ABG ANALYSIS
Arterial Blood Gas (ABG)
• Use to assess the acid-base
status of the patient
• It analyze the partial
pressures of gas in the
blood.
• obtained from the arterial
circulating system
INDICATION:
1. To obtain information about patient ventilation (PCO2) ,
oxygenation (PO2) and acid base balance
2. Monitor gas exchange and acid base abnormalities for patient
on mechanical ventilator or not
3. To evaluate response to clinical intervention and diagnostic
evaluation ( oxygen therapy )
4. most useful when a person's breathing rate is increased or
decreased or when the person has very high blood sugar levels,
a severe infection, or heart failure
ABG COMPONENT
pH: measures hydrogen ion concentration in the blood, it shows
blood’ acidity or alkalinity
PCO2 : It is the partial pressure of CO2 that is carried by the
blood for excretion by the lungs, known as respiratory parameter
PO2: It is the partial pressure of O2 that is dissolved in the blood
HCO3 : known as the metabolic parameter, it reflects the
kidney’s ability to retain and excrete bicarbonate
NORMAL VALUES
PH = 7.35 – 7.45
PCO2 = 35 – 45 mmHg
PO2 = 80 – 100 mmHg
HCO3 = 22 – 28 meq/L
EQUIPMENT
Blood gas kit OR 1ml syringe
23-26 gauge needle Stopper or cap
Alcohol swab Disposable gloves
Plastic bag & crushed ice Lidocaine (optional)
Vial of heparin (1:1000) Par code or label
PREPARATORY PHASE:
1. Record patient inspired oxygen concentration
2. Check patient temperature
3. Explain the procedure to the patient
4. Provide privacy for client
5. If not using heparanized syringe, heparanize the needle
6. Perform Allen's test
7. Wait at least 20 minutes before drawing blood for ABG
after initiating, changing, or discontinuing oxygen
therapy, or settings of mechanical ventilation, after
suctioning the patient or after extubation
DIAGNOSTIC TEST
• ABGs
• Allen test measures radial or ulnar patency
• Evaluate acid–base balance and oxygenation
• Blood drawn by respiratory therapists, healthcare
providers, or nurses with specialized skills
ALLENS TEST
• It is a test to determine that collateral circulation is
present from the ulnar artery or if the blood flow in the
hand is normal.
SITES FOR OBTAINING ABG
1. Radial artery
• Radial is the most common and preferable site:
= It is easy to access
= It is not a deep artery which facilitate palpation, stabilization
and puncturing
= The artery has a collateral blood circulation
2. Brachial artery
3. Femoral artery
PHYSIOLOGY REVIEW
Buffer Systems
• Buffers prevent major changes in pH
• Bind with hydrogen ions when excess acid is present
• Releases hydrogen ion if body fluids too basic
• Act quickly
Three major buffer systems
• Bicarbonate–carbonic acid buffer system
• Phosphate buffer system
• Protein buffers
Respiratory System
• Regulates carbonic acid by eliminating/retaining CO2
• CO2 is potential acid when combined with water
• Increase in CO2 or H+ stimulates respiratory center
• Increasing rate and depth of respiration increase
• Eliminates CO2 and carbonic acid
• Increases pH to normal range
• Alkalosis decreases rate and depth of respiration
Renal System
• Long-term regulation of acid–base balance
• Kidneys eliminate nonvolatile acids
• Regulate bicarbonate (HCO3) in ECF slower
• Selectively excrete or retain H+ to maintain pH
• Base excess is a calculated value
• Reflects degree of imbalance
• Indicates body's total buffering capacity
• Normal Value for BE in arterial blood is +2 to –2
• CO2 retention
• CO2 combines with H2O
• Restores carbonic acid levels
• increases pH back to normal
CONCEPT RELATED TO ACID-BASE BALANCE
• Communication
• Cognition
• Fluids and Electrolytes
• Perfusion
• Oxygenation
ALTERATIONS TO ACID-BASE BALANCE
Two major categories
• Acidosis: pH below 7.35 = H+ increases above normal
• Alkalosis: pH above 7.45 = H+ decreases below normal
ALTERATIONS AND MANIFESTATIONS
Metabolic à change in HCO3 concentration
Metabolic acidosis
• Abnormal bicarbonate losses
• Excess nonvolatile acids in body
Metabolic alkalosis
• Excess of bicarbonate in relation to hydrogen
Respiratory à retention of CO2, increasing carbonic
acid
Respiratory acidosis
• Retention of carbon dioxide
• Increase of carbonic acid
Respiratory alkalosis
• Excess loss of carbon dioxide
RISK FACTORS
• Metabolic acidosis occurs in clients with insulin-
dependent diabetes mellitus and chronic renal failure.
• Metabolic alkalosis occurs in clients in acute care.
• Risk for respiratory acidosis when alveolar
hypoventilation occurs.
• Older adults and young children at risk for respiratory
acidosis with large-dose salicylate ingestion.
