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Arterial Blood Bas (ABG) Procedure and Interpretation

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Arterial Blood Bas (ABG) Procedure and Interpretation

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Arterial Blood Bas (ABG) Procedure and Interpretation

  1. 1. Arterial Blood Gas (ABG) Procedure & Interpretation November 29, 2014
  2. 2. Objectives: 1.Understand ABG and its terms 2.Know some of the indications and contraindications for performing an arterial puncture. 3.Be able to demonstrate the technique for performing an arterial puncture.
  3. 3. What is an ABGWhat is an ABG • Arterial Blood Gas • Drawn from artery- radial, brachial, femoral • It is an invasive procedure • Caution must be taken with patient anticoagulants. • Helps differentiate oxygen deficiencies from primary ventilatory deficiencies from primary metabolic acid-base abnormalities.
  4. 4. Common termsCommon terms • PCO2 (ventilation) – Partial Carbon Dioxide • PaO2 - (oxygenation) –Partial Oxygen • HCO3 – (metabolism) -Bicarbonate • O2Sat – Oxygen Saturation • pH – Acid/Base balance • BE – Base excess
  5. 5. Normal ABG valuesNormal ABG values • pH - 7.35 – 7.45 • PCO2 - 35 – 45 mmHg • PO2 - 80 – 100 mmHg • HCO3 - 22 – 26 mmol/L • SaO2 - >95%
  6. 6. Information Obtained from an ABGInformation Obtained from an ABG • Acid base status • Oxygenation • Dissolved O2 (pO2) • Saturation of hemoglobin • CO2 elimination • Levels of carboxyhemoglobin and methemoglobin
  7. 7. IndicationsIndications • Assess the ventilatory status, oxygenation and acid base status. • Assess the response to an intervention. • Regulate electrolyte therapy. • Establish preoperative baseline parameters.
  8. 8. Contraindications: Contraindications: Bleeding diathesisBleeding diathesis AV fistulaAV fistula Severe peripheralSevere peripheral vascular disease,vascular disease, absence of an arterialabsence of an arterial pulsepulse Infection over site.Infection over site.
  9. 9. Complications: Complications: The most commonThe most common complication from ancomplication from an arterial puncture isarterial puncture is hematomahematoma at the site.at the site. Less common butLess common but important complicationsimportant complications areare thrombus in thethrombus in the artery and infection atartery and infection at the sitethe site..
  10. 10. Allentestfor Allentestforcollateralflow: collateralflow:
  11. 11. WhichArteryto WhichArterytoChoose? Choose? TheThe radial arteryradial artery isis superficial, hassuperficial, has collaterals and is easilycollaterals and is easily compressed. It shouldcompressed. It should almost always be the firstalmost always be the first choice.choice. Other arteries (femoral,Other arteries (femoral, dorsalis pedis, brachial)dorsalis pedis, brachial) can be used incan be used in emergencies.emergencies.
  12. 12. The ProcedureThe Procedure
  13. 13. Wash your hands, introduce yourself to theWash your hands, introduce yourself to the patient and clarify their identity.  Explain whatpatient and clarify their identity.  Explain what you would like to do and obtain consent. Thisyou would like to do and obtain consent. This is a slightly uncomfortable procedure so youis a slightly uncomfortable procedure so you should let the patient know this.should let the patient know this.
  14. 14. Gatherthe Gatherthe necessaryfollowing necessaryfollowingequipment: equipment:  a blue (23 G) needle a blue (23 G) needle  2ml syringe with heparin 2ml syringe with heparin  a cap for the syringe a cap for the syringe  a plastic bung a plastic bung local anaesthetic (plus needle local anaesthetic (plus needle and syringe for giving) and syringe for giving)  alcohol gel alcohol gel gauze gauze  gloves gloves  a sharps bin a sharps bin Usually, the syringe, needle, cap Usually, the syringe, needle, cap and bung are all provided in and bung are all provided in one pack. one pack.
  15. 15. Position the patient’s arm with the wristPosition the patient’s arm with the wrist extended.extended. Locate the radial artery with your index andLocate the radial artery with your index and middle fingers.middle fingers.
