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ABG Interpretation The Ultimate Guide Toarterial Blood Gases PDF
ABG Interpretation The Ultimate Guide Toarterial Blood Gases PDF
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Are you ready to learn about arterial blood gases and ABG interpretation? I sure
hope so because that is what this study guide is all about.
So if you’re ready to get started learning how to interpret ABGs, let’s go ahead and
dive right in. But before you learn how to interpret ABGs, you must rst know exactly
what is an Arterial Blood Gas?
What is an ABG?
An arterial blood gas (ABG) is a test that measures the blood levels of oxygen and
carbon dioxide as well as the level of acid-base (pH) in your body. An ABG test is used
to check how well your lungs move oxygen into di erent body parts and how e cient
it eliminates carbon dioxide.
Normally, healthy lungs move oxygen into the blood and push carbon dioxide out
e ciently during inhalation and exhalation (called gas exchange). With this process,
your body receives energy while making sure to eliminate waste. However, if you have
breathing problems or a disease that a ects your lung function, your ABG result can
be abnormal that’s why your doctor may order this test.
For you to better understand the key elements in an ABG test, it is important for you
to know the de nition of each:
pH: 7.35-7.45
Partial pressure of oxygen (PaO2): 75-100 mmHg
Partial pressure of carbon dioxide (PaCO2): 35-45 mmHg
Bicarbonate (HCO3): 22-26 mEq/L
Oxygen saturation (SpO2): 94-100%
It is important to keep in mind that normal value ranges may vary slightly in di erent
publications, but these are typically the values that you will need to remember.
In order to best truly learn ABG interpretation, you must rst learn and understand
the normal values. They are listed above, so if you need to take a minute to review
them, you can do that now. If you know the normal ABG values, then let’s move right
along.
First things rst, in order to be able to interpret ABG results, you must obtain an
actual arterial blood sample from the patient. We discuss how to stick an ABG below,
but for now, let’s focus on the interpretation.
So after you have obtained an arterial sample, ran the sample, and have the results,
now we can gure out what the results mean.
ABG Interpretation (basic): Easy and Simple
First and foremost, we need to determine if the pH is acidotic or alkalotic. Again, the
normal value for pH is 7.35 – 7.45.
In this step, we will look at the PaCO2 (carbon dioxide) and the HCO3 (bicarb) to
determine if the issue is a respiratory issue or a metabolic issue.
If the PaCO2 value is abnormal, meaning that it falls outside of the normal range (35
– 45 mmHg), while the HCO3 value is normal, this would mean you have a
Respiratory issue.
If the PaCO2 value is normal, meaning that it is within the normal range (35 – 45
mmHg), while the HCO3 value is abnormal, this would mean that you have a
Metabolic issue.
pH: 7.26
PaCO2: 51
HCO3: 25
Looking at the pH, we can see that this is Acidosis since 7.26 is less than 7.35.
Looking at the PaCO2, we can see that it is elevated above the normal range,
which is abnormal. This indicates that there is a Respiratory issue.
Looking at the HCO3, we can see that it falls within the normal range. This also
helps con rm that there is a Respiratory issue.
So now we have con rmed that the pH is Acidosis and we looked a the PaCO2 and
HCO3 to determine there is a Respiratory issue.
pH: 7.26
PaCO2: 38
HCO3: 19
Looking at the pH, we can see that this is Acidosis since 7.26 is less than 7.35.
Looking at the PaCO2, we can see that it falls in the normal range, so this tells us
that it is not a Respiratory issue.
Looking at the HCO3, we can see that it falls below the range, which tells us that
we have a Metabolic issue.
So now we have con rmed that the pH is Acidosis and we looked a the PaCO2 and
HCO3 to determine there is a Metabolic issue.
When we have a Respiratory problem (PaCO2), our body will compensate with
Bicarbonate.
When we have a Metabolic problem (HCO3), our body will compensate with
Carbon Dioxide.
Metabolic Compensation:
For example, when we have Respiratory Acidosis the body will try to compensate by
increasing the amount of Bicarb in our system.
Bicarbonate is a base, so one of its functions is to try to neutralize the acid that is
causing the problem. When we have Respiratory Alkalosis, it’s going to do the
opposite by decreasing the amount of Bicarb.
For us to conclude that there is compensation, the increase or decrease of HCO3 has
to go outside the normal range. In other words, it has to be lower than 22 or higher
than 26.
