Performed to measure the pH, oxygen, and carbon dioxide levels in the blood. Arterial blood is preferably used. It is important in monitoring acid-base status of the patients. Disorders in acid-base balance may pose serious complications in patients, particularly those who are critically ill. ARTERIAL BLOOD GASES TEST Commonly includes: pH pCO2 pO2 Calculated Values Total Carbon Dioxide Bicarbonate Oxygen Saturation Oxygen Content Base Excess Alveolar-arterial gradient PATIENT CARE Collection is done with patient in a supine position. Make sure that the patient is relaxed. Specimen: Whole Blood • Collection is done using heparinized syringe, or if not possible, via in-dwelling arterial line - make use of syringe with needles of small diameter - place a stopper on the heparinized syringe after blood has been collected - usually 25 gauge - drawn into air-free heparinized syringe, then stoppered • Favored site: Radial artery; alternative is brachial artery PATIENT CARE All specimens should be placed on ice and brought to the laboratory immediately • Indicate mode of oxygen delivery or if room air • Maintain strict anaerobic conditions • Do not do collection immediately after exercise • Do not put too much heparin PATIENT CARE Blood drawn from a vein or capillary can provide helpful information on pH, pCO2, and occasionally, pO2 Storage instructions: • Place on ice (following in vitro changes occur in blood gas parameters): - pH, 0.001/10 minutes at 4 degree Celcius - pCO2, 0.1 mmHG/10 minutes at 4 degree Celsius - pO2, 3 mmHg/10 minutes at 4 degree Celsius PATIENT CARE • Reject if the specimen is not placed on ice or if air bubbles or clots are present in the syringe • Special instructions: - confusing results may be obtained if the sample was collected just after a change in FiO2 Interpretative Reference Range Arterial pH: 7.35-7.45 pCO2 : 35-45 mmHG pO2 : BP-adult = 80-95 mmHg newborn = 60-70 mmHg TCO2 : 23-29 mmol/L O2: 95% - 99% saturation Possible Panic Range pH < 7.2 or > 7.55 pCO2 < 20 mmHg or > 60 mmHg pO2 < 40 mmHg Uses of ABG measurement For evaluation of patient’s respiratory function as well as acid-base status Evaluation of respiratory status in patients with pulmonary problems such as COPD and other lung diseases Monitoring of respiratory function of patients who underwent coronary arterial bypass surgery Interpretation 1. What are the normal values? Interpretation 2. Acidosis or Alkalosis? The first thing that is checked is the pH. Normal blood pH level is 7.35-7.45. If it is < 7.35, this is considered ACIDOSIS. If it is > 7.45, consider ALKALOSIS. Interpretation 3. Respiratory or Metabolic? Next thing to look at is the PaCO2 and the HCO3 levels. It is RESPIRATORY if the abnormality is the PaCO2. It is METABOLIC if the abnormality involves HCO3. Interpretation If the pH is alkaline and the PaCO2 is reduced, the problem is RESPIRATORY ALKALOSIS. If the pH is acidic and the PaCO2 is increased, the problem is RESPIRATORY AIDOSIS.
If HCO3 and pH are both elevated, consider
METABOLIC ALKALOSIS. If both pH and HCO3 are reduced, it is METABOLIC ACIDOSIS. Interpretation 4. Create a chart Similar to “tic tac toe” where you can enter the values for easier analysis. Interpretation 5. Fill up the chart Mark the chart based on the laboratory values obtained. Sample values: pH 7.20, paCO2 30, HCO3 17 Interpretation 6. Determine level of compensation If both PaCO2 and HCO3 are both deranged while pH is normal = COMPENSATED If PaCO2, HCO3, and pH are all abnormal = PARTIALLY COMPENSATED If either PaCO2 or HCO3 is abnormal and pH is also abnormal = UNCOMPENSATED
• In the above example, the acid-base disturbance is
Partially Compensated Metabolic Acidosis. THANK YOU