Title: Basic Atrial Blood Gas(ABG) interpretation
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2ABGArterial Blood Gas
- By
- Shams Ali Shah
- Respiratory Therapy Tech PSCCQ KSA
3- An ABG (arterial blood gas ) is a blood test that
is performed using arterial blood
4Indication of ABG
- To evaluate situation of ventilation,
- oxygenation, and oxygen carrying
- capacity of blood.
- To evaluate the patient response to
- intervention and treatments.
- To record the severity and progression
- of a documented disease process.
5ABG Machine
6pH
- Normal range in Blood (7.35-7.45)
- pH stand for Potential Hydrogen Ions
- It show the Quantity of Hydrogen
- Ions blood the pH will Hi(Alkalemia)
- pH6.1logHCO3/0.03xCO2)
- henderson-hasselbach equation
7pH Continued
Common causes of low pH (acidosis) Respiratory
acidosis as alveolar hypoventilation or
increased metabolic rate . Metabolic acidosis as
circulatory impairment, renal failure, diabetic
ketoacidosis or gastro-intestinal loss of
bicarbonate(diarrhea) Common causes of high pH
(alkalosis) Respiratory alkalosis as alveolar
Hyperventilation Metabolic alkalosis as
diuretics, gastrointestinal loss of acid
(vomiting)or hypokalemia.
8pO2 (80-100) or 100-1/2 of age
- The arterial oxygen tension is an indicator of
the oxygen uptake in the lungs.
Common causes of low P0 2 is pulmonary disease,
cardiac right to left shunt, low alveolar
ventilation and ambient pressure.
9pCO2(35-100)
- PCO2 (Partial Pressure of CO2) is a direct
reflection of the adequacy of alveolar
ventilation in relation to the metabolic rate.
Common causes of low pCO2 alveolar
hyperventilation hypocapnia Common causes of
high PCO2 Alveolar hypoventilation -
hypercapnia) may be lung disease,central nervous
system depression, either primary, or secondary
to.
10PCO2
Carbon dioxide partial pressure or tension also
written PCO2
pCO2 reflects the amount of carbon dioxide gas
dissolved in the blood. Indirectly, the pCO2
reflects the exchange of this gas through the
lungs to the outside air
11Total Hemoglobin (ctHb)
Oxymetery Values
- is a measure of the potential oxygen-
carrying capacity of the blood.
Hi tHb indicates a high blood viscosity. Common
causes of Hi tHb (polycytemia). Dehydration,
chronic lung disease, chronic heart disease,
living at high altitude Common Cause of Low
tHb Anemia , impaired red cell production,
hemolysis, bleeding, dilution (over hydration) .
12Oxygen Saturation (sO 2)
- sO2 is the percentage of oxygenated
hemoglobin in relation to the amount of
hemoglobin capable of carrying oxygen. s02 allows
evaluation of oxygenation.
Hi (normal) s02 Measure of sufficient
utilization of
actual oxygen transport capacity. Common causes
of low s02 may be impaired oxygen
uptake.
13Fraction of Oxyhemoglobin (FO2Hb)
- FO2Hb is a measure of the utilization of the
potential oxygen transport capacity that is the
fraction of oxyhemoglobin in relation to all
hemoglobins present (tHb) including
dyshemoglobins.
High (normal) FO2Hb may be an indication of
sufficient utilization of oxygen transport
capacity. Common causes of low FO2Hb may be
impaired oxygen uptake or presence of
dyshemoglobins.
14Fraction of CarboxyhemoglobinThe compound that
is formed when inhaled carbon monoxide combines
with hemoglobin in the blood. Also called carbon
monoxide hemoglobin (1.45 in smokers and non
smokers 1.34)
FCOHb is the fraction of Carboxyhemoglobin
- .
- It is incapable of transporting oxygen because
CO the Hb will not pick O2.
15Fraction of Methemoglobin (FMetHb)
- In normal erythrocytes, Methemoglobin is
present at 1 to 2. - Fe2 becomes Fe3
16Lactate (cLac)
Metabolites
- The lactate measurements measure the
concentration of lactate in plasma. - Lactate measurements serve as a marker of
critical imbalance between tissue oxygen - demand and oxygen supply.
Glucose
Is concentration of glucose in Plasma..
17ELECTROLYTES
Potassium (cK) Sodium (cNa) Calcium (cCa 2 )
Chloride (cCl-)
18HCO3
Hydrogen carbonate ion or bicarbonate ion
More than 90 of carbon dioxide in your blood
exists in the form of Bicarbonate (HCO3). The
rest of the carbon dioxide is either dissolved
carbon dioxide gas (CO2) or carbonic acid
(H2CO3).
