ARTERIAL BLOOD GAS ANALYSIS Arterial Blood Gas (ABG) analysis is often used to identify the specific acid-base

disturbance and the degree of compensation that has occurred, based on arterial blood sample. Arterial Blood Gas interpretation is an easy skill to master. It simply requires an understanding of pH, respiratory component (pCO2), a metabolic component (HCO3), what they represent what the normal ranges are. A. pH pH describes the concentration of hydrogen ions and that a pH of 7.0 is perfectly neutral. The acceptable pH range of our blood is 7.35 7.45 which is slightly alkaline. The first step in interpreting ABG results is to determine if the ph represents acidosis or alkalosis, or is perfectly normal. For purposes of ABG interpretation, we will consider the middle of acceptance range (7.4) as neutral for the blood, less than 7.4 is acidotic and any value higher than 7.4 is alkalotic. ACIDOTIC pH ALKALOTIC

7.35

7.4

7.45

The pH alone is not sufficient to tell us whether an imbalance is due to a respiratory or metabolic problem. B. Respiratory Component Carbon dioxide is an end product of metabolism, and when dissolved in the blood becomes carbonic acid. pCO2 represents partial pressure of carbon dioxide dissolved in the arterial blood, and provides an important measure of the adequacy of a patients ventilation. The lungs normally maintain an acceptable balance of CO2 (which is acidotic) in the bloodstream. The normal range of pCO2 is 35 45 mmHg and is maintained by ventilation. The second step in ABG interpretation, is to evaluate the pCO2, to determine if it falls within the acceptable range, falls below the lower limit (respiratory alkalosis) or is above the upper limit (respiratory acidosis).

C. Metabolic Component Bicarbonate (HCO3) represents the metabolic component of ABG interpretation, with normal range of 22 26 meq/L. Bicarbonate is a weak base that is regulated by the kidney. The third step in ABG interpretation is to determine the direction of the metabolic component HCO3, whether it is within the normal limits, is high (metabolic alkalosis) or low (metabolic acidosis). D. Compensation 1. Respiratory Acidosis and Respiratory Alkalosis 1.1. When compensation has occurred, the pH will be within normal limits. 1.2. The blood gas reflects partial compensation if the bicarbonate concentration is abnormal. 1.3. The blood gas result reflects uncompensated condition if the bicarbonate is normal. 2. Metabolic Acidosis and Metabolic Alkalosis 2.1. When compensation has occurred, the pH will be within normal limits. 2.2. The blood gas result reflects partial compensation if the pCO2 is abnormal. 2.3. The blood gas reflects an uncompensated condition if the pCO2 is normal. NORMAL VALUES Partial Pressure of Oxygen (PaO2) Partial Pressure (PaCO2) of Carbon 80 100 mmHg Dioxide 35 45 mmHg 22 26 meq/L 95% - 100%

Bicarbonate (HCO3) Oxygen Saturation (O2Sat)

The concentration of oxygen being breathed, called the fraction of inhaled oxygen (FiO2), is also usually reported. E. ABG Specimen Extraction 1. Perform handwashing. 2. Obtain vital signs 3. Perform Allens test to determine the presence of collateral circulation. Allens Test: a. Apply pressure over the clients ulnar and radial arteries simultaneously. b. While applying, ask the client to open close the hand repeatedly; the hand should blanch. c. Release pressure from the ulnar artery while compressing the radial artery and asses the color of the extremity distal to the pressure point. d. If pinkness fail to return within 6 seconds, the ulnar artery is insufficient, indicating that the radial artery should not be used for obtaining a blood specimen. 4. Clean the needle site with alcohol. 5. Put needle into the artery. 6. Allow the blood to fill the syringe. 7. Put a guaze pad or cotton ball over the needle site as needle is removed. 8. Put a bandage over the puncture site and apply firm pressure for 5 to 10 minutes.