CATACUTAN, MAE ANNE CAMILLE D.

ARTERIAL BLOOD GAS

An arterial blood gas (ABG) is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. The most common puncture site is the radial artery at the wrist, but sometimes the femoral artery in the groin or other sites are used. The blood can also be drawn from an arterial catheter.
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Partial pressure of oxygen (PaO2). This 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). WHO EXTRACTS BLOOD? y y y y Phlebotomist Nurse Respiratory therapist Physician

PURPOSE
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To evaluate gas exchange in the lungs. To assess integrity of the ventilatory control system. To determine the acid-base level of the blood. To monitor respiratory therapy.

CATACUTAN, MAE ANNE CAMILLE D.

PATIENT PREPARATION
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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 him 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 him 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.

PROCEDURE AND POSTTEST CARE

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Perform an arterial puncture. 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.

PRECAUTIONS
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Wait at least 15 minutes before drawing arterial blood when starting, changing, or discontinuing oxygen therapy. Before sending the sample to the laboratory, note on the laboratory slip whether the patient was breathing room air or receiving oxygen therapy when the sample was collected. If the patient was receiving oxygen therapy, note the flow rate. If he is on a ventilator, note the fraction of inspired oxygen and tidal volume. Note the patient's rectal temperature and respiratory rate.

REFERENCE VALUES Normal ABG values fall within the following ranges:
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PaO2: 75 to 100 mm Hg PacO2: 35 to 45 mm Hg

CATACUTAN, MAE ANNE CAMILLE D.

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pH: 7.35 to 7.45 O2CT: 15% to 22% SaO2: 95% to 100% HCO3 -: 24 to 28 mEq/L

ABNORMAL FINDINGS Low PaO2, O2CT, and SaO2 levels and a high PacO2 may result from conditions that impair respiratory function, such as respiratory muscle weakness or paralysis, respiratory center inhibition (from head injury, brain tumor, or drug abuse, for example), and airway obstruction (possibly from mucus plugs or a tumor). Similarly, low readings may result from bronchiole obstruction caused by asthma or emphysema, from an abnormal ventilation-perfusion ratio due to partially blocked alveoli or pulmonary capillaries, or from alveoli that are damaged or filled with fluid because of disease, hemorrhage, or near-drowning. When inspired air contains insufficient oxygen, PaO2, O2CT, and SaO2 decrease, but PacO2 may be normal. Such findings are common in pneumothorax, impaired diffusion between alveoli and blood (due to interstitial fibrosis, for example), or an arteriovenous shunt that permits blood to bypass the lungs. Low O2CT - with normal PaO2, Sa02 and, possibly, PacO2 values may result from severe anemia, decreased blood volume, and reduced hemoglobin oxygen-carrying capacity.