19BE
- The value is usually reported as a
- concentration in units of mEq/L, with
- positive numbers indicating an excess of
- base and negative a deficit.
- A typical Reference range for base excess is -2
- to 2 mEq/L.
Base deficit x 0.3 x bodyweight (kg) deficit in
meq.
20- Lactate (Lac)
- The lactate measurements measure the
concentration of lactate in plasma. Lactate
measurements serve as a marker of critical
imbalance between tissue oxygen demand and oxygen
supply. - Fraction of Oxyhemoglobin (FO2Hb)
- FO2Hb is a measure of the utilization of the
- potential oxygen transport capacity that
is the - fraction of Oxyhemoglobin in relation to
all - hemoglobin present (tHb) including
- dyshemoglobins.
21p50
- the oxygen tension at which hemoglobin is 50
saturated
22Acid Base Balance
23pH Scale
7.4
Acidosis
Alkalosis
Base Normal Acid
24BASICs of ABG Interpretation
- pH (7.35-7.45 normal)
- lt7.35 Acidosis
- gt7.45 Alkalosis
- pH is the single best index of overall acid base
status
25Con.. BASICs of ABG Interpretation
- PaCO2 (35-45 normal)
- lt35 alkalosis
- gt45 acidosis
- PaCO2 is the single best indicator of
respiratory acid- - base control.
- PaCO2 moving in opposite direction of pH
- respiratory cause
- PaCO2 moving in same direction of pH
- respiratory compensation of a metabolic
- process
26Con.. BASICs of ABG Interpretation
- PaO2 (80-100 normal)
- gtPaO2 determines oxygenation status
- PaO2 gt 100 hyperoxia
- PaO2 80-100 normal
- PaO2 60-79 mild hypoxemia
- PaO2 45-59 moderate hypoxemia
- PaO2 lt 45 severe hypoxemia
27Con.. BASICs of ABG Interpretation
- HCO3 (22-26 normal
- HCO3 moving in same direction as pH
- metabolic cause
- HCO3 moving in same direction as
- PaCO2 metabolic compensation for a
- respiratory process
28 Respiratory Acidosis Signs and Symptoms
Con.. BASICs of ABG Interpretation
Acid Base Status
- Impaired respirations
- Poor exhalation
- General weakness
- Altered mental status
- Disorientation
- Stupor
- Coma
29Con.. BASICs of ABG Interpretation
Acid Base Status
Respiratory Alkalosis Signs and Symptoms
- Deep and/or rapid respirations
- Light headedness
- Tetany(seizure)
- Convulsions
- Unconsciousness
30Metabolic Acidosis
Con.. BASICs of ABG Interpretation Acid Base
Status
Signs and Symptoms
- Weakness
- Kussmals respirations(Rapid Breathing)
- Dyspnea
- Disorientation
- Coma
31Body Mechanism of Compensation
pCO2 HCO 3
paCO2 HCO 3
HCO3 CO 2
HCO3 CO2
32ABG PRACTICE
33Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.79
PCO2(24)
HCO3 (21)
pH(7.79
HCO3 (21)
PCO2(24)
34Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.79
PCO2(24)
pH(7.79
HCO3 (21)
HCO3 (21)
PCO2(24)
Partial compensated Respiratory Alkalosis
35Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.17)
PCO2(35)
pH(7.17)
PCO2(35)
HCO3 (12)
HCO3 (12)
36Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.17)
PCO2(35)
pH(7.17)
PCO2(35)
HCO3 (12)
HCO3 (12)
Uncompensated Metabolic Acidosis
37Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.45)
PCO2(48)
pH(7.45)
PCO2(48)
HCO3 (28)
HCO3 (28)
38Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.45)
PCO2(48)
pH(7.45)
PCO2(48)
HCO3 (28)
HCO3 (28)
Fully Compensated Metabolic Alkalosis
39Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Normal
Acid
pH(7.42)
PCO2(40)
pH(7.42)
HCO3 (23)
PCO2(40)
HCO3 (23)
40Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.42)
PCO2(40)
pH(7.42)
HCO3 (23)
PCO2(40)
HCO3 (23)
Normal ABG
41Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Acid
Normal
pH(7.63)
PCO2(24)
pH(7.63)
HCO3 (18)
HCO3 (18)
PCO2(24)
42Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.63)
PCO2(24)
pH(7.63)
HCO3 (18)
HCO3 (18)
PCO2(24)
Partial Compensated Respiratory Alkalosis
43Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Acid
Normal
pH(7.33)
PCO2(22)
pH(7.33)
PCO2(22)
HCO3 (21)
HCO3 (21)
44Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Normal
Acid
pH(7.33)
PCO2(22)
pH(7.33)
