abg interpretation 3.0

7/26/2019 ABG Interpretation 3.0

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BASIC ARTERIAL BLOOD GAS (ABG)INTERPRETATION

By: Jesus Mario A Lopez Jr., R.N., R.T.R.P.


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Terminology

Acids- substances that donate free ! ions, ap "a#ue of $%.& is considered acidic

Bases ' substances that re(o"e ! ions fro(the so#ution, a p "a#ue of )%.& isconsidered a#*a#ine

Buffers ' +ea* acids or +ea* bases thataccept or donate ! ions to pre"ent the+ide f#uctuation of p in the body so thenor(a# (etabo#is( can continue


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Terminology

p puissance ydroen- symbol for thelogrithm of the re!i"ro!l of the hy#rogen ion!on!entrtion$

Pa/01- Partia# pressure of /arbon 2io3ide,arterial

Pa01 ' Partia# pressure of 03yen,arterial

/04 ' Bicarbonate

BE%BD & Bse E'!ess%Bse Defi!it

5p01 ' Pu#se 03y(etry


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Terminologyen#ersonsselbl!h e*+tion - is metho# of

!l!+lting the " of b+ffer system$ In me#i!ine, it is+se# to !l!+lte ny one of the three "rmeters of !i#bse bln!e- ", PCO., or bi!rbonte$

As long s the rtio of !rboni! !i# (.CO/) to bi!rbonte(CO/ 0) is ""ro'imtely 1-.2, the " of bloo# is norml$It is this rtio tht #etermines the bloo# ", rther thn thebsol+te 3l+es of e!h


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TerminologyA Gr#ient in#i!tes 4hether gs trnsfer is norml n#

gi3es n i#e of ho4 4ell o'ygen is mo3ing from the l3eoli tothe rteril bloo#$ It hel"s to #isting+ish hy"o3entiltion from

other !+ses s+!h s 5%6 mismt!h, sh+nting, n#%or

#iff+sion bnormlities


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Terminology


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Terminology


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TerminologyAn esier n# less !om"li!te# metho# to "re#i!t sh+nting is the

PO.%7iO. (P%7) rtio$ It is !l!+lte# th+s-PO. 8 7iO.

9sing the !riteri from the "re3io+s e'm"le-

:2 8 2$.1

PO.%7iO. rtio ; torr? lo4er in#i!tes sh+nt$

ARTERIAL O. CONTENT (C2.) is "rimrily #etermine# by the mo+nt

of hemoglobin in rteril bloo# tht is st+rte# 4ith o'ygen-

CO. ; (gb @ 1$/: @ SO.) (2$22/ @ PO.)

A *+i!er 4y to estimte this 3l+e-

gb @ 1$/: @ SO.

Norml 3l+e- 1 to .< 3ol+me "er!entge


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TerminologyB A S E E X C E S S / D E F I C I T

Th e bse e'!ess%#efi !it is !l!+lte# n+mber tht re"resents themo+nt of bse tht m+st be ##e# to restore the bloo# to norml " of

$< (Norml rnge ; 0. to . mE*%L)$

Bse excess is positive number n# signifies metboli! llosis.

Bse deficit is negative number n# signifies metboli! !i#osis


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" ele!tro#e

CO.

PO.

S2.

C2/

Is "erforme# by inserting sol+tions or gses 4ith no4n

3l+es (one lo4 3l+e n# one high 3l+e)

It ss+res the !onsisten!y n# !!+r!y of the ele!tro#e4ithin their limits? ho4e3er theres no ss+rn!e tht the

gses n# sol+tions being +se# s !librtion referen!es

re !orre!t n# !onsistent, e'ternl 6C m+st be

!!om"lishe#$H refer to Instr+!tionl Fn+l of rti!+lr ABG m!hine

2irect#y (easured "a#ues:

/a#cu#ated "a#ues:

/a#ibration:


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KA 6+lity Fngement System for

elth!re$The Quality System Essentials (QSE)

7. 2ocu(ents and records %. 8nfor(ation (anae(ent

1. 0ranization 9. Nonconfor(in

(anae(ent e"ent

4. Personne# . Assess(ent

;. 6. Process (anae(ent 71. ?aci#ities and safety


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Common Arteril Bloo# Gs P+n!t+re

Sites


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Adu#t /hi#d ) 1;(onths

Neonate$ 71

(onths

7@ -Radia# A.