  16. 16. Perform Allen’s test where you compress both thePerform Allen’s test where you compress both the radial and ulnar arteries at the same time.Theradial and ulnar arteries at the same time.The hand should become white, release the ulnarhand should become white, release the ulnar artery and the colour should return to the hand.artery and the colour should return to the hand. This ensures that there will still be a bloodThis ensures that there will still be a blood supply to the hand should the ABG cause asupply to the hand should the ABG cause a blockage in the radial artery.blockage in the radial artery.
  17. 17. Put on your gloves Put on your gloves and attach the needle and attach the needle to the heparinised to the heparinised syringe. syringe. Also prepare your Also prepare your local anaesthetic and local anaesthetic and give a small amount give a small amount over the palpable over the palpable radial artery. radial artery.
  18. 18. Take the cap off theTake the cap off the needle, flush the heparinneedle, flush the heparin through the syringe andthrough the syringe and again locate the radialagain locate the radial artery using your non-artery using your non- dominant hand.dominant hand.
  19. 19.  Let the patient know you are about to proceed and toLet the patient know you are about to proceed and to expect a sharp scratch.expect a sharp scratch.  Insert the needle at 30 degrees to the skin at theInsert the needle at 30 degrees to the skin at the point of maximum pulsation of the point of maximum pulsation of the radial arteryradial artery.. Advance the needle until arterial blood flushes intoAdvance the needle until arterial blood flushes into the syringe.The arterial pressure will cause thethe syringe.The arterial pressure will cause the blood to fill the syringe.blood to fill the syringe.
  20. 20. Remove the needle/syringe placing theRemove the needle/syringe placing the needle into the bung. Press firmly over theneedle into the bung. Press firmly over the puncture site with the gauze to halt thepuncture site with the gauze to halt the bleeding. Remain pressed for 5 minutes.bleeding. Remain pressed for 5 minutes.
  21. 21. Remove the needle and discard safely in theRemove the needle and discard safely in the sharps bin.sharps bin.
  22. 22. Cap the syringe, push out any air within it, andCap the syringe, push out any air within it, and send immediately for analysis ensuring that thesend immediately for analysis ensuring that the sample is packed in ice. Remove your gloves andsample is packed in ice. Remove your gloves and dispose them in the clinical waste bin.  Washdispose them in the clinical waste bin.  Wash your hands and thank the patient.your hands and thank the patient.
  23. 23.  An extension to this station An extension to this station could be  could be Blood gas interpretation Blood gas interpretation.. Before attempting to Before attempting to interpret the results you interpret the results you should know whether the should know whether the patient was on room air or patient was on room air or on oxygen when the on oxygen when the sample was taken, and if sample was taken, and if on oxygen, what on oxygen, what concentration. concentration. It is also useful to know It is also useful to know whether the patient has a whether the patient has a temperature or not, and temperature or not, and this should be clearly this should be clearly written on the sample. written on the sample.
  24. 24. Obtaining ABG sampleObtaining ABG sample
  25. 25. ABG InterpretationABG Interpretation Metabolic AcidosisMetabolic Acidosis pH: pH: ↓↓ pCOpCO22: ↔: ↔ Bicarbonate: Bicarbonate: ↓↓ RespiratoryRespiratory AcidosisAcidosis pH: pH: ↓↓ pCOpCO22: : ↑↑ Bicarbonate: ↔Bicarbonate: ↔ • Metabolic AlkalosisMetabolic Alkalosis pH: pH: ↑↑ pCOpCO22: ↔: ↔ Bicarbonate: Bicarbonate: ↑↑ • Respiratory AlkalosisRespiratory Alkalosis pH: pH: ↑↑ pCOpCO22: : ↓↓ Bicarbonate: ↔Bicarbonate: ↔
  26. 26. INTERPRETATION INTERPRETATION ACID NORMAL BASE ACIDICACIDIC BASEBASE pH:pH: 7.35 – 7.457.35 – 7.45 PCOPCO22:: 45 – 35 (Respiratory)45 – 35 (Respiratory) HCOHCO33:: 22 – 26 (Metabolic)22 – 26 (Metabolic) 7.35 7.40 7.45
  27. 27. Thankyou!!! Thankyou!!! Louie Ray, R.N. Louie Ray, R.N. http://nursesinfosite.blogspot.com/ http://www.slideshare.net/blueash/

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