If the Bicarb is still within normal limits, you can conclude that there is no
compensation going on.
pH: 7.29
PaCO2: 51
HCO3: 47
As we have already learned using the previous steps, we can conclude that the pH is
Acidosis because it is less than 7.35.
Now we need to identify if it is a Respiratory or Metabolic problem. The PaCO2 is
elevated above the normal range which indicates that there is a Respiratory issue.
The HCO3 is 47 which means that the body detected that there was acidosis so it tried
to compensate by increasing the amount of base in the system. So this tells us that
there is de nitely is compensation.
To answer this question, we need to look back at the pH. Since the pH of 7.29 is
outside of the normal range, this means that the compensation was not enough to
bring the pH back to normal.
Respiratory Compensation:
When we have a metabolic problem, always remember that our Respiratory system
will compensate by regulating the amount of carbon dioxide in the blood.
When we have Metabolic Alkalosis, our body will do the opposite. It will try to
compensate by increasing the amount of carbon dioxide in our system.
pH: 7.51
PaCO2: 51
HCO3: 42
As we have already learned using the previous steps, we can conclude that the pH is
Alkalosis because it is greater than 7.45.
Remember that PaCO2 is acidic and HCO3 is basic. We’ve already decided that the pH
is Alkalotic which indicates that there are more bases (HCO3) in the blood.
Since we have a Metabolic problem, the next step is to look at the respiratory system.
In this case, we see that the carbon dioxide (PaCO2) is elevated above the normal
range which tells us that there is some compensation.
To answer this question, we need to look back at the pH. What the compensation
enough to bring the pH back to normal? The answer is no, so this indicates that there
is only a partial compensation. If the pH would have been within the normal range,
then it would be a full compensation.
In most cases, your doctor may order an ABG if you have the following symptoms:
Breathing di culties
Changes in mental status
Nausea and vomiting
An ABG test requires collecting a small sample of blood from an artery. The sample
must be obtained by a Respiratory Therapist, doctor, or skilled technician. First and
foremost, your healthcare provider will determine the best site for collecting the
blood sample.
In addition, a blood sample can also be obtained in a pre-existing arterial line. An ABG
blood sample cannot be obtained from a vein, as this would instead be a VBG or
venous blood gas.
Once the site is determined, the healthcare provider will sterilize the injection site
using an antiseptic or antimicrobial solution. The patient will be then positioned either
lying down or sitting with the arm well supported.
The healthcare provider may use a rolled towel positioned under the patient’s wrist in
order to provide comfort and hyperextend the site of injection. This position also
makes it easier to palpate the pulse.
After the radial artery is located, the healthcare provider will then insert a sterile
needle into the artery to draw blood.
In some cases, the syringe needs to be repositioned in order to locate and puncture
the artery. When doing this, the healthcare provider will withdraw the tip of the
syringe to the subcutaneous tissue (fat tissue) to prevent severing the artery or
tendons and avoiding damage to the nearby tissues.
Once the blood sample is obtained, a sterile bandage will be placed over the
punctured wound in order to stop bleeding and avoid infection.
The blood sample will be immediately sent to the laboratory for analysis. The
specimen must be analyzed within 10 minutes after extraction in order to ensure an
accurate ABG result.
In severe cases, it can also cut the artery and cause a signi cant amount of bleeding.
In this case, the healthcare provider may need to use alternate sites in order to draw
a blood sample. Therefore, collecting a blood sample for an ABG test can be quite
challenging for some Respiratory Therapists.
But as I always say, practice makes perfect; and the more you do it, the easier it gets
and the better you get at sticking ABGs.
Respiratory acidosis occurs when your lungs cannot remove all of the carbon dioxide
formed in your body. As a result, your blood and other body uids become too acidic.
When carbon dioxide mixes with water in the body, it produces carbonic acid. If left
untreated, long-term respiratory acidosis causes the body to compensate by
increasing the excretion of carbonic acid while retaining bicarbonate base in the
kidneys.
The acidifying e ect of long term elevation in carbon dioxide levels can be lessened in
the blood. However, this e ect is not lessened in your brain. As a result, you can
su er from sleeping di culties, headaches, memory problems, anxiety, and mood
changes.
Breathing problems
Cardiac arrest
Lung disorders such as chronic obstructive pulmonary disease (COPD),
emphysema, asthma, or pneumonia.
Neuromuscular disorders that a ect the muscles of the airways (e.g. Multiple
sclerosis, muscular dystrophy, or Guillain–Barré syndrome).
