Arterial Blood Gases

ARTERIAL BLOOD GAS AS A

TEST
• Blood test that is performed using blood from an artery
• Involves puncturing an artery with a thin needle and syringe and drawing
a small volume of blood
• SITES:
• Radial artery
• Femoral tap
• Brachial artery
• Arterial catheter
• For infants:
• Scalp
• Umbilical cord
Uses:
• Determines the:
• pH of the blood
• partial pressure of carbon dioxide (PaCO2)
• partial pressure of oxygen (PaO2)
• bicarbonate level
• Mainly used in pulmonology, to determine gas exchange
levels in the blood related to lung function, but has a variety
of applications in other areas of medicine
Techniques
 A. PREPARATION FOR RADIAL ARTERY PUNCTURE

1. Perform Allen Test to confirm collateral 3. Clean radial entry site

circulation
• Occlude vessels on wrist. • Povidone-Iodine solution
• Make fists to empty veins. (betadine)
• Once bleaching is visible on the palm, release
pressure on ulnar artery. • Alcohol swab
• If there is automatic filling, then proceed with
blood extraction. 4. Consider local anesthetic at
2. Heparinize syringe entry site
• Start with 3 cc syringe and 21 gauge needle
• Draw up 0.5 ml of Heparin (1000 units/ml)
• Small skin wheal of Lidocaine 1%
• Rotate syringe and work plunger to distribute
Heparin
• Minimal Heparin should remain (0.15 ml)
 B. OBTAINING RADIAL ARTERY SAMPLE

1. Needle entry • If flow ceases slowly withdraw

• Identify radial artery with gentle pressure needle 1-2mm
• Patient dorsiflexes wrist
• Repositions needle back inside
• Needle and syringe angled 45° toward arm
(pulse area)
arterial lumen
• Enter skin just distal to palpated artery site • Avoid air bubbles!
• Slowly advance needle until spontaneous 3. Withdraw needle from skin.
blood enters
2. Arterial blood collection
4. Immediately apply pressure over
• Hold needle steady until 1-2cc blood
entry site.
obtained 5. Hold pressure at entry site for 5
• Allow syringe to fill itself (avoid aspirating!) minutes.
C. COMPLETING SAMPLE COLLECTION

1. Sample preparation for lab

• Express any air bubbles from syringe
• Cork needle or remove needle and cap syringe
• Roll syringe between fingers to mix heparinize sample
• Immediately place sample on ice
2. Label sample.
• Patient identification data
• Sample acquisition time
• FIO2 at time of sample draw
• Patient's body temperature
3. Deliver sample quickly to the lab.
COMPLICATIONS:
• Nerve Injury
• Ischemic changes hand and wrist
o Always check Allen Test before radial artery puncture
• Occult bleeding especially at brachial and femoral artery punctures
REMINDERS:
• LABEL your specimen.
• Complete all the data in your request (Temp, HgB, etc.)
• ABG specimen should be at least 1.00 cc
o Result of low sample volume specimen may not interpret true patient’s
condition
• Submit your specimen in ice (not in water only)
o Specimen not in ice will affect the result (pH, pCO2, pO2)
• Ideal ABG specimen:
o NO clot
o NO bubbles
o NO airspace
ARTERIAL BLOOD GASES
• Reflects oxygenation, gas exchange and acid-base balance
• PaO2 - partial pressure of oxygen dissolved in arterial blood
• SaO2 - is the amount of oxygen bound to hemoglobin
• Oxygen is transported from the alveoli into the plasma
RANGES:

• pH = <7.35 – Acidosis, >7.45 – Alkalosis

• paCO2 (Respiratory) = 35 – 45
• HCO3 (Metabolic) = 22 - 26
• PaO2 = 80 - 100 mmHg at sea level
o < 80 mm Hg Hypoxemia
o < 60 mm Hg COPD patients
o < 40 mm Hg Life threatening
• SaO2 = 93 - 100% is a normal saturation
o Hypoxia is decreased oxygen at the tissue level
Arterial Blood Gas Interpretation
Determine Level of Compensation
• If both PaCO2 and HCO3 are both deranged while pH is normal
• COMPENSATED
• If PaCO2, HCO3 and pH are all abnormal
• PARTIALLY COMPENSATED
• If either PaCO2 or HCO3 is abnormal and pH is also abnormal
• UNCOMP
• ENSATED