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Section G1 Group 1

ARTERIAL BLOOD GASES TEST



 Performed to measure the pH, oxygen, and carbon
dioxide levels in the blood.
 Arterial blood is preferably used.
 It is important in monitoring acid-base status of the
patients. Disorders in acid-base balance may pose
serious complications in patients, particularly those
who are critically ill.
ARTERIAL BLOOD GASES TEST

Commonly includes:
 pH
 pCO2
 pO2
Calculated Values

 Total Carbon Dioxide
 Bicarbonate
 Oxygen Saturation
 Oxygen Content
 Base Excess
 Alveolar-arterial gradient
PATIENT CARE

 Collection is done with patient in a supine position. Make
sure that the patient is relaxed.
 Specimen: Whole Blood
• Collection is done using heparinized syringe, or if not
possible, via in-dwelling arterial line
- make use of syringe with needles of small diameter
- place a stopper on the heparinized syringe after
blood has been collected
- usually 25 gauge
- drawn into air-free heparinized syringe, then
stoppered
• Favored site: Radial artery; alternative is brachial artery
PATIENT CARE

 All specimens should be placed on ice and brought
to the laboratory immediately
• Indicate mode of oxygen delivery or if room air
• Maintain strict anaerobic conditions
• Do not do collection immediately after exercise
• Do not put too much heparin
PATIENT CARE

 Blood drawn from a vein or capillary can provide
helpful information on pH, pCO2, and occasionally,
pO2
 Storage instructions:
• Place on ice (following in vitro changes occur in blood
gas parameters):
- pH, 0.001/10 minutes at 4 degree Celcius
- pCO2, 0.1 mmHG/10 minutes at 4 degree Celsius
- pO2, 3 mmHg/10 minutes at 4 degree Celsius
PATIENT CARE

• Reject if the specimen is not placed on ice or if air
bubbles or clots are present in the syringe
• Special instructions:
- confusing results may be obtained if the sample
was collected just after a change in FiO2
Interpretative Reference Range

 Arterial pH: 7.35-7.45
 pCO2 : 35-45 mmHG
 pO2 : BP-adult = 80-95 mmHg
newborn = 60-70 mmHg
 TCO2 : 23-29 mmol/L
 O2: 95% - 99% saturation
Possible Panic Range

 pH < 7.2 or > 7.55
 pCO2 < 20 mmHg or > 60 mmHg
 pO2 < 40 mmHg
Uses of ABG measurement

 For evaluation of patient’s respiratory function as
well as acid-base status
 Evaluation of respiratory status in patients with
pulmonary problems such as COPD and other lung
diseases
 Monitoring of respiratory function of patients who
underwent coronary arterial bypass surgery
Interpretation

1. What are the normal values?
Interpretation

2. Acidosis or Alkalosis?
 The first thing that is checked is the pH. Normal blood
pH level is 7.35-7.45.
 If it is < 7.35, this is considered ACIDOSIS.
 If it is > 7.45, consider ALKALOSIS.
Interpretation

3. Respiratory or Metabolic?
 Next thing to look at is the PaCO2 and the HCO3
levels.
 It is RESPIRATORY if the abnormality is the PaCO2.
 It is METABOLIC if the abnormality involves HCO3.
Interpretation

 If the pH is alkaline and the PaCO2 is reduced, the
problem is RESPIRATORY ALKALOSIS.
 If the pH is acidic and the PaCO2 is increased, the
problem is RESPIRATORY AIDOSIS.

 If HCO3 and pH are both elevated, consider


METABOLIC ALKALOSIS.
 If both pH and HCO3 are reduced, it is METABOLIC
ACIDOSIS.
Interpretation

4. Create a chart
 Similar to “tic tac toe” where you can enter the values
for easier analysis.
Interpretation

5. Fill up the chart
 Mark the chart based on the laboratory values
obtained.
 Sample values: pH 7.20, paCO2 30, HCO3 17
Interpretation

6. Determine level of compensation
 If both PaCO2 and HCO3 are both deranged
while pH is normal = COMPENSATED
 If PaCO2, HCO3, and pH are all abnormal =
PARTIALLY COMPENSATED
 If either PaCO2 or HCO3 is abnormal and pH is
also abnormal = UNCOMPENSATED

• In the above example, the acid-base disturbance is


Partially Compensated Metabolic Acidosis.
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