BLOOD GAS ANALYSIS ( TAKE ARTERIAL BLOOD AT MANNEQUIN)

1.Do take arterial blood in mannequin

Obtaining Arterial Blood Sample

Prior to Obtaining Sample

 Check patients chart for

o The order (with or without oxygen?)
o What is the current oxygen order?
o Is the patient a COPD ?
 If a recent FIO2 change has occurred, you must wait 5-10 minutes before performing the
puncture. With COPD patients wait 20-30 minutes!
 Is the patient receiving anti-coagulants or thrombolytics? Bleeding disorders? Shunt?
 Prepare the syringe ---- wet with heparin and no air space in syringe.
Ways to Obtain Arterial Blood

 Radial Puncture
 Brachial Puncture
 Femoral Puncture
 Arterial Line Draws
Radial Site

 Near the surface

 Best chance of collateral circulation
 No large veins nearby
 Not too painful
Perform the Allen’s Test Prior to Radial Puncture

 Tests for adequate collateral circulation

 Results can assist in determining which radial artery to use - left versus right
 Have patient make a fist while you tightly squeeze both the radial and ulnar arteries; Let go of
the ulnar and watch to see if hand is uniformly re-perfused (pinks up). If large areas remain
pale - check the other hand.

Steps in Performing Arterial Puncture

 Choose site - Radial is first site of choice

 Don gloves & clean site using Betadine &/or alcohol pad
 Prepare syringe - position gauze for holding the site after puncture is completed
 Palpate site; make sure bevel of needle is pointing up & needle is parallel to artery.
 Insert needle slowly at a 45 degree until blood enters the hub of the needle
Issues in Arterial Puncture

 Blood will enter syringe automatically because it is under pressure

 Arterial blood is generally brighter red than venous blood. It is best to obtain a 1 - 2 ml of
arterial blood. (Most blood gas machines can give accurate blood gas values with a sample of
low as 0.2 ml of arterial blood.)
 Use supplied 1 inch 22 gauge needle for radial
 Use larger and longer for brachial (can continue to use 22 gauge for brachial)
 Definitely hand brachial needle ( 1 and half inch 20guage) to ER doctor for femoral draw
  Use smaller gauge needle for infants and smaller volume sample of blood
Helpful Hints for better technique

 Elevate the wrist for better success – Positioning one of the keys
 Quickly enter the skin and then slowly advance to ‘flash in the hub’
 If advance too quickly, can flash and stop – Slowly withdraw – blood may restart
 If miss the artery on first angle of attack, then withdraw to the bevel and redirect medially or
laterally
 Second key is keep palpating the pulse after first direction unsuccessful
 You will need to decide on which side you missed the artery on
 Some protocols dictate only two redirects
Post-puncture Issues

 Upon needle removal, immediately hold site with pressure using gauze for 5 minutes.
Inspect site to assure bleeding has stopped. Band-aid is optional
 Ice sample unless it is to be run immediately
 Note patient’s FIO2 and temperature
 If you have time, return after running sample and check for hematoma or occlusion
of vessel
Complications of Arterial Puncture

 Arteriospasm Air or clotted blood emboli

 Hematoma at site Hemorrhage
 Pain Trauma to artery or nerve
 Inadvertent needle stick Loss of feeling below puncture site

2. Handling syringe and specimen after puncture

 Expel any air present using care not to splatter blood

 Insert exposed needle into “rubber block” or “wax cap”. DANGER! Do NOT re-
cap needle! (In old days - Scoop with a one-hand-technique)
o Prevents contact with oxygen in air and inadvertent needle sticks
 Mix blood (with heparin) by rolling syringe between fingers and turning it upside down
 DELIVER THE SPECIMEN TO THE LABORATORY WITHIN 15 MINUTES OF COLLECTION
3. How to interpretation blood gas analysis result
Characteristics of Arterial Blood Gas Values

 Blood gas machine actually measures only the following values

o PO2; PCO2; Ph, SO2% (saturation); HCO3; Base Excess
o
PURPOSE TO EXAMINE ARTERIAL BLOOD GAS ANALIZE
1.Evaluates how effectively the lungs are delivering oxygen to
the blood and how efficiently they are eliminating carbon
dioxide from it.
2 Evaluates how well the lungs and kidneys are interacting to
maintain normal blood pH (acid-base balance).