PCO2(22)
HCO3 (21)
HCO3 (21)
Partial Compensated Metabolic Acidosis
45Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.15)
PCO2(46)
pH(7.15)
HCO3 (34)
HCO3 (34)
PCO2(46)
46Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.15)
PCO2(46)
pH(7.15)
HCO3 (34)
PCO2(46)
Partially Compensated Respiratory Acidosis
47Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.54)
PCO2(24)
pH(7.54)
HCO3 (25)
HCO3 (25)
PCO2(24)
48Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.54)
PCO2(24)
pH(7.54)
HCO3 (25)
HCO3 (25)
PCO2(24)
Uncompensated Respiratory Alkalosis
49Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.35)
PCO2(42)
pH(7.35)
HCO3 (25)
PCO2(42)
HCO3 (25)
50Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.35)
PCO2(42)
pH(7.35)
HCO3 (25)
PCO2(42)
HCO3 (25)
Normal ABG
51Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.55)
PCO2(20)
pH(7.55)
HCO3 (19)
HCO3 (19)
PCO2(20)
52Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Normal
Acid
Base
pH(7.55)
PCO2(20)
pH(7.55)
HCO3 (19)
HCO3 (19)
PCO2(20)
Partially Compensated Respiratory Alkalosis
53Doing ABG by Direct Method and choosing the
Artery.
- The radial artery is superficial, has collaterals
and is easily compressed. It should almost always
be the first choice. - Other arteries (femoral, dorsalis pedis,
brachial) can be used in emergencies.
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56Preparing to perform the Procedure
- Make sure you and the patient are comfortable.
- Assess the patency of the radial and ulnar
arteries.
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58The Kit
59Performing the Direct Arterial Blood Draw
- If you are going to use local anesthetic,
infiltrate the skin with 2 xylocaine. - Open the ABG kit
- Line the needle up with the artery, bevel side
up. - Enter the artery and allow the syringe to fill
spontaneously.
60Performing the Direct Arterial Blood Draw
- Withdraw the needle and hold pressure on the
site. - Protect needle
- Remove any air bubbles
- Gently mix the specimen by rolling it between
your palms - Place the specimen on ice and transport to lab
immediately.
61- May be It is a Venous sample
- Look for absence of flash and auto filling
- of syringe.
- Compare the saturation of sample and
- pulse Oxymetery saturation
- Look at the patient
62Transporting the ABG Sample
- Placing the AGB on ice may help minimize changes,
depending on the type of syringe, pO2 and white
blood cell count. - Its probably not as important if the specimen is
delivered immediately.
63Transport
- After specimen collected and air bubble removed,
gently mix and invert syringe. - Because the wbcs are metabolically active, they
will consume oxygen. - Plastic syringes are gas permeable.
- Key Minimize time from sample acquisition to
analysis.
64Performing the Blood Draw from Arterial Line
65 Things Required for Arterial Blood Sampling
from Arterial Line
66How to Draw ABG sample from Line step 1
67How to Draw ABG sample from Line step2
68How to Draw ABG sample from Line step3
69How to Draw ABG sample from Line step4
70- Anticoagulants(Heparin)
- Arterial line 4-6ml of waste should
- be discarded prior to obtaining the
- sample
- Contaminated samples will show a
- Decrease in PaCO2 and an increase
- in pH
-
71- Temperature
- Increased patient temperature will show
- increased PaO2 , PaCO2 and decreased
- pH
- Decreased patient temperature will show
- decreased PaO2 and PaCO2, increased
- pH
72How to Draw ABG sample from Line step 5
73How to Draw ABG sample from Line step 6
74How to Draw ABG sample from Line step 7
75How to Draw ABG sample from Line step 8
76How to Draw ABG sample from Line step 9
77How to Draw ABG sample from Line step 10
78Hazards Can Occur after ABG
- Hematoma
- Arteriospasm
- Air or clotted-blood emboli
- Anaphylaxis from local anesthetic
- Infection
- Hemorrhage
- Trauma to the vessel
- Arterial occlusion
- Vasovagal response
- Pain
79Thank You