PRESENTED BY DR.

KRUTHI

ARTERIAL BLOOD GAS ANALYSIS AND INTERPRETATION

 ARTERIAL BLOOD GAS ANLYSIS IS AN

INVASIVE PRCEDURES DONE TO MEASURE THE GAS EXCHANGE IN THE BLOOD USING VARIOUS PARAMETERS SUCH AS PARTIAL PRESSURE OF OXYGEN AND CARBON DIOXIDE , PH ,SaO2 , HCO 3

INDICATION
THE TEST IS USUALLY DONE IN THE

CRITICAL PATIENTS WHERE THERE IS RESPIRARORY DISTURBANCES SUCH AS HYPOXIA , HYPO OR HYPERCAPNIA , AND DISTURBANCES IN PH. COMMON SITUATIONS ARE : MYOCARDIAL INFARCTION CARDIAC ARREST RESPIRATORY DISTRESS

 Stroke with altered levels of consciousness After prolonged anaesthesia Poisoning or trauma resulting in respiratory

depression Shock Renal failure Acid base disorders

PaO

This is the partial pressure of

oxygen dissolved within the arterial blood and will determine oxygen binding to haemoglobin (SaO2). It is of vital importance. The normal range -9.3-13.3 kPa or 80-100 mmHg . Values less than that indicate hypoxia.

PaCO2
This is the partial pressure of

carbon dioxide dissolved within the arterial blood. It is used to assess the effectiveness of ventilation. The normal range for a healthy person is 4.7-6.0 kPa or 35-45 mmHg A high PaCO2 (respiratory acidosis) indicates underventilation, a low PaCO2 (respiratory alkalosis) indicates hyper- or overventilation

BICARBONATE
Bicarbonate is a chemical (buffer)

that keeps the pH of blood from becoming too acidic or too basic & indicates whether a metabolic problem is present (such as ketoacidosis Normal range - 2226 mmol/l

 A low HCO3- indicates metabolic acidosis, a

high HCO3- indicates metabolic alkalosis. HCO3- levels can also become abnormal when the kidneys are working to compensate for a respiratory issue so as to normalize the

PH

The pH of blood usually between 7.35 to 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.

SaO 2
Oxygen saturation measures how

much of the haemoglobin (Hb) in the red blood cells is carrying oxygen (O2). Although similar to SpO2 (measured by a pulse oximeter), it is more accurate. The normal levels are 97% and above.

BASE EXCESS
The base excess indicates the amount of

excess or insufficient level of bicarbonate in the system. The normal range is 2 to +2 mEq/liter. (A negative base excess indicates a base deficit in the blood.)

PROCEDURE
Blood is most commonly drawn from

the radial artery because it is easily accessible, can be compressed to control bleeding, Alternatively Brachial or Femoral artery can also be used

 Under aseptic precautions skin at the site of

the puncture over the radial artery is cleaned . needle is inserted in 45 degree . Aspirate 1-2 ml of the blood and and withdraw the needle Pressure to be applied at the site of puncture with cotton ball for minimum 5 minutes. Tap the syringe to expel any air bubble present. Put this syringe in ice box and transfer it to blood gas machine

INTERPRETATION
1.determine if the pH should be assessed to

know if the blood is within normal range, alkalotic or acidotic. If it is above 7.45, the blood is alkalotic. If it is below 7.35, the blood is acidotic.

 2.If the pH rises above 7.45, the PaCO2

should fall. Compare the pH and the PaCO2 values. If pH and PaCO2 are indeed moving in opposite directions, then the problem is primarily respiratory in nature

 Finally, the HCO3 value should be assessed.

with a metabolic problem, normally as the pH increases, the HCO3 should also increase. Likewise, as the pH decreases, so should the HCO3. If pH and HCO3 are moving in the same direction, then the problem is primarily metabolic in nature.

3.Assess pao2 < 80 mm Hg - Hypoxemia For a resp. disturbance : acute, chronic The differentiation between acute and chronic respiratory disorders is based on whether there is associated acidemia / alkalemia. If the change in paco2 is associated with the change in pH, the disorder is acute. In chronic process the compensatory process brings the pH to within the clinically acceptable range ( 7.30 7.50)

pH Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

paCO2
Normal Normal

HCO3 Normal Normal

 When a patient develops an acid-base

imbalance, the body attempts to compensate. the lungs and the kidneys are the primary buffer response systems in the body. The body tries to overcome either a respiratory or metabolic dysfunction in an attempt to return the pH into the normal range.

 A patient can be uncompensated or

partially compensated or fully compensated pH remains outside the normal range pH has returned within normal range- fully compensated though other values may be still abnormal In a fully compensated patient.

pH paco2 Resp.Acidosis Normal but<7.40 Resp.Alkalosis Normal but>7.40 Met. Acidosis Normal but<7.40 Met. Alkalosis Normal but>7.40

Hco3

Partially compensated
pH
RRespiratory Aacidosis RRespiratory A alkalosis metabolic Acidosis MMet .Alkalosis.

paco2

Hco3

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