ARTERIAL-BLOOD GAS

ANALYSIS
ARTERIAL-BLOOD GAS ANALYSIS

A measurement of O2, CO2, and the pH

of the blood that provides a means of
assessing the adequacy of ventilation
(PaCO2), metabolic status (pH), and
oxygenation (PaO2).
ARTERIAL-BLOOD GAS ANALYSIS

Used for diagnostic

evaluation and evaluation
of response to clinical
interventions (oxygen
therapy, mechanical
ventilation, etc.).
ARTERIAL-BLOOD GAS ANALYSIS

Allows assessment of body’s acid-

base (pH) status, indicating if acidosis or
alkalosis is present, whether acidosis or
alkalosis is respiratory or metabolic in
origin, and whether it is compensated or
uncompensated.
PURPOSES
• An ABG analysis evaluates how
effectively the lungs are delivering
oxygen to the blood and how
efficiently they are eliminating
carbon dioxide from it.

• The test also indicates how well the

lungs and kidneys are interacting to
maintain normal blood pH (acid-
base balance).
Blood gas studies are usually
done to assess respiratory
disease and other conditions
that may affect the lungs, and
to manage patients receiving
oxygen therapy (respiratory
therapy).

In addition, the acid-base

component of the test provides
information on kidney function
too.
An ABG is typically requested to determine the pH of the blood
and the partial pressures of carbon dioxide (PaCO2) and oxygen
(PaO2) within it.

It is used to assess the effectiveness of gaseous exchange and

ventilation, be it spontaneous or mechanical.
If the pH becomes deranged, normal cell metabolism is affected.
The ABG allows patients' metabolic status to be assessed too,
giving an indication of how they are coping with their illness.

It would therefore seem logical to request an ABG on any

patient who is or has the potential to become critically ill.
This includes patients in critical care areas and those on wards
who 'trigger' early-warning scoring systems.
QUICK REVIEW OF ACID-BASE
IMBALANCE
QUICK REVIEW OF ACID-BASE
IMBALANCE
Respiratory acidosis is
characterized by a lower pH and
an increased PCO2 and is due to
respiratory depression (not
enough oxygen in and CO2 out).

This can be caused by many

things, including pneumonia,
chronic obstructive pulmonary
disease (COPD), and over-
sedation from narcotics.
QUICK REVIEW OF ACID-BASE
IMBALANCE
Respiratory alkalosis,
characterized by a raised
pH and a decreased PCO2,
is due to over ventilation
caused by hyperventilating,
pain, emotional distress, or
certain lung diseases that
interfere with oxygen
exchange.
QUICK REVIEW OF ACID-BASE
IMBALANCE
QUICK REVIEW OF ACID-BASE
IMBALANCE
Metabolic acidosis is
characterized by a lower
pH and decreased
HCO3-; the blood is too
acidic on a
metabolic/kidney level.
Causes include diabetes,
shock, and renal failure
pH
QUICK REVIEW OF ACID-BASE
IMBALANCE
Metabolic alkalosis is
characterized by an
elevated pH and
increased HCO3- and is
seen in hypokalemia,
chronic vomiting
(losing acid from the
stomach), and sodium
bicarbonate overdose.
 Nursing and Patient Care Considerations
1. Blood can be obtained from any artery but
is usually drawn from the radial, brachial, or
femoral site. It can be drawn directly by
arterial puncture or accessed by way of
indwelling arterial catheter. Determine facility
policy for qualifications for ABG sampling and
site of arterial puncture.

2. If the radial artery is used, an Allen test

must be performed before the puncture to
determine if collateral circulation is present.
3. Arterial puncture should not be
performed through a lesion,
through or distal to a surgical shunt,
or in area where peripheral vascular
disease or infection is present.

4. Coagulopathy or medium- to
high-dose anticoagulation therapy
may be a relative contraindication
for arterial puncture.
5. Results may be affected by recent changes in oxygen therapy,
suctioning, or positioning.
6. Interpret ABG values by looking at trends for the patient as
well as the following normal values:

a. PaO2—partial pressure of arterial oxygen (80 to 100 mm Hg)

b. PaCO2—partial pressure of arterial carbon dioxide (35 to 45
mm Hg)
c. SaO2—arterial oxygen saturation (>95%)
d. pH—hydrogen ion concentration, or degree of acid-base
balance (7.35 to 7.45); bicarbonate (HCO3−) ion primarily
a metabolic buffer (22 to 26 mEq/L).
 STEPS ON
EFFCTIVE ABG
ANALYSIS
INTERPRETATION
STEP I: REMEMBER THE NORMAL
VALUES
BLOOD PH 7.35-7.45
paO2 80-100
paCO2 35-45
HCO3 22-26
O2 saturation 95-100%
Base Excess/ Base Deficit -2 to +2
STEP II: LOOK AT THE PH. DOES IT INDICATE
ACADEMIA, OR ALKALOSIS OR NORMAL PH.

