ABG Analysis and Other Cardiopulmonary

Monitoring
Delce Mondares
Althea Marie Toledo
 Blood Gas Interpretation

 It is essential for evaluating gas exchange when providing

respiratory care
 ABG taken from a peripheral artery reflects pulmonary gas
exchange info
 Procedure(ABG Sampling)
 Explain the procedure to the patient
 Perform modified Allen test
 Place a folded towel under the patient’s wrist to keep it hyper-
extended
 Clean the puncture site with alcohol or other appropriate disinfectant
 Practitioner must wear gloves
 A local anaesthetic(lidocaine) may be used around the puncture site
for patients being punctured more than once
 Procedure(ABG Sampling)

 With the syringe in one hand, palpate the artery with the other
hand.
 The needle should enter the skin at a 45 degree angle with the bevel
pointed up
 Advance needle until blood pulsates into the syringe
 Obtain 2-4mL of blood and apply sterile gauze pad or cotton on the
puncture site with pressure for 3-5 minutes
 Procedure(ABG Sampling)

 Air bubbles should be removed

 Place cap or rubber stopper over the needle or remove the needle
 Transport to the laboratory within 30 minutes
 Umbilical Artery Catheterization

 Invasive blood gas technique that involves insertion of the catheter

in the umbilical artery
 The umbilicus has one large lumen vein and 2 smaller-lumen
arteries, that can be threaded with a catheter
 Procedure(UAC)

 The catheter is cut to a predetermined length, so the tip is at T8

level or the L3-4 space
 The UAC is secured by strips of tape or suture fastened in a
“goalpost” shape around the catheter.
 The UAC is constantly purged with isotonic heparinized solution to
prevent clotting at the catheter tip and keep it of blood
 Procedure(UAC)

 The purge rate is maintained at a slow infusion rate by connecting

the UAC system to an infusion pump to maintain a system pressure
greater than the arterial BP
 The UAC is removed when the infant stabilizes and frequent blood
gas measurements are not required
 The UAC should be removed whenever occlusion, infection,
bleeding around the UAC, or necrotizing enterocolitis is suspected
ABG vs Capillary
 ABG Sampling  Capillary Sampling
› Involves percutaneous puncture of › Involves making a puncture into
the artery the cutaneous layer of the skin in
collecting the free-flowing blood
into a glass capillary tube
ABG vs Capillary
 ABG Sampling  Capillary Sampling
› Risk of infection can occur without › Increased WOB
aseptic technique › Fatigue
› Severe bleeding › Cutaneous fibrosis of heel
› Risk of embolism › Bone spurs from deep punctures
› Nerve damage › Puncture of posterior tibial artery
› Hematoma
 Pulse Oximetry

 Uses light absorption to continuously measure SpO2 an pulse rate

 O2 saturation is measured by comparing the amount of red light
absorbed by the deoxygenated hemoglobin with the amount of
infrared light absorbed by oxygenated hemoglobin
 Indicated for anyone needing continuous monitoring of gas
exchange
Pulse Oximetry
 Advantages  Disadvantages
› Displays O2 saturation › Affected by vasoacive drugs and
› Monitors perfusion shock
› Displays real time values › Affected by motion artifacts and
› Requires no calibration bright light sources
› Does not detect hyperoxia at high
› Easy to apply
saturation levels
› Used for all ages
› Reusable sensors
› Cost-effective
 Transcutaneous Monitoring

 Measures O2 and CO2 partial pressure on the skin surface using a

gas measuring electrode
 Used in laboratory measurement of blood gas
 Blood Gas Analyzers

 Severinghaus
› Measures PCO2 by causing the CO2 gas to produce ions by means of a
chemical reaction
 Blood Gas Analyzers

 Clark
› Measures PO2 as a result of chemical reaction in which electron flow is
measured
 Blood Gas Analyzers

 Sanz
› Measures pH by quantifying the acidity and alkalinity of a solution of
blood
› Measured by potential difference across a pH-sensitive glass membrane
 Oxygen Monitoring

 Transcutaneous O2 tension directly reflects a correlation to arterial

oxygentation
 The thin skin of an infant allow the correlation of PaO2 and PtcO2
to be close in the range of 85-95%
 Good correlation between PtcO2 and PaO2 depends on the operator
and on physiological-related factors
 Operator-related Factors

 Proper application of sensor to the skin with the appropriate

temperatue(43-44 degrees Celsius) and no air bubbles or pressure
applied on the electrode
 Site location including avoidance of bony areas
 Proper cleaning of the skin surface to wipe away dead skin, oils,
and medication
 Operator-related Factors

 Proper calibration techniques by the operator

 Regular frequency in changing electrode membranes(meticulously
following the manufacturer’s membrane-changing procedure)
 Accurate measurement of the correlating blood gases
 Carbon Dioxide Monitoring

 Same factors affecting the transcutaneous monitoring of O2 also

after the measurement of the transcutaneous CO2 affect the
measurement of the trancutaneous CO2 tension(PtcCO2)
 Same operator-related factors that affect the correlation of PtCO2
also affect the PtcCO2
 Capnometry

 Is a measurement of CO2 tension by infrared spectophotometry

 Used to measure PCO2 at the airway at the end of exhalation, or
end-tidal CO2(etCO2)
 End-tidal CO2 is most accurate when used on an intubated person
 Types

 Sidestream analyzer
› Aspirates a sample through small-diameter tubing to the sample chamber
 Mainstream analyzer
› Measures CO2 directly at the airway
› The airway-analyzing chamber is incorporated in the airway interface
› The chamber is heated to minimize errors from condensation and
secretions
 Parameters

 End-tidal CO2
 SaO2
 HR
 RR