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ABG ANALYSIS

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Purpose of ABG Analysis:

To evaluate how effective the lungs are in


bringing oxygen to the blood and removing
carbon dioxide from it.

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Radial artery is the


most frequently used
artery for ABGs

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Allens Test

Patient clenches fist


Apply firm pressure to
radial & ulnar arteries
Patient relaxes hand
Release pressure on
the ulnar artery
Palm should flush
within 5-15 secs

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Arterial Blood Sampling

Prep site
Pierce skin over arterial at a 6090 angle
Obtain 3 mL of blood without
air bubbles
Twirl syringe to mix heparin
with sample
Place in ice
Hold pressure for 5-10 minutes
Wait 30 minutes before drawing
sample if O2 setting changed
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Documentation

Must Include:

Presence of positive Allens Test


Date and time of procedure
Site chosen
Patients tolerance to procedure
FiO2 patient is on at the time the sample is drawn

Chart By Exception:

Adverse side effects of procedure


Length of time pressure applied, if greater than 5 minutes
Negative Allens Test

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Key to bodys response to acid-base imbalance is:


Hydrogen Ion Concentration
When H+
HCO3- + H+ H2CO3 CO2 + H2O

When H+
CO2 + H2O H2CO3 HCO3- + H+

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Components of ABG

pH- Hydrogen ion concentration in plasma


PaCO2- Partial pressure of CO2 dissolved in
plasma
HCO3- Bicarbonate concentration in plasma
PaO2- Partial pressure of O2 dissolved in
plasma
Base Excess- The amount of base
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Interpretation of ABGs

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pH

pH reflects the hydrogen ion (H+)


concentration of plasma
pH range

0= pure acid
14= pure base
7.0 =neutral (equal parts acids/base)

Normal pH in the blood = 7.35- 7.45

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Acidosis
Decrease in pH resulting from an increase in
hydrogen ion concentration
H+

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Alkalosis
Increase in pH resulting from a decrease in
hydrogen ion concentration

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FOUR STEPS to evaluate ABGs


1.
2.
3.
4.

Evaluate each number


Check pH to determine cause of imbalance
Find value that matches acid-base status of pH
Determine extent of compensation:

Absent
Partial
Complete

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Step 1 evaluating each number

Is the pH on the acid or


alkaline side?
What does the PaCO2
show?
What does the HCO3
show?
Does the PaO2 show
hypoxemia?
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CO
2
HCO3

Buffe
r

PO2

hgb

ph
Base

acid
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Step 2
Is the pH on the acid or alkaline side?
Normal pH 7.35 - 7.45

pH < 7.40 = acidosis

pH > 7.40 = alkalosis

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Step 3
Does the PaCO2 match the pH?
Normal PaCO2 35-45 mm Hg

PaCO2 > 45

PaCO2 < 35

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Step 3
Does the HCO3 match the pH?

Normal HCO3 22 - 26 mEq/L

HCO3 < 22

HCO3 > 26

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Which System is Involved?

Lungs
(Respiratory)

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Kidneys
(Metabolic)

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Step 4
What is the extent of compensation?

Absent - value that doesnt match the pH is normal


Partial - value that doesnt match the pH & pH are
above or below normal
Complete - value that doesnt match the pH is above
or below normal, but the pH is normal

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Metabolic System compensates


for the Respiratory System

Respiratory acidosis

Kidneys re-absorb more bicarbonate

Respiratory alkalosis

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Kidneys excrete more bicarbonate

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Respiratory System compensates


for Metabolic abnormalities

Metabolic acidosis

Hyperventilation lowers PaCO2 so the ratio of


Bicarbonate to Carbonic acid returns to normal

Metabolic alkalosis

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Hypoventilation so the PaCO2 rises and the ratio of


Bicarbonate to Carbonic Acid returns to normal

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Oxygen
Oxygen is carried in the blood in two ways:

In combination with hemoglobin


Dissolved in plasma

97% bound by Hgb


3% dissolved in plasma

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PaO2

Normal on room air


Mild hypoxemia =
Moderate hypoxemia =
Severe hypoxemia =

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80-100 mm Hg
60-80 mmHg
40-60 mmHg
below 40 mmHg

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Does the PaO2 show hypoxemia?

Is the client hypoxemic?


Is the clients PaO2 or SaO2 low?
Is the client anemic?

