Introduction

to
Arterial Blood Gas
(ABG)

Prepared by: Josephine Grace P. Camarillo, RTRP

 ABG
• It is an extremely useful diagnostic test
used for the clinical assessment of:
– Ventilation
– Acid-base status
– Oxygenation
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 4.0 INDICATIONS:
•Indications for blood gas and pH analysis and hemoximetry
include:
•4.1 the need to evaluate the adequacy of a patient’s
ventilatory, acid-base, and/or oxygenation status, the
oxygen-carrying capacity and intrapulmonary shunt (Qsp/Qt)
•4.2 the need to quantitate the response to therapeutic
intervention and/or diagnostic evaluation
•4.3 the need to monitor severity and progression of
documented disease processes.
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 5.0 CONTRAINDICATIONS:
Contraindications to performing pH-blood gas
analysis and hemoximetry include:
•5.1 an improperly functioning analyzer
•5.2 an analyzer that has not had functional status
validated by analysis of commercially prepared
quality control products or tonometered whole
blood5, or has not been validated through
participation in a proficiency testing program(s)
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 5.0 CONTRAINDICATIONS:
Contraindications to performing pH-blood gas
analysis and hemoximetry include:
•5.3 a specimen that has not been properly
anticoagulated;
•5.4 a specimen containing visible air bubbles;
•5.5 a specimen stored in a plastic syringe at room
temperature for longer than 30 minutes
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 5.0 CONTRAINDICATIONS:
Contraindications to performing pH-blood gas
analysis and hemoximetry include:
•5.6 an incomplete requisition which should contain:
– 5.6.6 respiratory rate and for the patient on
supplemental oxygen fractional concentration of
inspired oxygen (FIO2) or oxygen flow;
– 5.6.7 ventilator settings for mechanically ventilated
patients
– 5.6.8 signature of person who obtained sample
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 5.0 CONTRAINDICATIONS:
Contraindications to performing pH-blood gas
analysis and hemoximetry include:
•5.7 an inadequately labeled specimen
lacking the patient’s full name or other
unique identifier
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
BGA 6.0 HAZARDS/COMPLICATIONS:
Possible hazards or complications include:
•6.1 infection of specimen handler from blood
carrying the human immunodeficiency virus, or
HIV, hepatitis B, other blood-born pathogens
•6.2 inappropriate patient medical treatment based
on improperly analyzed blood specimen or from
analysis of an unacceptable specimen or from
incorrect reporting of results.
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
• BGA 8.0 ASSESSMENT OF NEED:
• THE PRESENCE OF A VALID
INDICATION IN THE SUBJECT TO BE
TESTED SUPPORTS THE NEED FOR
SAMPLING AND ANALYSIS.
AARC Clinical Practice Guideline Sampling
for Arterial Blood Gas Analysis
• BGA 11.0 MONITORING:
• Monitoring of personnel, sample handling,
and analyzer performance to assure
proper handling, analysis, and reporting
should be ongoing, during the process.
 Clinical Indications For ABG
1. Sudden, unexplained dyspnea
2. Cyanosis
3. Abnormal breath sounds
4. Severe, unexplained tachypnea
5. Heavy use of accessory muscles
6. Change in ventilator settings
ANATOMICAL LOCATIONS FOR
ARTERIAL PUNCTURE:
• Radial artery- best site
– Easily accessible
– Close to the surface of the skin
– Easy to palpate
ANATOMICAL LOCATIONS FOR
ARTERIAL PUNCTURE:
Radial artery- best site
•ADVANTAGE:
•Safe
•Presence Of Collateral Circulation
•Supplied with blood by both the
radial and ulnar arteries
•No veins or nerve adjacent to the
radial artery
ANATOMICAL LOCATIONS FOR
ARTERIAL PUNCTURE:
Radial artery- best site
•DISADVANTAGE:
– Small size
– Difficult to puncture: hypotensive and
hypovolemic state or low cardiac
output
 Brachial Artery
• It is commonly punctured
at the elbow in the
anticubital fossa
• Located on the medial
side of the fossa near the
insertion of the biceps
muscle at the radial
tuberosity
 Brachial Artery
ADVANTAGE:
•Large and
•Easily palpated
DISADVANTAGES
•Close to large vein and nerve
•Inadvertent venous sampling
•Extreme discomfort
•Inadvertent injury
 Femoral Artery
• It is accessible for
arterial sampling in the
groin.
• It may be palpated
laterally from the pubis
bone.
 Femoral Artery
• ADVANTAGE:
• very large
• Easily palpated
• Presents a large target
• DISADVANTAGE:
• The proximity of a major vein
• A lack of collateral circulation
• Deep and difficult to locate
 Advantages/Disavantages:
ARTERY ADVANTAGE DISTADVANTAGE
1. RADIAL Safety afforded Small size
No vein or nerves
immediately adjacent to the
radial artery
Reduced chance of
inadvertent venous puncture
or nerve damage
2. The size is large and easily Close to large veins and nerves
BRACHIAL palpated Inadvertent venous sample is
common at this site
Accidental contact with nerves may
cause extreme discomfort
3. Femoral Very large Proximal to major veins and nerves
Easily palpated Lack of collateral circulation
Deep and difficult to locate
Complications Of Arterial Puncture
• Vessel spasm
• Thrombi
• Emboli
• Infection or
• Loss of blood flow and circulation
 The Modified Allen’s Test for
Collateral Circulation

