Arterial Blood Gas
Collection and Interpretation
Excercise
pH - 7.52 pH - 7.30
PC02 - 29 PC02 - 30
HC03 - 23 HC03 - 14
pH - 7.38 pH - 7.40
PC02 - 53 PC02 - 38
HC03 - 32 HC03 - 24
Exercise #1
• pH - 7.52 Alkalotic
• PC02 - 29 Alkalotic
• HC03 - 23 Normal
• Answer:
Uncompensated Respiratory Alkalosis
Exercise #2
• pH - 7.30 Acidotic
• PC02 - 30 Alkalotic
• HC03 - 14 Acidotic
• Answer:
Partially Compensated
Metabolic Acidosis
Exercise #3
• pH - 7.38 Normal (←)
• PC02 - 53 Acidic
• HC03 - 32 Alkalotic
• Answer:
Fully Compensated
Respiratory Acidosis
Exercise #4
• pH - 7.40 Normal
• PC02 - 38 Normal
• HC03 - 24 Normal
• Answer:
Normal ABG
What is ABG?
– Arterial blood gas (ABG) studies aid in
assessing the ability of the lungs to provide
adequate oxygen and remove carbon dioxide,
which reflects ventilation, and the ability of the
kidneys to reabsorb or excrete bicarbonate
ions to maintain normal body pH, which
reflects metabolic status (Hinkle & Cheever,
2014).
INDICATIONS
• Assessing and managing a patient’s respiratory
(ventilation) and metabolic (renal) acid/base and
electrolyte homeostasis.
• Assessing adequacy of oxygenation.
• Monitoring patients on ventilators, to monitor
critically ill nonventilator patients, to establish
preoperative baseline parameters, and to
enlighten electrolyte therapy (Pagana & Pagana,
2013).
CONTRAIDICATIONS
• Patients with a negative Allen test
• Patients with arteriovenous fistula proximal
to the site of proposed access
• Patients with severe coagulopathy
NORMAL VALUES
pH 7.35-7.45
PC02 (Partial Carbon Dioxide) 35-45
HC03 (Bicarbonate) 22-26
Other values:
P02 (Partial Oxygen) 80-100
Sa02 (Oxygen Saturation) 95-100%
BE (Base Excess) -2 to +2
Equipment
• 20-25G needle
• ABG syringe with heparin
• Cap for the syringe
• Rubber stopper for needle
• Local anesthetic (plus needle and syringe for giving)
• Alcohol pads
• Gauze
• Gloves
• Sharps bin
Site Selection
• Radial (preferred)
• Brachial
• Femoral
Nursing Responsibilities
• Explain to the patient that this test is used to evaluate
how well the lungs are delivering oxygen to blood and
eliminating carbon dioxide.
• Tell the patient that the test requires a blood sample.
Explain who will perform the arterial puncture and when
and which site - radial, brachial, or femoral artery - has
been selected for the puncture.
• Inform patient that he needn't restrict food or fluids.
• Instruct the patient to breathe normally during the test,
and warn him that he may experience a brief cramping
or throbbing pain at the puncture site.
Nursing Responsibilities
• After applying pressure to the puncture site for 3 to 5
minutes, tape a gauze pad firmly over it. (If the puncture
site is on the arm, don't tape the entire circumference;
this may restrict circulation.)
• If the patient is receiving anticoagulants or has a
coagulopathy, hold the puncture site longer than 5
minutes if necessary.
• Monitor vital signs, and observe for signs of circulatory
impairment, such as swelling, discoloration, pain,
numbness, and tingling in the bandaged arm or leg.
• Watch for bleeding from the puncture site.
Original and Modified Allen’s
Test
Procedure
Special Considerations
• If the patient is receiving oxygen, make sure that therapy has been
underway for at least 15 minutes before collecting an arterial blood sample.
• Unless ordered, don’t turn off existing oxygen therapy before collecting
arterial blood samples. Be sure to indicate on the laboratory request form
the amount and type of oxygen therapy the patient is receiving.
• If patient has just received a nebulizer treatment, wait about 20 minutes
before collecting the sample.
• If necessary, you can anesthetize the puncture site with 1% lidocaine or
0.9% benzyl alcohol according to the facility’s policy.
• When filling out a laboratory request form for ABG analysis, include: the
patient’s current temperature, most recent hemoglobin level, current
respiratory rate, and if the patient is on ventilator, fraction of inspired
oxygen, tidal volume, and ventilator frequency.
Complications
• Arteriospasm
• Haematoma
• Nerve damage
• Fainting or a vasovagal response
• Other problems can include a drop in
blood pressure, complaints of feeling faint,
sweating or pallor that may precede a loss
of consciousness
Causes of Imbalance
Respiratory Acidosis Respiratory Alkalosis
• COPD • Hyperventilation
• Barbiturate or sedative overdose • Stimulated respiratory center
• Chest wall abnormality • Mechanical hyperventilation
• Severe pneumonia
• Atelectasis
• Respiratory muscle weakness
• Mechanical hypoventilation
Metabolic Acidosis Metabolic Alkalosis
• DKA • Severe vomiting
• Lactic acidosis • Excess gastric suctioning
• Starvation • Diuretic therapy
• Severe diarrhea • Potassium deficit
• Renal failure
Interpretation
• Step 1: Analyze the pH
• Step 2: Analyze the C02
• Step 3: Analyze the HC03
• Step 4: Match the C02 or the 03 with the pH
• Step 5: Does the C02 or HC03 Go the
opposite direction of the pH?
• Step 6: Analyze the P02 and the 02
saturation
