ARTERIAL BLOOD GASES

An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and
carbon dioxide in the blood from an artery. This test is used to check how well your lungs
are able to move oxygen into the blood and remove carbon dioxide from the blood.

As blood passes through your lungs, oxygen moves into the blood while carbon dioxide
moves out of the blood into the lungs. An ABG test uses blood drawn from an artery,
where the oxygen and carbon dioxide levels can be measured before they enter body
tissues. An ABG measures:

 Partial pressure of oxygen (PaO2). These measures the pressure of oxygen dissolved in
the blood and how well oxygen is able to move from the airspace of the lungs into the
blood.
 Partial pressure of carbon dioxide (PaCO2). This measures how much carbon dioxide is
dissolved in the blood and how well carbon dioxide is able to move out of the body.
 pH. The pH measures hydrogen ions (H+) in blood. The pH of blood is usually between
7.35 and 7.45. A pH of less than 7.0 is called acid and a pH greater than 7.0 is called
basic (alkaline). So blood is slightly basic.
 Bicarbonate (HCO3). Bicarbonate is a chemical (buffer) that keeps the pH of blood from
becoming too acidic or too basic.
 Oxygen content (O2CT) and oxygen saturation (O2Sat) values. O2 content measures the
amount of oxygen in the blood. Oxygen saturation measures how much of the
hemoglobin in the red blood cells is carrying oxygen (O2).
Blood for an ABG test is taken from an artery. Most other blood tests are done on a
sample of blood taken from a vein, after the blood has already passed through the
body's tissues where the oxygen is used up and carbon dioxide is produced.

Purpose:

An arterial blood gas (ABG) test is done to:

 Check for severe breathing problems and lung diseases, such as asthma, cystic fibrosis, or
chronic obstructive pulmonary disease (COPD).
 See how well treatment for lung diseases is working.
 Find out if you need extra oxygen or help with breathing (mechanical ventilation).
 Find out if you are receiving the right amount of oxygen when you are using oxygen in
the hospital.
 Measure the acid-base level in the blood of people who have heart failure, kidney failure,
uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose.

Assess the client for:

 bleeding problems or take blood thinners, such as aspirin or warfarin ( Coumadin).

 Medicines that they are currently taking.
 Any allergic reactions for medicines, such as those used to numb the skin (anesthetics).

If on oxygen therapy, the oxygen may be turned off for 20 minutes before the blood
test. This is called a "room air" test. And if the client cannot breathe without the
oxygen, the oxygen will not be turned off.

Normal ABG values fall within the following ranges:

 PaO2 (partial pressure of oxygen): 75 to 100 mm Hg

 PacO2 (partial pressure of carbon dioxide): 35 to 45 mm Hg
 pH: 7.35 to 7.45
 O2CT (oxygen content): 15% to 22%
 SaO2 (oxygen saturation):90% to 100%
 HCO3 – (bicarbonate): 24 to 28 mEq/L.

pH is a measurement of the acidity of the blood, reflecting the number of hydrogen ions present. 

Lower numbers mean more acidity; higher number means more alkalinity.

pH is Elevated (more alkaline, higher pH) with:

 Hyperventilation

 Anxiety, pain
  Anemia

 Shock

 Some degrees of Pulmonary disease

 Some degrees of Congestive heart failure

 Myocardial infarction

 Hypokalemia (decreased potassium)

 Gastric suctioning or vomiting

 Antacid administration

 Aspirin intoxication

pH is Decreased (more acid, lower pH) with:

 Strenuous physical exercise

 Obesity

 Starvation

 Diarrhea

 Ventilatory failure

 More severe degrees of Pulmonary Disease

 More severe degrees of Congestive Heart Failure

 Pulmonary edema

 Cardiac arrest

 Renal failure

 Lactic acidosis

 Ketoacidosis in diabetes

pCO2 (Partial Pressure of Carbon Dioxide) reflects the the amount of carbon dioxide gas dissolved in
the blood. 
Indirectly, the pCO2 reflects the exchange of this gas through the lungs to the outside air. Two factors
each have a significant impact on the pCO2. The first is how rapidly and deeply the individual is
breathing:

 Someone who is hyperventilating will "blow off" more CO2, leading to lower pCO2 levels

 Someone who is holding their breath will retain CO2, leading to increased pCO2 levels

The second is the lungs capacity for freely exchanging CO2 across the alveolar membrane:

 With pulmonary edema, there is an extra layer of fluid in the alveoli that interferes with the lungs'
ability to get rid of CO2. This leads to a rise in pCO2.

 With an acute asthmatic attack, even though the alveoli are functioning normally, there may be
enough upper and middle airway obstruction to block alveolar ventilation, leading to CO2
retention.

Increased pCO2 is caused by:

 Pulmonary edema

 Obstructive lung disease

Decreased pCO2 is caused by:

 Hyperventilation

 Hypoxia

 Anxiety

 Pregnancy

 Pulmonary Embolism (This leads to hyperventilation, a more important consideration than the
embolized/infarcted areas of the lung that do not function properly. In cases of massive
pulmonary embolism, the infarcted or non-functioning areas of the lung assume greater
significance and the pCO2 may increase.)

