Arterial Blood Gas Analysis Dr. Tongjun Ma Emergency Department of Tianjin medical university General Hospital
<ul><li>3 parts: </li></ul><ul><li>introduction: contents, indications </li></ul><ul><li>artery puncture technique </li></...
Contents of ABG <ul><li>Measures </li></ul><ul><li>pH Percent of H +  Concentration </li></ul><ul><li>pCO 2 Pressure of Ca...
 
Indications <ul><li>assess respiratory function </li></ul><ul><ul><li>adequacy of ventilation and oxygenation </li></ul></...
Blood sample collection  <ul><li>2 methods: </li></ul><ul><li>artery puncture </li></ul><ul><li>capillary blood </li></ul>
Complications of Puncture <ul><li>Bleeding </li></ul><ul><ul><li>Local, occult </li></ul></ul><ul><li>Ischemic consequence...
Puncture sites <ul><li>consider  </li></ul><ul><ul><li>the risk   of   hemorrhage   and how to control </li></ul></ul><ul>...
Radial artery   <ul><li>the one most  commonly used </li></ul><ul><li>collateral circulation </li></ul><ul><li>the risk of...
Femoral artery
Brachial artery <ul><li>the risk of complications is greater than radial artery </li></ul><ul><ul><li>has little collatera...
Puncture technique <ul><li>4 steps: </li></ul><ul><li>Preparation </li></ul><ul><li>cleanse the skin, local anesthesia </l...
Preparation 1 <ul><li>Preparation of Client </li></ul><ul><li>Oxygen, the settings for the respirator, the temperature  </...
Preparation 2 <ul><li>Syringe </li></ul><ul><ul><li>a prepackaged ABG kit </li></ul></ul><ul><ul><li>Choose a syringe with...
Step 2  <ul><li>cleanse the skin </li></ul><ul><ul><li>iodine and alcohol </li></ul></ul><ul><li>local anesthesia </li></u...
Puncture <ul><li>Angle </li></ul><ul><ul><li>30°to 45°, 60 °, 75 ° </li></ul></ul><ul><li>If resistance is met or no blood...
Cap and transport   <ul><li>expel all air bubbles within 2 min  </li></ul><ul><li>Cap the syringe  </li></ul><ul><li>trans...
Key points <ul><li>Use small-gauge needle </li></ul><ul><li>Do not puncture the same site repeatedly </li></ul><ul><li>Con...
 
What is pH Acidic Alkaline Neutral 0 14 7 <ul><li>How acidic or base a substance is </li></ul><ul><li>Scale runs from 1 – ...
Arterial   Blood pH 7.4   Academia Acidosis? Alkalemia  Alkalosis? 7.35~7.45 6.8 7.8 DEATH DEATH
Importance  of pH <ul><li>Ensure metabolic intermediates are in the ionized state </li></ul><ul><li>Intracellular enzymes ...
Adverse Clinical Effects of Acidemia
Compensation <ul><li>The goal is to try to maintain normal pH </li></ul><ul><li>If the compensation occurs fully, the pH r...
Lungs Compensation <ul><li>by changing respiratory rate </li></ul><ul><li>  pH (acid) ,  respiratory rate   to blow off...
Body is open <ul><li>If add 12 mM H +  to closed system </li></ul><ul><ul><li>if all acid is buffered </li></ul></ul><ul><...
Kidneys Compensation <ul><li>Changes the amount of hydrogen excreted and bicarbonate retained </li></ul><ul><li>  pH (aci...
pH pH  ? uncompensated alkalosis pH  ↓   ? uncompensated acidosis Normal pH ?
PCO 2 <ul><li>Carried as carbonic acid , so it has an inverse ration with pH </li></ul><ul><li>Controlled by the lungs  </...
HCO 3 - <ul><li>Measurement of amount of bicarbonate in blood </li></ul><ul><li>Normal range  22~ 26  mmol/L, Controlled b...
Hendersen-Hasselbalch equation
If  = 1  pH = 6.1 If  = 10  pH = 7.1 If  = 20  pH = 7.4 If  = 30  pH = 7.6
Base Excess <ul><li>Indication of how much extra base is available to the body </li></ul><ul><li>Normal ABG: -2 to +2 </li...
PaO 2   <ul><li>Measures oxygen carried by red blood cells and dissolved in plasma </li></ul><ul><li>75-100mmHg  </li></ul...
SaO 2   <ul><li>the actual amount of oxygen carried by Hb compared with the amount of oxygen that  Hb is capable of carryi...
Comparison with PO2 values  20mmHg 35% 50mmHg 84% 60mmHg 89% 80mmHg 95% 100mmHg 98%
Review of Normal ABG   <ul><li>pH 7.35 – 7.45 </li></ul><ul><li>pCO2 35 – 45 </li></ul><ul><li>pO2 75 – 100 </li></ul><ul>...
Thank you
Upcoming SlideShare
Loading in...5
×