1@ - Brachia# A.4@ - 2orsa#isPedis A.

;@-PosteriorTibia# A.

=@ - ?e(ora# A.

7@ -Radia# A.

1@ - Brachia# A.

7@ Radia# A.

1@ (bi#ica# .4@ /api##iary

and ee# 5tic*

sa(p#es

opitiona#

;@- Brachia# A.

Obtining ABG P+n!t+re Sites


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7!tors my ffe!t ABG !!+r!y

res+lts

7. 0riin of the sa(p#e

1. Type of eparin used e.. 7,&&& i.u. "s /a!!Li

4. Accuracy of the ABC Machine e.. cartride "s. so#ution

;. Post suctionin $ 4& (ins.

=. Nebu#ization afterD

>. Mo"e(ent e..Turnin

%. Medications 8..?.

9. Acti"ityEProcedures

. and#in of sa(p#e 7& (ins F 4%G/H 7hr on s#ush ice7&. Aitation of sa(p#e ro## not sha*e syrineIIII

77. 5*i## of the operator


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Norml 5l+es-

Parameters Range Absolute Venous

pH %.4=-%.;= %.;& 7.31-7.41

PaCO2 4=-;= (( ;& (( 41-51 mmHg

PaO2 9&-7&& (( = (( 37-43 mmHg

HCO3 11-1> (( 1; (6


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p - $%.4=KAcidotic

)%.;=KA#*a#otic

/04 - $11(6(6


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Primry n# Com"enstory res"onse

for !i#bse #isor#ers-

Pri(ary 6"ent /o(pensatory Response

Pa/01 /04

Pa/01 /04


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Arteril O'ygention Stt+s (PO.)ith ypo3e(ia F R.A.

More than ade


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ABC ana#ysis /onfir(atoryIII Pu#se o3i(etry #east

6t/01 (onitorin spot chec*Etransport "ent /api##ary as deter(inationneonates on#y, "ery

rare

Transcutaneous (onitorin

*onitorin' of $% + C$% stat"s


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Ste"s in ABG Inter"rettion-

7. 2eter(ine the p

1. 2eter(ine +hether respiratory or(etabo#ic in oriin

4. 2eter(ine the co(pensation

;. 2eter(ine the 03yenation 5tatus

OOOOOOOO OOOOOOO OOOOOOO OOOOOOOO


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8nterpretation: Partia##y /o(pensated Respiratory

Acidosis +E uncorrected o3yenation


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ABG- RESPIRATORQ ACIDOSIS

/auses (ain#y air+ay obstruction resp. depression

Respiratory

Q Acute upper air+ay obstruction

Q Ate#ectasis

Q /0P2 e.. Asth(a, Bronchiectasis, Bronchitis, 6(physe(aQ 5e"ere diffuse air+ay obstruction acute or chronic

Q Massi"e pu#(onary ede(a

Q ypo"enti#ation

Nonrespiratory

Q 2ru o"erdose e.. 5edati"es, narcotics, anesthetics

Q 5pina# cord trau(a

Q Neuro(uscu#ar disease

Q ead trau(a

Q Thoracic trau(a

Q Cross obesity e.. Pic*+ic*an syndro(e


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5E53

RR depth

A, "isua# disturbance,rest#essness, dro+siness, confusion

2iaphoresis

/yanosis

yper

dysrhyth(ias ?


