By

Shirley O. Solitario,RMT
 OUTLINE:

• Introduction
• Definition
• Indication
• ABG component
• Normal value
• Procedure:
preparatory – performance – follow up phase
• Complication
• acid-base disorders
• Result interpretation
• compansation
• Tutorial
2
 Introduction
 The major function of the pulmonary system
(lungs and pulmonary circulation) is to deliver
oxygen to cells and remove carbon dioxide from
the cells.
 If the patient’s history and physical examination
reveal evidence of respiratory dysfunction,
diagnostic test will help identify and evaluate the
dysfunction.
 ABG analysis is one of the first tests ordered to
assess respiratory status because it helps
evaluate gas exchange in the lungs.
 An ABG test can measure how well the person's
lungs and kidneys are working and how well the
body is using energy.

3
 DEFINITION
It is a diagnostic procedure in which a
blood is obtained from an artery directly
by an arterial puncture or accessed by a
way of indwelling arterial catheter

5 A.Y.T
 Indication

 To obtain information about patient ventilation

(PCO2) , oxygenation (PO2) and acid base
balance
 Monitor gas exchange and acid base
abnormalities for patient on mechanical
ventilator or not
 To evaluate response to clinical intervention
and diagnostic evaluation ( oxygen therapy )
 An ABG test may be most useful when a
person's breathing rate is increased or
decreased or when the person has very high
blood sugar levels, a severe infection, or
heart failure
6
 ABG component
 PH:
measures hydrogen ion concentration in the blood,
it shows blood’ acidity or alkalinity
 PCO2 :
It is the partial pressure of CO2 that is carried
by the blood for excretion by the lungs, known as
respiratory parameter
 PO2:
It is the partial pressure of O2 that is dissolved in
the blood , it reflects the body ability to pick up
oxygen from the lungs
 HCO3 :
known as the metabolic parameter, it reflects the
kidney’s ability to retain and excrete bicarbonate
8 A .Y .T
 EQUIPMENT

Blood gas kit OR

 1ml syringe
 23-26 gauge needle
 Stopper or cap
 Alcohol swab
 Disposable gloves
 Plastic bag & crushed ice
 Lidocaine (optional)
 Vial of heparin (1:1000)
 Par code or label
9 A.Y.T
 Preparatory phase:
 Record patient inspired oxygen concentration
 Check patient temperature
 Explain the procedure to the patient
 Provide privacy for client
 If not using hepranized syringe , hepranize
the needle
 Perform Allen's test
 Wait at least 20 minutes before drawing blood
for ABG after initiating, changing, or
discontinuing oxygen therapy, or settings of
mechanical ventilation, after suctioning the
patient or after extubation.

10 A.Y.T
 ALLEN’S TEST
It is a test done to determine that
collateral circulation is present from the
ulnar artery in case thrombosis occur in
the radial

11 A.Y.T
 Sites for obtaining abg
 Radial artery ( most
common )
 Brachial artery
 Femoral artery

Radial is the most preferable

site used because:
 It is easy to access
 It is not a deep artery
which facilitate palpation,
stabilization and puncturing
 The artery has a collateral
blood circulation

13 A.Y.T
 Performance phase:
 Wash hands
 Put on gloves
 Palpate the artery for maximum pulsation
 If radial, perform Allen's test
 Place a small towel roll under the patient wrist
 Instruct the patient to breath normally during
the test and warn him that he may feel brief
cramping or throbbing pain at the puncture
site
 Clean with alcohol swab in circular motion
 Skin and subcutaneous tissue may be
infiltrated with local anesthetic agent if
needed

14 A.Y.T
 Insert needle at 45
radial ,60 brachial and 90
femoral
 Withdraw the needle and
apply digital pressure
 Check bubbles in syringe
 Place the capped syringe
in the container of ice
immediately
 Maintain firm pressure
on the puncture site for
5 minutes, if patient has
coagulation abnormalities
apply pressure for 10 –
15 minutes

