arterial blodd gas analysis
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by: MARITES A. ROSAPAPAN, RN,MANc
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Acid Base Balance Acid
- substance that can donate or release hydrogen
ionsie Carbonic acid, Hydrochloric acid
** Carbon dioxide – combines with water to form
carbonic acid
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Base- substance that can accept hydrogen ions
Ie Bicarbonate
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BUFFER - substance that canaccept or donate hydrogen- prevent excessive changes in pH
TYPES OF BUFFER
1. Bicarbonate (HCO3): carbonic acid buffer(H2CO3)
2. Phosphate buffer
3. Hemoglobin buffer
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Dynamics of Acid Base Balance Acids and bases are constantly produced in
the body
They must be constantly regulated
CO2 and HCO3 are crucial in the balance
A HCO3:H2CO3 ratio of 20:1 should bemaintained
Respiratory and renal system are active inregulation
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Kidney- Regulate bicarbonate level in ECF
1. RESPIRATORY/METABOLIC ACIDOSIS- kidney excrete H and reabsorbs/generatesBicarbonate
2. RESPIRATORY/METABOLIC ALKALOSIS
- kidney retains H ion and excrete Bicarbonate
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Lung- Control CO2 and Carbonic acid content of ECF
1. METABOLIC ACIDOSIS- increased RR to eliminate CO2
2. METABOLIC ALKALOSIS- decreased RR to retain CO2
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pH - measures degree of acidity andalkalinity - indicator of H ion concentration
- Normal ph 7.35-7.45
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ACIDOSIS
- decreased pH; < 7.35
- increased Hydrogen
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ALKALOSIS - increased pH-; > 7.45- decreased Hydrogen
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ACUTE AND CHRONIC
METABOLIC ACIDOSIS- Low pH
- Increased H ion concentration
- Low plasma BicarbonateEtiology: diarrhea, fistulas, diuretics, renal insufficiency,TPN w/o Bicarbonate, ketoacidosis, lactic acidosis
S/sx: headache, confusion, drowsiness, inc RR, dec BP,cold clammy skin, dysrrythmia, shock
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Dx: ABG – low Bicarbonate, low pH, Hyperkalemia,
ECG changes
Rx: Bicarbonate for pH < 7.1 and Bicarbonate level < 10monitor serum K
dialysis
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ACUTE AND CHRONIC
METABOLIC ALKALOSIS
High pH
Decreased H ion concentration
High plasma Bicarbonate
Etiology: vomiting, diuretic, hyperaldosteronism,
hypokalemia, excesive alkali ingestion
s/sx: tingling of toes, dizziness, dec RR, inc PR, ventricular disturbances
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Dx:ABG – pH > 7.45, serum Bicarbonate > 26 mEq/L,inc PaCO2
Rx: restore normal fluid balancecorrect hypokalemia
Carbonic anhydrase inhibitors
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ACUTE AND CHRONIC
RESPIRATORY ACIDOSIS Ph < 7.35
PaCO2 > 42 mmHg
Etiology: pulmonary edema, aspiration, atelectasis,pneumothorax, overdose of sedatives, sleep apneasyndrome, pneumonia
s/sx: sudden hypercapnia produces inc PR, RR, incBP, mental cloudinesss, feeling of fullness in head,papil edema and dilated conjunctival blood vessels
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Dx: ABG – pH < 7.35
PaCO2 - > 42 mmHg
Rx: improve ventilation
pulmonary hygiene
mechanical ventilation
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ACUTE AND CHRONIC
RESPIRATORY ALKALOSIS
pH > 7.45
PaCO2 < 38 mmHg
Etiology: extreme anxiety, hypoxemia
s/sx: light headednes, inability to concentrate,numbness, tingling, loss of consciousness
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Dx: ABG – pH > 7.45
PaCO2 < 35dec K
dec Ca
Rx: breathe slowly
sedative
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ARTERIAL BLOOD GAS ANALYSISParameter Normal Value
