Umm Al-Qura University Faculty of Nursing Critical Care & Emergency Nursing

Arterial Blood Gases(ABG)

Definition:
ABG: is a test which measures the amount of oxygen (O2) and carbon dioxide ( CO2) in the blood, as well as the acidity (pH) of the blood.

Objectives: 1. An ABG analysis evaluates how effectively the lungs are delivering oxygen to the blood and how efficiently they are eliminating carbon dioxide from it especially in people who have respiratory diseases. 2. It is used to determine the effectiveness of oxygen therapy. 3. The acid-base component of the test also gives information on how well the kidneys are functioning. Steps
I. Preparation: A. Equipment: 1. 3-ml heparinized syringe. 2. 23 to 25 guage needle. 3. Syringe cap 4. Alcohol swabs (2) 5. 2X2 gauze pad.

Rational

6. Tape 7. Cup or plastic bag with crushed ice 8. Lable with client information. 9. Laboratory requisition.
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10. Clean gloves. 11. Protective eye wear

B. Environment: Keep quite arranged environment. Provide privacy for the patient. C. Patient: 1. Explain the procedure to the patient. Assess for: A. Assess clients risk factors for acid base imbalance B. Assess factors that influence ABG measurement: a. Suction b. Oxygen therapy c. Ventilator sitting change d. Body temperature C. Identify medications that could affect acid-base balance as diuretics d. Assess client for use of anticoagulant medications To provide privacy and gain her cooperation. To avoid the risk of supine hypotension. Full bladder will displace the uterus and cause wrong fundal height reading. To relax the abdominal muscles. To put her at ease and to help you to get all required information.

II. Safety Measures:

1. Wash hands. 2. Reviewing physician description.

III. Implementation
1. Select an appropriate site, the radial, femoral, or brachial arteries commonly used. are Arterial blood reflect accurate measurement of oxygen saturation and content of acid base status.

2. Assess collateral blood flow to the hand using allen's test. Allens test: Step 1: Occlude radial and ulnar arteries. (See Fig. 1) Step 2: Have client close hand in to a tight fist for 20 seconds. Step 3: Open hand and look for blanching (See Fig. 2) Step 4: Release ulnar artery and look for capillary refill (5-7 sec) 3. Palpate selected site with fingertips

To ensure that circulation to the extremity will not be compromised by arterial puncture. Flushing can be seen immediately when flow through ulnar artery is good, which confirm that radial artery can used for puncture. If there is no

flushing within 15 seconds, circulation is inadequate, and radial artery should not punctured, check other arm if same use brachial or femoral artery. Determine the area of maximal impulse for puncture site facilitate insertion of needle.

4. Stabilize artery by hyper extending wrist slightly (See Fig. 3) 5. Clean area of maximal impulse with alcohol swap, wiping in circular motion. (See Fig. 3) 6. Hold needle bevel up and insert at 45- degree angle, observing blood return (See Fig. 4) 7. Stop advancing the needle when blood is observed and allow arterial pulsations to pump 2-3ml of blood into the heparinized syringe. 8. When sampling is complete, hold 2x2 gauze pad over puncture site and quickly withdraw needle, applying pressure over and just proximal to puncture site. 9. While applying pressure with one hand, expel air bubbles from syringe with other hand 3

For easier insertion of the needle.

To prevent infection in the site of injection

Needle position facilitate flow of blood into syringe.

To prevent bleeding in the site of injection.

To maintain accurate results.

10. Maitain continuous pressure on and proximal to site for 3-5 minutes or longer.

To avoid hematoma formation If client is receiving anticoagulant therapy or has bleeding disorder, pressure may be needed for up to 15 minutes.

11. Inspect site for signs of bleeding or hematoma formation. 12. Palpate artery distal to the puncture site. To determine presence of any complication from decreased blood flow to the site after sampling. To insure correct result for correct patient. To maintain accurate results. Supplemental oxygen influence test result, elevated body temperature decrease oxygen saturation.

13. Place identification label on syringe.

14. Place syringe in ice.

15. Attach apropriate laboratory requisition, note on the requisition if patient using oxygen, and indicate clients body

temperature. 16. Transport specimen to the laboratory immediately 17. Evaluate ABG results to determine if acid base imbalance exist. 18. observe for complication: - nerve injury. - infection - hematoma - arterial spasm For early abnormality. For early abnormality. management of any To maintain accurate results.

management

of

any

V. Documentation: 1. date and time of the procedure. 2. Allens test result 3. assessment of puncture site. 4. oxygen therapy during procedure. 5. patient temperature during the procedure. 6. ABGs interpretation.
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References:

Figure (1) Allens test: Step 1: Occlude radial and ulnar arteries

Figure (2) Allens test: Step 3: Open hand and look for blanching

Figure (3) Stabilize artery by hyper extending wrist slightly. Clean area of maximal impulse with alcohol swap, wiping in circular motion

Figure (4) Hold needle bevel up and insert at 45degree angle, observing blood return