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Gas Analysis
Mira Puspita
Indications
Respiratory Failure in acute and chronic states
Any severe illness which may lead to a metabolic
acidosis - for example:
Cardiac failure
Liver failure
Renal failure
Hyperglycaemic states associated with diabetes mellitus
Multiorgan failure
Sepsis
Burns
Poisons/toxins
Evaluation Therapy
Contraindications
Absolute
A possitive Allen Test
Local infection or
distorted anatomy at
the potential puncture
The presence of
arteriovenous
fistulasor vascular
grafts
Known or suspected
severe peripheral
vascular disease of
the limb involved
Relative
Severe coagulopathy
Use of thrombolytic
agents, such as
streptokinase or
tissue plasminogen
activator
Femoral artery
COMPLICATION
Local hematoma
Artery vasospasm
Arterial occlusion
Air or thrombus embolism
Local anesthetic anaphylactic reaction
Infection at the puncture site
Vessel laceration
Hemorrhage
Local pain
ALLEN TEST
To assess the arterial blood flow to the hand
Periprocedural Care
Informed Consent
Equipment
INTERPRETATION OF
ARTERIAL BLOOD GASES
7.35 7.45
Pao2: The partial pressure oxygen that is dissolved in arterial blood.
80-100 mm Hg.
PCO2: The amount of carbon dioxide dissolved in arterial blood.
35 45 mmHg
HCO3: The calculated value of the amount of bicarbonate in the blood
22 26 mmol/L
B.E:
The base excess indicates the amount of excess or
insufficient
level of bicarbonate. -2 to +2mEq/L
Step 1. Acidosis or
Alkalosis?
pH??
If pH <7.35 primary disorder is
acidosis
If pH > 7.45 primary disorder is
alkalosis
HCO3
Searah dengan PH : Murni komponen metabolik
sebagai penyebab
Berlawanan dgn PH : Kompensasi metabolik
dengan komponen respirasi sebagai penyebab
utama
HCO3
Searah dengan PH : Murni komponen metabolik
sebagai penyebab
Berlawanan dgn PH : Kompensasi metabolik
dengan komponen respirasi sebagai penyebab
utama
pH
PaCo2
HC03
normal
Respiratory
acidosis
Respiratory
Alkalosis
Metabolic
Acidosis
Metabolic
Alkalosis
normal
normal
normal
STEP 5. COMPENSATION
A patient can be uncompensated or
partially compensated or fully
compensated
pH has returned within normal rangefully compensated though other
values may be still abnormal
TERIMA KASIH
LOCATIONS
Arteri Radialis, merupakan pilihan pertama yang paling
aman dipakai untuk pungsi arteri kecuali terdapat banyak
bekas tusukan atau haematom juga apabila Allen test
negatif.
Arteri Brachialis, merupakan pilihan kedua karena lebih
banyak resikonya bila terjadi obstruksi pembuluh darah.
Arteri Femoralis, merupakan pilihan terakhir apabila pada
semua arteri diatas tidak dapat diambil. Bila terdapat
obstruksi pembuluh darah akan menghambat aliran darah
ke seluruh tubuh/ tungkai bawah dan bila yang dapat
mengakibatkan berlangsung lama dapat menyebabkan
kematian jaringan. Arteri femoralis berdekatan dengan vena
besar, sehingga dapat terjadi percampuran antara darah
vena dan arteri.
Contraindications
bsolute contraindications for ABG sampling include the following:
An abnormal modified Allen test (see below), in which case consideration
should be given to attempting puncture at a different site[2]
Local infection or distorted anatomy at the potential puncture site (eg, from
previous surgical interventions, congenital or acquired malformations, or
burns)
The presence ofarteriovenous fistulasor vascular grafts, in which case
arterial vascular puncture should not be attempted
Known or suspected severe peripheral vascular disease of the limb involved [2]
Relative contraindications include the following:
Severe coagulopathy[2]
Anticoagulation therapy with warfarin, heparin and derivatives, direct
thrombin inhibitors, or factor X inhibitors; aspirin is not a contraindication for
arterial vascular sampling in most cases[2]
Use of thrombolytic agents, such as streptokinase or tissue plasminogen
activator[2]
Indications
Identification of respiratory, metabolic, and mixed acid-base disorders, with or without
physiologic compensation
Respiratory failure- in acute and chronic states.
Any severe illness which may lead to a metabolic acidosis - for example:
Cardiac failure.
Liver failure.
Renal failure.
Hyperglycaemic states associated withdiabetes mellitus.
Multiorgan failure.
Sepsis.
Burns.
Poisons/toxins.
Ventilated patients.
Sleep studies.
Severely unwell patients from any cause - affects prognosis.
Indications
Determination of arterial respiratory gases during diagnostic evaluations [2, 3](eg, assessment of
the need for home oxygen therapy in patients with advanced chronic pulmonary disease)
Procurement of a blood sample in an acute emergency setting when venous sampling is not
feasible (many blood chemistry tests could be performed from an arterial sample [4] )