ABG(Arterial Blood Gas)

Presenter: Anup Paudel & Santosh Chaudhary

5th batch Bsc.MLT
• ABG test measures the amount of arterial blood gases like O2,
CO2 .
• Also measures the blood gases tension value of arterial partial
pressure of O2, CO2, blood pH and arterial O2 saturation.
• ABG test is done to patient’s with respiratory disease or
critical illness (most commonly to ICU patients).
• An arterial blood sample is collected from an artery, primarily
to determine arterial blood gases
• Sites : Radial artery, Brachial artery, Femoral artery
Equipment and supplies
• Heparinised syringe: 0.05 to 0.10 ml of a dilute solution (1000
units/ml) will anticoagulate 1 ml of blood. After flushing the
syringe with heparin, a sufficient amount usually remains in
the syringe and needle for anticoagulation
• Bandage
• Anesthesia
• Analyser
 Procedure
• Introduce yourself to the patient and clarify their identity.
Explain procedure and obtain consent. Place the patient on
their back, lying flat
• Locate the radial artery by performing an Allen test for
collateral circulation. If the initial test fails to locate, repeat the
test on the other hand. Once a site is identified, note anatomic
landmarks. Before collection give local anesthesia
• Disinfect the site and use the index finger
to locate the pulse again, then insert the
needle at a 45 degree angle, approx. 1 cm
distal to the index finger
• Advance the needle into the radial artery until a blood
flashback appears, then allow the syringe to fill to the
appropriate level. Do not pull back the syringe plunger.

• Withdraw the needle and syringe; place a clean, dry piece of

gauze or cotton wool over the site and apply firm pressure at
site for 5 min.
• Remove the needle and cap the syringe
• Room air has a pO2 of approximately 150 mm Hg and pCO2
of essentially zero. Thus, air bubbles that mix and equilibrate
with arterial blood will shift the PaO2 toward 150 mm Hg and
will lower the PaCO2.
 After collection, the specimen should be analyzed expeditiously .
If a delay of more than 10 minutes is anticipated, the specimen
must be immersed in an ice bath .

Change in value every 10 At RT Iced sample at 4°C

min
pH 0.01 0.001
Pco2 1 mm hg 0.1mm hg
Po2 0.1% 0.01%
 Modified Allen test

• Instruct the patient to clench his or her fist; if the patient is unable to
do this, close the person's hand tightly.
• Using your fingers, apply occlusive pressure to both the ulnar and
radial arteries, to obstruct blood flow to the hand.
• While applying occlusive pressure to both arteries, have the patient
relax his or her hand, and check whether the palm and fingers have
blanched. If this is not the case, you have not completely occluded
the arteries with your fingers.
• Release the occlusive pressure on the ulnar artery
– If the hand flushes within 5-15 seconds it indicates that the ulnar
artery has good blood flow; this normal flushing of the hand is
considered to be a positive test.
– If the hand does not flush within 5-15 seconds, it indicates that ulnar
circulation is inadequate or nonexistent; in this situation, the radial
artery supplying arterial blood to that hand should not be punctured.
Positive modified allens test Negative modified allens test
 ABG electrodes
ABGs are now routinely measured with an automated analyzer .
The basic components of such a unit are 3 electrodes

• pH electrode: It measures the potential difference between a

measuring electrode (which contains the sample in contact
with a special glass membrane permeable only to H+ ions) and
a reference electrode (which has a known, stable pH) . From
the voltage across these electrodes, the sample pH is
calculated.
• pCO2 electrode (Severinghaus electrode): It employs an
adaptation of the pH measurement. Carbon dioxide from the
blood sample equilibrates across a gas-permeable membrane
with a bicarbonate solution in a reaction that generates H+
ions. The pCO2 of the sample is determined indirectly by
sensing the pH change in this solution.

• pO2 electrode (Clark electrode): it determines pO2

amperometrically. Oxygen from the blood sample diffuses
across a semipermeable membrane and is reduced at the
cathode of a polarographic electrode . This reaction produces a
measurable current that is directly proportional to the sample
pO2.
• The electrodes are maintained at 37°C in a thermostatically
regulated waterbath; therefore, all ABG measurements are
made at 37°C regardless of the patient's temperature .
 Interpretation
 pH & H+
 Normal range pH: 7.35- 7.45
H+: 35-45 nmol/l
 The pH or H+ indicates if a person is acidemic (pH < 7.35; H+ >45) or
alkalemic (pH > 7.45; H+ < 35).
 Under normal conditions, the Henderson–Hasselbalch equation will give
the blood pH

