Blood Gas Analysis

Blood gas analysis is also called arterial blood gas (ABG)

It is a test that measures the amount of oxygen and carbon dioxide in the blood as well as the blood acidity (pH)

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 the 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.

Acid base component of the test provides information on kidney function.

For blood gas analysis, arterial blood is suitable e.g. radial, brachial or femoral artery.

Arterial blood pressure is much higher than the venous blood

Venous blood has slightly acidic pH than arterial blood

Venous blood has high levels of CO2.

Radial artery is preferred to other sites due to the following reasons;
(i) Easy to puncture
(ii) It s a superficial and easily accessible
(iii) Easy to palpate and stabilize, Easily compressible with better control of bleeding
(iv) There is no nerve nearby to worry about.
(v) Has a collateral blood flow (in-case of damage, ulna artery can supply the tissues supplied by radial artery)

Acid base balance is maintenance of H+ under control.

The above balance is largely dependent on secretion of H+ from the body through the urine by renal tubular
action.

The body depends on healthy functioning of both the kidneys and lungs for a normal acid base homeostasis.

The acids in the body includes; lactic, carbonic, sulphuric, ketoacids, phosphatic , pyruvic acid etc.

Blood gas analysis ( profile )

pH : 7.35 7.45

PaC02 : Partial pressure of carbon dioxide (35-45 mmHg)

PaO2 : Partial pressure of oxygen (75-100 mmHg)

SaO2 : Arterial saturation of oxygen (94-100%)

SaCO2 : Arterial saturation of carbon dioxide
-

HCO3 : Bicarbonate (22-26 mEq/L)

TCO2 : Total carbon dioxide

PvCO2 : Partial pressure of carbon dioxide in venous blood

QT : Cardiac output

O2CT : Oxygen content (15-23%)

B.E : Base excess

Abnormal results

Values differ from those listed above may indicated respiratory, metabolic or kidney disease

Results may be abnormal if the patient has experienced trauma (especially head and neck injuries) that
may affect breathing.

Disorders such as anemia that affects the oxygen carrying capacity of blood.

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 Clinical significance of Acid base disturbances

Disturbances of acid base balance may either be respiratory or metabolic in origin (acidosis or Alkalosis)

Acidosis : The abnormal process which produces acidaemia (blood pH below 7.35).
Alkalosis: Abnormal process which produces alkalemia (blood pH above 7.45)
Anion gap: Mathematical approximation of the difference between cations and anions routinely measured in
serum. The calculated difference between the vely charged and +vely charged electrolytes measured
in serum.
Cations Anions = 12 -16 mEq/L

Patient preparation

There is no special patient preparation (no restrictions on drinking or eating before the test)

If the patient is receiving oxygen, O2 conc. should remain the same for 20min before the test.

If the test is to be taken without oxygen, O2 should be turned off for 20min before the test

Collection of arterial blood

Prepare the patient by positioning him/her according to the site chosen

Set up your own tray with necessary equipment

Cleanse the skin over the puncture site with alcohol swab

Palpitate the pulse with an index finger of your non-dominant hand

Insert the needle at a specific angle just under skin surface
(i) For dorsalis pedis artery, insert the needle at 45-60
(ii) For brachial artery, insert the needle at 45-60O
(iii) For femoral artery, insert the needle at 60-90O angle, 1-2 cm below the inguinal crease.

Continue to gently insert the needle until there is flash back of blood into the syringe

If there is no flash back of blood into the syringe, slowly withdraw until there is flashback

If there is still no flash back, withdraw the needle & re-direct it without coming out of the skin.

Arterial pressure should fill the syringe spontaneously unless the patient is in shock

If the syringe does not fill spontaneously, aspirate to obtain the sample.

Maintain the position of the needle until the syringe fill with 2-4 ml of blood.

Remove the needle swiftly and apply pressure with the gauze to the puncture site for 5-10min.

Patient may maintain the pressure if he/she is able to.

NB:
o If the artery goes into vasospasm, try another site & wait for it to recover.
o Do not try more than 2-3 puncture attempt at one site
o Take care to avoid femoral nerve which lies lateral to the femoral artery.

Patient aftercare

After blood is taken, pressure should be applied at the puncture site for 10-15 min to stop the bleeding

Patient should rest quietly while applying pressure and observed for signs of bleeding or circulatory problems.

Risks

Risks are very low when the test is done correctly.

Risks include bleeding or bruising at the site or delayed bleeding from the site.

Very rarely, there may be a problem with circulation in the puncture area.

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