Basic Atrial Blood Gas(ABG) interpretation

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ABGArterial Blood Gas

• By
• Shams Ali Shah
• Respiratory Therapy Tech PSCCQ KSA

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• An ABG (arterial blood gas ) is a blood test that
  is performed using arterial blood

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Indication of ABG

• To evaluate situation of ventilation,
• oxygenation, and oxygen carrying
• capacity of blood.
• To evaluate the patient response to
• intervention and treatments.
• To record the severity and progression
• of a documented disease process.

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ABG Machine
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pH

• Normal range in Blood (7.35-7.45)
• pH stand for Potential Hydrogen Ions
• It show the Quantity of Hydrogen
• Ions blood the pH will Hi(Alkalemia)
• pH6.1logHCO3/0.03xCO2)
• henderson-hasselbach equation

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pH Continued
Common causes of low pH (acidosis) Respiratory
acidosis as alveolar hypoventilation or
increased metabolic rate . Metabolic acidosis as
circulatory impairment, renal failure, diabetic
ketoacidosis or gastro-intestinal loss of
bicarbonate(diarrhea) Common causes of high pH
(alkalosis) Respiratory alkalosis as alveolar
Hyperventilation Metabolic alkalosis as
diuretics, gastrointestinal loss of acid
(vomiting)or hypokalemia.
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pO2 (80-100) or 100-1/2 of age

• The arterial oxygen tension is an indicator of
  the oxygen uptake in the lungs.

Common causes of low P0 2 is pulmonary disease,
cardiac right to left shunt, low alveolar
ventilation and ambient pressure.
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pCO2(35-100)

• PCO2 (Partial Pressure of CO2) is a direct
  reflection of the adequacy of alveolar
  ventilation in relation to the metabolic rate.

Common causes of low pCO2 alveolar
hyperventilation hypocapnia Common causes of
high PCO2 Alveolar hypoventilation -
hypercapnia) may be lung disease,central nervous
system depression, either primary, or secondary
to.
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PCO2
Carbon dioxide partial pressure or tension also
written PCO2
pCO2 reflects the amount of carbon dioxide gas
dissolved in the blood. Indirectly, the pCO2
reflects the exchange of this gas through the
lungs to the outside air
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Total Hemoglobin (ctHb)
Oxymetery Values

• is a measure of the potential oxygen-
  carrying capacity of the blood.

Hi tHb indicates a high blood viscosity. Common
causes of Hi tHb (polycytemia). Dehydration,
chronic lung disease, chronic heart disease,
living at high altitude Common Cause of Low
tHb Anemia , impaired red cell production,
hemolysis, bleeding, dilution (over hydration) .
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Oxygen Saturation (sO 2)

• sO2 is the percentage of oxygenated
  hemoglobin in relation to the amount of
  hemoglobin capable of carrying oxygen. s02 allows
  evaluation of oxygenation.

Hi (normal) s02 Measure of sufficient
utilization of
actual oxygen transport capacity. Common causes
of low s02 may be impaired oxygen
uptake.
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Fraction of Oxyhemoglobin (FO2Hb)

• FO2Hb is a measure of the utilization of the
  potential oxygen transport capacity that is the
  fraction of oxyhemoglobin in relation to all
  hemoglobins present (tHb) including
  dyshemoglobins.

High (normal) FO2Hb may be an indication of
sufficient utilization of oxygen transport
capacity. Common causes of low FO2Hb may be
impaired oxygen uptake or presence of
dyshemoglobins.
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Fraction of CarboxyhemoglobinThe compound that
is formed when inhaled carbon monoxide combines
with hemoglobin in the blood. Also called carbon
monoxide hemoglobin (1.45 in smokers and non
smokers 1.34)
FCOHb is the fraction of Carboxyhemoglobin

• .
• It is incapable of transporting oxygen because
  CO the Hb will not pick O2.

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Fraction of Methemoglobin (FMetHb)

• In normal erythrocytes, Methemoglobin is
  present at 1 to 2.
• Fe2 becomes Fe3

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Lactate (cLac)
Metabolites

• The lactate measurements measure the
  concentration of lactate in plasma.
• Lactate measurements serve as a marker of
  critical imbalance between tissue oxygen
• demand and oxygen supply.

