Venous Blood Gases Station

Facilitation Guide
Objectives:
After participating in the station, the RN/LPN will be able to:
State the advantages and disadvantages of VBGs
Identify the correlation of VBG values to ABG values
Describe how different sample sites affect interpretation of VBG values
(central/femoral/peripheral)
o What can/cannot reasonably be evaluated from the sample based on site
o When VBGs are not reliable/useful (and ABGs are indicated)
o Interpretation of specific results (high/low)
Describe/Demonstrate the correct technique for obtaining VBGs from a central line
and peripherally
Describe/Demonstrate the correct technique for sending the sample to the lab
Station
1. What are some advantages of doing a VBG instead of an ABG? [flip chart]
Nurses can obtain blood sample (fewer delays in care)
Less painful than arterial puncture
Less at risk for bleeding and hematoma
Less potential for nerve injury
pH, PCO2, HCO3 and base excess are usually adequate for clinical decision making

2. What are some disadvantages? [flip chart]

ABGs are the gold standard
VBGs cannot determine the PaO2

3. How do VBG values correlate with ABG values? [flip chart activity]
[Discuss each sample site separately. Use interactive chart on flip paper to demonstrate
visually]
The site the sample is drawn from (central/femoral/peripheral) affects how you
interpret the values
Preferred method is to draw VBG from a central catheter (internal jugular,
subclavian, PICC)
o Be mindful of how much you are sampling from a CVAD- regarding discard
o Provides a broader reflection of systemic pH as compared to peripheral
o Correlation between ABGs and central VBGs supported by the most research
evidence and clinical experience
o Limited to reflect only the venous return from organs captured by catheter
location (e.g. subclavian line sample reflects blood coming from the head
and upper extremities)
 ABG (N values) VBG-Central Notes VBG-
Peripheral
pH 7.35 7.45 0.03-0.05 below Venous tends to 0.02-0.04
be more acidic below
PCO2 35-45mmHg 4-5 above Dissociates 3-8 above
once above 45.
Venous does
trend up as
arterial rises
but correlation
is lost.
HCO3 22- 26 mmol/l Almost the same Best correlation 1-2 above

PO2 80100 mmHg No correlation No correlation

Base + 2mEq/L About the same About the same

Excess
Lactate < 2mmol/L About the same Correlates About the same
unless >2

pH
most useful value but still limitations
slightly more acidic than arterial

O2
Although pH, PaCO2 and bicarb closely correlate, arterial and venous O2 does not
correlate at all- what does venous O2 tell us?
o Is of no value assessing the patients oxygenation status
o The O2 level in a venous gas reflects the amount of oxygen leftover in the
blood after the tissues have extracted oxygen but before re-oxygenation.
Does not tell us how much oxygen was in the blood to begin with (arterial)
o Normal value 40 50 mmHg
o Trends are more valuable than the absolute value
o A lower O2 level indicates that more oxygen is being extracted- this can
occur when cardiac output alone is insufficient to meet tissue oxygen
demand - compensate by extracting more oxygen
o To evaluate treatment aimed at increasing cardiac output, sats or arterial
paO2 is used
Oxygen Delivery = Cardiac Output X Oxygen Content (Hb X SaO2)
o Higher O2 levels are most commonly associated with sampling errors such as
air in the syringe or with high arterial levels of O2
Peripheral Venous gases
Are useful in determining acid-base balance and to follow acid- base balance
trends
4. When are venous gases not useful (and ABGs are indicated) ?
 All correlation between venous gases and arterial gases will break down in shock
and severe hypotensive states, therefore arterial gases are recommended in
hypotensive/critically ill patients
To accurately determine the PaO2
To accurately determine the PaCO2 if hypercapnnic (PaCO2 greater than 45 mmHg).
If venous CO2 is elevated, you know that the arterial CO2 is elevated but you have
no way of knowing by how much.[Correlates within the normal values but above
this range correlates poorly with the PaCo2]
5. Sampling Technique
Peripheral
Remove needle and air from blood gas syringe
Attach blood gas syringe to butterfly needle ( Vacutainer Safety- Lok blood collection set,
not push button set)
Choose a vein , once in the vein gently withdraw minimum of 1.7 mLs of blood
Then disconnect blood gas syringe from butterfly

Central Venous Access Device (CVAD)

Remove needle and air from blood gas syringe
Connect 10 mL syringe to needleless adaptor and discard 6 mLs
Connect 10 mL syringe to needleless adaptor and withdraw 3 mLs of blood
Flush CVAD as per policy
Connect 3 mL sample and empty blood gas syringe using the double connector
Gently transfer a minimum volume of 1.7 mLs of blood to the blood gas syringe

Once Collected in Blood Gas Syringe:

Expel air from blood gas syringe and attach black cap
Mix sample for at least 20 seconds to ensure proper mixing with Heparin
Label barrel of syringe and place in slurry of ice and water
Complete blood gas requisition (indicate venous blood gas, location of sampling site,
temperature and whether receiving supplementary oxygen or room air) and send to lab
Note: Venous Gases are Last in the Order of Draw
References:

1) London Health Sciences Centre (2016). Procedure for Venous Blood Gas Sampling.
Retrieved from:
http://www.lhsc.on.ca/Health_Professionals/CCTC/procedures/venousgases.htm

2) Life in the Fast Lane (2016). VBG versus ABG. Retrieved from:
http://lifeinthefastlane.com/ccc/vbg-versus-abg/

3) Acadoodle (2015). How to read a venous blood gas, top 5 tips. Retrieved from:
https://www.acadoodle.com/index.php/how-to-read-a-venous-blood-gas-vbg-top-5-tips?
fb_comment_id=571097109673140_708432612606255

4) Medical Surgical Nursing in Canada (2014). Chapter 19, Table 19-16. Elsevier. Toronto
Canada.