Abg

2,541

Published on

arterial blood gas analysis

Published in: Business, Technology
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,541
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
191
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Abg

  1. 1. Arterial Blood Gas Analysis Dr. Tongjun Ma Emergency Department of Tianjin medical university General Hospital
  2. 2. <ul><li>3 parts: </li></ul><ul><li>introduction: contents, indications </li></ul><ul><li>artery puncture technique </li></ul><ul><li>explain the important measurements </li></ul>
  3. 3. Contents of ABG <ul><li>Measures </li></ul><ul><li>pH Percent of H + Concentration </li></ul><ul><li>pCO 2 Pressure of Carbon Dioxide </li></ul><ul><li>pO 2 Pressure of Oxygen </li></ul><ul><li>Sao 2 Oxygen Saturation </li></ul><ul><li>BE Base Excess </li></ul><ul><li>HCO 3 Bicarbonate </li></ul>
  4. 5. Indications <ul><li>assess respiratory function </li></ul><ul><ul><li>adequacy of ventilation and oxygenation </li></ul></ul><ul><ul><li>make changes in treatment, such as ventilator settings </li></ul></ul><ul><li>evaluate acid-base status </li></ul>
  5. 6. Blood sample collection <ul><li>2 methods: </li></ul><ul><li>artery puncture </li></ul><ul><li>capillary blood </li></ul>
  6. 7. Complications of Puncture <ul><li>Bleeding </li></ul><ul><ul><li>Local, occult </li></ul></ul><ul><li>Ischemic consequences </li></ul><ul><ul><li>spasm, thrombosis, embolism </li></ul></ul><ul><li>trauma </li></ul><ul><ul><li>Nerve, tendon </li></ul></ul><ul><li>Infection </li></ul><ul><li>With the use of proper technique, the complication rate is extremely low. </li></ul>
  7. 8. Puncture sites <ul><li>consider </li></ul><ul><ul><li>the risk of hemorrhage and how to control </li></ul></ul><ul><ul><li>the risk of complete blood flow loss </li></ul></ul><ul><ul><li>the risk of injury </li></ul></ul><ul><ul><li>patient comfort and nursing care concerns </li></ul></ul><ul><li>possible sites: Radial, Femoral, Brachial </li></ul>
  8. 9. Radial artery <ul><li>the one most commonly used </li></ul><ul><li>collateral circulation </li></ul><ul><li>the risk of obtaining venous blood or damaging a nerve is low </li></ul>
  9. 10. Femoral artery
  10. 11. Brachial artery <ul><li>the risk of complications is greater than radial artery </li></ul><ul><ul><li>has little collateral circulation </li></ul></ul><ul><li>avoid except in extreme circumstances </li></ul>
  11. 12. Puncture technique <ul><li>4 steps: </li></ul><ul><li>Preparation </li></ul><ul><li>cleanse the skin, local anesthesia </li></ul><ul><li>Puncture </li></ul><ul><li>Cap the syringe and transport </li></ul>
  12. 13. Preparation 1 <ul><li>Preparation of Client </li></ul><ul><li>Oxygen, the settings for the respirator, the temperature </li></ul><ul><li>Found the artery </li></ul><ul><ul><li>The pulsations of the radial artery should be palpable just proximal to the transverse wrist creases </li></ul></ul>
  13. 14. Preparation 2 <ul><li>Syringe </li></ul><ul><ul><li>a prepackaged ABG kit </li></ul></ul><ul><ul><li>Choose a syringe with minimal dead space (e.g., BD insulin syringe) , 0.5-1.0 ml, Airtight </li></ul></ul><ul><ul><ul><li>Heparinized, eliminate heparin-related errors ,All heparin should be ejected </li></ul></ul></ul>
  14. 15. Step 2 <ul><li>cleanse the skin </li></ul><ul><ul><li>iodine and alcohol </li></ul></ul><ul><li>local anesthesia </li></ul><ul><ul><li>an intradermal wheal of 1% lidocaine </li></ul></ul>
  15. 16. Puncture <ul><li>Angle </li></ul><ul><ul><li>30°to 45°, 60 °, 75 ° </li></ul></ul><ul><li>If resistance is met or no blood returns, the needle should be slowly withdrawn </li></ul><ul><li>press for 5 minutes or longer to control bleeding </li></ul>
  16. 17. Cap and transport <ul><li>expel all air bubbles within 2 min </li></ul><ul><li>Cap the syringe </li></ul><ul><li>transport to the laboratory </li></ul><ul><ul><li>put the sample on ice if the test is not completed within 10 min </li></ul></ul>
