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Arterial Blood Gas Sampling and analysis: Radial Approach. Presented by: Jonna Bobeck BSN, RN, CEN. Objectives. Understand ABG Discuss indications Describe contraindications for performing an arterial puncture. Demonstrate the technique for performing an arterial puncture.

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arterial blood gas sampling and analysis radial approach

Arterial Blood Gas Sampling and analysis:Radial Approach

Presented by:

Jonna Bobeck BSN, RN, CEN

objectives
Objectives
  • Understand ABG
  • Discuss indications
  • Describe contraindications for performing an arterial puncture.
  • Demonstrate the technique for performing an arterial puncture.
  • Analyze and interpret results
introduction
Introduction
  • ABG sampling
  • Information with limitations
indications
Indications
  • Determination of pH and partial pressure of respiratory gases
  • Determination of other serum blood levels
  • Assessment of patient response to therapeutic interventions
  • Assessment of progression of disease process
contraindications
Contraindications
  • Coagulopathy, anticoagulant meds, thrombolysis
  • Abnormalities of the overlying skin
  • Prior vascular surgery at or proximal to the entry site
  • Inadequate circulation
the allen test
The Allen Test
  • Assess collateral circulation
equipment
Equipment
  • Gloves
  • Antiseptic solution
  • Syringe
  • 1% lidocaine (optional)
  • 1.5-inch 22 to 23 guage needle
  • Specimen bag with ice
  • Syringe cap
  • Bandage
anatomy of radial artery
Anatomy of Radial Artery
  • Preferred site
  • Superficial location
  • Relatively immobile
procedure
Procedure
  • Explain procedure
  • Universal precautions
  • Prepare region
  • Local anesthetic: optional
procedure initial artery approach
Procedure: Initial Artery Approach
  • Allen test
  • Position
  • Identify artery
specimen collection
Specimen Collection
  • Slowly advance
  • Blood will fill syringe spontaneously
  • If unsuccessful withdraw and redirect
  • Prepare specimen for submission to lab
post procedure care
Post Procedure Care
  • Apply direct pressure
complications
Complications
  • Hematoma
  • Distal ischemia
  • Pseudoaneurysm
  • Localized trauma
  • Infection
where are abg kits kept in the ed
Where are abg kits kept in the ed?

Trauma 2

Dirty Utility

Supply Pyxis

Materials

analysis
Analysis
  • Part of diagnosis
overview
Overview
  • pH (7.35 – 7.45)
  • PaCO2 (35 – 45)
  • PaO2 (80 – 100)
  • HCO3 (23 – 27)
  • Respiratory buffer response
  • Renal buffer response
acid base disorders
Acid base disorders

Respiratory acidosis

Respiratory alkalosis

acid base disorders1
Acid base disorders

Metabolic acidosis

Metabolic alkalosis

components of abg
Components of ABG
  • pH
  • PaO2
  • PaCO2
  • HCO3
  • Base Excess (B.E.)
steps to interpretation abg town
Steps to Interpretation: ABG town
  • Look at pH to determine the first and last name of your ABG
  • Look at CO2 and HCO3 to determine which one has same last name
slide25

FIRST MIDDLE LAST

Compensated Respiratory Acidosis

Uncompensated Metabolic Alkalosis

pH

Uncompensated Acid…………..7.35 --- 7.45……………Uncompensated Alk

CO2 Respiratory Acid

Respiratory Alkalosis………………35 – 45………………Respiratory Acidosis

HCO3 Metabolic Base

Metabolic Acidosis………………….23 – 27………………Metabolic Alkalosis

Compensated Gases

7.35…………………………….......7.40/7.41………………………………..7.45

Compensated Acidosis Compensated Alkalosis

example one
Example One

Jane Doe is a 45 year-old female admitted

to the nursing unit with a severe asthma

attack. She has been increasing shortness

Of breath since admission three hours ago.

