Documenti di Didattica
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Documenti di Cultura
Sept, 2010
Definition
Arterial Blood Gas (ABG) Analysis, is a test which
measures the amounts of oxygen and carbon dioxide,
as well as the acidity (pH) of the blood.
is an essential part of diagnosing and managing a
patient’s oxygenation status and acid-base balance
Some analysis machines give more results e.g. Na, K,
Cl, etc (not provided by Prodia, but from Sanglah)
Indication
Respiratory failure (in acute and chronic sate)
Any severe illness which may lead to a metabolic
acidosis e.g. Cardiac failure, liver failure, renal failure,
hyperglycemic sates associated with DM, multiorgan
failure, sepsis, Burns, Poisons/toxins
Ventilated patient
Sleep studies
Severely unwell pt from any cause (affects prognosis)
Components of the Arterial Blood Gas
1. pH
• Measurement of acidity or alkalinity, based on the hydrogen (H+)
ions present.
• The normal range is 7.35 to 7.45
2. PaO2
• The partial pressure of oxygen that is dissolved in arterial blood.
• The normal range is 80 to 100 mm Hg.
3. SaO2
• The arterial oxygen saturation.
• The normal range is 95% to 100%.
4. PaCO2
• The amount of carbon dioxide dissolved in arterial blood.
• The normal range is 35 to 45 mm Hg.
Components of the Arterial Blood Gas Continue
5. HCO3
• The calculated value of the amount of bicarbonate in
the bloodstream
• The normal range is 22 to 26 mEq/liter
6. B.E.
• The base excess indicates the amount of excess or
insufficient level of bicarbonate in the system
• The normal range is –2 to +2 mEq/liter
• A negative base excess indicates a base deficit in the
blood
Acid-Base Balance
Overview
The pH is a measurement of the acidity or alkalinity of the blood.
The pH of a solution is measured on a scale from 1 (very acidic) to 14
(very alkalotic). A liquid with a pH of 7, such as water, is neutral
(neither acidic nor alkalotic).
When the pH is below 7.35, the blood is said to be acidic, and above
7.45 the blood is said to be alkalotic.
Acid-Base Balance continue
Step Two
If the blood is alkalotic or acidotic, we now need to
determine if it is caused primarily by a respiratory or
metabolic problem.
To do this, assess the PaCO2 level. Remember that with a
respiratory problem, as the pH decreases below 7.35, the
PaCO2 should rise.
If the pH rises above 7.45, the PaCO2 should fall. Compare
the pH and the PaCO2 values. If pH and PaCO2 are indeed
moving in opposite directions, then the problem is
primarily respiratory in nature.
Steps to an Arterial Blood Gas Interpretation
continue
Step Three
Finally, assess the HCO3 value. Recall that with a metabolic
problem, normally as the pH increases, the HCO3 should
also increase. Likewise, as the pH decreases, so should the
HCO3.
Compare the two values. If they are moving in the same
direction, then the problem is primarily metabolic in
nature.
The following chart summarizes the relationships between
pH, PaCO2 and HCO3.
Obtaining an Arterial Blood Sample
Draw blood from an arterial line
Percutaneous punture from an artery
(current metode in BIMC)
Femoral artery
Contraindications
Negative result of an Allen test
Arterial puncture should not be performed through a lesion
Never puncture same limb as there is a surgical shunt (absolutely
never through or distal to it)
If there is evidence of infection or peripheral vascular
disease involving selected limbs, an alternative site
should be selected
Femoral puncture should not be performed outside
the hospital need Dr assistance
If pt on coagulant or medium to high dose anticoagulation
threatment may be a relative contraindication for arterial
puncture e.g. Heparin or coumadin, streptokinase and tissue
plasminogen activator but not necessarily aspirin)
COMPLICATIONS
Hematoma
Arteriospasm
Air or clotted-blood emboli
Anaphylaxis from local anestetic
Hemorrhage
Arterial occlusion
Pain
Trauma to the vessel
Infection
Potential Sampling Error
Air in the sample: Will elevate the pO2 in the sample, rendering it
inaccurate.
Too much time before analyzing: Gas must be placed on ice if not
analyzed w/in 20 min.
If not analyzed within 1 hrs, certain cells may continue to consume O2
and produce CO2 while in the syringe. This will affect your pO2 and
pCO2 unless the sample is not analyzed right away.
Anticoagulants: Heparin can dilute the concentrations of gases in the
blood sample (willdecrease pCO2).
Temperature: The temperature of the blood affects the pO2 and pCO2.
Allen Test
Allen test must be done before collect blood sample from radial artery
Indications
Test wrist collateral Blood Flow
Arterial Puncture for BGA
Technique
Patient elevates hand and makes a fist for 20 seconds
Using your index and midle finger press on the radial and ulnar
arteries . Hold this position for for a few second
Without removing your finger, ask pt to unclench his/her fist and
hold hand in a relaxed position. The palm should blanche white
Release pressure on the ulnar artery. If the hand become flushed,
which indicates blood filling the vessels. Can safely proceed with
the radial artery puncture. If doesn’t flush, perform to the other arm
Allen Test continue
Normal Result
Hand color flushes within 5 to 7 seconds
Abnormal result: Inadequate collateral circulation
Hand remains white until radial pressure released
Risk of serious hand ischemia if radial vessel spasm
Arterial Blood Gas Sampling
Preparation
Equipment
• Examination gloves
• Apron
• Small towel
• Alcohol Swabs
• 4 cm x 4 cm Sterile gauze
• Syringe 3 ml and Heparin 1:1000 or Heparinized Blood Gas Syringe
• Needle 22G or 23G
• Rubber cap
• Sharps box
• Box with ice or Plastic bag w/ crushed ice and call OB if not use lab
inside hospital
• bandage or tape
• Pt ID Label (name, DOB, MRN, date and time sample taken)
• Lab order form
• Underpad
• Trolley
• Assisting nurse if needed
Arterial Blood Gas Sampling continue
Preparation Phase :
• Labelled and fixed lab form and sign by Dr
• Identify you talk to the right pt with check ID pt (name, MRN, DOB)
• Explain to the pt that you need collect an arterial blood sample
• Obtain verbal consent and record inspired O2 concentration and
temperature on the lab form
• If using Syringe without Heparin :
Disinfectand your hands
Push out all heparin (leave just enough to wet the syringe)
Performance Phase :
• Disinfectand your hands and wear gloves and apron
• Place underpad and rolled towel under pt wrist for support. If needed:
Tape pt hand to bedrail to stabilise a good position
Mark the position of the artery with a pen
• Locate the artery and palpate it for a strong pulse
• Perform allen test
• Using a circular motion, clean the area with alcohol for 30 second and
allow it dry completely
• Palpate the artery with the index and middle finger on one hand while
holding the syringe over the puncture site (keep finger separated, not to
touch and contamined)
• Find a puncture site as distal as possible (if fail can try again above)
• Hold the needle bevel up at 30° to 45° angle. When puncturing brachial
artery , hold needle at a 60°
Arterial Blood Gas Sampling continue