ABG

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  • ABG

    1. 1. Acid-Base Balance
    2. 7. Normal Blood pH <ul><li>Changes from normal blood pH (7.35 to 7.45) interfere with many normal functions by: </li></ul><ul><ul><li>Changing the shape of hormones and enzymes so that they may no longer perform their normal functions </li></ul></ul><ul><ul><li>Changing the distribution of other electrolytes, causing fluid and electrolyte imbalances </li></ul></ul><ul><ul><li>Altering the responses of excitable membranes </li></ul></ul><ul><ul><li>Decreasing the uptake, activity, and effectiveness of many hormones and drugs </li></ul></ul>
    3. 8. Acid-Base Balance <ul><li>Acids </li></ul><ul><li>Bases </li></ul><ul><li>Chemical buffers </li></ul>
    4. 9. Acidosis <ul><li>Arterial blood pH level < 7.35 </li></ul><ul><li>Can be caused by metabolic problems, respiratory problems, or both </li></ul><ul><li>Clients at greatest risk for acute acidosis: those with problems that impair breathing </li></ul><ul><li>Major changes in body function: an increase in hydrogen ions creates imbalances of electrolytes, especially potassium </li></ul>
    5. 10. Respiratory Acidosis <ul><li>Respiratory acidosis results from: </li></ul><ul><ul><li>Impaired respiratory function that reduces the exchange of oxygen and carbon dioxide </li></ul></ul><ul><ul><li>Retention of carbon dioxide (through hypoventilation) that causes increased production of free hydrogen ions </li></ul></ul>
    6. 11. Causes of Respiratory Acidosis <ul><li>Respiratory depression </li></ul><ul><ul><li>Chemical depression </li></ul></ul><ul><ul><li>Physical depression </li></ul></ul><ul><li>Inadequate chest expansion </li></ul><ul><ul><li>Skeletal problems </li></ul></ul><ul><ul><li>Respiratory muscle weakness </li></ul></ul><ul><ul><li>External conditions </li></ul></ul><ul><ul><li>Airway obstruction </li></ul></ul><ul><ul><li>Reduced alveolar-capillary diffusion </li></ul></ul>
    7. 12. Respiratory Alkalosis <ul><li>Excessive loss of carbon dioxide through hyperventilation </li></ul><ul><li>Anxiety, fear, or improper settings on mechanical ventilators causing hyperventilation </li></ul><ul><li>Direct stimulation of central respiratory center from fever, metabolic acidosis, central nervous system lesions, and drugs, also causing hyperventilation </li></ul>
    8. 13. Respiratory Alkalosis <ul><li>Classic profile: </li></ul><ul><ul><li>Reduced bicarbonate level </li></ul></ul><ul><ul><li>Low pressure of arterial carbon dioxide </li></ul></ul><ul><li>Low serum potassium level </li></ul><ul><li>Low serum calcium level </li></ul>
    9. 14. Metabolic Acidosis <ul><li>Overproduction of hydrogen ions </li></ul><ul><li>Underelimination of hydrogen ions </li></ul><ul><li>Underproduction of bicarbonate ions </li></ul><ul><li>Overelimination of bicarbonate ions </li></ul>
    10. 15. Metabolic Alkalosis <ul><li>Base excess results from excessive intake of bicarbonates, carbonates, acetates, citrates, and lactates. </li></ul><ul><li>Acid deficit is caused by disease processes or medical treatments, or by prolonged vomiting, excess cortisol, or hyperaldosteronism. </li></ul>
    11. 16. Metabolic Alkalosis <ul><li>The hallmark is an increased bicarbonate level with a rising partial pressure of arterial carbon dioxide. </li></ul><ul><li>Serum potassium level decreases. </li></ul><ul><li>Calcium binding increases and hypocalcemia results. </li></ul><ul><li>Most of the serious problems are caused by the resulting hypocalcemia. </li></ul>
    12. 17. ABG (Arterial Blood Gas) Roseviminda M. Chumacera, RN, MAN
    13. 18. Description: <ul><li>A measurement of O 2 , CO 2 , as well as the pH of the arterial blood that provides a means of assessing the adequacy of ventilation and oxygenation. </li></ul><ul><li>It is also used to assess the client’s overall acid-base balance. </li></ul>