Normal ABG Values

pH 7.40 (7.35 – 7.45)
 PaCO2 35 – 45 mmHg
PaO2 80 – 100 mmHg
HCO3 : 22 – 26 m eq /L
O2 saturation : 95 – 100 %
Base excess : + or - 2

THE'6'EASY'STEPS'TO'ABG'ANALYSIS:

2. Is"the"pH"normal?
Analyze pH The"first"step"in"analyzing"ABGs"is"to"look"at"the"pH.""
Normal"blood"pH"is 7.35"to"7.45.
If"blood"pH"falls"below"7.35"it"is"acidotic.""
If" blood"pH"rises above"7.45,"it"is"alkalotic
3. Is"the"CO2"normal?
Step2: Analyze CO2
The"second"step"is"to"examine"the"pCO2.""Normal"pCO2"levels"are"35-
45mmHg.""
Below" 35"is"alkalotic,"above"45"is"acidotic.
4. Is"the"HCO3"normal?
Analyze the HCO3
The"third"step"is"to"look"at"the"HCO3"level.""A"normal"HCO3"level"is"22 -26
"mEq/L.
If"theHCO3"is"below"22,"the"patient"is"acidotic
If"the"HCO3"is"above"26,"the"patient"is" alkalotic
5. Match"the"CO2"or"the"HCO3"with"the"pH
Next"match"either"the"pCO2"or"the"HCO3"with"the"pH"to"determine"the"acid
base" disorder.
For"example,
IF THE PH IS ACIDOTIC ( < 7,35) :
a) IF "the"CO2"is"acidotic, ( > 45 ) the"acid base"
disturbance"is"being"caused"by"the"respiratory"system.""
Therefore,"we"call"it"a" respiratory acidosis.
b) If the HCO3 is acidotic ( < 22 ) the"acid base"
disturbance"is"being"caused"by"the"metabolic system.
Therefore,"we"call"it"a" metabolic acidosis.
IF"THE"PH"IS"ALKALOTIC ( > 7,45 )
a) IF "the"CO2"is"alkalotic ( < 35 ) the"acid base"
disturbance"is"being"caused"by"the"respiratory"system.""
Therefore,"we"call"it"a" respiratory"alkalosis.
b) If the HCO3 is alkalotic ( > 26 ) the"acid base"
disturbance"is"being"caused"by"the"metabolic system.
Therefore,"we"call"it"a" metabolic alkalosis.
 6. Does"the"CO2"or"the"HCO3"go"the"opposite"direction of"the pH?
Fifth,"does"either"the"CO2"or"HCO3"go"in"the"opposite"direction"of"the"pH?
If"so,"there"is"compensation"by"that"system.
For"example,"the"pH"is"acidotic,"the"CO2"is"acidotic,"and"
the"HCO3"is"alkalotic.
The"CO2"matches"the"pH"making"the"primary"acid base"disorder :
respiratory"acidosis.
The"HCO3"is"opposite"of"the"pH"and"would"be"evidence"of"
compensation"from"the"metabolic"system.
7. Are"the"pO2"and"the"O2"saturation"normal?
Step 6: Analyze the $pO2 and the O2 saturation.
Finally,"evaluate"the"PaO2"and"O2"sat.""If"they"are"below"normal"there"is"evi
dence"of" hypoxemia.

Case Example :
Tono 30 years old male , brought into ER unconcious.A friend found him. No other
history is available. Phy Exam is unremarkable except rapid and shallow breathing
. Arterial blood gas :
pH : 7,2 ( N : 7,35 – 7,45)
p CO 2 : 37 mm Hg ( N : 35 – 45 )
p O2 : 77 mm Hg ( N ; 75 – 100 )
p HCO3 : 17 mmol/L (N : 22 – 26 )
O2 sat : 95 % ( 95 – 100 )
O2 content : 18 ml / 100 ml blood ( 17 – 22 )
ACYDOSIS METAB

pH : 7,33 ( N : 7,35 – 7,45)

p CO 2 : 32 mm Hg ( N : 35 – 45 )
p O2 : 77 mm Hg ( N ; 75 – 100 )
p HCO3 : 17 mmol/L (N : 22 - 26 )
O2 sat : 95 % ( 95 – 100 )
O2 content : 18 ml / 100 ml blood ( 17 – 22 )
ACIDOSIS METAB TERKOMPENSASI ( HAMPIR PENUH)

pH : 7,50 ( N : 7,35 – 7,45)

p CO 2 : 31 mm Hg ( N : 35 – 45 )
p O2 : 77 mm Hg ( N ; 75 – 100 )
p HCO3 : 25 mmol/L (N : 22 – 26 )
O2 sat : 95 % ( 95 – 100 )
O2 content : 18 ml / 100 ml blood ( 17 – 22 )
Alkalosis Respiratoric