PO2 (Partial Pressure of Oxygen) reflects the amount of oxygen gas dissolved in the blood. It primarily
measures the effectiveness of the lungs in pulling oxygen into the blood stream from the atmosphere.

Elevated pO2 levels are associated with:

 Increased oxygen levels in the inhaled air

 Polycythemia
Decreased PO2 levels are associated with:

 Decreased oxygen levels in the inhaled air

 Anemia

 Heart decompensation

 Chronic obstructive pulmonary disease

 Restrictive pulmonary disease

 Hypoventilation

CO2 Content is a measurement of all the CO2 in the blood. 

Most of this is in the form of bicarbonate (HCO3), controlled by the kidney. A small amount (5%) of the
CO2 is dissolved in the blood, and in the form of soluble carbonic acid (H2CO3).

For this reason, changes in CO2 content generally reflect such metabolic issues as renal function and
unusual losses (diarrhea). Respiratory disease can ultimately effect CO2 content, but only slightly and
only if prolonged.

Elevated CO2 levels are seen in:

 Severe vomiting

 Use of mercurial diuretics

 COPD

 Aldosteronism

Decreased CO2 levels are seen in:

 Renal failure or dysfunction

 Severe diarrhea

 Starvation

 Diabetic Acidosis

 Chlorthiazide diuretic use

Base Excess or Base Deficit

Whenever there is an accumulation of metabolically-produced acids, the body attempts to neutralize
those acids to maintain a constant acid-base balance. 

This neutralizing is achieved by using up various "buffering" compounds in the blood stream, to bind the
acids, disallowing them from contributing to more acidity.

About half of these buffering compounds come from HCO3, and the other half from plasma and red blood
cell proteins and phosphates.

The words "base deficit" and "base excess" are equivalent and are generally used interchangeably. The
only difference is that base deficit is expressed as a positive number and base excess is expressed as a
negative number.

A "Base Deficit" of 10 means that 10 mEqu/L of buffer has been used up to neutralize metabolic acids
(like lactic acid). Another way to say the same thing would be the "Base Excess is minus 10."

More Negative Values of Base Excess may Indicate:

 Lactic Acidosis

 Ketoacidosis

 Ingestion of acids

 Cardiopulmonary collapse

 Shock

More Positive Values of Base Excess may Indicate:

 Loss of buffer base

 Hemorrhage

 Diarrhea

 Ingestion of alkali

Oxygen Saturation (SO2) measures the percent of hemoglobin which is fully combined with oxygen. 

While this measurement can be obtained from an arterial or venous blood sample, it's major attractive
feature is that it can be obtained non-invasively and continuously through the use of a "pulseoximeter."

Normally, oxygen saturation on room air is in excess of 95%. With deep or rapid breathing, this can be
increased to 98-99%. While breathing oxygen-enriched air (40% - 100%), the oxygen saturation can be
pushed to 100%.
Oxygen Saturation will fall if:

 Inspired oxygen levels are diminished, such as at increased altitudes.

 Upper or middle airway obstruction exists (such as during an acute asthmatic attack)

 Significant alveolar lung disease exists, interfering with the free flow of oxygen across the alveolar
membrane.

Oxygen Saturation will rise if:

 Deep or rapid breathing occurs

 Inspired oxygen levels are increased, such as breathing from a 100% oxygen source

For analysis a small sample of arterial blood (approximately 2ml) is taken from an arterial
sampling device (arterial line) situated in an artery, or taken via an intermittent ‘stab’ into an
artery. The former method is better for patients if frequent samples are required as it reduces pain
and the risk of damage to the artery.

An ABG is typically requested to determine the pH of the blood and the partial pressures of
carbon dioxide (PaCO2) and oxygen (PaO2) within it. It is used to assess the effectiveness of
gaseous exchange and ventilation, be it spontaneous or mechanical. If the pH becomes deranged,
normal cell metabolism is affected. The ABG allows patients’ metabolic status to be assessed,
giving an indication of how they are coping with their illness. It would therefore seem logical to
request an ABG on any patient who is or has the potential to become critically ill. This includes
patients in critical care areas and those on wards who ‘trigger’ early-warning scoring systems.
Others who give cause for concern are patients with acute illnesses or exacerbations of
conditions and those in the peri-operative and peri-arrest periods.

Transferring the sample to the analyser

In order for the sample to be accurate, it should be analysed within 10 minutes of sampling from
the patient (Cornock, 1996). To prevent haemolysis it should be handled gently, avoiding any
vigorous shaking. Providing constant agitation by rolling the syringe gently will also prevent
plasma separation.

Patient details and percentage of oxygen being administered must be entered along with their
identification number. Some machines request patients’ core temperature as it is known to affect
the gases dissolved within the plasma, and result in a more accurate reading. However, Woodrow
(2004) pointed out that temperature probes can be inaccurate and so entering a temperature of
37ºC for all patients would be better practice.