Normal PaO2 is 80-100


Normal SaO2 is 95-100
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ABG Example

pH 7.48
PaCO2 32

HCO3 22

Normal

Uncompensated Respiratory Alkalosis

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Acid-Base Disorders
ABG Disorder

Possible Causes Signs and


Symptoms

Respiratory Acidosis

CNS

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depression
(barbiturate or sedative
OD)
Asphyxia
Hypoventilation
COPD
Respiratory muscle
weakness (GuillainBarre)
Chest wall
abnormality (obesity)

Diaphoresis
Headache
Tachycardia
Confusion
Restlessness
Apprehension

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Acid-Base Disorders
ABG Disorder

Possible Causes

Signs and
Symptoms

Respiratory Alkalosis

Hyperventilation

Rapid,

Respiratory

stimulation (septicemia,
encephalitis, brain
injury, salisylate
poisoning)
Gram-negative
bacteremia

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deep
respirations
Paresthesias
Light-headedness
Twitching
Anxiety
Fear

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Acid-Base Disorders

ABG Disorder

Possible Causes

Signs and
Symptoms

Metabolic Acidosis

HCO3-

Rapid,

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depletion
from diarrhea
Excessive production
of organic acids
Inadequate excretions
of acids from renal
disease
DKA, Lactic acidosis
Shock, GI fistulas

deep breathing
Fruity breath
Fatigue
Headache
Lethargy
Nausea
Vomiting
Coma

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Acid-Base Disorders
ABG Disorder

Possible Causes Signs and


Symptoms

Metabolic Alkalosis

Loss

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of hydorchloric
acid from vomiting or
NG suctioning
Loss of hydrogen
ions due to increased
renal excretion from
diuretic therapy
Excessive alkali
ingestion

Slow, shallow

respirations
Muscle twitching
Hypertonic muscles
Restlessness
Tetany (convulsion)
Coma

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ABG Case Studies


Exercises

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A patient was admitted to the ICU after suffering a


stroke. The third day, the patient is more lethargic
than the day before. His lung sounds are diminished
in the lower lobes. ABGs are drawn and the
following results were obtained.

pH 7.33
PaCO2 55

HCO3 29

PaO2 60

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What is the ABG result for the CVA patient?


1.
2.
3.

4.

Comp. resp. acidosis with


mild hypoxemia
Part. Comp. resp. acidosis
with mild hypoxemia
Part. Comp. metabolic
acidosis with mod.
hypoxemia
Comp. metabolic alkalosis
with mod. hypoxemia

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A postop cholecystectomy patient is hyperventilating


due to anxiety and pain. She complains of tingling
and numbness in her fingers. Her ABG values are as
follows:

pH 7.55
PaCO2 28

HCO3 24

PaO2 90

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What is the ABG result for the S/P cholecystectomy


patient?
1.
2.
3.
4.

Comp. resp. alkalosis with


normal oxygenation
Part. comp. resp. alkalosis
with mild hypoxemia
Uncomp. Resp. alkalosis
with normal oxygenation
Comp. metabolic alkalosis
with mild hypoxemia

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A patient has acute tubular necrosis, brought on by


cardiopulmonary arrest. His ABG results are as
follows:

pH 7.32
PaCO2 34

HCO3 17

PaO2 95

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What is the ABG result for the ATN patient?


1.
2.
3.
4.

Comp. resp. acidosis with


normal oxygenation
Comp. metabolic alkalosis
with normal oxygenation
Uncomp. metabolic acidosis
with mild hypoxemia
Part. comp. metabolic
acidosis with normal
oxygenation

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A patient has a history of pancreatitis. He has been


vomiting for several days PTA. He presently has a
NGT to suction. His ABG values are as follows:

pH 7.52
PaCO2 49

HCO3 40

PaO2 93

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What is the ABG result for the patient with


pancreatitis?
1.

2.
3.
4.

Part. comp. metabolic


alkalosis with normal
oxygenation
Comp. metabolic acidosis
with normal oxygenation
Comp. respiratory alkalosis
with normal oxygenation
Part. comp. resp. alkalosis
with normal oxygenation

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A patient has a history of smoking three packs of


cigarettes for 40 years and has a history of COPD.
His ABGs are as follows:

pH 7.35
PaCO2 70

HCO3 30

PaO2 55

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What is the ABG result for the COPD patient?


1.
2.
3.
4.

Part. comp. resp. acidosis, mod.


hypoxemia
Comp. metabolic alkalosis, mod.
hypoxemia
Comp. resp. acidosis, mod.
hypoxemia
Part. comp. metabolic acidosis,
mod. hypoxemia

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