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T3

5e(i-?o+#ers, 01, couhin

ydration5uction secretions

0? RR distress, hyper

Antibiotics other (eds asordered


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8nterpretation: nco(pensated Respiratory A#*a#osis +E(oderate hypo3e(ia


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ABG- RESPIRATORQ ALALOSIS

/auses (ain#y o"ersti(u#ation of therespiratory syste(yper"enti#ation?e"erypo3iaysteria

0"er"enti#ation by (ech "ent.Pain5a#icy#ates


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5E53

RR depth then RR

A, #iht-headedness, "ertioypo /a: paresthesia, tetany,

con"u#sion

ypo Musc#e +ea*ness or spas(s


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T3

Treat under#yin cause


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ABG- FETABOLIC ACIDOSIS

/auses:8ncrease in fi3ed acids:

Q Rena# fai#ure dista# tubu#esEretention of !

Q Type A #actic acidosis tissue hypoperfusion, e.. shoc*, cardiac arrest

Q Type B #actic acidosis no tissue hypoperfusion, e.. #i"er fai#ure, 2M 2A,star"ationE(a#nutrition

Q 8nestion of acids e.., (ethano#Loss of base /04 :

Q 5e"ere 2iarrhea

Q Pancreatic fistu#a

Q Rena# fai#ure pro3i(a# tubu#esE#oss of /04

Q ypera#i(entation

0thers:Q A5A aspirin to3icity

Q ih fat diet

Q 8nsufficient /0 (etabo#is(


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5E53

RR, uss(au#s respiration

A, NEEdiarrhea?ruity-s(e##in breath

/N5 depression

T+itchin, con"u#sion

yper

2ysrhyth(ias


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T3

Na/04 8

5z precaution?or 2A: N5 Reu#ar 8nsu#in

8

?or R?: /0N, ca#orie dietHdia#ysis


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8nterpretation: ?u##y co(pensated Metabo#ic A#*a#osis +Euncorrected o3yenation


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ABG- FETABOLIC ALALOSIS

/auses

2iuretic therapy

5teroid therapy

ypo*a#e(ia or hypoch#ore(ia63cessi"e "o(itin

C8 suctionin

ypera#dosteronis(63cessi"e Na/04 inta*e

Massi"e BT citrate con"erted to /04


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5E53

RR depth

NEEdiarrheaRest#essness

Paresthesia, t+itchin

ypo, ypo/aR, dysrhyth(ias


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T3 Treat under#yin cause

rep#etion

Na/# 8A#dosterone inhibitor

A/6 inhibitor

2iscontinue steroids

Acetazo#a(ide if N5 is contraindicateddue to /?

2ia#ysis



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8nterpretation: nco(pensated Respiratory

A#*a#osis +E corrected o3yenation


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8nterpretation: Nor(a# Acid-Base Ba#ance +E

uncorrected o3yenation


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8nterpretation: Partia##y co(pensated Metabo#ic

Acidosis +E (oderate hypo3e(ia


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8nterpretation: /o(bined Respiratory and Metabo#ic

Acidosis +E o"er corrected o3yenation


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8nterpretation: Partia##y /o(pensated Metabo#ic

A#*a#osis +E o"er corrected o3yenation


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8nterpretation: ?u##y /o(pensated Respiratory



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8nterpretation: Nor(a# Acid Base Ba#ance +E



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8nterpretation: Partia##y /o(pensated Metabo#ic

A#*a#osis +E (i#d hypo3e(ia


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8nterpretation: ?u##y co(pensated Respiratory

A#*a#osis +E ade


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Acidosis +E uncorrected o3yenation


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8nterpretation: Nor(a# Acid Base Ba#ance +E



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Referen!es-

6ans ?unda(enta#s of Respiratory /areby ac(are*, i#*ins, 5to##er, 7&thedition

6ssentia#s in Respiratory /are byac(are*, 4rdedition

andboo* of B#ood CasEAcid'Base8nterpretation by Ashfa< asan

abg interpretation 3.0

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