pH 7.35 – 7.45
PaCO2 35 – 45 mmHg
HCO3 22-26mEq/L
O2 saturation 95 - 100%
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How to Obtain blood sample? Allen’s test - evaluate patency of
radial and ulnar artery
Heparinized syringe andcontainer
Pressure dressing, no activity atthe site and check 5 p’s distal tothe site of punctured artery
Note if patient is under O2therapy
Label the sample and sendimmediately to the laboratory
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ABG Responsibilities Arterial blood
Radial or ulnar artery
Allen’s test
Prepare
Heparinized (Syringe, specimen container)
Note: 02 therapy, FIO2, temp (bmr, o2)
Bring specimen to the LAB (ice)
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After injection
Maintain extension position, no activity 8H
Apply pressure 5-15 min Observe the site
Distal, 5 p’s
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Vascular assess
Pulselessness
Pain Paresthesia
Poikilothermia
Pallor
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Handling of Specimen Expel all air bubbles immediately
Do not agitate the syringe
Discard frothy specimen
1:1000 U/ml HEPARIN
Place sample in ice
Cool sample to 5 C if it can not be analyzed quickly
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Evaluating ABG’s 1. Note the pHpH = 7.35 – 7.45 (normal)pH = < 7.35 (acidosis)pH = > 7.45 (alkalosis)
Partially compensated – if the Co2 and Hco3are the same, with abnormal pH
Fully Compensated – if the pH is normal Uncompensated – if the Co2 and HCo3 are opposite,
with or if one of them is normal, abnormal pH
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2. Determine primary cause of disturbance2.1 pH > 7.45
a. PaCo2 < 40 mmHg – respiratory alkalosisb. HCO3 > 26 mEq/L – metabolic alkalosis
2.2 pH < 7.35
a. PaCo2 > 40 mmHg – respiratory acidosisb. HCO3 < 26 mEq/L – metabolic acidosis
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3. Determine compensation by looking at the valueother than the primary disturbance
pH PaCO2 HCO3
7.20 60mmHg
24mEq/L
7.30 60
mmHg
37
mEq/l
28
UncompensatedRespiratory acidosis
Partially CompensatedRespiratory acidosis
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4. Mixed acid-basedisorders
pH 7.21 Dec acid
PaCO2 52 Inc acid
HCO3 13 Dec acid
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MetabolicandRespiratory
Acidosis
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DRILL pH = 7.40
HCO3 = 20
PaCO2 = 40
Simple Metabolic Acidosis
pH = 7.40
HCO3 = 28
PaCO2 = 40
Simple Metabolic Alkalosis
pH = 7.40
HCO3 = 24
PaCO2 = 48
Simple Respiratory Acidosis
pH = 7.40
HCO3 = 24
PaCO2 = 32
Simple Respiratory Alkalosis
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pH = 7.33
HCO3 = 20
PaCO2 = 40
pH = 7.47
HCO3 = 28 PaCO2 = 40
pH = 7.33
HCO3 = 24
PaCO2 = 48
pH = 7.47
HCO3 = 24 PaCO2 = 32
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DRILL
pH = 7.33
HCO3 = 20
PaCO2 = 32
pH = 7.47
HCO3 = 28
PaCO2 = 48
pH = 7.33
HCO3 = 28
PaCO2 = 48
pH = 7.47
HCO3 = 20
PaCO2 = 32
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ANSWER:
pH = 7.33
HCO3 = 20
PaCO2 = 32
Uncompensated Metabolic Acidosis
pH = 7.47
HCO3 = 28
PaCO2 = 48
Uncompensated Metabolic Alkalosis
pH = 7.33
HCO3 = 28
PaCO2 = 48
Uncompensated Respiratory Acidosis
pH = 7.47
HCO3 = 20
PaCO2 = 32
Uncompensated Respiratory Alkalosis
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DRILL
pH = 7.40
HCO3 = 18
PaCO2 = 32
pH = 7.35
HCO3 = 30
PaCO2 = 48
pH = 7.40
HCO3 = 28
PaCO2 = 48
pH = 7.44
HCO3 = 20
PaCO2 = 32
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ANSWER
pH = 7.40 HCO3 = 18 PaCO2 = 32 Fully
Compensated Metabolic Acidosis
pH = 7.35 HCO3 = 30 PaCO2 = 48 Partially Compensated Respiratory
Acidosis
pH = 7.40 HCO3 = 28 PaCO2 = 48 Fully
Compensated Respiratory Acidosis
pH = 7.44 HCO3 = 20
PaCO2 = 32 Partially Compensated Respiratory
Alkalosis
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Thank You!