pH --------LOW Below 7.35------ ACIDOSIS

pH --------HIGH Above 7.45 ------ ALKALOSIS

STEP II: LOOK AT THE PH. DOES IT INDICATE
ACADEMIA, OR ALKALOSIS OR NORMAL PH.

example : pH 7.31 (low) ACIDOSIS

pH 7.48 (high) ALKALOSIS

PLEASE DO THIS EXERCISE. IDENTIFY
WHETHER THE PH IS NORMAL, ACIDOTIC
OR ALKALOTIC

1. 7.41
2.7.32
3.7.50
STEP III: LOOK AT THE PaCO2
Pao2 is a respiratory indicator
Co2 act as an ACID. When CO@ combines with plasma.
Carbonic acid is formed (CO2 + H2O = H2CO3)

• PaCO2---- HIGH (above 45mmhg): Respiratory acidosis

• Paco2 ---- LOW (below 35mmHg): Respiratory alkalosis
STEP III: LOOK AT THE PaCO2
PLEASE DO THESE EXERCISE, IDENTIFY WETHER
THE FOLLOWING, VALUES REPRESENT
REPIRATORY ACIDOSIS, RESPIRATORY
ALKALOSIS, OR NORMAL VALUES.
1. ph- 7.32
paCO2- 50

2. pH 7.5
paCO2- 30

3. ph 7.37
paCO2 41
STEP IV: LOOK AT THE HCO3
PLEASE DO THESE EXERCISE. IDENTITY WHETHER THE
FOLLOWING VALUES REPRESENT METABOLIC
ACIDOSIS, METABOLIC ALKALOSIS, NORMAL VALUES
1. pH-7.28
HCO3-16
2. pH-7.52
HCO3-32
3. pH-7.43
HCO3-25
4. pH-7.30
HCO3-20
5. pH-7.4
HCO3-16
STEP V: DETERMINE THE PRIMARY
ACID-BASE DISTURBANCE.
The change that matches the pH is the primary ACID-BASE
DISTURBANCE
1. pH and PaCO2 MATCH RESPIRATORY ACID-BASE
IMBALANCE
a. pH ACIDOSIS
paCo2 ACIDOSIS RESPIRATORY ACIDOSIS

b. pH ALKALOSIS
paCo2 ALKALOSIS RESPIRATORY ALKALOSIS
STEP V: DETERMINE THE PRIMARY
ACID-BASE DISTURBANCE.
The change that matches the pH is the primary ACID-BASE
DISTURBANCE
1. pH and HCO3 MATCH METABOLIC ACID-BASE
IMBALANCE
a. pH ACIDOSIS
HCO3 ACIDOSIS METABOLIC ACIDOSIS

b. pH ALKALOSIS
HCO3 ALKALOSIS METABOLIC ALKALOSIS
THEREFORE IF
PH AND PCO2- ARE PRIMARILY AFFECTED
(SAME INTERPRETATION)
RESPI ACID-BASE IMBALANCE

PH AND HCO3- ARE PRIMARILY AFFECTED

(SAME --INTERPRETATION)
METABOLIC IMBALANCE OCCUR
Think about ROME

R-Respiratory
O-Opposite
M-metabolic
E-Equal
CHECK ON THESE:
• 1. REPIRATORY ACID-BASE IMBALANCE
RESPIRATORY OPPOSITE MEANS: THE
DIRECTION OF THE PH AND PACO2 ARE
OPPOSITE.
LOOK AT THESE EXAMPLES

•pH LOW
•PaCO2 HIGH RESPIRATORY ACIDOSIS

• pH HIGH
•paCO2 LOW RESPIRATORY ALKALOSIS
CHECK ON THESE:
• 2. METABOLIC ACID-BASE IMBALANCE
METABOLIC EQUAL MEANS: THE
DIRECTION OF THE PH AND HCO3 ARE
EQUAL.
LOOK AT THESE EXAMPLES

•pH LOW
•HCO3 LOW METABOLIC ACIDOSIS

• pH HIGH
•HCO3 HIGH METABOLIC ALKALOSIS
NOW You’re ready to do the following excercises.
Indicate the following spaces provided wether the
values represent acidosis, alkalosis, or normal.

1. Ph- 7.5
Paco2 32
Hco3-26

2. Ph- 7.5
Paco2 32
Hco3-26
NOW You’re ready to do the following excercises.
Indicate the following spaces provided wether the
values represent acidosis, alkalosis, or normal.