    14. 19. Indications: <ul><li>The need to evaluate the adequacy of ventilation, acid-base, oxygenation status, and the oxygen-carrying capacity of blood. </li></ul><ul><li>The need to quantify the patient’s response to therapeutic intervention and/or diagnostic evaluation (e.g., oxygen therapy, exercise testing) </li></ul><ul><li>The need to monitor severity and progression of a documented disease process. </li></ul>
    15. 20. Materials: <ul><li>2-3ml syringe </li></ul><ul><li>Needle Gauge 23-25 </li></ul><ul><li>0.5 ml sodium heparin (1:1000) </li></ul><ul><li>Rubber stopper or cap </li></ul><ul><li>2 x 2 gauze </li></ul><ul><li>Alcohol and iodine prep pad </li></ul><ul><li>Container with ice </li></ul><ul><li>Gloves </li></ul><ul><li>Towel </li></ul><ul><li>Specimen label </li></ul><ul><li>Lidocaine </li></ul>
    16. 21. Procedure: <ul><li>Explain procedure, gather materials and wash hands. </li></ul><ul><li>Palpate the artery to be used (radial, brachial or femoral). </li></ul><ul><li>If puncturing the radial artery, perform Allen’s test. </li></ul><ul><ul><li>Rest the client’s arm on the mattress or bedside stand, and support his wrist with a rolled towel. </li></ul></ul><ul><ul><li>Ask client to make a tight fist. </li></ul></ul><ul><ul><li>Press the radial and ulnar arteries for one min. using index and middle finger. </li></ul></ul>
    17. 23. Procedure: <ul><ul><li>Have client open hand. </li></ul></ul><ul><ul><li>Release pressure on ulnar artery and observe. </li></ul></ul><ul><ul><ul><li>Fingers and hand should flush within 15 secs. (Positive Allen’s test) </li></ul></ul></ul><ul><ul><ul><li>If test is negative (no flushing), radial artery should be avoided. Check the other hand. </li></ul></ul></ul><ul><li>Hyperextend client’s wrist over rolled towel. </li></ul><ul><li>Apply disposable gloves. </li></ul>
    18. 24. Procedure: <ul><li>Cleanse site with alcohol prep pad followed by povidone iodine in a circular motion and allow to dry. </li></ul><ul><li>Flush 3ml syringe with small amount of heparin and then empty syringe leaving heparin in needle and hub. (excess heparin will lower the pH and pCO 2 ) </li></ul><ul><li>Attach label to specimen syringe with client’s name, hospital #, room #, date and time, client’s body temp., and inspired oxygen concentration if client is on oxygen therapy. </li></ul>
    19. 25. Procedure: <ul><li>Palpate and stabilize the radial artery using index and middle fingers. ~ </li></ul><ul><li>Insert needle @ 30°-45° angle (60°-90° for brachial artery, 90° for femoral artery) </li></ul><ul><li>Advance the needle and observe for pulsating flow of blood into syringe. </li></ul><ul><li>Extract sufficient amount of blood for analysis, usually 2-3ml. </li></ul><ul><li>Withdraw the needle and syringe from the artery. </li></ul><ul><li>Apply firm pressure over the puncture site with sterile 2x2 gauze. Then apply pressure dressing. </li></ul>
    20. 26. Procedure: <ul><li>Expel air bubbles from the syringe and needle. Cork needle into rubber stopper. </li></ul><ul><li>Rotate syringe to mix blood with heparin for 20-30 seconds. </li></ul><ul><li>Submerge syringe in crushed ice. </li></ul><ul><li>Have specimen transported to laboratory immediately. </li></ul><ul><li>Discard materials in appropriate container. </li></ul><ul><li>Wash hands and document the procedure. </li></ul>
    21. 27. Contraindications: <ul><li>Negative results of a modified Allen test </li></ul><ul><li>Arterial punctures should not be performed: </li></ul><ul><ul><li>through a lesion or distal to a surgical shunt (e.g., AV shunt) </li></ul></ul><ul><ul><li>if there is evidence of infection or peripheral vascular disease involving the selected limb </li></ul></ul>
    22. 28. Contraindications: <ul><li>Femoral punctures should not be performed outside the hospital. </li></ul><ul><li>A coagulopathy or medium-to-high dose anticoagulation therapy (e.g., heparin or coumadin, streptokinase, and tissue plasminogen activator but not necessarily aspirin) may be a relative contraindication for arterial puncture. </li></ul>