15 A.Y.T
 Follow up phase:
 Send labeled, iced specimen to the lab immediately
 Palpate the pulse distal to the puncture site
 Assess for cold hands, numbness, tingling or
discoloration
 Documentation include: results of Allen's test, time
the sample was drawn, temperature, puncture site,
time pressure was applied and if O2 therapy is
there
 Make sure it’s noted on the slip whether the
patient is breathing room air or oxygen.
 If oxygen, document the number of liters .
 If the patient is receiving mechanical ventilation,
FIO2 should be documented
16 A.Y.T
ARTERIAL BLOOD GAS TEST
 ARTERIAL BLOOD COLLECTION
 Syringe/ABG syringe
 18-20g (branchial artery)
 45-60 degree: 90 deg.for femoral artery
 Compress the puncture site quickly (3-5 mins)
 Expel air from the syringe
 Place in ice or water (1-5C) to minimize WBC
O2 consumption.
 Normal values:

 PH = 7.35 – 7.45

 PCO2 = 35 – 45 mmHg

 PO2 = 80 – 100 mmHg

 HCO3 = 22 – 26 meq/L

19 A.Y.T
Most blood gas analyzers
measure pO2,pCO2 and
pH by Ion-Specific
Electrodes and calculate
bicarbonate
concentration by the
Henderson- Hasselbach
equation.
The Henderson - Hasselbach Equation
-expresses acid-base relationship in a
mathematical formula.
Bicarbonate
PH = -----------------
Carbonic acid

HC03
PH = ------------------
PC02
ACID-BASE DISTURBANCES:
 Acidosis
 General term applied for the any condition
where the pH of the blood and the
bicarbonate concentration of the blood are
below normal. pH HCO3
 Alkalosis
 General term applied for any condition with
an increase in blood pH (above normal range)
characterized by an elevation in the H+ ion
accepting buffer of the plasma (UC03) and a
reduction in the H+ ion substances (H2CO3)
 pH
a. The negative logarithm of hydrogen
ion activity with a normal average
range of 7.35-7.45 (average 7.4)
b. Venous blood =7.35
c. Arterial blood = 7.45
d. Rxn: slightly basic
e. Acidosis: pH below 7.35
f. Alkalosis: pH above 7.45
g. Inversely proportional to H+
concentration
Major factors regulating blood pH:
1) Chemical buffers
2) Respiratory regulatory
mechanism
3) Renal regulatory mechanism
Classification of Acid-Base Imbalance
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis
 ORGANS IN ABB
1. LUNGS (RESPIRATORY MECHANISM)
- CO2 + H2O H2CO3
-maintain normal CO2 level in blood
-regulated by medullary respiratory
center, which is stimulated by changes in pH
and pCO2.
- regulates pH through retention or
elimination of CO2 by changing the rate and
volume of respiration.
 ORGANS IN ABB
- increasing pulmonary ventilation
(hyperventilation) will decrease pCO2,decrease
carbonic acid and thereby increasing pH
*fast respiration ---- release CO2 = CO2
H2CO3 pH
Decreasing pulmonary ventilation (hypoventilation)
will increase pCO2,
increase carbonic acid, thereby decreasing pH
* slow respiration -= CO2 H2CO3 pH
ORGANS IN ABB
2. KIDNEYS( RENAL MECHANISM)
- H2CO3 H + HCO3
 BLOOD COLLECTION FOR BLOOD GAS AND
pH ANALYSIS
1. The pCO2 of air (0.2mmHg) Is much
less than that of the blood (38
mmHg) so that when blood is exposed
to air, the ctCO2 and pCO2 decreases;
and the pH increases, thus it is a must
to collect, transfer and manipulate
blood for blood gas analysis in
condition where air Is avoided or at least
kept at a minimum level.
PARAMETERS OF INTEREST
 Evaluate (normal pH -
7.35-7.45)
 <7.35 - acidosis
 >7.45 – alkalosis
PARAMETERS OF INTEREST
 Evaluate the ventilation
(Lungs)
 pC02 - 35 - 45 mm Hg
 < 35 respiratory alkalosis
 > 45 respiratory acidosis
PARAMETERS OF INTEREST
 Evaluate the metabolic
Process (kidneys)
 HC03 = 21-26 meq/L
 < 21 - metabolic acidosis
 >28 – metabolic alkalosis
ACID-BASE pH pCO2 HC03 Common Cause COMPENSATORY
DISTRUBANCES 7.35- 35-45 21-26 MECHASNISM
7.45 mmHg meq/L

