ABG SAMPLING

Dr Sarita Singh
Dr Rajesh Raman
Dr Neel Kamal Mishra
Department of Anesthesiology
King George Medical University ,Lucknow
ABG SAMPLING
 ARTERIAL BLOOD GAS ANALYSIS

An arterial blood gas (ABG) test measures oxygen and

carbon dioxide levels in blood. It also measures
body’s acid- base (pH) level, which is normally balanced
when healthy.

Oxygen
CO2
Acid base balance
Metabolism
Electrolytes
 COMMON TERMS

• PCO2 (ventilation) – partial pressure of CO2

• PaO2 - (oxygenation) – partial pressure of O2

• HCO3 – (metabolism) -Bicarbonate

• SO2 – Oxygen Saturation

• pH – Acid/Base balance
 Blood Gas Norms

pH pCO2 pO2 HCO3 BE

Arterial 7.35-7.45 35-45 80-100 22-26 -2 to +2

Venous 7.30-7.40 43-50 ~45 22-26 -2 to +2

 INDICATIONS
 Assess adequacy of ventilation and oxygenation .
 Assess the response to intervention.
 Assess acid-base balance
 Regulate electrolyte therapy.

 Oxygen therapy
 Metabolic disorder: very high glucose
 Electrolyte disorder: Na, K+
 Poisoning
Sites for drawing blood for ABG
analysis
Allen’s Test
 Articles for Procedure
 Arterial blood gas syringe-2ml syringe
 Needles (20, 22-24 gauge, of different lengths)
 Heparin
 Alcohol wipe
 Gauze
 Tape
 Sharps container
 Gloves
 Small roll or bottle
 Lignocaine and 1 ml syringe
 Articles for Procedure

 Pre-heparanise: Draw 0.5 ml heparin in syringe, expel the heparin- very

small amount of heparin should remain in syringe hub
 PREPARATION
• Patient should be in supine

position with arm extended

• Place a small bottle/roll below wrist
to keep the wrist extended (20-30°)
• Prepare all the equipment in the tray

• Palpate the radial artery on the patient’s

non-dominant hand
 Clean the site with an alcohol wipe for 30 seconds
and allow to dry before proceeding

 Wash hands again

 Wear gloves.
 PROCEDURE

 Palpate the radial artery with your non-dominant hand’s

index finger and middle finger.
 Warn the patient you are going to insert the needle.
 Inject LA at puncture site: maximal artery pulsation

 Holding the ABG syringe like a dart insert the ABG needle
through the skin at an angle of 45° over the point of maximal
radial artery pulsation.
PROCEDURE
CONTD….

 Advance the needle into the radial artery until you

observe blood flashback into the ABG syringe hub.
 The syringe should then begin to self-fill in a
pulsatile manner (do not pull back the syringe
plunger).
 Once the 1-2 ml of blood has been collected,
remove the needle and apply immediate firm
pressure over the puncture site with some gauze
CONTD….

 Remove the ABG needle from the syringe and

discard safely into a sharps bin
 Place a cap onto the ABG syringe and label the
sample
 Yourself or a colleague should continue to apply
firm pressure for 3-5 minutes to reduce the
risk of hematoma formation.
 Remove any air bubble from syringe
To complete the procedure:
 Dress the puncture site
 Enquire the patient for any discomfort.
 Wash hands.

 Take the ABG sample to be analyzed immediately as

delays longer than 10 minutes can affect the
accuracy of results
Abnormal pain/swelling/paraesthesia/pallor

Report: Oxygen Device: Flow/ventilator settings,

SPO2 at time of taking sample
TECHNICAL ERRORS IN
SAMPLING EXCESSIVE HEPARIN

 Do not leave excessive heparin in the syringe

 Heparin has dilutional effect:
 Low HCO3
 Low PCO2
 High Sr Na
TECHNICAL ERRORS IN SAMPLING BODY:

 Sample mixed with venous blood

 Visible superficial vein
 Use another alternate puncture site/other side/another
artery
 Don’t pull plunger
TECHNICAL ERRORS IN
SAMPLING
 ALTERATION OF RESULTS WITH SIZE OF
SYRINGE/NEEDLE AND VOL OF SAMPLE
 Syringes must have > 50% blood
 Use only 3ml or smaller syringes
 25% lower values if 1 ml sample taken in 10ml
syringe (0.25ml heparin in needle
TECHNICAL ERRORS IN
SAMPLING AIR BUBBLES IN
BLOOD SAMPLE

