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Arterial Blood Gas Sampling and analysis: Radial Approach Presented by: Jonna Bobeck BSN, RN, CEN.

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Presentation on theme: "Arterial Blood Gas Sampling and analysis: Radial Approach Presented by: Jonna Bobeck BSN, RN, CEN."— Presentation transcript:

1 Arterial Blood Gas Sampling and analysis: Radial Approach Presented by: Jonna Bobeck BSN, RN, CEN

2 Objectives Understand ABGUnderstand ABG Discuss indicationsDiscuss indications Describe contraindications for performing an arterial puncture.Describe contraindications for performing an arterial puncture. Demonstrate the technique for performing an arterial puncture.Demonstrate the technique for performing an arterial puncture. Analyze and interpret resultsAnalyze and interpret results

3 Introduction ABG samplingABG sampling Information with limitationsInformation with limitations

4 Indications Determination of pH and partial pressure of respiratory gasesDetermination of pH and partial pressure of respiratory gases Determination of other serum blood levelsDetermination of other serum blood levels Assessment of patient response to therapeutic interventionsAssessment of patient response to therapeutic interventions Assessment of progression of disease processAssessment of progression of disease process

5 Contraindications Coagulopathy, anticoagulant meds, thrombolysisCoagulopathy, anticoagulant meds, thrombolysis Abnormalities of the overlying skinAbnormalities of the overlying skin Prior vascular surgery at or proximal to the entry sitePrior vascular surgery at or proximal to the entry site Inadequate circulationInadequate circulation

6 The Allen Test Assess collateral circulationAssess collateral circulation

7 Equipment GlovesGloves Antiseptic solutionAntiseptic solution SyringeSyringe 1% lidocaine (optional)1% lidocaine (optional) 1.5-inch 22 to 23 guage needle1.5-inch 22 to 23 guage needle Specimen bag with iceSpecimen bag with ice Syringe capSyringe cap BandageBandage

8 Anatomy of Radial Artery Preferred site Superficial location Relatively immobile

9 Procedure Explain procedureExplain procedure Universal precautionsUniversal precautions Prepare regionPrepare region Local anesthetic: optionalLocal anesthetic: optional

10 Procedure: Initial Artery Approach Allen testAllen test PositionPosition Identify arteryIdentify artery

11 Specimen Collection Slowly advanceSlowly advance Blood will fill syringe spontaneouslyBlood will fill syringe spontaneously If unsuccessful withdraw and redirectIf unsuccessful withdraw and redirect Prepare specimen for submission to labPrepare specimen for submission to lab

12 Post Procedure Care Apply direct pressureApply direct pressure

13 Complications HematomaHematoma Distal ischemiaDistal ischemia PseudoaneurysmPseudoaneurysm Localized traumaLocalized trauma InfectionInfection

14 review

15 Where are abg kits kept in the ed? Trauma 2 Dirty Utility Supply Pyxis Materials

16 A modified Allen's test is only required for patient’s with poor circulation? True False

17 If unsuccessful withdraw to epidermis and redirect? True False

18 Place the abg on ice and tube to lab? True False

19 Analysis Part of diagnosisPart of diagnosis

20 Overview pH (7.35 – 7.45)pH (7.35 – 7.45) PaCO2 (35 – 45)PaCO2 (35 – 45) PaO2 (80 – 100)PaO2 (80 – 100) HCO3 (23 – 27)HCO3 (23 – 27) Respiratory buffer responseRespiratory buffer response Renal buffer responseRenal buffer response

21 Acid base disorders Respiratory acidosis Respiratory alkalosis

22 Acid base disorders Metabolic acidosis Metabolic alkalosis

23 Components of ABG pHpH PaO2PaO2 PaCO2PaCO2 HCO3HCO3 Base Excess (B.E.)Base Excess (B.E.)

24 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

25 FIRST MIDDLE LAST Compensated Respiratory Acidosis Uncompensated Metabolic 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

26 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

27 Result First name – uncompensatedFirst name – uncompensated Last name – acidosisLast name – acidosis Look at CO2 and HCO3 to determine which one has the same last nameLook at CO2 and HCO3 to determine which one has the same last name CO2 – 55 (acidosis)CO2 – 55 (acidosis) Uncompensated respiratory acidosisUncompensated respiratory acidosis

28 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

29 Result First name – uncompensatedFirst name – uncompensated Last name – alkalosisLast name – alkalosis Look at CO2 and HCO3 to determine which one has the same last nameLook at CO2 and HCO3 to determine which one has the same last name HCO3 – 33 (alkalosis)HCO3 – 33 (alkalosis) Uncompensated metabolic acidosisUncompensated metabolic acidosis

30 Compensation Over time the body attempts to compensateOver time the body attempts to compensate Uncompensated, partially compensated, fully compensatedUncompensated, partially compensated, fully compensated When the CO2 or HCO3 go in the opposite direction of the pH there is compensation by that systemWhen the CO2 or HCO3 go in the opposite direction of the pH there is compensation by that system

31 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

32 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

33 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%

34 Practice test

35 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 AcidosisRespiratory Alkalosis Metabolic AcidosisMetabolic Alkalosis

36 Is Her ABG Compensated or Uncompensated? Compensated Uncompensated

37 What test is used to assess collateral circulation prior to obtaining an ABG? Semmes-Weinstein Test The Allen Test The Snuffbox Test

38 Indications for obtaining an ABG? Determination of other serum blood levels Determination of pH and partial pressure of respiratory gases Assessment of patient response to therapeutic interventions Assessment of progression of disease process All the above

39 The preferred site for arterial puncture? Femoral Brachial Radial Ulnar

40 True or False: during specimen collection blood will auto fill the syringe? True False

41 Post procedure how long do you apply direct pressure to puncture site? 10 Minutes 5 Minutes Just apply dressing 30 seconds

42 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 Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis

43 Is the ABG Compensated or Uncompensated? Compensated Uncompensated

44 Ph 7.48 PCO2 15 HCO3 25 What is the acid base disturbance Respiratory Acidosis Metabolic AlkalosisMetabolic Acidosis Respiratory Alkalosis

45 Is the ABG Compensated or Uncompensated? Compensated Uncompensated

46 pH – 7.56 PCO2 – 42 HCO3 - 46 What is this acid base disturbance? Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis

47 Is the ABG Compensated or Uncompensated? Compensated Uncompensated

48 pH – 7.48 PCO2 – 16 HCO3 - 26 What is this acid base disturbance? Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis

49 Is the ABG Compensated or Uncompensated? Compensated Uncompensated

50 pH – 7.38 PCO2 – 50 HCO3 - 27 What is this acid base disturbance? Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis

51 Is the ABG Compensated or Uncompensated? Compensated Uncompensated

52 pH – 7.50 PCO2 – 35 HCO3 - 32 What is this acid base disturbance? Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis Metabolic Acidosis

53 Is Her ABG Compensated or Uncompensated? Compensated Uncompensated

54 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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