arterial BLOOD
ARTERIAL blood gas
GAS
NORMAL VALUES
The ABG test measures the pH: 7. 35 – 7.45
PCO2: 35 – 45 mmHg
oxygen and carbon dioxide
HCO3: 22 – 26 mmol/L
levels in your blood as well
ROME
your blood’s pH balance.
Metabolic Equal
Respiratory Opposite
pH:
o 7.4 pH = ALKALOSIS
o 7.4 pH = ACIDOSIS Example: Example:
Respiratory or Metabolic Metabolic Respiratory
Acidosis Alkalosis
o PCO2: RESPIRATORY
pH – 7.32 – Acid pH – 7.48 – Alka
Acidosis: >45 (higher)
PCO2 – 30 – Alka PCO2 – 29 – Alka
Alkalosis: <35 (lower)
HCO3 – 19 - Acid HCO3 – 19 - Acid
o HCO3: METABOLIC
Acidosis: <22 (lower)
Alkalosis: >26 (higher)
Compensated or Uncompensated
o Compensated: if PCO2 and HCO3 are abnormal
o Uncompensated: if PCO2 or HCO3 are within normal range
Compensated
o Fully Compensated: if pH is within normal range
o Partially Compensated: if pH is abnormal
Example:
pH – 7.43; PCO2 – 49; HCO3 – 29 = M. Alk; Compensated; Fully
pH – 7.32; PCO2 – 36; HCO3 – 20 = M. Acid; Uncompensated
pH – 7.30; PCO2 – 48; HCO3 – 40 = R. Acid; Compensated; Partially
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Why ABG instead of Pulse oximetry?
Indications:
Pulse oximetry uses light absorption at
Assess the ventilator status,
two wavelengths to determine
oxygenation and acid base status.
hemoglobin saturation.
Assess the response to an
Pulse oximetry is non-invasive and
intervention.
provides immediate and continuous
Contraindications: data.
Pulse Oximeter does not assess
Bleeding diathesis
ventilation (PCO2) r acid base status.
AV Fistula
Pulse oximetry becomes unreliable
Severe peripheral vascular dse,
when saturation fall below 70 – 80 %
absence of an arterial pulse
Technical sources of error
Infection over site
Pulse oximetry cannot interpret
methemoglobin or carboxyhemoglobin.
The radial artery is superficial, has collaterals
and is easily compressed.It should almost
always be the first choice!
Other arteries like femoral, dorsalis pedis and
brachial can be used in emergencies.
PERFORMING ALLEN’S TEST
This is to check for the patency of the ulnar artery.
PROCEDURE:
1. The patient’s hand is initially held high
while the fist is clenched and both radial
and ulnar arteries are compressed, this
allows the blood to drain from the hand.
2. The hand is then lowered,
3. And the fist is opened.
4. After pressure is released over the ulnar
artery.
Color should return to the hand within six
seconds to indicate a patent ulnar artery
and an intact superficial palmar arch.
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EQUIPMENTS
Blue (23g) needle Alcohol gel
2mL syringe with heparin Gauze
A cap for the syringe Gloves
A plastic bung A sharps bin
Local anesthetic plus needle and syringe for Usually the syringe, needle, cap and bung are
administration all provided in one pack
Procedure
1. Wash your hands, introduce yourself to the patient and clarify their identity. Explain what you would like to do
and obtain consent. This is a slightly uncomfortable procedure so you should let the patient know this.
2. Gather all the necessary equipment for the procedure.
3. Position the patient’s arm with the wrist extended.
4. Locate the radial artery with your index and middle fingers.
5. Perform Allen’s test.
6. Put on the gloves and attach the needle to the heparinized syringe.
7. Also prepare your local anaesthetic and give a small amount over the palpable radial artery.
8. Take the cap off the needle, flush the heparin through the syringe and again locate the radial artery using your
non-dominant hand.
9. Let the patient know you are about to proceed and to expect a sharp scratch.
10. Insert the needle at 30 degrees to the skin at the point of maximum pulsation of the radial artery. Advance the
needle until arterial blood flushes into the syringe. The arterial pressure will cause the blood to fill the syringe.
11. Remove the needle/syringe placing the needle into the bung. Press firmly over the puncture site with the gauze
to halt the bleeding. Remain pressed for 5 minutes.
12. Remove the needle and discard safely in the sharps bin.
13. Cap the syringe, push out any air within it, and send immediately for analysis ensuring that the sample is packed
in ice. Remove your gloves and disposed them in the clinical waste bin. Wash your hands and thank the patient.
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