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ARTERIAL BLOOD GASES

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ABGs Introduction
ABGs are drawn and analyzed to determine the
acid-base relationship of the blood and if the pt. is
being well oxygenated
Changes in the blood related to lung function are
called respiratory and changes caused by renal
action are called metabolic
Arterial blood is used because it is a better
indicator of activity in all parts of body
pH, PaCO
2
, PaO
2
, are primary values
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pH
Is a measurement of hydrogen ion activity and is
expressed logarithmically
As hydrogen ion concentration increases, pH
decreases
Normal pH range is 7.35 - 7.45, and if outside this
range, have acid-base imbalance
- < 7.35 = acidemia
- > 7.45 = alkalemia
Survival is unlikely if pH < 6.8 or > 8.0
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pH (contd)
Buffers prevent extreme changes in the free
Hydrogen ion concentration
Four major buffer systems:
- hemoglobin - phosphate
- bicarbonate - serum protein

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PaCO
2

PaCO
2
directly reflects the adequacy of alveolar
ventilation
About 95% of CO
2
in the blood is transported
through buffering mechanisms in the rbc, but 5%
is dissolved in plasma
This dissolved CO
2
determines the blood partial
pressure
Normal range is 35-45 mmHg (torr) with a mean
of 40 mmHg
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PaCO
2
(contd)
Physiologic deadspace vs. anatomic
deadspace
Vd/Vt = PaCO
2
- PECO
2
/PaCO
2

Normal Vd/Vt = 0.2 - 0.4
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PaCO
2
- pH Relationship
When acute changes in ventilation occur, a
predictable relationship between pH and plasma
carbonic acid results
Normal PaCO
2
= 40 mmHg
- increase of 10 mmHg = pH decr. 0.08
- decrease of 10 mmHg = pH incr. 0.08
Chronic ventilatory failure is when metabolic
compensation of the acidemia has occurred, see
high PaCO
2
and normal pH
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O
2
Transport and Utilization
Person requires 250 ml of O
2
/min. at rest and
exercise can incr. 20x
Most of bodys O
2
is combined with Hgb at 4
heme groups on the Hgb molecule
- Hgb + O
2
= oxyhemoglobin
Carbaminohemoglobin = CO
2
+ Hgb
Carboxyhemoglobin = CO + Hgb
- competes with O
2
, but has 200x the
affinity for Hgb
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O
2
Transport (contd)
Normal Hgb. for male 14-16 g/100ml
-female 12-15 g/100ml
PaO
2
represents O
2
dissolved in plasma
- for each mmHg of pressure there is
0.003 vol% of dissolved O
2

O
2
capacity = amt. of O
2
that can be max. bound to
Hgb.
- each gram of Hgb. can bind with 1.34
ml of O
2

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O
2
Transport (contd)
O
2
capacity = 1.34 x Hgb. + (PaO
2
x 0.003)
O2 content = 1.34 x Hgb. x O
2
Sat +
(PaO
2
x 0.003)
O
2
sat. (SaO
2
or SpO
2
) varies directly with O
2

tension in accordance to the oxyhemoglobin
dissociation curve
Shape of dissoc. curve means the Hgb. holds on to
O
2
over a wide range at the upper end and lets go
at the lower tensions
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O
2
Transport (contd)
Normal PaO
2
= 80 -100 mmHg
- varies with age - rule of thumb-
PaO
2
= 105 - (.5 x age)

- varies with altitude
PaO
2
(corr.) = PaO
2
[at 760] x Act. Pb
760
- varies with FIO2
PaO
2
= O
2
% x 5
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Complications of Arterial
Puncture
Arteriospasm
-artery surrounded by smoothe muscle,
may see spasm which may cause
occlusion
Thrombi
-possible dislodging of an
atherosclerotic plaque or thrombus
Emboli
-may lead to occlusion of distal vessels
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Complications (contd)
Infection
Loss of blood flow and circulation
-repeated punctures may compromise
vessel integrity and circulation
Hemorrhage
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Arterial Cannulation
Refers to placement of indwelling arterial cannula
for the immediate availability of arterial blood
samples and continuous arterial pressure
monitoring
A-line is indicated when a pt. is, or may become,
CP unstable , or needs serial blood gases and/or
needs cont. arterial press. monitoring
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Complications of A-lines
Necrosis and loss of tissue (small percentage)
Infection (same incidence as venous)
Thrombosis
Hemorrhage
Arteriospasm
Emboli
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Equipment for A-line
Arterial cannula
1% xylocaine, 25 guage needle, syringe
Antiseptic swabs
Continuous arterial keep-open setup consisting of:
-heparin -IV tubing set
-500 ml NS -pressure bag
-press. transducer -stopcocks
-flushing device