`Arterial Blood Gas (ABG)

 Specimen of arterial blood that assesses oxygenation, ventilation, and acid-base

status.
 Performed to evaluate the client’s acid-base balance and oxygenation. Arterial
blood is used because it provides a truer reflection of gas exchange in the
pulmonary system than venous blood. Blood gases may be drawn by laboratory
technicians, respiratory therapy personnel, or nurses with specialized skills.
Because a high –pressure artery is used to obtain blood, it is important to apply
pressure to the puncture site for 5 minutes. After the procedure to reduce the risk
of bleeding or bruising.

Six Measurements are commonly used to interpret arterial blood gas test:
 Ph :a measure of relative acidity or alkalinity of the blood.
 PaO2: the pressure exerted by oxygen dissolved in the plasma of arterial
blood; an indirect measure of blood oxygen content.
 PaCO2 : the partial pressure of carbon dioxide in arterial plasma; the
respiratory component of acid-base determination.
 Bicarbonate HCO3‫־‬: a measure of the metabolic component of acid-base
balance.
 Base Excess (BE): a calculated value of bicarbonate levels, also reflective
of the metabolic component of acid-base balance.
 Oxygen Saturation (SaO2): the percentage of hemoglobin saturated
(combined) with oxygen.

Procedure of obtaining specimen for ABG:

1. Do Allen’s test (to check for competence of the artery from which
sample will be derived)
2. Use Heparinized syringe (heparin is flushed through the barrel of the
syringe)
3. No bubbles in the syringe (remember, it is blood gas being measured
here)
4. Send specimen on ice and occlude needle to prevent air from coming
in the syringe
5. Check site for hematoma, bleeding, and pain
6. Avoid suctioning prior to drawing blood specimen.
 Normal Values of Arterial Blood Gases

pH 7.35-7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3‫־‬ 22-26 meq/L
BE -2 to +2 meq/L
SaO2 95-98%

Interpretations
Ph: less than 7.35
~ acidosis
Ph: greater than 7.45
~alkalosis
 If ph is 7 and below or 7.8 and above death occurs.
 PCO2: less than 35
~alkalosis
PCO2: greater than 45
~acidosis
 HCO3: less than 22
~acidosis
 HCO3: greater than 26
~alkalosis
 If pH and PCO2 are primarily affected, Respiratory Acid-Base Imbalance
will result.
 If pH and PCO3 are primarily affected, Metabolic Acid-Base Imbalance will
be experienced.
 The kidneys and lungs attempts to compensate one another in
maintaining acid-base balance.
 In acid-base imbalances, the normal bicarbonate-carbonic acid ratio of
20:1 is lost. The body attempts to compensate in an effort to maintain the
normal 20:1 ratio.
 In compensation, the kidneys attempt to compensate for changes in blood
CO2 by making a corresponding adjustment in blood bicarbonate.
Normally, almost all the bicarbonate formed by the kidneys are retained.
 On the other hand, the lungs attempt to compensate for abnormal
changes in blood bicarbonate by making corresponding adjustment in
blood CO2.
 Another compensatory mechanism for acid-base imbalances is shifting of
hydrogen ions from the ECF to the ICF or vice versa:

Chest Physiotherapy
What is chest Physiotherapy?
Chest physiotherapy usually refers to the used to postural drainage in
combination with adjunctive techniques that are thought to enhance the
clearance of the mucus from the airway. These techniques include manual
percussion, vibration, and squeezing of the chest. The goals of chest
physiotherapy are to remove bronchial secretions, improve ventilation and
increase the efficiency of the respiratory muscles.
Why do we need to perform
Chest Physiotherapy?
to remove the secretions to
allow more effective
breathing and increase the
amount of oxygen getting into
the body.
POSTURAL DRAINAGE
(Segmented Bronchial Drainage)
This uses gravity and correct positioning to bring the secretions into
the throat where it is easier to remove.
Because the patient usually sits in an upright position, secretions
are likely to accumulate in the lower parts of the lungs. When postural
drainage is used, the patient is placed sequentially in different positions,
so that the force of gravity helps to drain secretions from the smaller
bronchial airways to the main bronchial and trachea. The secretions then
are removed by coughing.
Nursing Consideration
The nurse should be aware of the patient’s diagnosis as well as the
lung lobes or segments involved, the cardiac status and any structural
deformities of the chest wall and spine. Auscultating the chest before and
after the procedure helps to identify the areas needing drainage and the
effectiveness of treatment.
Postural drainage is usually performed two to four times daily,
before meals (to prevent nausea, vomiting and aspiration.) And at the
bedtime. If prescribed, bronchodilators, water or saline may be nebulized
and inhaled before postural drainage to dilate the bronchioles, reduce
bronchospasm, decrease the thickness of mucus and sputum and combat
edema of the bronchial walls.
Percussion
Percussion is rhythmically striking the chest wall with cupped
hands. It is also called cupping, clapping, or tapotement. The purpose of
percussion is to break up thick secretions in the lungs so that they can be
more easily removed. Percussion is performed on each lung segment for
one to two minutes at a time.
Vibration
Technique of applying manual compression and tremor to the chest
wall during the exhalation phase of respiration. This maneuver helps to
increase the velocity of the air expired from the small airways, freeing the
mucus. After three or four vibrations the patient is encouraged to cough,
using the abdominal muscles.
 Nursing Intervention
When performing chest physiotherapy, it is important to make sure
the patient is comfortable, is not wearing restrictive clothing and has not
just eaten a meal. The upper most of the lungs are treated first.
Medication is given for pain, as prescribed, before percussion and
vibration: and pillows are used to support as needed. The positions are
varied, but focus is placed on the affected areas. On completion of the
treatment, the patient is assisted to a comfortable position.
The treatment should be stopped if any of the following develop:
• Increased pain
• Increased shortness of breath
• Weakness
• Light-headedness
• Hemoptysis
• Precautions!
Chest physiotherapy should not be performed on people with:
• bleeding from the lungs
• neck or head injuries
• fractured ribs
• collapsed lungs
• damaged chest walls
• tuberculosis
• acute asthma
• recent heart attack
• pulmonary embolism
• lung abscess
• active hemorrhage
• some spine injuries
• recent surgery, open wounds, or burns
•