Oxygen therapy, ABGs & ABG interpretation

Oxygen Therapy
O2 therapy is a treatment designed to provide the patient with extra oxygen, as the
patient may not be getting enough as a result of their disease process. It helps
patients decrease their SOB and fatigue, improve activity, sleep and sleep-related
breathing disorders and increase the lifespan of some patients with
COPD. Use pulse oximetry to monitor patients and maintain SpO2 > 90%

Acute O2 Therapy
 Cardiac or respiratory arrest
 Hypoxaemia (SaO2 <90%)
 Hypotension (sys BP <100mmHg)
 Decreased cardiac output
 Severe pneumonia
 Severe asthma
 Respiratory distress RR> 24/min
 Bronchopulmonary dysplasia – premature babies

Chronic O2 Therapy
 COPD
 Late stage heart failure
 Cystic fibrosis
 Sleep apnea

The oxygen is delivered through a tube and may be used in any of the following
ways:
 Nasal cannula – two small plastic tubes (nasal prongs) that are inserted into
both nostrils
o 4L/min is comfortable, but if necessary can give up to 15L/min
o Can leave in for a long time, however this can lead to crusting and
drying of mucous membranes
 Face mask – fits over nose and mouth
o Hudson mask (simple) – FiO2 (fraction of expired O2 ie percent of O2
participating in gas exchange) up to 60%, do not use with COPD! Can
get CO2 build up in mask
o Venturi mask – this method gives the highest flow of O2. It is good for
CO2 retainers as there is no rebreathing of gas
o Rebreather mask – Partial, non-rebreather. It prevents mixing expired
gas with o2
 Transtracheal oxygen therapy - mall tube inserted into windpipe through the
front of your neck
 Portable - many oxygen therapy devices are portable to allow patients to
easily maneuver around their house – a nurse or trained staff will teach the
patient how to self-manage O2 therapy at home. Types:
o Oximiser – increases FiO2 at the same flow rate
 o Oxyam – no facial contact
o Conservation device – O2 bolus on inspiration
only
o Humidifier – to prevent drying up
 It is important to note that home oxygen it is a fire risk. It
does not start a fire itself, but can worsen a fire. Further,
the compressed oxygen gas comes in a cylinder that can
explode if it is exposed to heat. Safety guidelines include:
o Do not smoke or be around people smoking
o Stay five feet away from candles, gas stoves etc.
o Do not use gasoline, aerosol sprays or other flammable materials

Risks and complications

 Dry or blood nose – this may be aided by a nasal spray or a humidifier added
to the oxygen equipment
 Skin irritation – due to nasal cannula or facemask. Can be treated by a better
fitting mask or over the counter creams
 Fatigue, morning headaches
 Transtracheal complications – more serious. Can cause mucous ball to
develop on the tube inside the windpipe (gross) as the O2 dries out the
airways, leading to coughing and clogging of the windpipe. It can also cause
infection and injury to the lining of the windpipe.

ABGs
Arterial Blood Gasses are a measurement of the amount of O2 and CO2 is in the
blood. It also is able to determine the pH of blood. It can also evaluate respiratory
diseases, assess the effectiveness of oxygen therapy and the general metabolic state
of the body eg. diabetic acidosis, lactic acidosis, metabolic acidosis,
resp alkalosis etc.

Blood is normally taken from:

 The radial artery in the wrist
 The femoral artery in the groin
 The brachial artery in the arm
Usually, before blood is taken circulation of the arm and hand is assessed. If the
patient so wishes, anaesthetic may be administered before the needle is inserted.
If the patient is on oxygen therapy, the oxygen concentration must be constant for
twenty minutes preceding the test. Risks of ABGs are low and
include bleeding from puncture site, haematoma, infection,
bruising, feeling faint or light headed.

Normal values (at sea level)

Note Pa = partial pressure
 PaO2: 80-100mmHg
 PaCO2: 35-45mmHg
 Arterial blood pH: 7.35-7.45
 SaO2 (Oxygen saturation): 95-100%
 o Note that this differs from the normal COPD values (88-92%)
 HCO3: 22-26mEq/L (millequivalents per litre)
Note that when altitude increases, oxygen values decrease.

6 Easy Steps to ABG Analysis:

1. Is the pH normal?
 Normal blood pH: 7.35-7.45
 Below 7.35 is acidotic, higher than 7.45 is alkalotic
2. Is the CO2 normal?
 Below 35 is alkalotic
 Above 45 is acidic
3. Is the HCO3 normal?
 Below 22 is acidotic
 Above 26 is alkalotic
4. Match the CO2 or the HCO3 with the pH
 Is the acidic/basic state caused by CO2 or HCO3?
 CO2  resp cause, HCO3  metabolic cause
 Label as metabolic acidosis/alkalosis or respiratory
acidosis/alkalosis
5. Does the CO2 or the HCO3 go the opposite direction of the pH?
 This implies compensation
 If pH remains abnormal, then compensation is partial
 If the pH returns to normal, the compensation is complete
 HCO3 is controlled by the kidneys, CO2 is decreased by fast and
deep breathing, and is increased by slow and shallow breathing
 Eg. pH is acidotic, CO2 is acidotic, an HCO3 is alkalotic. Thus, it is
compensated respiratory acidosis
6. Are the pO2 and the O2 saturation normal?
 If they are below normal there is hypoxemia
 If the pO2 has increased it indicates O2 therapy

ROME
Respiratory Opposite
Metabolic Equal (ie equal to pH up/down)

Anion gap = ([Na+] + [K+]) - ([Cl-] + [HCO3-]) = RR 8-16mmol

Normochloraemic/anion gap metabolic Diabetic ketoacidosis, Alcoholic ketoacidosis, Lactic acidosis, Renal
acidosis (↑unmeasured anions but failure, Starvation, Ethylene glycol poisoning, Methyl alcohol
normal Cl-) poisoning

Hyperchloraemic/non-anion gap Congenital renal tubular acidosis, Drainage of pancreatic juice,

metabolic acidosis (↑Cl but normal Pancreatic fistula, Ammonium chloride
unmeasured anions)
http://www.nlm.nih.gov/medlineplus/ency/article/003855.htm
http://www.ed4nurses.com/resources/1/pdf/ABGebook.pdf
http://www.nhlbi.nih.gov/health/health-topics/topics/oxt/
http://www.australianprescriber.com/magazine/33/4/124/9#.UYchsUL6HcY

Fun link:
http://www.wisc-online.com/Objects/ViewObject.aspx?ID=nur202

Video:
http://www.youtube.com/watch?v=0Rr6vpFMKPE