ARTERIAL BLOOD GAS

ABG

Monitors:
Arterial oxygenation PaO2 Alveolar ventilation PACO2 Acid-base status pH Oxygen delivery to tissues PvO2

Common sites in obtaining sample

Radial most common site Brachial Femoral Dorsal artery of the foot

Allens test to determine collateral circulation

Arterial oxygenation
PaO2 ( partial pressure of arterial oxygen) portion of O2 dissolved in plasma

PAO2 (partial pressure of alveolar oxygen) is compared with PaO2 to determine P(A-a) gradient

Formula
PAO2 =((PB47torr)(FIO2))(PaCO2 X 1.25) PAO2 = (760 47torr)(0.21) (40torr X 1.25 PAO2 = (713 X 0.21) 50 PAO2 = 150 50 = 100torr

Oxyhemoglobin Dissociation Curve

Factors affecting the affinity of O2

Shift to the right: indicates that hgb affinity for O2 has decreased a. hypercapnia b. acidosis c. hyperthermia d. increased 2,3- DPG

Factors affecting the affinity of O2

Shift to the left: hgb affinity for O2 has increased a. hypocapnia b. alkalosis c. hypothermia d. decreased of 2,3 DPG e. carboxyhemoglobin

Haldane effect
As oxygen combines with the hemoglobin this enhances the release of carbon dioxide

Bohr effect
As the RBC travels to the tissue, it releases the oxygen. This release of oxygen is due to the fact that elevated carbon dioxide levels, which are present around tissues, decreases hemoglobins affinity for oxygen

Normal PaO2 levels

Age <60------------------------60--------------------------65--------------------------70--------------------------75--------------------------80-------------------------- PaO2 (torr) 80-100 80 75 70 65 60

SaO2
Arterial oxygen saturation refers to the quantity of oxygen being carried by the hemoglobin compared with the maximum that may be carried.

Normal = 95% and above

PaCO2
CO2 -dissolves in plasma -enters the RBC -bound to hemoglobin -as bicarbonate The adequacy of ventilation is determined by PaCO2 level Normal = 35 45 torr

pH
Determined by the amount of acid in the blood in relation to the amount of base.

Acid carbonic acid ( H2CO3) Base bicarbonate (HCO3) Bicarbonate to carbonic acid ratio is 20:1 Normal = 7.35 7.45

pH Compensation
The challenge? correct the pH level How? The levels of HCO3 and CO2 will always change in order to keep the pH normal.

Important notes
If the compensated pH is 7.35 to 7.40, the pH must be assumed to have been acidotic initially. Decide if the PCO2 or HCO3 cause the initial acidemia If the compensated pH is 7.40 to 7.45, the pH must be assumed to have been alkalotic initially. Decide if the PCO2 or HCO3 cause the initial alkalemia

ABG interpretation
pH-------------------------PaCO2-------------------PaO2---------------------HCO3--------------------B.E.----------------------- 7.35 7.45 35 -45 torr 80 -100 torr 22 26 mEq/L -2 to +2 ( refers to the total base deficit or excess

Basic steps
1. Determine the acid base status by observing the pH 2. Determine if the pH change is the result of a PCO2 change or a HCO3 change 3. When this is determined, observe for signs of compensation. 4. Determine oxygenation status by observing PO2.

ABG interpretation chart

pH Normal N PCO2 N HCO3 N

ABG interpretation chart

Uncompensated Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH D I D I PCO2 I D N N HCO3 N N D I

ABG interpretation chart

Partially compensated Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH D I D I PCO2 I D D I HCO3 I D D I

ABG interpretation chart

Fully compensated Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis pH N N N N PCO2 I D D I HCO3 I D D I

ABG interpretation chart

Mixed Acidosis alkalosis pH D I PCO2 I D HCO3 D I

Blood Gas Electrodes

Sanz pH Severinghaus PCO2 Clark PO2

Thank you. Godbless

Jay Mark B. Burgos, RMT