Respiratory Physiology: Arterial Blood Gas

Arterial Blood Gas Analysis

*Modified Allen's Test/Allen's Test

involves puncturing an artery with thin needle

and syringe and drawing a small volume of blood

less risk for occlusion

routine investigation to monitor acid base

balance

Medicine I

only way of getting accurately determining the

CONFIMATORY TEST for the collateral

blood flow to the hand

a test for occlusion of the radial or ulnar

alveolar-oxygen gradient

artery in which one of these arteries is

provides information:

compressed

Oxygenation

Ventilation adequacy

Acid-base levels

after

blood

has

forced out with hand by clenching it

into a fist

Failure of the blood to diffuse into the

it also indicates the severity of a condition and

hand when open is an indicative of

help to assess treatment

occlusion of uncompressed artery.

Indications for ABG analysis:

1. Respiratory Failure (acute or chronic)
2. Any severe illnesses w/c may lead to metabolic
acidosis

been

a. elevate the hand first and make a first for

approximately 30 seconds
b. apply pressure over the ulnar and the radial
arteries occluding both (keep the hand still elevated)

cardiac failure

c. open the hand which will be blanched

liver failure

d. release pressure on the ulnar artery and look

renal failure

hyperglycemic states assoiciated with DM

Multi-organ failure

sepsis

burns

poisons/ toxins

3. Ventilated patients
4. Sleep studies
5. Severe unwell patients from any cause
-affects prognosis

for the perfusion of the hand for about 7 to 8 seconds

f. If there is any delay then it may not be safe to
perform radial artery puncture
2. Allow the patient to titrate with O2 for 5-10 minutes
*if the patient has COPD, allow it for 30 minutes
before taking the sample
3. Use ABG syringes which are heparinized
*little amount of heparin content for
anticoagulation
4. Wrist is extended

Methods of Arterial Blood Gas

5. Palpate the artery and hold fingers over the pulsation

1. Radial Artery Blood Sampling

6. Introduce the needle @ 45 degrees angle, slowly with

2. Femoral Artery Blood Sampling

the bevel facing upwards and aiming for the point of

3. Brachial Artery Blood Sampling

maximal pulsation
7. Obtain 2-3 ml once hit the artery

Procedure of ABG analysis (Radial Artery

Sampling)

8. Apply firm pressure for a minimum of 2 minutes.

*longer, if the patient is on any antiplatelet

1. Assess for Artery

medication or anticoagulant

*Radial Artery

most common site for the direct arterial

puncture for ABG analysis

easily accessible

can be compressed to control bleeding

Delta Transcription Factor ^_^

Side Effects of ABG analysis

1. Bleeding or bruising at the puncture site
2. Feeding Faint
3. Blood accumulation under the skin
4. Infected at the puncture site

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Respiratory Physiology: Arterial Blood Gas

Medicine I
Organ systems responsible for acid-base

Contraindications of ABG
1. Coagulopathy
2. Severe atherosclerosis
3. Infection/burn/previous surgery or cut down at
site
4. Decreased collateral flow

regulation

Parameters of ABG (Normal values)

arterial: range

normal

Blood
electrolytes are leached from bone and
other tissues such as hair and nails if too
acidic.
Kidneys

venous range normal

are the primary organ responsible

for excreting acid and regulating

pH

7.35 -7.45

7.40

7.31 -7.41

7.36

PCO2
PaO2
HCO3
O2 sat
BE

35 - 45 mmHg
80-95 mmHg
22-26 mEq/L
95 - 99%
-2 to +2

40
100
24
97
0

41 - 51 mmHg
35 - 45 mmHg
22 - 26 mEq/L
68 - 77 %
-2 to +2

46
40
24
75%
0

electrolyte balance.

Lungs

higher levels of CO2

Metabolic Acidosis
a.Acute
b.Partially
compensated
c.Compensated
Metabolic Acidosis
a.Acute
b.Partially
compensated
c.compensated

the most efficient way of maintaining

acid/base balance, especially in the
short-term

Interpretation of ABG

Respi Alkalosis
a.Acute
b.Partially
compensated
c.Compensated

regulate acidity by increasing the rate of

respiration which results in excreting

*BE = base excess

Respi Acidosis
a.Acute
b.Patially
Compensated
c.Compensated

calcium and other minerals and

pH

PaCO2

HCO3

Causes

N.

Lung Disease
(pneumonia
or COPD)

N.

N.

N.

Increased
RR/ fast
breathing,
Pain or
anxiety

N.

Kidney
Failure,
shock, DKA

N.

N.

N.

Delta Transcription Factor ^_^

Skin

acts as a secondary kidney.

Chronic
vomiting,
hypokalemia

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