Her arterial blood gas result is as follows:

pH – 7.22

CO2 – 55

HCO3 – 25

B.E - 23

result
Result
  • First name – uncompensated
  • Last name – acidosis
  • Look at CO2 and HCO3 to determine which one has the same last name
  • CO2 – 55 (acidosis)
  • Uncompensated respiratory acidosis
example two
Example Two

John Doe is a 55 year-old male admitted to

your Emergency Department with a bowel

Obstruction. He has been experiencing

intractable vomiting for the last several

hours. His arterial blood gas result is as follows:

pH – 7.50

CO2 – 42

HCO3 – 33

B.E. - 26

result1
Result
  • First name – uncompensated
  • Last name – alkalosis
  • Look at CO2 and HCO3 to determine which one has the same last name
  • HCO3 – 33 (alkalosis)
  • Uncompensated metabolic acidosis
compensation
Compensation
  • Over time the body attempts to compensate
  • Uncompensated, partially compensated, fully compensated
  • When the CO2 or HCO3 go in the opposite direction of the pH there is compensation by that system
a bit harder
A Bit harder

pH = 7.36 PaCO2 = 56 HCO3- = 26

pH = 7.43 PaCO2 = 32 HCO3- = 29

pH = 7.35 PaCO2 = 31 HCO3- = 18.1

pH = 7.19 PaCO2 = 45 HCO3- = 18.1

pH = 7.44 PaCO2 = 47 HCO3- = 26

the prefix to the name
The prefix to the name

pH = 7.09 PaCO2 = 50 HCO3- = 30

pH = 7.21 PaCO2 = 55 HCO3- = 28

pH = 7.67 PaCO2 = 60 HCO3- = 45

pH = 7.45 PaCO2 = 33 HCO3- = 20

pH = 7.01 PaCO2 = 20 HCO3- = 10

o2 and base excess
O2 and base excess

pH 7.34, PCO2 34, HCO3- 18.6, BE -6, PO2 86%

pH 7.58, PCO2 48, HCO3 48, BE +22, PO2 59%

slide35

Mrs. Smith is a 65 year-old woman who is in your ED with decreased level of consciousness. Her ABG results:

pH – 7.28 PCO2 – 74 HCO3 - 26

What is the acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

what test is used to assess collateral circulation prior to obtaining an abg
What test is used to assess collateral circulation prior to obtaining an ABG?

Semmes-Weinstein Test

The Allen Test

The Snuffbox Test

indications for obtaining an abg
Indications for obtaining an ABG?

Determination of pH and partial pressure of respiratory gases

Determination of other serum blood levels

Assessment of patient response to therapeutic interventions

Assessment of progression of disease process

All the above

post procedure how long do you apply direct pressure to puncture site
Post procedure how long do you apply direct pressure to puncture site?

10 Minutes

30 seconds

Just apply dressing

5 Minutes

mr j is in trauma 6 with a history of iddm his abg results ph 7 25 pco2 35 hco3 38
Mr. J is in trauma 6 with a history of IDDM. His ABG results:pH – 7.25 PCO2 – 35 HCO3 - 38

What is this acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

ph 7 48 pco2 15 hco3 25 what is the acid base disturbance
Ph 7.48 PCO2 15 HCO3 25What is the acid base disturbance

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

ph 7 56 pco2 42 hco3 46
pH – 7.56 PCO2 – 42 HCO3 - 46

What is this acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

ph 7 48 pco2 16 hco3 26
pH – 7.48 PCO2 – 16 HCO3 - 26

What is this acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

ph 7 38 pco2 50 hco3 27
pH – 7.38 PCO2 – 50 HCO3 - 27

What is this acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

ph 7 50 pco2 35 hco3 32
pH – 7.50 PCO2 – 35 HCO3 - 32

What is this acid base disturbance?

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

references
references

Corning, HS & Bryant, SL. Mosby’s Respiratory Care PDQ. Mosby, 2005.

Hennessey, I & Japp, A. Arterial blood gases made easy. Churchill Livingstone, 1st edition. 2007.

Hogan, MA & Wane, D. Fluids, electrolytes, and acid –base balance. Pearson Education, Inc., 1st edition. 2003.

Malley, WJ. Clinical blood gases: Assessment & Intervention. Saunders, 2nd edition. 2004.

Morton, PG, Fontaine, DK, Hudak, CM, Gallo, BM. Critical care nursing: A holistic approach. Lippincott, Williams, and Wilkins, 8th edition. 2005.

Oakes, D. Arterial blood gas pocket guide. Respiratorybooks.com. 2009.

Springhouse. Respiratory care made incredibly easy. Lippincott, Williams & Wilkins. 2004.