8-Step Guide to ABG Analysis: Tic-Tac-Toe

Method
The easiest method to interpret ABGs!

By Gil Wayne, RN - Jan 21, 2015

87k
SHARES a 76k Facebook d f h 10k s v

An arterial blood gas (ABG) is a blood test that measures the acidity (pH) and the levels of oxygen
and carbon dioxide in the blood. Blood for an ABG test is taken from an artery whereas most other
blood tests are done on a sample of blood taken from a vein. This test is done to monitor several
conditions that can cause serious health complications especially to critically ill individuals.

Every day, a lot of nursing and medical students assigned in acute areas encounter ABG results,
which they may not necessarily be able to interpret with its knotty aspect. They struggle over the
interpretation of its measurements, but they are not especially complicated nor difficult if you
understand the basic physiology and have a step by step process to analyze and interpret them.

There may be various tips and strategies to guide you, from mnemonics, to charts, to lectures, to
practice, but this article will tell you how to interpret ABGs in the easiest possible way. And once you
have finished reading this, youll be doing actual ABG analysis in the NCLEX with fun and excitement!
Here are the steps:

1. Know thenormal values

Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to
remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3. Remember
also this diagram and note that paCO2 is intentionallyinverted for the purpose of this method.
2. Determine if pH is under acidosis or alkalosis
Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH
level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to
keep pH in balance.

pH level below 7.35 is acidosis

pH level above 7.45 is alkalosis

3. Determine if acid-base is respiratory or metabolic

Next thing you need to determine is whether the acid base is Respiratory or Metabolic.

paCO2 = Respiratory
HCO3 = Metabolic
4. Remember ROME
Still, it all boils down to mnemonics. The mnemonic RO-ME.

Respiratory Opposite

When pH is up, PaCO2 is down = Alkalosis

When pH is down, PaCO2 is up = Acidosis

Metabolic Equal

When pH is up, HCO3 is up = Alkalosis

When pH is down, HCO3 is down = Acidosis

5. Tic-Tac-Toe
And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do is make a
blank chartsimilar to this:
6. Mark the Chart
Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample problem:

pH: 7.26, paCO2: 32, HCO3: 18

Using the normal values reference chart in the first step, determine where the values should be under
in the tic-tac-toe. In the given example, the solution is as follows:

pH of 7.26 is LOW = ACID so place pH under Acid

paCO2of 32 is LOW = BASE so place paCO2 under Base
HCO3of 18 is LOW = ACID so place HCO3 under Acid

Your chart should looklike this:

7. Matchit up
In this step, determineat which column matches up with the pH. In the given example, HCO3 goes
with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so this example
implies Metabolic Acidosis.
8. Determinecompensation
The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated.
Heres the trick:

If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated

If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated
If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated

Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .

By applying the steps above, interpret the following ABGs:

pH:7.44, PaCO2: 30, HCO3:21

pH is NORMAL = NORMAL so place pH under Normal

PaCO2 is LOW = BASE so place PaCO2 under Base
HCO3 is LOW = ACID so place HCO3 under Acid

*Since the acidity of the blood is determined by the value of the pH, determine whether the normal pH
is SLIGHTLY ACIDIC or SLIGHTLY BASIC. In this example, pH is NORMAL but SLIGHTLY BASIC
therefore it is ALKALOSIS.

In this case PaCO2 goes with pH. PaCO2 is considered Respiratory (shown in step 3), and both are
under Basic, so this example implies Respiratory Alkalosis. The HCO3 is also abnormal. When pH is
NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates FULL COMPENSATION.

Therefore this ABG is RESPIRATORY ALKALOSIS, FULLY COMPENSATED.

Try this problem next:

pH 7.1, PaCO2 40, HCO3 18

pH is LOW = ACID so place pH under Acid
PaCO2 is NORMAL = NORMAL so place PaCO2 under Normal
HCO3 is LOW = ACID so place HCO3 under Acid

In this case HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under
Acidic, so this example implies Metabolic Acidosis. The PaCO2 is normal. When pH is ABNORMAL,
and when either one of PaCO2 or HCO3 is ABNORMAL, it indicates UNCOMPENSATION.

Therefore this ABG is METABOLIC ACIDOSIS, UNCOMPENSATED.

Try it out with these quizzes

Want to try out the Tic-Tac-Toe method? Here are some sample ABG Analysis quizzes:
 ABG Analysis NCLEX Exam 1 (10 Items)
ABG Analysis NCLEX Exam 2 (10 Items)
ABG Analysis NCLEX Exam 3 (10 Items)

87k
SHARES a 76k Facebook d f h 10k s v

Gil Wayne, RN
http://nurseslabs.com

Gil Wayne is a registered nurse and a contributor at Nurseslabs.com. Prefers writing, traveling and discovering stuffs. Not a
fan of working in a hospital, but enjoys exploring nursing outside its walls! I like the color gray, but cant imagine myself in gray
scrubs... lol!