ABG

Definition:
• Assisting in collection of blood sample from an artery.

• 3 physiologic process that maintains homeostasis

 Alveolar
Ventilation

Oxygenation

Acid Base
Balance

ABG
 Purposes:

• To assess the degree of oxygenation of blood and adequacy of

alveolar ventilation

• To assess acid base status accurately.

Indications for ABG
• Sudden dyspnea
• Cyanosis
• Abnormal breath sounds
• Sudden or unexplained tachypnea
• Heavy use of accessory muscles
• Change in ventilator setting
• Diffuse infiltrates in chest x-ray
 Contraindications
Absolute contraindications: 

• An abnormal modified Allen test

• Local infection or distorted anatomy at the potential puncture site

• The presence of arteriovenous fistulas or vascular grafts, in which case

arterial vascular puncture should not be attempted

• Known or suspected severe peripheral vascular disease of the limb

involved
 Contraindications
Relative contraindications:

• Severe coagulopathy

• Anticoagulation therapy with warfarin, heparin and derivatives, direct

thrombin inhibitors, or factor X inhibitors; aspirin is not a
contraindication for arterial vascular sampling in most cases

• Use of thrombolytic agents, such as streptokinase or tissue plasminogen

activator
Criteria for choosing site for obtaining ABG
samples must be based on:

• Safety

• Accessibility

• Patient Comfort
 Different Sites

 • Brachial Artery

• Radial Artery

• Dorsalis pedis

• Femoral Artery
 Preparation for Procedure
• Articles:
• Syringe (ABG)
• Needle (26 G)
• Leur Lock for syringe
• Alcohol / spirit swabs
• Crushed ice
• Gloves
• Drapes
 Preparation for Procedure
• Patient / Family
• Explain
• Obtain consent
• Perform a modified Allen test to ensure adequate collateral circulation from ulnar artery.

• Position the patient's hand with the wrist extended 20-30".

• Greater extension of the wrist may impede arterial flow.

• Identify the radial artery by palpating the pulse; choose a site where the pulse is
prominent.

• Clean the sampling site with an alcohol wipe.

• Expel the heparin from syringe.

• Insert the needle at 45*, bevel facing up.

• When the needle is in the artery a flash of pulsatile blood will appear in the barrel of the
needle.

• Obtain at least 3 mL of blood before withdrawing.

Procedure
Complications
Hematoma
 Arteriospasm
 Air or clotted-blood emboli  
 Anaphylaxis from local anesthestic
Introduction of contagion at sampling site and consequent
infection in patient; introduction of contagion to sampler by
inadvertent needle 'stick.’
Hemorrhage
 Trauma to the vessel
 Arterial occlusion
 Vasovagal response
 Pain
5 simple steps:

1. PaO 2 levels -----------? Hypoxemia

2. pH level ……………? Acid or alkali

3.Pa CO2 level………………? Resp acidosis/ alkalosis/ normal

4. HCO3- level………………..? metabolic acidosis/ alkalosis/

normal

5. pH level……………….? Compensated or uncompensated

• pH < 7.35 acidemia

• pH > 7.45 alkalemia

• This is usually the primary disorder

• Is the disturbance respiratory or metabolic?

• What is the relationship between the direction of change

in the pH and the direction of change in the PaCO2?

• In primary respiratory disorders, the pH and PaCO2

change in opposite directions; in metabolic disorders the
pH and PaCO2 change in the same direction.

ROME
 Common causes of respiratory acidosis

Airway obstruction - Upper - Lower

• COPD. Asthma

• CNS depression

• Sleep disordered breathing (OSA )

• Neuromuscular impairment

• Ventilatory restriction

• Increased CO2 production: shivering, rigors, seizures, malignant hyperthermia,

hypermetabolism, increased intake of carbohydrates

• Incorrect mechanical ventilation settings

Common causes of respiratory alkalosis
• CNS stimulation: fever, pain, fear, anxiety, CVA, cerebral edema, brain trauma,
brain tumor, CNS infection

• Hypoxemia or hypoxia: lung disease, profound anemia, low FiO2

• Stimulation of chest receptors: pulmonary edema, pleural effusion, pneumonia,

pneumothorax, pulmonary embolus

• Drugs, hormones: salicylates, catecholamines, medroxyprogesterone, progestins

• Pregnancy, liver disease, sepsis, hyperthyroidism

• Incorrect mechanical ventilation settings

Common causes of metabolic acidosis
• Methanol intoxication

• Uremia

• Diabetic ketoacidosis, alcoholic ketoacidosis,

starvation ketoacidosis

• Paraldehyde toxicity

• Isoniazid

• Lactic acidosis
 Common causes of metabolic alkalosis
• Hypovolemia with Cl- depletion

• GI loss of H+…………….Vomiting, gastric suction, villous adenoma, diarrhea with

chloride-rich fluid

• Renal loss H+……..Loop and thiazide diuretics, post-hypercapnia (especially after

institution of mechanical ventilation)

• Hypervolemia, Cl- expansion

• Renal loss of H+: edematous states (heart failure, cirrhosis, nephrotic syndrome),
hyperaldosteronism, hypercortisolism, excess ACTH, exogenous steroids,
hyperreninemia, severe hypokalemia, renal artery stenosis, bicarbonate
administration
DISORDER pH Pa CO2 HCO 3-
R. Acidosis: Uncompenated <7.35 >45 mmHg 22-26 mEq/L
Partial <7.35 >45mmHg >26 mEq/L
Compensated 7.35-7.39 >45 mmHg >26 m Eq/L

R.alkalosis: Uncompensated >7.45 <35 mmHg 22-26 mEq/L

Partial >7.45 <35 mmHg <22 mEq/L
Compensated 7.41-7.45 <35 mmHg <22m Eq/L

M.Acidosis: Uncompensated <7.35 35-45 mmHg <22 mEq/L

Partial <7.35 <35 mmHg <22m Eq/L
compensated 7.35-7.39 <35 mmHg <22m Eq/L

M. Alkalosis: Uncompensated >7.45 35-45 mmHg >26 mEq/L

Partial >7.45 >45 mmHg >26 m Eq/L
compensated 7.41-7.45 >45 mmHg >26 mEq/L

Combined resp and metabolic acidosis <7.35 >45 mmHg <22 meq/L
Combined resp and metabolic alkalosis >7.45 <35 mmHg >26 m Eq/L