, severe status asmatikus, lung infection

3. Others
Abdomen distention (peritonitis, asites), severe obesity, sleep disorder
 Asidosis metabolik:
Asidosis not caused by respiratory disorders (non-
respiratorik acidosis), is marker by a decrease in
HCO3-

Cause:
1. Production of organic acid excretion Diabetes
Mellitus
2. Disturbed acid secretion (decreases) renal failure,
renal tubular acidosis
3. Excessive HCO3- exhaust Diarrhea
 Alkalosis respiratorik:
Alkalosis caused by respiratory distress, marked by
decreased PcO2

cause:
1. Stimulation center of the breath (not from breath)
Histeri, febris, septikemia, central nevouse system infection,
intracranial surgery, hypoksia, hypertyroidism
2. Lung disease
Pneumonia, Asma, emboli paru, interstitial lung disease,
CHF, respiratory compensation after correction of metabolic
acidosis
3. other
hiperventilation cause respirator
 Alkalosis metabolik:
Alkalosis that is not caused by respiratory disorder
-
(non-
repiratorik alkalosis), marked by increased HCO3 in
plasma
cause:
1. Excessive basa (alkali) distribution: NaHCO3, sitras to
blood tranfusio, antasid
2. Lost HCl stomach and hipovolemia after long vomiting,
after gastric suction, obstruksi pilorik or intestin uper
3. Deficiency Kalium hipoaldosteronisme, sindrom
Cushing
4. Retensi HCO3- In renal
5. Certain long-term diurettic therapy furosemida
6. after laxatives and infusion of fluid no K+
Therapy

ASIDOSIS METABOLIK:
If the pH reamins < 7,2 can be given Natrium
bikarbonat (NaHCO3) dose 1 mEq/kgBB (empiris) or
with BE calculation:
NaHCO3 = BE X 30% X BB
in practice it is usually given a half dose and
controlled by an AGD examination.

ALKALOSIS RESPIRATORIK
if the pH > 7,6 can be given HCl or NH4Cl
Terima Kasih