    23. 29. Complications: <ul><li>Hematoma </li></ul><ul><li>Arteriospasm </li></ul><ul><li>Air or clotted emboli </li></ul><ul><li>Anaphylaxis from local anesthetic </li></ul><ul><li>Infection </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Trauma to the vessel </li></ul><ul><li>Arterial occlusion </li></ul><ul><li>Pain </li></ul>
    24. 30. Normal Values: 95 – 100 % SaO 2 80 -100 mmHg pO 2 22 – 26 mmol/L HCO 3 35 – 45 mmHg pCO 2 7.35 – 7.45 pH
    25. 31. ABG Interpretation <ul><li>STEP 1: Classify the pH </li></ul><ul><ul><ul><li>Normal = 7.35 – 7.45 </li></ul></ul></ul><ul><ul><ul><li>Below 7.35 = Acidemia </li></ul></ul></ul><ul><ul><ul><li>Above 7.45 = Alkalemia </li></ul></ul></ul><ul><li>STEP 2: Assess PaCO 2 </li></ul><ul><ul><ul><li>Normal = 35 – 45 mmHg </li></ul></ul></ul><ul><ul><ul><li>Below 35 = Resp. Alkalosis – caused by alveolar hyperventilation </li></ul></ul></ul><ul><ul><ul><li>Above 45 = Resp. Acidosis – caused by alveolar hypoventilation . </li></ul></ul></ul>
    26. 32. <ul><li>STEP 3: Assess HCO 3 </li></ul><ul><ul><ul><li>Normal = 22 – 26 mEq/L </li></ul></ul></ul><ul><ul><ul><li>Below 22 mEq/L = Metabolic Acidosis </li></ul></ul></ul><ul><ul><ul><li>Above 26 mEq/L = Metabolic Alkalosis </li></ul></ul></ul><ul><li>STEP 4: Determine presence of compensation </li></ul><ul><ul><ul><li>Compensation present: PaCO 2 and HCO 3 are abnormal in opposite directions, e.g., one is acidotic and the other alkalotic </li></ul></ul></ul><ul><ul><ul><li>Compensation absent: One component (PaCO 2 or HCO 3 ) is abnormal, and the other is normal </li></ul></ul></ul>
    27. 33. <ul><li>STEP 5: Identify primary disorder </li></ul><ul><ul><ul><li>Match either the pCO 2 or the HCO 3 with the pH to determine the acid-base disorder. </li></ul></ul></ul>
    28. 34. <ul><li>STEP 6: Classify degree of compensation, if present </li></ul><ul><ul><li>Partial compensation: Evidence of compensation, but pH is still abnormal. </li></ul></ul><ul><ul><li>Complete compensation: Evidence of compensation, pH is normal. </li></ul></ul>
    29. 35. Blood Parameters of Acid-Base Balance during Uncompensated & Compensated States <ul><li>Respiratory Acidosis </li></ul> Normal HCO 3   PaCO 2 Low Normal  pH Compensated Uncompensated
    30. 36. Blood Parameters of Acid-Base Balance during Uncompensated & Compensated States <ul><li>Respiratory Alkalosis </li></ul> Normal HCO 3   PaCO 2 High Normal  pH Compensated Uncompensated
    31. 37. Blood Parameters of Acid-Base Balance during Uncompensated & Compensated States <ul><li>Metabolic Acidosis </li></ul>  HCO 3  Normal PaCO 2 Low Normal  pH Compensated Uncompensated
    32. 38. Blood Parameters of Acid-Base Balance during Uncompensated & Compensated States <ul><li>Metabolic Alkalosis </li></ul>  HCO 3  Normal PaCO 2 High Normal  pH Compensated Uncompensated
    33. 39. Compensatory Response in Acid-Base Disorders  HCO3  HCO3  PaCO2,  pH  PaCO2, N/  pH Resp. Alkalosis Acute Chronic  HCO3  HCO3  PaCO2,  pH  PaCO2, N/  pH Resp. Acidosis Acute Chronic  PaCO2  HCO3  pH Met. Alkalosis  PaCO2  HCO3  pH Met. Acidosis Compensatory Response Primary Abnormality Primary Disorder
    34. 40. ABG Interpretation Exercises
    35. 41. # 1 Interpretation: _________________________________ 95 % 90 35 55 7.44 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    36. 42. # 2 Interpretation: _________________________________ 96% 82 27 47 7.3 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    37. 43. # 3 Interpretation: _________________________________ 85% 70 17 39 6.8 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    38. 44. # 4 Interpretation: _________________________________ 88% 78 20 30 7.42 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    39. 45. # 5 Interpretation: _________________________________ 80% 65 28 44 7.22 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    40. 46. # 6 Interpretation: _________________________________ 92% 84 29 49 7.38 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    41. 47. Thank You for Listening!
