Arterial Blood Gas Analysis

What is an ABG?
The Components
pH / PaCO2 / PaO2 / HCO3 / O2sat / BE

Desired Ranges
pH - 7.35 - 7.45 PaCO2 - 35-45 mmHg PaO2 - 80-100 mmHg HCO3 - 21-27 O2sat - 95-100% Base Excess - +/-2 mEq/L

Why Order an ABG?

Aids in establishing a diagnosis Helps guide treatment plan Aids in ventilator management Improvement in acid/base management allows for optimal function of medications Acid/base status may alter electrolyte levels critical to patient status/care

 When to order an arterial line - Need for continuous BP monitoring Need for multiple ABGs

Where to place -- the options

Radial Femoral Brachial Dorsalis Pedis Axillary

Assessment
Blood gas analyzer Arterial blood Heparinised blood collected & directly introduced to analyser Blood gas analysers have electrodes analyzing various parameters Blood should be analyzed in hour of collection No contact with air In suspected acid base disorder electrolytes should be estimated

 Partial pressure
The pressure exerted by each type of gas in a mixture

Diffusion of gases through liquids

Concentration of a gas in a liquid is determined by its partial pressure and its solubility

 Transport of gases between the alveoli and (pulmonary) capillaries and eventually from the capillaries to the tissues diffusion dependent on perfusion and the

partial pressure (pp) exerted by each gas

gases diffuse from area of conc. (pp) to

conc. (pp)

Diffusion

concentration pp of gas diffusion

CO2 more soluble than O2, therefore it diffuses faster

Oxygen and Carbon Dioxide Diffusion Gradients

Oxygen
Moves from alveoli into blood. Blood is almost completely saturated with oxygen when it leaves the capillary P02 in blood decreases because of mixing with deoxygenated blood Oxygen moves from tissue capillaries into the tissues

Carbon dioxide
Moves from tissues into tissue capillaries Moves from pulmonary capillaries into the alveoli

10

PO2 and PCO2 in Blood

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The Terms
ACIDS
Acidemia Acidosis
Respiratory CO2 Metabolic HCO3

BASES
Alkalemia Alkalosis
Respiratory CO2 Metabolic HCO3

The Steps
Start with the pH Note the PCO2 Calculate anion gap Determine compensation

Acid Base Balance

The body produces acids daily
15,000 mmol CO2 50-100 mEq Nonvolatile acids

The lungs and kidneys attempt to maintain balance