Obstruction of the airways
Scoliosis
Sedative overdose
Severe obesity (a ects lung expansion)
There are several factors that can a ect the result of an ABG test. These are the
following:
Drawing the blood sample from the incorrect patient. This can signi cantly
alter the course of treatment of a critical patient. This can be caused by posting
the ABG results on the incorrect patient record, or mislabelling the blood
sample.
Failure to obtain a blood sample from an artery or vein. In some cases,
inexperienced healthcare providers might not hit an artery or vein, therefore
obtaining blood sample from the surrounding tissues. Also, obtaining blood
sample from an existing IV line increases the chance of aspirating blood mixed
with intravenous uid.
Blood clotting. It is highly recommended to analyze the blood sample 10
minutes after extraction in order to avoid clotting. Analyzing a blood sample
that has already clotted will yield inaccurate result and will render the specimen
useless.
Obtaining a blood sample on incorrect settings or support. This can
signi cantly a ect the course of the treatment of the patient and the medical
team’s assessment of health needs. For instance, if a nurse obtained a blood
sample when the patient is still on supplemental oxygen instead of room air, the
results can be incorrect. This can yield falsely elevated PaO2 levels.
Air contamination of the blood sample. Air contamination can alter the result
of an ABG by causing the measured PaO2 of the patient to drop toward room air
PaO2.
Contamination caused by too much heparin. Too much liquid heparin dilutes
the blood sample and causes changes in pH levels. Moreover, it can decrease
the measurement of hemoglobin/hematocrit available on modern instruments
and it can cause liquid bubble. These mechanisms can signi cantly a ect PaO2
and PaCO2 values.
Inappropriate mixing of the blood sample. Depending on hospital or
laboratory protocol, healthcare providers thoroughly mixed the blood sample
with heparin immediately upon collection to avoid clotting. It’s also remixed
before introduction to the instrument. The best way to mix the sample is to roll
it between your palms. The most common error that healthcare providers
commit when mixing the blood sample is vigorously shaking the vial or
container. Another error is mixing iced samples for a shorter period of time. It is
recommended to mix iced samples longer to promote mobilization and mixing
of all the components of the blood sample.
Prolonged delays in blood sample analysis. The blood sample must be sent to
the laboratory for analysis not longer than 10 minutes after extraction. Any
delay in blood sample analysis causes changes in the PaO2 and PaCO2 levels
due to continuous red blood cell metabolism.
Not all patients are potential candidates for an ABG test. The following are the
contraindications for the test:
The Allen test for assessment of blood ow was originally developed by Edgar V. Allen
in 1929 as a non-invasive method of assessing the patency of arteries in patients with
Buerger disease, a recurring progressive in ammation, and clotting of arteries and
veins of the hands and feet. Since then, it has been adopted as the Modi ed Allen test
(MAT).
The di erence between MAT and the original Allen test is that MAT e ciently
evaluates the adequacy of blood circulation at one hand at a time. In contrast, the
original Allen test compresses one artery of each hand at the same time.
MAT measures the competency and quality of the artery and should be performed
prior to performing an ABG test.
So now that you have a full understanding of arterial blood gases and ABG
interpretation, let’s go through some practice questions so that we can really
reinforce this information into your brain.
Phew! You have nally made it all the way through our ultimate guide on Arterial
Blood Gases and ABG Interpretation. By doing so, I know that you now have a great
understanding of the ins and outs of ABGs.
With that being said, what better way to reinforce that knowledge into your brain than
by going through practice questions? That is exactly why we listed out the absolute
best ABG practice questions for you below. Are you ready to get started?
9. What is oxygenation?
It is represented by the PaO2; it is measured only of the oxygen dissolved in plasma.
12. What is the longest time an ABG sample could go (without ice) without being
analyzed?
15 minutes.
13. What test is performed to con rm collateral circulation before doing an ABG
stick?
Modi ed Allen Test.
17. What are the three major criteria for selection of the arterial puncture site?
Collateral blood ow, vessel accessibility, and peripheral structures.
23. What would you look at if you wanted to determine the oxygenation status
of a patient?
Look at the PaO2.
25. A patient comes in with a pH of 7.52, a PaCO2 of 25, an HCO3 of 25, and a BE
+1. What would be the interpretation of this blood gas?
Respiratory Alkalosis
26. The patient has a pH of 7.10, CO2 of 20, HCO3 of 10, and BE of -20, what is
your interpretation of this blood gas?