    42. 48. ABG Interpretation Quiz
    43. 49. # 1 Interpretation: _________________________________ 80% 50 26 58 7.30 O 2 Sat. pO 2 HCO 3 pCO 2 pH
    44. 50. # 2 Interpretation: _________________________________ 89% 70 25 56 7.28 O2 Sat. pO 2 HCO 3 pCO 2 pH
    45. 51. # 3 Interpretation: _________________________________ 96% 88 20 48 7.28 O2 Sat. pO2 HCO3 pCO2 pH
    46. 52. # 4 Interpretation: _________________________________ 89% 77 14 55 7.02 O2 Sat. pO2 HCO3 pCO2 pH
    47. 53. # 5 Interpretation: _________________________________ 89% 58 35 63 7.37 O2 Sat. pO2 HCO3 pCO2 pH
    48. 54. # 6 Interpretation: _________________________________ 97% 92 27 36 7.5 O2 Sat. pO2 HCO3 pCO2 pH
    49. 55. # 7 Interpretation: _________________________________ 98% 96 28 46 7.48 O2 Sat. pO2 HCO3 pCO2 pH
    50. 56. # 8 Interpretation: _________________________________ 97% 86 29 42 7.46 O2 Sat. pO2 HCO3 pCO2 pH
    51. 57. # 9 Interpretation: _________________________________ 50% 42 13 70 6.89 O2 Sat. pO2 HCO3 pCO2 pH
    52. 58. # 10 Interpretation: _________________________________ 89 % 78 14 59 7.0 O2 Sat. pO2 HCO3 pCO2 pH
    53. 59. # 11 Interpretation: _________________________________ 98% 100 16 19 7.54 O2 Sat. pO2 HCO3 pCO2 pH
    54. 61. ABG Sampling in an Arterial Line <ul><li>Materials: </li></ul><ul><li>2-5ml syringe </li></ul><ul><li>Gauge 21 needle </li></ul><ul><li>Heparin </li></ul><ul><li>Alcohol wipe container with ice </li></ul><ul><li>Label </li></ul>
    55. 62. <ul><li>Procedure: </li></ul><ul><li>Remove protective cap from open port on a 3-way stopcock closest to insertion site. </li></ul><ul><li>Attach non-heparinized 5ml sterile syringe without needle to open port. </li></ul><ul><li>Turn stopcock off to transducer. </li></ul><ul><li>Aspirate 5ml of blood. </li></ul><ul><li>Turn stopcock midway between open port and IV tubing </li></ul>
    56. 63. <ul><li>Procedure: </li></ul><ul><li>Discard blood filled syringe. </li></ul><ul><li>Remove 21 gauge needle from the specimen to stopcock </li></ul><ul><li>Attach specimen syringe to stopcock. </li></ul><ul><li>Turn stopcock to open port to syringe. </li></ul><ul><li>Withdraw 5ml arterial blood gas specimen. </li></ul><ul><li>Turn stopcock off to open port. </li></ul><ul><li>Expel any air in syringe and cork syringe with air lock or rubber stopper. </li></ul>
    57. 64. <ul><li>Procedure: </li></ul><ul><li>Rotate syringe to mix blood with heparin for 20-30 seconds. </li></ul><ul><li>Submerge syringe in crushed ice. </li></ul><ul><li>Have specimen transported to the laboratory immediately. </li></ul><ul><li>Irrigate or flush the line with NSS. </li></ul><ul><li>Reattach protective cap on open port. </li></ul><ul><li>Ensure good arterial waveform on monitor and document procedure. </li></ul>

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