 In air, PO2 is 150 mm of Hg & PCO2 is 0

 Contact with air bubble will lead to higher PO2

and lower PCO2

 Seal syringe immediately after sampling

Complications related to ABG sampling

• Artery spasm

• Hematoma

• Nerve damage

• Fainting

• Other problems can include a drop in blood pressure,

complaints of feeling faint, sweating or pallor that
may precede a loss of consciousness.
 Venous sample: Lebel it properly- on syringe and on report

pH pCO2 pO2 HCO3 BE

Arterial 7.35-7.45 35-45 80-100 22-26 -2 to +2

Venous 7.30-7.40 43-50 ~45 22-26 -2 to +2

Arterial line
 Initial 5-10 ml of blood is diluted-don’t use for sampling

 Flush after taking sample in heparinized syringe

 AVOID AIR BUBBLES-
SEAL THE INJECTION PORT
LABEL CLEARLY
 Common ICU
infusions
Different methods
Adrenaline
Noradrenaline Proper labelling & charting
Dopamine Ascetic technique
Vasopressin Alarms
NTG
Monitoring
 Adrenaline/Epinephrine
 1 mg/ml ampoule
 Standard preparation: in 50 ml NS, D5 or D10
 Single strength: Adrenaline in mg =Weight X 0.03
 Eg for 60 kg patient: 60 x 0.03= 1.8 mg
1 ml/hr= 0.01µg/kg/minute; rate 1-20 ml/hr
 Double strength: weight x 0.06

 In 500 ml NS/D5: 2 mg of adrenaline should be dissolved in 500 ml

(conc. 4microgram/ml)
 For 60 kg adult rate of infusion =15 -240 microdrop/mins or
 4-60 drops/minute (normal drip set)
 Indication of
Adrenaline infusion
 Septic shock
 Bradycardia
 Anaphylactic shock
 Norepinephrine
 1 mg base/ml ampoule
 Standard preparation: in 50 ml NS, D5 or D10
 Single strength: Adrenaline in mg =Weight X .03
1 ml/hr= 0.01µg/kg/minute; rate 1-40 ml/hr
 Double strength: weight x 0.06
 Quadruple strength: weight X 0.12
 In 500 ml of NS/D5: 4 mg of norepinephrine should be dissolved in
500 ml of NS/D5 (conc. 8 microgram/ml)
 For 60 kg adult rate of infusion =15 -240 microdrop/mins or
 4-60 drops/minute (normal drip set)
 Indication of
Norepinephrine infusion
 It is initial vasopressor of choice in septic shock and
hypovolemic shock.

 It is also used for the treatment of cardiogenic shock.

 Wide range of doses utilized clinically.

 Dopamine
 40mg/ml
 Drug in mg= 3 X weight
 Eg 60kg pt: 3x 60= 180 mg or 4.5 ml in 50 ml syringe D5/NS
 1ml/hr = 1mcg/kg/min
 Normal rates: 3-20 ml/hr

 In 500 ml of D5: 800 mg of dopamine should be dissolved in 500 ml of

NS/D5 (conc. 1.6 mg per ml)
 For 60 kg adult rate of infusion =3-45 microdrops/ mins
 Indication of Dopamine Infusion

 It used as alternative to norepinephrine in septic shock in highly

selected patients like patients with compromised systolic function or
absolute or relative bradycardia and patient at low risk of
tachyarrhythmia.
 More adverse effect (e.g tachyarrythnmias) and less effective in
reversing hypotension in than norepinephrine in septic shock.
Vasopressin

 20Units/ml
 20 unit in 50 ml syringe- NS or D5
 1-4 ml/hr
 In 500 ml of NS/D5: 50 units of vasopressin should be
dissolved in 500 ml of NS/D5 (conc 0.1 unit/ml)

 For 60 kg adult rate of infusion: 18-24 microdrops/mins

Indication of vasopressin infusion

 It is used as add on or to norepinephrine to raise blood pressure to target

MAP or to decrease amount of norepinephrine.

 It is not recommended as a replacement for first line vasopressor.

 It’s a pure vasoconstrictor, may decrease stroke volume and cardiac out
put in myocardial dysfunction or precipitate ischemia in coronary artery
disease.
Nitroglycerine infusion
 5 mg/ml ampoule
 Drug= weight x .3 weight in 50 ml NS or D5
 For 60 kg patient: 0.3 x 60 =18 mg
 1ml/hr = 0.1microgram/kg/minute
 usual rate: 1-40 ml/hr

 10 ml(=50 mg) NTG is dissolved in 500 ml NS or D5

 Run at 3-40 microdrops/minute
Summary of infusions
 Dopamine and Dobutamine: weight x 3 mg D N
R

 Nitroglycerine: weight x 0.3 mg

 AdRenaline & NoradRenaline weight x 0.03 mg

 50 ml syringe
THANK YOU