ARTERIAL BLOOD GAS ANALYSIS

INTRODUCTION:

The most commonly used measures of gas exchange are the partial pressures of
O2 and CO2 in arterial blood, i.e., PaO and PaCO , respectively. These partial
pressures do not measure 22 directly the quantity of O2 and CO2 in blood but rather the
driving pressure for the gas in blood. The actual quantity or content of a gas in blood
also depends on the solubility of the gas in plasma and the ability of any component of
blood to react with or bind the gas of interest. Since hemoglobin is capable of binding
large amounts of O2, oxygenated hemoglobin is the primary form in which O2 is
transported in blood.

DESCRIPTION

 A measurement of oxygen, CO2, and the pH of the blood that provides a means
of assessing the adequacy of ventilation (Paco 2), oxygenation (PaO2).
 Allows assessment of the acid-base (pH) status of the body whether acidosis or
alkalosis is present, whether acidosis or alkalosis is respiratory or metabolic in
origin and to what degree (compensated or uncompensated).
 Allows evaluation of response to clinical interventions and diagnostic evaluation
(oxygen therapy, exercise testing).

PROCEDURE:

Assisting with Arterial Puncture for Blood Gas Analysis

EQUIPMENT

 Commercially available blood gas kitor

 2- or 3-mL syringe
 23G or 25G needle
 0.5 mL sodium heparin (1:1,000)
  Stopper or cap
 Lidocaine
 Sterile germicide
 Cup of plastic bag with crushed ice
 Gloves

PROCEDURE

Nursing Action Rationale

Preparatory phase
1 Record the patient's inspired Changes in inspired oxygen concentration alter the
. oxygen concentration. . change in PaO2. Degree of hypoxemia cannot be
assessed without knowing the inspired oxygen
concentration.

2 Take the patient's temperature. May be considered when results are evaluated.
. Hyperthermia and hypothermia influence oxygen
release from hemoglobin.

If not using a commercially available blood gas kit:

3 Heparinize the 2-mL syringe.  

.
  a.Withdraw heparin into the  a.This action coats the interior of the syringe with
syringe to wet the plunger heparin to prevent blood from clotting.
and fill dead space in the
needle.
  b.Hold syringe in an upright  b.Air in the syringe may affect measurement of
position and expel excess PaO2; heparin in the syringe may affect
heparin and air bubbles. measurement of the pH.
Performance phase (By physician, or by nurse or respiratory therapist with special
instruction)
1. Wash hands  
2. Put on gloves.  
3. Palpate the radial, brachial or femoral artery. The radial artery is the preferred site
of puncture. Arterial puncture is
performed on areas where a good
pulse is palpable.
4. If puncturing the radial artery, perform the The Allen test is a simple method
Allen test. for assessing collateral circulation in
the hand. Ensures circulation if
radial artery thrombosis occurs.

In the conscious patient:

  a.Obliterate the radial and ulnar pulses   a.Impedes arterial blood flow into
simultaneously by pressing on both blood the hand.
vessels at the wrist.
  b.Ask the patient to clench and unclench his  b.Forces blood from the hand.
fist until blanching of the skin occurs.
  c.Release pressure on ulnar artery (while   c. Documents that ulnar artery alone
still compressing radial artery). Watch for is capable of supplying blood to
return of skin color within 15 seconds. the hand, because radial artery is
still occluded.
 
In the unconscious patient:
  a.Obliterate the radial and ulnar pulses  
simultaneously at the wrist.
  b.Elevate the patient's hand above the heart  
and squeeze or compress his hand until
 blanching occurs.
  c.Lower the patient's hand while still  
compressing the radial artery (release
pressure on ulnar artery) and watch for
return of skin color.
5. For the radial site, place a small towel roll To make the artery more
under the patient's wrist. accessible.
6. Feel along the course of the radial artery and The wrist should be stabilized to
palpate for maximum pulsation with the allow for better control of the
middle and index fingers. Prepare the skin needle.
with germicide. The skin and subcutaneous
tissues may be infiltrated with a local
anesthetic agent (lidocaine).
7. The needle is at a 45- to 60-degree angle to The arterial pressure will cause the
the skin surface (see accompanying figure) syringe to be filled within a few
and is advanced into the artery. Once the seconds.
artery is punctured, arterial pressure will
push up the hub of the syringe and a
pulsating flow of blood will fill the syringe.

Technique of arterial puncture for blood gas analysis.

8. After blood is obtained, withdraw the needle Significant bleeding can occur
and apply firm pressure over the puncture because of pressure in the artery.
with a dry sponge.
9. Remove air bubbles from syringe and Proper closure of the needle
needle. Use safety syringe system for prevents room air from mixing with
closure. the blood specimen.
10 Place the capped syringe in the container of. Icing the syringe will prevent a
. ice. clinically significant loss of oxygen.
11 Maintain firm pressure on the puncture site. Firm pressure on the puncture site
. for 5 minutes. If the patient is on prevents further bleeding and
 anticoagulant medication, apply direct hematoma formation.
pressure over puncture site for 10 to 15
minutes and then apply a firm pressure
dressing.
12 For patients requiring serial monitoring of All connections must be tight to
. arterial blood, an arterial catheter (connected . avoid disconnection and rapid blood
to a flush solution of heparinized saline) is loss. The arterial line also allows for
inserted into the radial or femoral artery. direct blood pressure monitoring in
the critically ill patient.
Follow-up phase
1. Send the labeled, iced specimen to the Blood gas analysis should be done
laboratory immediately. as soon as possible because PaO 2
and pH can change rapidly.
2. Palpate the pulse (distal to the puncture Hematoma and arterial thrombosis
site), inspect the puncture site, and assess are complications following this
for cold hand, numbness, tingling, or procedure.
discoloration.
3. Change ventilator settings, inspired oxygen The PaO2 results will determine
concentration or type and setting of whether to maintain, increase, or
respiratory therapy equipment if indicated by decrease the Fio2. The PaO2 and pH
the results. results will detect if any changes are
needed in tidal volume of rate of
patient's ventilator.

NURSING AND PATIENT CARE CONSIDERATIONS

 Blood can be obtained from any artery but is usually drawn from the radial,
brachial, or femoral site. It can be drawn directly by arterial puncture or accessed
by way of indwelling arterial catheter. Determine facility policy for qualifications
for ABG sampling and site of arterial puncture.
  If the radial artery is used, an Allen test must be performed before the puncture
to determine if collateral circulation is present.
 Arterial puncture should not be performed through a lesion, through or distal to a
surgical shunt, or in area where peripheral vascular disease or infection is
present.
 Coagulopathy or medium- to high-dose anticoagulation therapy may be a relative
contraindication for arterial puncture.
 Interpret ABG values by looking at the following (normal values are listed):
o PaO2-”partial pressure of arterial oxygen (80 to 100 mm Hg)
o Paco2-”partial pressure of arterial carbon dioxide (35 to 45 mm Hg)
o Sao2-”arterial oxygen saturation (> 95%)
o pH- ”hydrogen ion concentration, or degree of acid-base balance (7.35 to
7.45); bicarbonate (HCO3-) ion primarily a metabolic buffer-”22 to 26
mEq/L.

CONCLUSION:

Arterial blood gas analysis is a frequent performed procedure in critical care

area. It gives an analysis of blood gases which is necessary for decision in treatment
modalities in critical care.
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