• 6.1 is the acid dissociation constant (pKa) of H2CO3 at 37°C

• HCO3– is the concentration of bicarbonate in the blood in mEq/L
• PaCO2 is the partial pressure of carbon dioxide in the arterial blood
in torr
 Arterial oxygen partial pressure(PaO2)
Normal range: 10–13 kPa (75–100 mmHg)
A low PaO2 indicates that the person is not oxygenating properly,
and is hypoxemic. At a PaO2 of less than 60 mm Hg,
supplemental oxygen should be administered.
 Arterial carbon dioxide partial pressure (PaCO2)
Normal range: 4.7–6.0 kPa (35–45 mmHg)
The PaCO2 is an indicator of CO2 production and elimination: for
a constant metabolic rate, the PaCO2 is determined entirely by
its elimination through ventilation. A high PaCO2 (respiratory
acidosis, alternatively hypercapnia) indicates underventilation
(or more rarely hypermetabolic disorder), a low PaCO2
(respiratory alkalosis, alternatively hypocapnia) hyper- or
overventilation.
 HCO3-
 Normal range: 22–26 mEq/L
 The HCO3– ion indicates whether a metabolic problem is
present (such as ketoacidosis).
 A low HCO3- indicates metabolic acidosis, a high HCO3–
indicates metabolic alkalosis. As this value when given with
blood gas results is often calculated by the analyzer,
correlation should be checked with total CO2 levels as directly
measured.
 SBCe
 Normal range:21 to 27 mmol/L
 the bicarbonate concentration in the blood at a CO2 of 5.33
kPa, full oxygen saturation and 37 Celsius.
 Base excess
 Normal range: −2 to +2 mmol/L
 The base excess is used for the assessment of the metabolic
component of acid-base disorders, and indicates whether the
person has metabolic acidosis or metabolic alkalosis.
Contrasted with the bicarbonate levels, the base excess is a
calculated value intended to completely isolate the non-
respiratory portion of the pH change.
 There are two calculations for base excess
(extra cellular fluid - BE(ecf) & blood - BE(b)).

 The calculation used for the BE(ecf) = cHCO3– − 24.8 + 16.2

× (pH − 7.4).

 The calculation used for BE(b) = (1 − 0.014 × hgb) × (cHCO3–

− 24.8 + (1.43 × hgb + 7.7) × (pH − 7.4).
• total CO2 (tCO2(P)c)
 Normal range: 23–30 mmol/L or (100–132 mg/dL)
 This is the total amount of CO2, and is the sum of HCO3–
and PCO2 by the formula: tCO2 = [HCO3–] + α×PCO2, where
α=0.226 mM/kPa, HCO3– is expressed in millimolar
concentration (mM) (mmol/L) and PCO2 is expressed in kPa
• O2 Content (CaO2, CvO2, CcO2)
 Expressed in vol% or (mL O2/dL blood)
 This is the sum of oxygen dissolved in plasma and chemically
bound to hemoglobin as determined by the calculation:
CaO2 = (PaO2 × 0.003) + (SaO2 × 1.34 × Hgb) ,where
hemoglobin concentration is expressed in g/dL.
Note:
• A 1 mmHg change in PaCO2 above or below 40 mmHg results
in 0.008 unit change in pH in the opposite direction.
• The PaCO2 will decrease by about 1 mmHg for every 1 mEq/L
reduction in [HCO−3] below 24 mEq/L
• A change in [HCO−3] of 10 mEq/L will result in a change in
pH of approximately 0.15 pH units in the same direction.

• Assess relation of pCO2 with pH: If pCO2 & pH are moving in

opposite directions i.e., pCO2 ↑ when pH is <7.4 or pCO2 ↓
when pH > 7.4, it is a primary respiratory disorder. If pCO2 &
pH are moving in same direction i.e., pCO2 ↑when pH is >7.4
or pCO2 ↓ when pH < 7.4, it is a primary metabolic disorder
 Cases
1.You are asked to review a 63-year-old female who
was admitted with shortness of breath. On your
arrival, the patient appears drowsy and is on 10L
of oxygen via a mask. You perform an ABG and
receive the following results…
• pH: 7.29 (7.35 – 7.45)
• PaCO2: 9.1 (4.7-6.0 kPa)
• HCO3–: 26 (22-26 mEg/L)
• Uncompensated Respiratory acidosis
2. A 17-year-old patient presents to A&E
complaining of a tight feeling in their chest,
shortness of breath, some tingling in their fingers
and around their mouth. They have no significant
past medical history and are not on any regular
medication. An ABG is performed on the patient
whilst they’re breathing room air and the results
are shown below…
• pH: 7.49 (7.35 – 7.45)
• PaCO2: 3.2 (4.7-6.0 kPa)
• HCO3–: 22 (22-26 mEg/L)
• Uncompensated respiratory alkalosis
3. pH: 7.05 (7.35 – 7.45)
• PaCO2: 3.5 (4.7-6.0 kPa)
• HCO3–: 7 (22-26 mEq/L)
Partially compensated metabolic acidosis
4. pH: 7.27 (7.35 – 7.45)
• PaCO2: 64.4 (35-45 mm hg)
• HCO3–: 28.3 (22-26 mEq/L)
Partially compensated respiratory acidosis
5 pH: 7.5 (7.35 – 7.45)
• PaCO2: 35.3 (35-45 mm Hg )
• HCO3–: 27.3 (22-26 mEg/L)
Uncompensated metabolic alkalosis
6 pH: 7.52 (7.35 – 7.45)
• PaCO2: 19.3 (35-45 mm Hg)
• HCO3–: 15.7 (22-26 mEg/L)
Partially compensated respiratory alkalosis
Thank you