Glucose
Is concentration of glucose in Plasma..
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ELECTROLYTES
Potassium (cK) Sodium (cNa) Calcium (cCa 2 )
Chloride (cCl-)
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HCO3
Hydrogen carbonate ion or bicarbonate ion
More than 90 of carbon dioxide in your blood
exists in the form of Bicarbonate (HCO3). The
rest of the carbon dioxide is either dissolved
carbon dioxide gas (CO2) or carbonic acid
(H2CO3).
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BE

• The value is usually reported as a
• concentration in units of mEq/L, with
• positive numbers indicating an excess of
• base and negative a deficit.
• A typical Reference range for base excess is -2
• to 2 mEq/L.

Base deficit x 0.3 x bodyweight (kg) deficit in
meq.
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• Lactate (Lac)
• The lactate measurements measure the
  concentration of lactate in plasma. Lactate
  measurements serve as a marker of critical
  imbalance between tissue oxygen demand and oxygen
  supply.
• Fraction of Oxyhemoglobin (FO2Hb)
• FO2Hb is a measure of the utilization of the
  
• potential oxygen transport capacity that
  is the
• fraction of Oxyhemoglobin in relation to
  all
• hemoglobin present (tHb) including
• dyshemoglobins.

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p50

• the oxygen tension at which hemoglobin is 50
  saturated

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Acid Base Balance
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pH Scale
7.4
Acidosis
Alkalosis
Base Normal Acid

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BASICs of ABG Interpretation

• pH (7.35-7.45 normal)
• lt7.35 Acidosis
• gt7.45 Alkalosis
• pH is the single best index of overall acid base
  status

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Con.. BASICs of ABG Interpretation

• PaCO2 (35-45 normal)
• lt35 alkalosis
• gt45 acidosis
• PaCO2 is the single best indicator of
  respiratory acid-
• base control.
• PaCO2 moving in opposite direction of pH
• respiratory cause
• PaCO2 moving in same direction of pH
• respiratory compensation of a metabolic
• process

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Con.. BASICs of ABG Interpretation

• PaO2 (80-100 normal)
• gtPaO2 determines oxygenation status
• PaO2 gt 100 hyperoxia
• PaO2 80-100 normal
• PaO2 60-79 mild hypoxemia
• PaO2 45-59 moderate hypoxemia
• PaO2 lt 45 severe hypoxemia

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Con.. BASICs of ABG Interpretation

• HCO3 (22-26 normal
• HCO3 moving in same direction as pH
• metabolic cause
• HCO3 moving in same direction as
• PaCO2 metabolic compensation for a
• respiratory process

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Respiratory Acidosis Signs and Symptoms
Con.. BASICs of ABG Interpretation
Acid Base Status

• Impaired respirations
• Poor exhalation
• General weakness
• Altered mental status
• Disorientation
• Stupor
• Coma

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Con.. BASICs of ABG Interpretation
Acid Base Status
Respiratory Alkalosis Signs and Symptoms

• Deep and/or rapid respirations
• Light headedness
• Tetany(seizure)
• Convulsions
• Unconsciousness

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Metabolic Acidosis
Con.. BASICs of ABG Interpretation Acid Base
Status
Signs and Symptoms

• Weakness
• Kussmals respirations(Rapid Breathing)
• Dyspnea
• Disorientation
• Coma