Inability to exhale CO2 Renal compensation

RESPIRATORY Emphysema,Pulmonary Excretion of H+ in urine
ACIDOSIS edema *VENTILATION
Airway obstruction, COPD,
Pneumonia
Low Co2, Hyperventilation, Renal Compensation
RESPIRATORY Pulmonary disease, Excretion OH in Urine
ALKALOSIS Psychogenic Severe anxiety, *BREATHE INTO A
Panic attacj, Pain,Aspirin PAPER BAG.
(Salicylate) overdose

Less HCO3, severe diarrhea, Respiratory

METABOLIC Failure to excrete H+ renal compensation
ACIDOSIS failure, Excess acid, Diabetic Hyoerventilation
ketoacidosis, Lactic acidosis *AMINISTRATION OF
and Renal Failure IV SODIUM
BICARBONATE AND
CORRECT THE POST
CAUSE ACTIVITY.
Loss of stomach acid Respiratory
(vomiting), Bicarbonate compensation
METABOLIC excess, Excessive intake of Hypoventilation
antacid, Dioretics, Secere *PROVIDE
ALKALOSIS dehydration ELECTROLYTE
THERAPY
A 24 year-old woman is found down in Burham park by some bystanders.
The medics are called and upon arrival find her with an oxygen saturation of
88% on room air and
Pinpoint pupils on exam. She is brought into SLU ER where an arterial blood gas
is performed and reveals:
pH= 7.25
pCO2= 60 mmHg
pO2 = 65
HCO3= 26mmol/L
 Compensation
 The respiratory and metabolic system works
together to keep the body’s acid-base balance
within normal limits.
 The respiratory system responds to metabolic
based PH imbalances in the following manner:
* metabolic acidosis: ↑ respiratory rate and depth
(↓PaCO2)
* metabolic alkalosis: ↓ respiratory rate and depth
(↑PaCO2)
 The metabolic system responds to respiratory
based PH imbalances in the following manner:
*respiratory acidosis: ↑ HCO3 reabsorption
*respiratory alkalosis: ↓HCO3 reabsorption

40 A.Y.T
 a. Respiratory acidosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↓ ↑ ------

Because there is no response from the kidneys yet to

acidosis the HCO3 will remain normal

Phase PH PaCO2 HCO3

PARTIAL COMPENSATED ↓ ↑ ↑

The kidneys start to respond to the acidosis by increasing

the amount of circulating HCO3

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↑ ↑

PH return to normal PaCO2 & HCO3 levels are still high to

correct acidosis
A.Y.T 41
 B. Respiratory alkalosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↑ ↓ ------

Because there is no response from the kidneys yet to

acidosis the HCO3 will remain normal

Phase PH PaCO2 HCO3

PARTIAL COMPENSATED ↑ ↓ ↓

The kidneys start to respond to the alkalosis by

decreasing the amount of circulating HCO3

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↓ ↓

PH return to normal PaCO2 & HCO3 levels are still low to

correct alkalosis
A.Y.T 42
 C. Metabolic acidosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↓ ------- ↓

Because there is no response from the lungs yet to

acidosis the PaCO2 will remain normal

Phase PH PaCO2 HCO3

PARTIAL COMPENSATED ↓ ↓ ↓

The lungs start to respond to the acidosis by decreasing

the amount of circulating PaCO2

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↓ ↓

PH return to normal PaCO2 & HCO3 levels are still low to

correct acidosis
A.Y.T 43
 D. Metabolic alkalosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↑ ------- ↑

Because there is no response from the lungs yet to

alkalosis the PaCO2 will remain normal

Phase PH PaCO2 HCO3

PARTIAL COMPENSATED ↑ ↑ ↑

The lungs start to respond to the alkalosis by increasing

the amount of circulating PaCO2

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↑ ↑

PH return to normal PaCO2 & HCO3 levels are still high to

correct alkalosis
A.Y.T 44
 Patterns of pH,PCO2 and
bicarbonate in different conditions1
CONDITION pH bicarbonate pCO2 Typical causes