  17. 18. Key points <ul><li>Use small-gauge needle </li></ul><ul><li>Do not puncture the same site repeatedly </li></ul><ul><li>Confirm the potency of the ulnar artery </li></ul><ul><ul><li>Doppler examination </li></ul></ul><ul><ul><li>Allen test </li></ul></ul>
  18. 20. What is pH Acidic Alkaline Neutral 0 14 7 <ul><li>How acidic or base a substance is </li></ul><ul><li>Scale runs from 1 – 14 </li></ul><ul><li>Less than 7 is acidic, Greater than 7 is base </li></ul>
  19. 21. Arterial Blood pH 7.4 Academia Acidosis? Alkalemia Alkalosis? 7.35~7.45 6.8 7.8 DEATH DEATH
  20. 22. Importance of pH <ul><li>Ensure metabolic intermediates are in the ionized state </li></ul><ul><li>Intracellular enzymes have a pH optimum </li></ul><ul><li>DNA, RNA and protein synthesis is facilitated at this pH </li></ul>Every enzymatic reaction in the body is affected by pH!
  21. 23. Adverse Clinical Effects of Acidemia
  22. 24. Compensation <ul><li>The goal is to try to maintain normal pH </li></ul><ul><li>If the compensation occurs fully, the pH returns to normal </li></ul><ul><li>If the compensating organ cant work hard enough to compensate, the pH will still be abnormal </li></ul>
  23. 25. Lungs Compensation <ul><li>by changing respiratory rate </li></ul><ul><li> pH (acid) , respiratory rate  to blow off CO 2 </li></ul><ul><li>Very sensitive and can compensate quickly </li></ul><ul><li>tires easily so cant continue long term </li></ul>
  24. 26. Body is open <ul><li>If add 12 mM H + to closed system </li></ul><ul><ul><li>if all acid is buffered </li></ul></ul><ul><ul><li>[CO 2 ] = 13.2, [HCO 3 ] = 12, pH = 6.06 : lethal </li></ul></ul><ul><li>If add 12 mM H + to body </li></ul><ul><ul><li>Body is open through lungs, all extra CO2 expelled </li></ul></ul><ul><ul><li>[CO 2 ] = 1.2, [HCO 3 ] =12, pH = 7.1 </li></ul></ul>
  25. 27. Kidneys Compensation <ul><li>Changes the amount of hydrogen excreted and bicarbonate retained </li></ul><ul><li> pH (acid) = kidneys excrete more H + and retain more bicarbonate so HCO 3  </li></ul><ul><li>More powerful but slower (hours to days) </li></ul>
  26. 28. pH pH  ? uncompensated alkalosis pH ↓ ? uncompensated acidosis Normal pH ?
  27. 29. PCO 2 <ul><li>Carried as carbonic acid , so it has an inverse ration with pH </li></ul><ul><li>Controlled by the lungs </li></ul><ul><li>Normal range 35~ 45 mmHg </li></ul><ul><ul><li> 35 = hyperventilation or base (alkalosis) </li></ul></ul><ul><ul><li> 45 = hypoventilation or acidic (acidosis) </li></ul></ul><ul><li>[H 2 CO 3 ]: 40×0.03=1.2mmol/L </li></ul>
  28. 30. HCO 3 - <ul><li>Measurement of amount of bicarbonate in blood </li></ul><ul><li>Normal range 22~ 26 mmol/L, Controlled by kidneys </li></ul><ul><ul><li> 22 = acidosis </li></ul></ul><ul><ul><li> 26 = alkalosis </li></ul></ul>
  29. 31. Hendersen-Hasselbalch equation
  30. 32. If = 1 pH = 6.1 If = 10 pH = 7.1 If = 20 pH = 7.4 If = 30 pH = 7.6
  31. 33. Base Excess <ul><li>Indication of how much extra base is available to the body </li></ul><ul><li>Normal ABG: -2 to +2 </li></ul><ul><ul><li> -2 = acidic (acidosis) </li></ul></ul><ul><ul><li> +2 = base (alkalosis) </li></ul></ul>
  32. 34. PaO 2 <ul><li>Measures oxygen carried by red blood cells and dissolved in plasma </li></ul><ul><li>75-100mmHg </li></ul><ul><li><75=hypoxia </li></ul><ul><li>drops about 3-5mmHg for each decade after 30 years of age </li></ul>
  33. 35. SaO 2 <ul><li>the actual amount of oxygen carried by Hb compared with the amount of oxygen that Hb is capable of carrying </li></ul><ul><li>95~100% </li></ul><ul><li>Often measured by a probe that is attached to a finger or earlobe </li></ul><ul><li>decreased occurs in carbon monoxide poisoning and hypoxia </li></ul><ul><li>Unreliable if peripheral perfusion is poor or in the presence of nail polish, excessive movement </li></ul>
  34. 36. Comparison with PO2 values 20mmHg 35% 50mmHg 84% 60mmHg 89% 80mmHg 95% 100mmHg 98%
  35. 37. Review of Normal ABG <ul><li>pH 7.35 – 7.45 </li></ul><ul><li>pCO2 35 – 45 </li></ul><ul><li>pO2 75 – 100 </li></ul><ul><li>HCO 3 - 22 – 26 </li></ul><ul><li>SaO 2  95% </li></ul>
  36. 38. Thank you
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×