Metabolic Acidosis
28. Can a blood gas be considered normal if the BE is NOT within the normal
limits?
No; everything must be within normal limits for the blood gas to be considered
normal.
29. If you get a gas and the pH is within normal range and CO2 and HCO3 are
moving in the same direction then how would you rst classify the gas?
Fully compensated.
30. If you get an ABG and it reads: pH is 7.56, CO2 is 42, HCO3 is 34, and BE is +5.
How would you name this gas?
Acute/Uncompensated metabolic alkalosis
35. You get an ABG and it reads: pH is 7.42, CO2 is 43, HCO3 is 25, and BE is +2.
How would you classify this gas?
Normal ABG
41. What are the drugs that can cause an elevated pH?
Sodium bicarbonate, sodium oxalate, and potassium oxalate.
44. Which organ system maintains the normal level of HCO3 at 24 mEq/L?
The renal system.
45. What is the limiting factor for H+ excretion in the renal tubules?
Insu cient bu ers.
46. What acts as the “ rst-line” or immediate defense against the accumulation
of H+ ions?
Blood bu er systems.
50. What are the common sites for a transcutaneous blood gas electrode?
Chest, abdomen, and lower back.
51. What are the sites used for Arterial Blood sampling by percutaneous needle
puncture?
Femoral, radial, and brachial.
52. Before a sample of capillary blood is taken, what should you do to the site?
Warm to 42 degrees Celsius and clean with an antiseptic solution.
54. Factors to determine the volume needed for an arterial blood sample
include?
ABG analyzer’s requirements, speci c anticoagulant used, other tests that will be
done.
55. After obtaining an arterial blood sample, what should you do?
Apply pressure to the site until bleeding stops, place sample in a transport container
with ice slush, mix the sample by rolling and inverting the syringe.
56. Transcutaneous blood gas monitoring is indicated when what need exists?
To continuously analyze gas exchange in infants and children, to quantify the real-
time responses to bedside interventions, to continuously monitor for hyperoxia in
newborn infants.
57. What size needle would you recommend to obtain an ABG sample on an
infant?
25 gauge.
58. The indications for arterial blood sampling by percutaneous needle puncture
include?
Monitor the severity of a disease process, evaluate ventilation and acid-base status,
evaluate a patient’s response to therapy.
59. After obtaining an arterial blood sample from an arterial Line, you would?
Flush the line and stopcock with heparinized intravenous solution, con rm that the
stopcock port is open to the intravenous bag solution and catheter, con rm an
undamped pulse pressure waveform on the monitor.
60. The patient parameters that should be assessed as part of arterial blood
sampling include?
Temperature, position and activity level, and clinical appearance.
64. The causes of Respiratory Acidosis in patients with normal lungs include?
Neuromuscular disorders, spinal cord trauma, anesthesia, and central nervous
system depression.
65. Before connecting the sample syringe to an adult arterial line stopcock,
what should you do?
Aspirate at least 5mL of uid or blood using a wasted syringe.
66. What is the equipment needed for capillary blood sampling?
Lancet, capillary tubes, and a warming pad.
70. What clinical ndings would you expect in a fully Compensated Respiratory
Acidosis patient?
An elevated HCO3 and a pH between 7.35 and 7.39.
75. What type of issues are we looking for when we look at the HCO3 and base
excess values?
Metabolic issues
76. What type of issues are we looking for when we look at the PaCO2 values?
Ventilation status.
79. What ABG value would we look for in patients that currently smoke or have
smoked heavily in the past?
% MetHb
80. What ABG value would we look for in patients that have carbon monoxide
poisoning or have been in a re?
% COHb
81. In a given ABG, if the pH and CO2 values are going in DIFFERENT directions,
what is this ABG considered to be?
Respiratory-related.
82. In a given ABG, if the pH and HCO3 values are going in the SAME direction,
what is this ABG considered to be?
Metabolic-related.
83. When interpreting a given ABG, what values must be abnormal for it to be
considered “partial”?
All values must be abnormal. (pH, CO2, and HCO3)
84. When interpreting a given ABG, what values must be normal for it to be
considered “uncompensated”?
Either the CO2 or HCO3 must be normal.
85. When interpreting a given ABG, what value must be normal for it to be
considered “compensated”?
The pH must be normal.
