Arterial blood gas

An arterial blood gas (ABG) is a blood test that is performed using blood
from an artery. It involves puncturing an artery with a thin needle and syringe
and drawing a small volume of blood. The most common puncture site is the
radial artery at the wrist, but sometimes the femoral artery in the groin or
other sites are used. The blood can also be drawn from an arterial catheter.
The test is used to determine the pH of the blood, the partial pressure of
carbon dioxide and oxygen, and the bicarbonate level. ABG testing is mainly
used in pulmonology, to determine gas exchange levels in the blood related to
lung function, but has a variety of applications in other areas of medicine.

Extraction and analysis

Arterial blood for blood gas analysis is usually extracted by a phlebotomist, nurse,
or respiratory therapist. Blood is most commonly drawn from the radial artery
because it is easily accessible, can be compressed to control bleeding, and has less
risk for occlusion. The femoral artery (or less often, the brachial artery) is also
used, especially during emergency situations or with children. Blood can also be
taken from an arterial catheter already placed in one of these arteries.
The syringe is pre-packaged and contains a small amount of heparin, to prevent
coagulation or needs to be heparinised, by drawing up a small amount of heparin
and squirting it out again. Once the sample is obtained, care is taken to eliminate
visible gas bubbles, as these bubbles can dissolve into the sample and cause
inaccurate results. The sealed syringe is taken to a blood gas analyzer. If the
sample cannot be immediately analyzed, it is chilled in an ice bath in a glass
syringe to slow metabolic processes which can cause inaccuracy. Samples drawn
in plastic syringes are not iced and are analyzed within 30 minutes.
Calculations
The machine used for analysis aspirates this blood from the syringe and measures
the pH and the partial pressures of oxygen and carbon dioxide. The bicarbonate
concentration is also calculated. These results are usually available for
interpretation within five minutes.

Reference ranges and interpretation

Analyte
pH

Range
7.357.45

PaO2

9.313.3 kPa
or
80100
mmHg

PaCO2
4.76.0 kPa
or
3545
mmHg

HCO3

H+

2226 m
mol/l

3545 n
mol/l

Interpretation
If pH < 7.35 - acidic.
If pH > 7.45 - alkalemic.
A low O2 indicates that the patient is not
respiring properly, and is hypoxemic.

A high PaCO2 (respiratory acidosis) indicates

under ventilation.
A low PaCO2 (respiratory alkalosis) hyper- or
over ventilation.
PaCO2 levels can also become abnormal
when the respiratory system is working to
compensate for a metabolic issue so as to
normalize the blood pH.
A low HCO3 indicates metabolic acidosis.
A high HCO3 indicates metabolic alkalosis.
HCO3 levels can also become abnormal when
the kidneys are working to compensate for a
respiratory issue so as to normalize the
blood pH.
+
If H >45-acidotic
If H+< 35-alkalemic

Normal Arterial Blood Gas Values

pH

7.35-7.45

PaCO2

35-45 mm Hg

PaO2

80-95 mm Hg

HCO3

22-26 mEq/L

O2 Saturation 95-99%
BE

Respiratory
Acidosis
Acute
Partly
Compensated
Compensated
Respiratory
Alkalosis
Acute
Partly
Compensated
Compensated
Metabolic
Acidosis
Acute
Partly
Compensated
Compensated
Metabolic
Alkalosis
Acute
Partly
Compensated
Compensated

+/- 1

pH

PaCO2

HCO3

< 7.35

> 45

Normal

< 7.35

> 45

> 26

Normal

> 45

> 26

> 7.45

< 35

Normal

> 7.45

< 35

< 22

Normal

< 35

< 22

< 7.35

Normal

< 22

< 7.35

< 35

< 22

Normal

< 35

< 22

> 7.45

Normal

> 26

> 7.45

> 45

> 26

Normal

> 45

> 26