Arterial blood gases

DR KIFAH SUHAIL
MBCHB, FICMS/ ANESTHESIA,IC
 Introduction:
• An arterial blood sample is collected from an artery, primarily to determine
arterial blood gases.
• Arterial blood sampling should only be performed by health workers who
have demonstrated proficiency after formal training.
• The sample can be obtained either through a catheter placed in an artery,
or by using a needle and syringe to puncture an artery.
• These syringes are pre-heparinized and handled to minimize air exposure
that will alter the blood gas values.
 Indications for ABG:
• Severe respiratory or metabolic disorders
• Clinical features of hypoxia or hypercapnia.
• Shock.
• Sepsis.
• Decreased cardiac output.
• Renal failure.
 Contraindication:
• No absolute contraindications.
• Dialysis shunt – choose another site.
• Mastectomy – use opposite side.
• Patient on anticoagulant/aspirin therapy – may have to hold
pressure on puncture site longer than normal.
 Choice of site:
Several different arteries can be used for blood collection.
The first choice is the radial artery:
• Radial artery- best site.
.located superficially, easy to palpate & stabilize.
.excellent collateral circulation via ulnar artery.
.not adjacent to large veins.
• Alternative sites for access are brachial or femoral arteries,
• but these have several disadvantages in that they:
.may be harder to locate, because they are less superficial than the
radial artery.
.have poor collateral circulation.
.are surrounded by structures
that could be damaged by faulty technique.
 Complications related to arterial blood sampling :
There are several potential complications related to arterial blood sampling.
• Pain.
• Hematoma, hemorrhage.
• Trauma to vessel.
• Arteriospasm .
• Air or clotted-blood emboli.
• Vasovagal response.
• Arterial occlusion.
• Infection.
 Sampling errors:
Inappropriate collection and handling of arterial blood specimens can
produce incorrect results. Reasons for an inaccurate blood result
include:
• presence of air in the sample;
• collection of venous rather than arterial blood;
• an improper quantity of heparin in the syringe, or improper mixing after blood is
drawn;
• a delay in specimen transportation.
 Procedure steps:
1.Wash your hands, introduce yourself to the patient and clarify their identity. Explain
what you would like to do and obtain consent. This is a slightly uncomfortable
procedure so you should let the patient know this.

Introduce yourself to the patient

Wash your hands
 Procedure steps:
2.Gather the necessary following equipment:
a blue (23 G) needle.
2ml syringe with heparin.
a cap for the syringe.
a plastic bung.
local anaesthetic (plus needle and syringe for giving).
alcohol gel.
Gauze.
Gloves.
a sharps bin.
Usually, the syringe, needle, cap and bung are all provided
in one pack.

.Equipment required for measuring arterial blood gases

 Procedure steps:
3.Position the patient’s arm with the wrist extended.
4.Locate the radial artery with your index and middle fingers. Perform Allen’s test where you compress
both the radial and ulnar arteries at the same time. The hand should become white, release the ulnar
artery and the color should return to the hand. This ensures that there will still be a blood supply to the
hand should the ABG cause a blockage in the radial artery.
Locate the radial artery with your index and middle fingers.

Allens Test.
Click here for a video
 Procedure steps:
5. Put on your gloves and attach the needle to the heparinised syringe.
• Also prepare your local anaesthetic and give a small amount over the palpable radial artery.

6. Take the cap off the needle,and again locate the radial artery using your
non-dominant hand.

Remove the cap from the needle.

 Procedure steps:
7.Let the patient know you are about to proceed and to expect a sharp scratch.
• Insert the needle at 30 degrees to the skin at the point of maximum pulsation of the radial artery.
Advance the needle until arterial blood flushes into the syringe. The arterial pressure will cause the
blood to fill the syringe.
• Remove the needle/syringe placing the needle into the bung. Press firmly over the puncture site with
the gauze to halt the bleeding. Remain pressed for 5 minutes.

Prepare to insert the needle.

 Procedure steps:
Remove the needle.

Place the needle into the bung.

 Procedure steps:
8.Remove the needle and discard safely in the sharps bin.

Remove the needle from the syringe.

Safety discard the needle into the sharps bin.