3. Ph- 7.30
Paco2- 60
Hco3- 32

4. Ph- 7.32
Paco2 30
Hco3-18
How are you doing at
this point?
If you’re doing well,
then proceed to the next step.
STEP VI: LOOK AT THE DEGREE OF
COMPENSATION
Check relationship between paco2 and HCO3:
§Remember, the lungs and kidneys normally attempt
to help each other to maintain acid-base balance
§If the lungs are unable to maintan acid-base balance,
kidneys will attempt to adjust levels of hco3
§If the kidneys are unable to maintain acid-base
balance, the lungs will attempt to adjust levels CO2
STEP VI: LOOK AT THE DEGREE OF
COMPENSATION
§If co2 and HCO3 levels more towards the same
direction, i.e. both are high or both are low, then
the acid-base imbalance is compensated.
e.g.

paCO2---High (acidosis) HCO3-----High (alkalosis)

PaCO2---low (alkalosis) HCO3-----low (acidosis)
STEP VII: 7. IF THE ACID-BASE IMBALANCE IS COMPENSATED,
DETERMINE WETHER IT IS PARTIAL COMPENSATION OR
COMPLETE COMPENSATION
When is the acid-base imbalance
considered as partial or complete
compensation?
1. When the acid-base balance is compensated, but the pH is still
ABNORMAL: PARTIAL COMPENSATION.
2. When the acid-base balance ius compensated, and the pH is
NORMAL: COMPLETE COMPENSATION
STEP VII: 7. IF THE ACID-BASE IMBALANCE IS COMPENSATED,
DETERMINE WETHER IT IS PARTIAL COMPENSATION OR COMPLETE
COMPENSATION

When is the acid-base imbalance

considered uncompensated?
When the CO2 and HCO3, levels move towards opposite
directions ( the problem is worsened)
Eg.
paCO2- high (Acidosis) HCO3- low (Acidosis)
paCO2- low (Alkalosis) HCO3- High (Alkalosis)

Or when paco2 is abnormal and HCO3 remains normal and

vice versa, the acid base imbalance is also uncompensated
 You are now ready to
apply your knowledge in
ABG analysis!
ACTIVITY NO. 2
ACID BASE IMBALANCE INTERPRETATION
Please check (/) whether the following date represent
respiratory acidosis, respiratory alkalosis or normal values.
PH PACO2 RESPI RESPI NORMAL
ACIDOSIS ALKALOSIS

11.7.20 54      
12. 7.52 28      
13. 7.33 50      
14. 7.48 30      
15. 7.41 41      
REFERENCES:

Nettina, S. M. (2018). Lippincott Manual of

Nursing practice (11th ed.). Lippincott
Williams and Wilkins.
Udan, J.Q. (2017). Medical-Surgical Nursing:
Concepts and Clinical Application (3rd ed).
Educational Pub. House
ACTIVITY NO. 2
ACID-BASE
IMBALANCE
INTERPRETATION
ACTIVITY NO. 2
ACID BASE IMBALANCE INTERPRETATION
Please a check (/) in the appropriate column indicating whether
the ph is normal, acidotic, and alkalotic
PH NORMAL ACIDOSIS ALKALOSIS
1. 7.37      
2. 7.61      
3. 7.19      
4. 7.50      
5. 7.30      
6. 7.41      
7. 7.48      
8. 7.28      
9. 7.35      
10. 7.52      
ACTIVITY NO. 2
ACID BASE IMBALANCE INTERPRETATION
Please check (/) whether the following date represent metabolic
acidosis, metabolic alkalosis, or normal values.

PH HCO3 BE METABOLIC METABOLIC NORMAL

ACIDOSIS ALKALOSIS
16. 7.26 19 -6      
17. 7.42 24 0      
18. 7.42 15 -8      
19. 7.54 35 +6      
20. 7.51 30 +4      
ACTIVITY NO. 2
ACID BASE IMBALANCE INTERPRETATION
IDENTIFY THE PRIMARY ACID-BASE DISTURBANCE IF ANY, AND
INDICATE WHETHER COMPENSATION IS PARTIAL OR COMPLETE
OR UNCOMPENSATED ACID BASE BALANCE.
21. pH - 7.5
paCO2 - 31 Respiratory Alkalosis
HCO3 – 26 Uncompensated

22. pH - 7.38
paCO2 - 32 Metabolic Acidosis
HCO3 – 19 Complete compensation

23. pH – 7.24
paCO2 - 60 Respiratory Acidosis
Partial Compensation
HCO3 – 32
 Respiratory Alkalosis
Complete Compensation

25. pH - 7.5 Metabolic Alkalosis

paCO2 - 42 Uncompensated
HCO3 - 33