ARTERIAL BLOOD GASES

An ABG is a blood test that measures the acidity, or pH,

and the levels of oxygen (O2) and carbon dioxide (CO2)
from an artery. The test is used to check the function of the
patient’s lungs and how well they are able to move oxygen
and remove carbon dioxide.
The utilization of an ABG analysis:
• Aids in establishing diagnosis.
• Guides treatment plan and management.
• Aids in ventilator management.

Acid/base status may alter electrolyte levels critical to a

patient’s status.
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How Is An ABG Drawn?

• An Arterial Blood Gas requires the respiratory
therapist to collect a small sample of blood -
generally a minimum of 0.5 ml, but a full 1 ml is
preferred. Blood can be drawn via an arterial stick
from the wrist or forearm.
• The radial artery is most commonly used to obtain
the sample. However, the femoral artery and
brachial artery can be used if necessary. If the
patient already has a pre-existing arterial line, this
can be used to obtain the sample.
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PCO2
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Blood Gas Analyzers

• Blood gas analyzers use electrodes as sensing
devices to measure PO2, PCO2, and pH.
• The PO2 measurement is amperometric, meaning
that the amount of current flow is an indication of
the oxygen present.
• The PCO2 and pH measurements are
potentiometric, in which a change in voltage
indicates the activity of each analyte.
• The blood gas analyzer can calculate several
additional parameters: bicarbonate, total CO2,
base excess, and SaO2.
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Measurement of PO2
 PO2 electrodes, called Clarke electrodes,
measure the amount of current flow in a circuit
that is related to the amount of O2 being reduced
at the cathode.
 A gas permeable membrane covering the tip of
the electrode selectively allows the O2 to diffuse
into an electrolyte and contact the cathode.
Electrons are drawn from the anode surface to
the cathode surface to reduce the O2.
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Measurement of pH and PCO2

• To measure pH, a glass membrane sensitive to
H+ is placed around an internal Ag–Agcl
electrode to form a measuring electrode. The
potential that develops at the glass membrane
as a result of H+ from the unknown solution
diffusing into the membrane’s surface is
proportional to the difference in H+ between the
unknown sample and the buffer solution inside
the electrode. Also Calomel electrode and Glass
electrode (most common) are used.
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• PCO2 is determined with a modified pH

electrode, called a Severinghaus electrode. An
outer semipermeable membrane that allows CO2
to diffuse into a layer of electrolyte, usually a
bicarbonate buffer, covers the glass pH electrode.
• The CO2 that diffuses across the membrane
reacts with the buffer, forming carbonic acid,
which then dissociates into bicarbonate plus H+.
The change in activity of the H+ is measured by
the pH electrode and related to PCO2.
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• In most instances, the ideal collection device for

arterial blood sampling is a 1- to 3-mL self-filling,
plastic, disposable syringe, containing the
appropriate type and amount of anticoagulant. Both
dry (lyophilized) and liquid heparin are acceptable
anticoagulants. Evacuated collection tubes are not
appropriate for blood gases.
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Sources of error in the collection and handling of

blood gas specimens include:
• collection device
• form and concentration of heparin
• speed of syringe filling
• maintenance of the anaerobic environment
• mixing of the sample
• transport and storage time before analysis
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• Transport time of specimen should be minimal to

reduce cell metabolism, which results in oxygen
and glucose consumption and carbon dioxide and
lactate production.
• While placing the filled syringe in an ice water
immediately after the draw minimizes metabolism,
there is a potential for PO2 to increase due to
oxygen diffusing from the water through the pores
of the plastic syringe.
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• For proper interpretation of blood gas results, the

patient’s status—ventilation (on room air or
supplemental O2) and body temperature— at the
time of sample collection must be documented.
• The best practice in avoiding many of the pre-
analytic errors is to analyze the sample as quickly
as possible. If the test cannot be done within 15
mins, have it transported in ice, and should be
performed within 45 mins.
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Oxygen Dissociation

• Oxygen dissociates from adult hemoglobin

(A1) in a particular manner. If this dissociation
is graphed with PO2 on the x-axis and percent
SO2 on the y-axis, the resulting curve is
sigmoid, or slightly S-shaped.
• Hemoglobin “holds on” to O2 until the O2
tension in the tissue is reduced to about 60
mm Hg. Below this tension, the O2 is released
rapidly.
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pH – increased
PCO2 – decreased
Temperature - decreased

pH – decreased
PCO2 – increased
Temperature –
increased
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• Hydrogen ion activity, PCO2, body temperature,

and 2,3-BPG can affect the position and shape
of the oxygen dissociation curve as well as the
affinity of hemoglobin for O2.
• Oxidative metabolism increases the temperature,
H+, CO2, and 2,3-BPG concentrations, which
results in a right shift of the dissociation curve.
This decreased affinity of hemoglobin for O2
promotes release of oxygen to the tissue.
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• In the lungs, temperature, H+, PCO2, and 2,3-

BPG decrease relative to tissue levels, shifting
the oxygen dissociation curve slightly to the left.
This enhances O2 binding to hemoglobin and
improves O2 uptake.
• When the β-chains of the hemoglobin molecule
bind 2,3-BPG, oxyhemoglobin dissociation
shifts to the right, with subsequent
enhancement of oxygen release.
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• Dyshemoglobins, such as coHb or MetHb,

can also affect oxyhemoglobin dissociation.
An elevation in CO from cigarette smoking or
CO exposure causes the curve to shift to the
left.
• As the percentage of COHb increases, the
shape of the curve loses some of its sigmoid
characteristics and shifts to the left, making
the release of O2 bound to hemoglobin much
more difficult.
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