METABOLIC <7.40 LOW LOW DIABETIC

ACIDOSIS KETOACIDOSIS,
LACTIC ACIDOSIS
METABOLIC >7.40 HIGH HIGH VOMITING
ALKALOSIS
RESPIRATOR <7.40 HIGH HIGH COPD,PARALYSIS
YACIDOSIS OF RESPIRATORY
MUSCLES
REPIRATORY >7.40 LOW LOW ANXIETY, ACUTE
ALKALOSIS PAIN
A 65 y.o man is brought into the hospital with complaints of
severe nausea and weakness. He has had problems with peptic
ulcer disease in the past and has been having similar pain in the
past two weeks. Rather than see a physician about it. He opted
to deal with the problem on his own and over the past week, he
been drinking significant quantities of milk, consuming large
quantities of TUMS (calcium carbonate). On his initial
laboratory studies, he is found to have a calcium level of 11.5
mg/dL, a creatinine of 1.4 and bicarbonate of 35. The Resident
working in the ER decides to draw a arterial blood gas which
reveals:
pH= 7.45
pCO2 = 49 mmHg
pCO = 68
HCO3= 34 mmol/L
Method of Determination
p02
 Clark p02 electrode
Principle: Based on amperometric

or polarographic measurement of
oxygen.
 Gasometric analysis
 Calculation from oxygen saturation,
pH and temperature by means of the
standard 02 dissociation curve.
pC02
 Use of pCO2 electrode
 Principle: Based on pH measurement of
a stationary NaHCO3 solution which is
in equilibrium with the test solution and
the test via a CO2 permeable membrane.
 Use of Henderson Hasselbach equation-
from pH and total carbon dioxide.
 From a measured pH value interpolated in
the C02 equilibrium curve.
pH
 PH electrode
 Principle: Based on polarographic
principle
 Use of PH meters
 Henderson - Hasselbach equation
 Nomogram and Slide Rule
 Siggard -Anderson Alignment
nomogram
ct C02:
 Manometric Method Using Natelson
Microgasometer
 Principle:
 Carbon dioxide is released front HC03 by
the addition of lactic add. The C02 and
other gases are, extracted under a partial
vacuum. The pressure difference at
constant value before and after
absorption of C02 by NaOH Is the
amount of C02 present in the sample.
Natelson Microgasometer
Reagents:
10% lactic acid releases C02 fromHC03
12% NaOH for total reabsorption of CO2
gas as Na2C03
Caprylic alcohol prevents foaming
Mercury separates the sample and
other reagents, prevent
introduction of air and seals
gasometer.
Distilled water washes the sample and
reagent into the reaction
chamber
Alternative Method
 Principle
 Involves the release of C02 gas when the
sample is added to H2S04 with subsequent
monitoring of this release with a pair of
pCO2 electrodes (reference and sample
electrodes). The rate of change in pH of the
buffer inside the pCO2 electrodes is a
measure of the concentration of its CO2 In
the Sample
Consequences of Acid- Base Imbalance:
 In Alkaloids, tetany ensues due to.
hypocalcemia, which can lead to
death because of respiratory muscle
spasm.
 In Acidosis, there is an inhibition of
the neural mechanisms which will
then lead to coma. A blood pH of 6.9
has been proven fatal
 complication

 Arteriospasm
 Hematoma
 Hemorrhage
 Distal ischemia
 Infection
 Numbness

56 A.Y.T
 A look at acids and bases
 The body constantly works to maintain a balance
(homeostasis) between acids and bases.
Without that balance, cells can’t function properly.
As cells use nutrient to produce the energy, two by-
products are formed H+ & CO2. acid-base balance
depends on the regulation of the free hydrogen ions

 Even slight imbalance can affect metabolism and

essential body functions.
 Several conditions as infection or trauma and
medications can affect acid-base balance

57 A.Y.T