89. For accurate ABG results, what are the components of quality control?
Recordkeeping, performance validation, preventative maintenance and function
checks, automated calibration/veri cation, internal statistical quality control, and
external quality control.
91. What does the blood gas machine accuracy depend on?
Accurately measuring barometric pressure, properly calibrating machine-running
measurements against known values, maintaining electrodes, and running quality
control procedures.
92. Inadequate warming and squeezing of the puncture site. Squeezing the
puncture site may result in venous and lymphatic contamination of the sample.
96. What can a good capillary blood gas sample provide and re ect?
Estimated arterial oxygenation and PCO2.
100. What is the rule of thumb in regards to the PaCO2 and FiO2?
The PaCO2 should be about 5 times the FiO2.
133. Prior to an ABG draw, what should the Respiratory Therapist review in the
patient’s chart?
Look for a low platelet count or increased bleeding time.
137. What should the Respiratory Therapist do if the Allen test is negative?
Try the other arm, then try the brachial artery.
138. What should the Respiratory Therapist do for a patient who needs frequent
ABG’s?
Recommend the insertion of an indwelling arterial catheter.
148. What are the common non-respiratory problems that can cause respiratory
acidosis?
Drug overdose, spinal cord injury, neuromuscular diseases, head trauma, and trauma
to thoracic cage.
150. If the expected level of HCO3 compensation is not occurring for acute or
chronic acidosis, what should the Respiratory Therapist suspect?
You should suspect that a complicating metabolic disorder is also present.
151. In acute respiratory acidosis, how high does the CO2 have to get for the
patient to reach a comatose state?
Around 70 mmHg.
156. What are the clinical signs and symptoms associated with respiratory
alkalosis?
Tachypnea, dizziness, sweating, tingling in ngers and toes, muscle weakness and
spasms.
159. What is the most common and obvious sign of metabolic acidosis?
Kussmaul’s breathing.
167. What three ways do we classify the primary problem of ABG’s as?
Normal, acidosis, or alkalosis.
168. What two types do we classify as the primary cause of ABG’s as?
Respiratory or metabolic.
174. If the pH and PcO2 are going in opposite directions, what does this indicate?
A respiratory problem.
175. If the pH and HCO3 are going in the same direction, what does this
indicate?
A metabolic problem.
176. What type of compensation is indicated when the pH, PCO2, and HCO3 are
all out of range?
Partially compensated.
177. What type of compensation is indicated when either the pH or PCO2 is out
of range?
Uncompensated.
178. What type of compensation is indicated when the pH is normal and the
PCO2/HCO3 are out of range?
Fully compensated.
180. What two things are used to determine the accurate percentage of the
MetHb and the COHb?
An ABG analyzer and co-oximeter.
181. What is the most important value to examine when looking at ABG’s?
Oxygenation
184. What two electrochemical oxygen analyzers are good for basic FiO2
monitoring?
Clark electrode and galvanic cell.
187. Why is the radial artery the preferred site for arterial blood sampling?
It is near the surface, it is easy to palpate and stabilize, the ulnar artery gives good
collateral circulation, it is not near any large veins, and the stick is relatively pain-free
(lol, nope).
188. What are the indications for ABGs?
The need to evaluate ventilation, acid base, oxygenation, status and oxygen carrying
capacity of blood; need to assess the patient’s response to therapy and/or diagnostic
tests; need to monitor severity and progression of a documented disease process.
192. What do you want to obtain for a patient who just survived a house re?
Get an ABG to check for carbon monoxide, and be sure to run the blood through co-
oximeter.
193. A good rule of thumb when deciding if a person is well oxygenated or not
based o of their PaO2 is?
5 x FiO2
194. What are the four main values you look at while trying to name a disorder
based o on an ABG?
pH, PaCO2, HCO3 and Base Excess.
197. What are some alternative methods for checking for collateral blood ow?
Doppler ultrasound, and pulse oximeter.
202. What should you document in the chart after obtaining an ABG?
Date, time, document puncture information, and verify that you sent the sample to
the lab.
Final Thoughts
So there you have it! That wraps up our study guide on arterial blood gases and ABG
Interpretation. I hope that this information was helpful for you. Understanding ABGs
is de nitely one of the most important things that is required of Respiratory Therapy
students. That is why I cannot stress to you enough how crucial it is for you to go
through this information until you truly know and understand it.
I wish you the best of luck on your journey towards becoming a Respiratory Therapist.
Thank you so much for reading and as always, breathe easy my friend.
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