PRH ED ABG Sampling and Analysis

Report
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.
• Analyze and interpret results
Introduction
• ABG sampling
• Information with limitations
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
• Coagulopathy, anticoagulant meds, thrombolysis
• Abnormalities of the overlying skin
• Prior vascular surgery at or proximal to the entry site
• Inadequate circulation
The Allen Test
• Assess collateral circulation
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
• Preferred site
• Superficial location
• Relatively immobile
Procedure
• Explain procedure
• Universal precautions
• Prepare region
• Local anesthetic: optional
Procedure: Initial Artery
Approach
• Allen test
• Position
• Identify artery
Specimen Collection
• Slowly advance
• Blood will fill syringe spontaneously
• If unsuccessful withdraw and redirect
• Prepare specimen for submission to lab
Post Procedure Care
• Apply direct pressure
Complications
• Hematoma
• Distal ischemia
• Pseudoaneurysm
• Localized trauma
• Infection
review
Where are abg kits kept
in the ed?
Trauma 2
Dirty Utility
Supply Pyxis
Materials
A modified Allen's test is only
required for patient’s with poor
circulation?
True
False
If unsuccessful withdraw to
epidermis and redirect?
True
False
Place the abg on ice
and tube to lab?
True
False
Analysis
• Part of diagnosis
Overview
• pH (7.35 – 7.45)
• PaCO2 (35 – 45)
• PaO2 (80 – 100)
• HCO3 (23 – 27)
• Respiratory buffer response
• Renal buffer response
Acid base disorders
• Respiratory acidosis
• Respiratory alkalosis
Acid base disorders
• Metabolic acidosis
• Metabolic alkalosis
Components of ABG
• pH
• PaO2
• PaCO2
• HCO3
• Base Excess (B.E.)
Steps to Interpretation: ABG
town
1.
Look at pH to determine the first and last name of
your ABG
2.
Look at CO2 and HCO3 to determine which one
has same last name
FIRST
MIDDLE
Compensated
Uncompensated
Respiratory
Metabolic
LAST
Acidosis
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
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
• 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
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
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
• 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
• 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
• 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
• pH 7.34, PCO2 34, HCO3- 18.6, BE -6, PO2 86%
• pH 7.58, PCO2 48, HCO3 48, BE +22, PO2 59%
Practice test
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
Is Her ABG Compensated or
Uncompensated?
Compensated
Uncompensated
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?
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
The preferred site for arterial
puncture?
Brachial
Femoral
Radial
Ulnar
True or False: during specimen
collection blood will auto fill the
syringe?
True
False
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
What is this acid base
disturbance?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Is the ABG Compensated or
Uncompensated?
Compensated
Uncompensated
Ph 7.48 PCO2 15 HCO3 25
What is the acid base
disturbance
Respiratory Acidosis
Metabolic Acidosis
Respiratory Alkalosis
Metabolic Alkalosis
Is the ABG Compensated or
Uncompensated?
Compensated
Uncompensated
pH – 7.56 PCO2 – 42 HCO3 - 46
What is this acid base
disturbance?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Is the ABG Compensated or
Uncompensated?
Compensated
Uncompensated
pH – 7.48 PCO2 – 16 HCO3 - 26
What is this acid base
disturbance?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Is the ABG Compensated or
Uncompensated?
Compensated
Uncompensated
pH – 7.38 PCO2 – 50 HCO3 - 27
What is this acid base
disturbance?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Is the ABG Compensated or
Uncompensated?
Compensated
Uncompensated
pH – 7.50 PCO2 – 35 HCO3 - 32
What is this acid base
disturbance?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Is Her ABG Compensated or
Uncompensated?
Compensated
Uncompensated
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.

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