 Procedure steps:
9.Cap the syringe, push out any air within it, and send immediately
for analysis ensuring that the sample is packed in ice. Remove your
gloves and dispose them in the clinical waste bin. Wash your hands
and thank the patient.
Cap the syringe.
 Procedure steps:
10.now sample is ready for analysis and to be connected to ABG machine .
Click here for a video
Practice questions
 ABG Practice
A. Normal
B. Respiratory acidosis
pH 7.36 C. Compensated respiratory acidosis
PaCO2 43 D. Respiratory Alkalosis
HCO3 22 E. Compensated respiratory alkalosis
F. Metabolic acidosis
Interpretation? G. Compensated metabolic acidosis
H. Metabolic alkalosis
A normal I. Compensated metabolic alkalosis

A. Normal
pH 7.45 B. Respiratory acidosis
PaCO2 30 C. Compensated respiratory acidosis
HCO3 19 D. Respiratory Alkalosis
E. Compensated respiratory alkalosis
Interpretation? F. Metabolic acidosis
G. Compensated metabolic acidosis
Answer: E. Compensated Respiratory
Alkalosis H. Metabolic alkalosis
I. Compensated metabolic alkalosis
PaCO2 is low
HCO3 is low
 A. Normal
pH 7.52 B. Respiratory acidosis
PaCO2 43
C. Compensated respiratory acidosis
HCO3 31
D. Respiratory Alkalosis
Interpretation? E. Compensated respiratory alkalosis
F. Metabolic acidosis
G. Compensated metabolic acidosis
Answer: H. Metabolic Alkalosis H. Metabolic alkalosis
PaCO2 is normal I. Compensated metabolic alkalosis

HCO3 is high
 A. Normal
B. Respiratory acidosis
pH 7.17
C. Compensated respiratory acidosis
PaCO2 89
HCO3 22 D. Respiratory Alkalosis
E. Compensated respiratory alkalosis
Interpretation F. Metabolic acidosis
G. Compensated metabolic acidosis
H. Metabolic alkalosis
Answer: B. Respiratory Acidosis I. Compensated metabolic alkalosis

PaCO2 is high
HCO3 is normal
 pH 7.3 A. Normal
PaCO2 72 B. Respiratory acidosis
HCO3 24
C. Compensated respiratory acidosis
D. Respiratory Alkalosis
Interpretation?
E. Compensated respiratory alkalosis
F. Metabolic acidosis
G. Compensated metabolic acidosis
H. Metabolic alkalosis
I. Compensated metabolic alkalosis
Answer: B. Respiratory Acidosis
PaCO2 is high
HCO3 is normal
 A. Normal
pH 7.31 B. Respiratory acidosis
PaCO2 36 C. Compensated respiratory acidosis
HCO3 18 D. Respiratory Alkalosis
E. Compensated respiratory alkalosis
Interpretation F. Metabolic acidosis
G. Compensated metabolic acidosis
Answer: F. Metabolic Acidosis H. Metabolic alkalosis
I. Compensated metabolic alkalosis
PaCO2 is normal
HCO3 is low

A. Normal
pH 7.39 B. Respiratory acidosis
PaCO2 42 C. Compensated respiratory acidosis
HCO3 23 D. Respiratory Alkalosis
E. Compensated respiratory alkalosis
F. Metabolic acidosis
G. Compensated metabolic acidosis
Answer: A. Normal H. Metabolic alkalosis
I. Compensated metabolic alkalosis
 A. Normal
pH 7.44
B. Respiratory acidosis
PaCO2 53
C. Compensated respiratory acidosis
HCO3 31
D. Respiratory Alkalosis
E. Compensated respiratory alkalosis
Answer: I. Compensated Metabolic F. Metabolic acidosis
Alkalosis G. Compensated metabolic acidosis
PaCO2 is high H. Metabolic alkalosis
I. Compensated metabolic alkalosis
HCO3 is high

pH 7.3 A. Normal
PaCO2 59 B. Respiratory acidosis
HCO3 24 C. Compensated respiratory acidosis
D. Respiratory Alkalosis
Answer: B. Respiratory Acidosis E. Compensated respiratory alkalosis
F. Metabolic acidosis
PaCO2 is high
G. Compensated metabolic acidosis
HCO3 is normal H. Metabolic alkalosis
I. Compensated metabolic alkalosis