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Analysis of ABG Samples

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ABG Analysis, Introduction

■ pH, PaCO2, PaO2 are measured directly by


special electrodes contained in a device
made for that purpose
■ Other indirect measurements can be made
or calculated from the above measurements
i.e., HCO3-, O2 Sat.

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pH
■ pH electrode is constructed of two half cells,
which develop an electrical potential when
connected together
■ Reference electrode maintains a constant potential
and is bathed in KCl
■ Glass electrode (Sanz electrode) develops an
electrical potential that is proportional to the
amount of H+ present

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PaCO2 Electrode (Severinghaus)
■ Measures carbon dioxide tensions by allowing the
CO2 gas to undergo a chemical reaction that produces
hydrogen ions
■ The hydrogen ion concentration produced is directly
proportional to the PCO2 in contact with the
membrane of the electrode
■ Operates on the principle of electric potential between
electrodes
■ CO2 + H2O H2CO3 H+ + HCO3-

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O2 Electrode (Clark)
■ Is a polarographic device that measures oxygen
tensions by oxidation/reduction reactions, a chemical
process that generates measurable electrical currents
■ Has platinum cathode and silver anode immersed in
an electrolyte solution
■ Volume of O2 will be directly proportional to the
number of electrons used in the cathode rxn. and by
measuring current ∆ is a measure of O2 diffused
across membrane

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QA in Blood Gas Analysis

■ ABG lab must be able to assure accurate


and reliable results
■ The above is accomplished by applying
protocols in 3 areas:
- pre-analytic error
- calibration
- quality control

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Pre-analytic Error
■ All factors that cause variance in lab results prior to
the sample arriving in the ABG lab.
■ 4 factors assoc. with signif. P. E. are: - air
bubbles in sample
- time delay (iced sample with more than 60 min.
or uniced with more than 10 min.)
- blood clots in sample
- small sample size where excessive
anticaogulation is suspect

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Calibration
■ Purpose is assure consistency
■ Def.: the systemic standardization of the graduation
of a quantitative measuring instrument
■ Calibrating standards for blood gas analyzers
should simulate the physical properties of blood
and meet manuf. specs.
■ When 2 standards are used ---> 2-point calibration,
performed after 50 blood gases or at least every 8
hours

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Calibration (cont’d)

■ A “one-point calibration” is an adjustment


of the electronic response of an electrode to
a single standard and is performed more
freq. than a 2 pt. cal., ideally prior to each
sample analysis

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pH Calibration
■ Several types of buffer solutions are acceptable for
pH electrode calibration
■ Buffers are excellent standards because of their long
shelf life and stability for days after being opened
■ 2-point cal. of pH electrode is done by setting the
“slope” potentiometer to a low pH buffer (6.84) and
setting the “balance” potentiometer with a near-
normal buffer (7.384) with an accuracy of +/- 0.005

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PaCO2 Calibration

■ PaCO2 electrode may be calibrated by


introducing a known gas concentration
■ Gases used are 5% and 10% CO2, +/- .03%
- 1-point cal. uses 5% standard to set the
“balance” point - 2-point cal. uses 5% for
“balance” point and 10% for “slope” point
■ PCO2 = (BP - 47 mmHg) x %CO2

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PO2 Calibration

■ Properly calibrated PO2 electrodes perform


within the manuf. stated accuracy in PaO2
ranges below 150 mmHg but may vary 20%
at 500 mmHg
■ 0% oxygen is used for the “slope” point and
12% or 20% for the “balance” point
■ PO2 = (BP - 47 mmHg) x % O2

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Quality Control
■ Refers to a system that documents the accuracy and
reliability of the blood gas measurements and is
essential to assure accuracy in the blood gas lab
■ Media available as blood gas controls include:
- aqueous buffers
- glycerin soltn.
- human/animal serum and blood - artificial
blood
■ A QC system must ID problems and specify
corrective action, document. of accept. oper.

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QC (cont’d)
■ Documentation of QC is usu. on Levy-Jennings
Chart which shows measured results on the y axis
versus time of measurement on the x axis
■ SD is used to summarize a mass of data: the
difference between a number in a data set and the
mean of the data set is called a deviation. A
deviation shows how much a number varies from
the mean

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QC (cont’d)
■ A properly functioning electrode that repeatedly
analyzes a known value will produce results
within a rel. small range, e.g., a PaCO2 electrode
that analyzes a 40 mmHg standard 100 times will
produce results where 2/3 of the measurements are
39 - 41 mmHg and nearly all measurements fall in
38 - 42 range
■ 95% of the control measurements should fall
within 2 SD
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QC (cont’d)
■ Random errors indicates a value outside of 2 SD of
the mean: a single random error has minor signif.,
but if number increased the machine and techniques
must be evaluated
■ Systematic errors is recurrent measurable deviation
from the mean
■ Causes of systematic errors:
- contaminated standard
- variations in electrode temp.
- inconsistent introduction of standard
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QC (cont’d)

■ Causes of systematic error (cont’d)


- inconsistent calibration technique
- change in QC standard storage or prep.
- electrode problems, e.g., protein
contamin., membrane malfunction,
contamin. electrolyte, or electrical
problems

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QC Levels

■ Level 1 simulates a patient hypoventilating


■ Level 2 simulates a patient with normal
ventilatory status
■ Level 3 simulates a patient hyperventilating

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