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Body Mechanism of Compensation
pCO2 HCO 3
paCO2 HCO 3
HCO3 CO 2
HCO3 CO2
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ABG PRACTICE
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.79
PCO2(24)
HCO3 (21)
pH(7.79
HCO3 (21)
PCO2(24)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.79
PCO2(24)
pH(7.79
HCO3 (21)
HCO3 (21)
PCO2(24)
Partial compensated Respiratory Alkalosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.17)
PCO2(35)
pH(7.17)
PCO2(35)
HCO3 (12)
HCO3 (12)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.17)
PCO2(35)
pH(7.17)
PCO2(35)
HCO3 (12)
HCO3 (12)
Uncompensated Metabolic Acidosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.45)
PCO2(48)
pH(7.45)
PCO2(48)
HCO3 (28)
HCO3 (28)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.45)
PCO2(48)
pH(7.45)
PCO2(48)
HCO3 (28)
HCO3 (28)
Fully Compensated Metabolic Alkalosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Normal
Acid
pH(7.42)
PCO2(40)
pH(7.42)
HCO3 (23)
PCO2(40)
HCO3 (23)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.42)
PCO2(40)
pH(7.42)
HCO3 (23)
PCO2(40)
HCO3 (23)
Normal ABG
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Acid
Normal
pH(7.63)
PCO2(24)
pH(7.63)
HCO3 (18)
HCO3 (18)
PCO2(24)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.63)
PCO2(24)
pH(7.63)
HCO3 (18)
HCO3 (18)
PCO2(24)
Partial Compensated Respiratory Alkalosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Base
Acid
Normal
pH(7.33)
PCO2(22)
pH(7.33)
PCO2(22)
HCO3 (21)
HCO3 (21)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Normal
Acid
pH(7.33)
PCO2(22)
pH(7.33)
PCO2(22)
HCO3 (21)
HCO3 (21)
Partial Compensated Metabolic Acidosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.15)
PCO2(46)
pH(7.15)
HCO3 (34)
HCO3 (34)
PCO2(46)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.15)
PCO2(46)
pH(7.15)
HCO3 (34)
PCO2(46)
Partially Compensated Respiratory Acidosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.54)
PCO2(24)
pH(7.54)
HCO3 (25)
HCO3 (25)
PCO2(24)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Base
Acid
Normal
pH(7.54)
PCO2(24)
pH(7.54)
HCO3 (25)
HCO3 (25)
PCO2(24)
Uncompensated Respiratory Alkalosis
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
22
26
Metabolic
Acid
Base
Normal
pH(7.35)
PCO2(42)
pH(7.35)
HCO3 (25)
PCO2(42)
HCO3 (25)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.35)
PCO2(42)
pH(7.35)
HCO3 (25)
PCO2(42)
HCO3 (25)
Normal ABG
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Acid
Base
Normal
pH(7.55)
PCO2(20)
pH(7.55)
HCO3 (19)
HCO3 (19)
PCO2(20)
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Acidic
Basic
7.35
7.45
pH
pCO2
Respiratory
45
35
HCO3
26
22
Metabolic
Normal
Acid
Base
pH(7.55)
PCO2(20)
pH(7.55)
HCO3 (19)
HCO3 (19)
PCO2(20)
Partially Compensated Respiratory Alkalosis
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Doing ABG by Direct Method and choosing the
Artery.

• The radial artery is superficial, has collaterals
  and is easily compressed. It should almost always
  be the first choice.
• Other arteries (femoral, dorsalis pedis,
  brachial) can be used in emergencies.

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Preparing to perform the Procedure

• Make sure you and the patient are comfortable.
• Assess the patency of the radial and ulnar
  arteries.

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The Kit
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Performing the Direct Arterial Blood Draw

• If you are going to use local anesthetic,
  infiltrate the skin with 2 xylocaine.
• Open the ABG kit
• Line the needle up with the artery, bevel side
  up.
• Enter the artery and allow the syringe to fill
  spontaneously.

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Performing the Direct Arterial Blood Draw

• Withdraw the needle and hold pressure on the
  site.
• Protect needle
• Remove any air bubbles
• Gently mix the specimen by rolling it between
  your palms
• Place the specimen on ice and transport to lab
  immediately.

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• May be It is a Venous sample
• Look for absence of flash and auto filling
• of syringe.
• Compare the saturation of sample and
• pulse Oxymetery saturation
• Look at the patient

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Transporting the ABG Sample

• Placing the AGB on ice may help minimize changes,
  depending on the type of syringe, pO2 and white
  blood cell count.
• Its probably not as important if the specimen is
  delivered immediately.

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Transport

• After specimen collected and air bubble removed,
  gently mix and invert syringe.
• Because the wbcs are metabolically active, they
  will consume oxygen.
• Plastic syringes are gas permeable.
• Key Minimize time from sample acquisition to
  analysis.

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Performing the Blood Draw from Arterial Line
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Things Required for Arterial Blood Sampling
from Arterial Line
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How to Draw ABG sample from Line step 1
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How to Draw ABG sample from Line step2
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How to Draw ABG sample from Line step3
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How to Draw ABG sample from Line step4
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• Anticoagulants(Heparin)
• Arterial line 4-6ml of waste should
• be discarded prior to obtaining the
• sample
• Contaminated samples will show a
• Decrease in PaCO2 and an increase
• in pH

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• Temperature
• Increased patient temperature will show
• increased PaO2 , PaCO2 and decreased
• pH
• Decreased patient temperature will show
• decreased PaO2 and PaCO2, increased
• pH

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How to Draw ABG sample from Line step 5
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How to Draw ABG sample from Line step 6
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How to Draw ABG sample from Line step 7
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How to Draw ABG sample from Line step 8
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How to Draw ABG sample from Line step 9
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How to Draw ABG sample from Line step 10
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Hazards Can Occur after ABG

• Hematoma
• Arteriospasm
• Air or clotted-blood emboli
• Anaphylaxis from local anesthetic
• Infection
• Hemorrhage
• Trauma to the vessel
• Arterial occlusion
• Vasovagal response
• Pain

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Thank You