NURSING ASSESSTMENT
• Health history
• Current prescribed/over-the-counter medications
• Complementary therapies
• Physical assessment
• Vital signs
• Pulse oximetry
NURSING INTERVENTIONS AND THERAPY
• Goal of treatment: restore and maintain normal body
balance
• Management is depends on the underlying cause
• Collaboration with healthcare team
• Get health history: conditions related to culture,
developmental stage
• Gain information from family members of client in
severe distress
INDEPENDENT NURSING MANAGEMENT
• Daily weight
• Monitoring of intake and output
• Assessing respiratory and renal function
• Maintenance of patent airway
• Oxygen saturation monitoring
• Vital sign measurement
• Assessment of level of consciousness and neurological
function
• Prompt reporting of changes in client condition
PHARMACOLOGIC THERAPHY
Goal in acidosis:
• reverse the effects of excess acids
• Return pH to normal levels quickly
• For acute acidosis
• Administer sodium bicarbonate infusions if
bicarbonate level low
• Monitor for signs of alkalosis (overcorrection of pH)
• Hold medication and notify healthcare provider
Symptoms of alkalosis (overcorrection of pH)
o Irritability o Confusion
o Cyanosis o Slow respirations
o Irregular pulse o Muscle weakness
o Monitor client's condition o Analyze ABG reports
o Assess client for symptoms related to acidosis
o Assess for causative factors
o Judicious use of sodium bicarbonate
Contraindications of sodium bicarbonate
• clients with cardiac and renal disorders
Other uses of sodium bicarbonate
• Alkalinize urine
• Speed excretion of acidic substances
• CRF à kidneys not excreting H+ ions
HOME REMEDY
• Client Teaching Sodium Bicarbonate
• Contact primary healthcare provider
• If gastric discomfort continues
• Accompanied by chest pain, dyspnea, or diaphoresis
• Use non-sodium antacids
• Do not use any antacid for more than 2 weeks
AIRWAY MANAGEMENT
• Intubation
• If PaCO2 is greater than 77mmHg, PO2 is less than
60mmHg, pH less than 7.20
• Chronic hypercarbia
• Correct slowly
• Quick correction may cause metabolic alkalosis
• Hypoxemia
o May require supplemental oxygen
INTERPRETING ABGs
NORMAL VALUES
pH 7.35 – 7.45
C02 35 – 45 mmHg
Pa02 80 – 100 mmHg
HC03 22 – 26 meq/L
02 Sat. 95 – 100%
• Abnormalities in the PaCO2 level indicate a
Respiratory problems
• Abnormalities in the HCO3 level indicate a
Metabolic problems
• If the PaCO2 level is decrease to less than
80mmHg – Hypoxemia is present
ACID – BASE MNEMONIC (ROME)
RESPIRATORY OPPOSITE METABOLIC EQUAL
pH pC02
ANALYSIS
pH HC03
ANALYSIS
7.35 - 7.45 35 – 45 7.35 - 7.45 22 – 26
ACIDOSIS ACIDOSIS
ALKALOSIS ALKALOSIS
Arrows in the same directions =
metabolic conditions
Arrows in opposite directions =
respiratory conditions
pH normal is 7.35 – 7.45
• If the pH is normal but closer to the acidotic end, and
both PaCO2 and HCO3 are elevated, the kidneys have
compensated for Respiratory problems.
• If the pH is normal, but closer to the alkalotic end of
the normal range, and both PaCO2 and HCO3 are
elevated, the lungs have compensated for a Metabolic
problem
pH normal is 7.35 – 7.45
pH midpoint is 7.4
< 7.4 = the original problem was acidosis in nature
> 7.4 = the original problem was alkalosis in nature
pH MIDPOINT IS 7.4
pH pCO2 HCO3
Interpretations
7.35-7.45 35 - 45 22- 26
a) 7.35 (< 7.4 ) 50 30 Compensated
b) 7.45 (> 7.4 ) 50 30 Compensated
c) 7.43 (> 7.4 ) 30 18 Compensated
d) 7.38 (< 7.4 )
30 18 Compensated
LEVEL OF COMPENSATION
UNCOMPENSATED – not corrected or abnormal pH, abnormal either
or both pCO2 and HCO3
PARTIALLY COMPENSATED – if the pH is not within or closed to the
normal range.
- Ex: pCO2 and HCO3 both high but pH is acidic – the compensatory
mechanisms tried but failed to bring the pH to normal range.
FULLY COMPENSATED – if the pH is back within normal ranges.
normal pH, abnormal pCO2 or HCO3
pH pCO2 HCO3 Interpretations
7.35-7.45 35 - 45 22- 26
1. 7.30 50 24
2. 7.50 45 30
3. 7.28 45 18
4. 7.48 32 25
5. 7.38 50 30
6. 7.44 30 20
7. 7.35 30 20
pH pCO2 HCO3 Interpretations
7.35-7.45 35 - 45 22- 26
1. 7.20 50 30
2. 7.46 50 30
3. 7.46 30 20
4. 7.55 40 20
5. 7.33 25 20
6. 7.39 44 23
