SUBMITTED TO - Mr.

Joby Johnson

( LECTURER C.I.M.S COLLEGE OF NURSING)

SUBMITTED BY - Rajwant Kaur

M.Sc(N)-2 nd yr ( Medical Surgical Nursing)

 Arterial Blood Gas Analysis (ABG)

Introduction

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. Many blood gas analyzers will also report concentrations
of lactate, hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin and
methemoglobin. 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. Combinations of disorders can be complex and difficult to interpret, so
calculators , nomograms, and rules of thumb are commonly used.

Definition

Arterial blood gas (ABG) analysis is used to measure the partial pressures of oxygen (PaO2)
and carbon dioxide (pacO2)' and the pH of an arterial sample. Oxygen content (O2CT),
oxygen saturation (SaO2) and bicarbonate (RCO3 -) values are also measured. A blood
sample for ABG analysis may be drawn by percutaneous arterial puncture or from an arterial
line.

Purpose

 To evaluate gas exchange in the lungs.

 To assess integrity of the ventilatory control system.
 To determine the acid-base level of the blood.
 To monitor respiratory therapy.

Patient preparation

 Explain to the patient that this test is used to evaluate how well the lungs are delivering
oxygen to blood and eliminating carbon dioxide.
 Tell him that the test requires a blood sample. Explain who will perform the arterial
puncture and when and which site - radial, brachial, or femoral artery - has been
selected for the puncture.
 Inform him that he needn't restrict food or fluids.
  Instruct the patient to breathe normally during the test, and warn him that he may
experience a brief cramping or throbbing pain at the puncture site.

PRE-PROCEDURE

INDICATIONS
1. Determination of pH and partial pressure of respiratory gases
2. Determination of other serum blood levels (e.g., lactate)
3. Assessment of response to therapeutic interventions and disease state
4. Sampling of blood in emergencies when venous blood cannot be obtained

CONTRAINDICATIONS
 Coagulopathy, anticoagulant medications, and thrombolysis.
 Abnormalities of the overlying skin
 Prior vascular surgery at or proximal to the entry site
 Inadequate local circulation

EQUIPMENT
1. Gloves and antiseptic **UNIVERSAL PRECAUTIONS** **STERILE
TECHNIQUE**
2. Syringe, 25- to 27-gauge needle and 1% lidocaine without epinephrine for anesthetic
(optional) See Local Anesthesia for further details.
3. Syringe for aspiration (heparinized). Prepackaged ABG kits are available, or a standard
syringe may be prepared with heparin.
4. 1.5-inch 22- to 23-gauge needle and syringe cap
5. Specimen bag and ice
6. BandageH
7. Alcohol swabs
8. Patient label (put on syringe prior to putting in ice bag)

ANATOMY
 Radial artery
 The radial artery is the preferred site for arterial puncture.
 Collateral circulation is from the palmar branches of the ulnar artery. The artery is
medial and proximal to the radial styloid on the volar side of the wrist.
 Brachial artery
 The brachial artery may be chosen if the radial arteries are not accessible. The brachial
artery lies deep in the antecubital fossa and may be difficult to enter. It is medial in the
antecubital fossa, lateral to the medial epicondyle, and medial to the biceps brachii
tendon.
 Femoral artery
 The femoral artery is the least desirable site.
 It is located midway between the symphysis pubis and anterior superior iliac spine,
 coursing under the inguinal ligament, lateral to the femoral vein, and medial to the
femoral nerve.
Reference values

Normal ABG values fall within the following ranges:

 PaO2: 75 to 100 mm Hg
 PacO2: 35 to 45 mm Hg
 pH: 7.35 to 7.45
 O2CT: 15% to 22%
 SaO2: 95% to 100%
 HCO3 -: 24 to 28 mEq/L.

Implementation-

 Perform the allen test before the arterial punchure by doing the following-
 Flex the patient elbow & elevate the forearm where the arterial punchure will be
made.
 Compress the radial & ulnar arteries simultaneously .
 Instruct the patient to open & close the fist until the palm of the hand appears
blanched .
 Release pressurse from the ulnar artery while maintaining pressure on the radial
artery.
 Observe whether the skin flushes or remains blanched.
 Release pressure on the radial artery.

Rationale-The allen test determine whether the hand has adequate ulnar arterial
blood supply should the radial artery become damaged or occlued . The redial
artery should not be punctured if the allen test shows absent or poor collateral
arterial blood flow , as evidenced by continued blaanced after pressure on the
ulnar artery has been released. Alternative sites include the brachial , femoral ,
or dorsalis pedis arteries
 Keep the patient at rest for at least 30minutes before obtaining the
specimen, unless the procedure is an emergency.
Rationale- Because an ABG reflects the patient status at the movement
of the blood sampling , activity can transiently lower levels of the
oxygen in the blood & lead to an incorrect interpretation of the result.
  Record the patient current temperature , respiratory rate & level of
activity if other than resting.
Rationale- increased metabolism & activity affect cellular oxygen
demands. Therefor , the data help in interpreting the result of laboratory
findings.
 Record the amount of oxygen the patient is receiving at the time of test .
Rationale- this information help in determining wehether oxygen therapy
is neceasery or aids in the evaluation its current effectiveness.
 Hyperexted the wrist over a roller towel .
Rational – Hyperextension brings the radial artery nearer the skin surface
to facilitate penetration .
 Comfort the patient during the puncture.
 After the specimen is obtained expel any air bubble from it
 Rotate the collected specimen
 Rationale-rotation mix the blood with anticoagulantsinthe specimen
tube , ensuring that the blood sample will not clot before it can be
examined.
 Place the specimen on the ice immediately
Rationale-blood cells deteriorate outside the body , causing changes in
the sample . cooling the sample slows cellular metabolism & ensure
more accurate result.
 Apply direct manual pressure to the arterial pressure site for 5 to 10 min.
Rationale-arterial blood flows under higher pressure than venous
blood.Therefore , prolonged manual pressures is necessary to control
bleeding
 Cover the pressure site with a pressure dressing composed of several 4”x
4”gauze sequares & tape.
Rationale-tight mechanical compression provides continouse pressure to
reduse potential from arterial bleeding.
 Assess the bleeding site periodically for bleeding or formation of a
hematoma beneath the skin.
 Report the laboratory finding to the prescribing physican as soon as they
are available.

POST-PROCEDURE CARE

 Immediately apply direct pressure to the puncture site, for up to 10-15 minutes for
patients taking anticoagulant medications or who have coagulopathy.
  Check site frequently and instruct the patient to not disturb the site and to report any
abnormalities immediately.
 Analyze results.

COMPLICATIONS
 Hematoma formation with possible transfusion, infection, and compression neuropathy
 Distal ischemia

 Pseudoaneurysm and arteriovenous fistula formation

 Localized trauma

 Infection (soft-tissue and bone)