•Modified Allen’s Test - it is the ability to

check the collateral circulation
 The Allen’s Test
• elevate the patient’s hand
higher than the level of the
heart
• Have the patient make a fist
for approximately 30 seconds.
• Apply pressure to both the
radial and ulnar arteries
occluding them.
• Have the patient open his or
her hand (it should appear
blanched).
• Release pressure on the ulnar
artery.
• Color should return to the
hand within 7 to 10 seconds.
The Allen’s Test
 Unconscious patient
• This test may be done on an
unconscious patient.
• Hold the hand above the heart for
30-60 seconds before releasing
pressure on the ulnar artery
 Pulse oximetry
• It is the measurement of
oxygen saturation
noninvasively using
multiple wavelengths of
light.
• Finger probe
 Sampling Syringes
Syringe (3ml to 5ml)
Needle (20 to 25 gauge)
Sodium heparin 1000
units
Alcohol and iodine prep
Label
Cork or stopper
Band-aid or elastoplast
tape
Ice slush and
Bag or container for
transport
Sampling Syringes
BLOOD GAS SAMPLING ERRORS
1. Bubbles
2. Delay in Sample Analysis
3. Use of the proper anticoagulant
4. Venous sampling
5. Patient anxiety
 PUNCTURE TECHNIQUES
1. Standard Precautions
2. Patient-Related Considerations
3. Use of an Anesthetic
4. Puncture Preparation
5. Obtaining the Specimen
 PUNCTURE TECHNIQUES
5. Obtaining the Specimen
Radial and Brachial Sites:
• pencil
• needle bevel up
• Flash
• 45° to 90° angle
 PUNCTURE TECHNIQUES
5. Obtaining the Specimen
Femoral:
• Deep
• Require a longer needle
• Bevel facing patient’s
head
• Watch for the flash and
allow the syringe to fill.
 Postpuncture Care
1. Apply firm pressure
2. Expel any air
3. Insert needle into a
rubber stopper to seal it.
4. Continue to apply firm
pressure – 5 mins
5. While holding firm
pressure – mix the
sample in the syringe.
 Postpuncture Care
6. Gently rolling the syringe between the thumb and
forefinger.
7. Ice the sample
8. Check the puncture site after 5 minutes
9. Observe the color of the skin
10. Check for circulation
11. Warm
12. Label the sample
13. Transport the sample
14. After 20 minutes, check the puncture site again
 PROCEDURE FOR RADIAL
ARTERY PUNCTURE
1. Check the chart to confirm the order and indications and
determine the patient’s primary diagnosis, history.
2. Confirm steady state conditions.
3. Obtain and assemble the necessary equipment and supplies.
4. Wash hands.
5. Explain the procedure to the patient.
6. Heparinize the syringe, and expel the excess.
-o.1 cc/ml
7. Position the patient depending on what site you are going to
puncture
8. Perform a modified Allen Test, and confirm collateral circulation.
9. Thoroughly cleanse the site with alcohol or an equivalent
antiseptic.
10. Palpate and secure the artery with one hand.
 PROCEDURE FOR RADIAL
ARTERY PUNCTURE
11. Slowly insert the needle, bevel up, through the skin at a
45 degree angle.
12. Allow 2 to 4 ml of blood to fill the syringe.
13. Apply firm pressure to the puncture site with sterile
cotton.
14. Expel any air bubbles from the sample.
15. Mix the sample by rolling and inverting the syringe.
16. Place the sample in a transport container with ice.
17. Properly dispose of waste material and sharps.
18. Document the result.
19.Check the site after 20 mins. For hematoma
THE FOLLOWING RULES FOR
CAREFUL HANDLING OF THE NEEDLE
1. Never recap a used needle without a safety
device.
2. Never bend, break, or removed used needles
from syringes by hand.
3. Always dispose of used syringes, needles, and
other sharp items in appropriate puncture
resistant sharps containers.
 Documentation
• To document the patient’s status,
properly record the following:
1. Date, time, and site of sampling
2. Results of Allen Test
3. Patient’s body temperature, position, and
respiratory rate.
4. FiO2 concentration or flow, as well as all
applicable ventilatory support settings.
 Potential Complications
• Pain
• Hematoma, hemorrhage
• Trauma to vessel
• Arteriospasm
• Air or clotted-blood
emboli
• Vasovagal response
• Arterial occlusion
• Infection
 Values
pH PCO2 HCO3
(mmHg) (mmol/L)
Normal 7.35 – 7.45 35 - 45 22 - 26
Acidosis < 7.35 > 45 < 22
Alkalosis > 7.45 < 35 > 26
ABG Machines