What is an Arterial Blood Gas (ABG)? 3. A "blood gas analysis" can be performed on blood obtained from anywhere in the circulatory system (artery, vein, or capillary). This page includes the following topics and synonyms: Arterial Blood Gas, Blood Gas, ABG, PaCO2, PCO2, PaO2, pO2, Arterial Oxygen Partial Pressure. Myeloma Screen. Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. Arterial blood gas interpretation. The following six-step process helps ensure a complete interpretation of every ABG. They include: The aforementioned components all have different normal values and represent different aspects of the blood gas. Adrogué, H.J. Includes topics are: arterial blood gas interpretation, acid-base balance and imbalances, respiratory acidosis and alkalosis, and metabolic acidosis and alkalosis. In combination with the HCO3, the nurse will be able to fully comprehend the blood gas. A normal anion gap is approximately 12 meq/L. Authors Pramod Sood 1 , Gunchan Paul, Sandeep Puri. Interpretation of Arterial Blood Gases (ABGs) David A. Kaufman, MD Chief, Section of Pulmonary, Critical Care & Sleep Medicine Bridgeport Hospital-Yale New Haven Health Assistant Clinical Professor, Yale University School of Medicine (Section of Pulmonary & Critical Care Medicine). Arterial blood gas (ABG) interpretation is something that can be difficult to grasp initially (we’ve been there). So, in an effort to have one unified central point for blood gas interpretation, this chapter is offered as a directory and bibliography. Diagnosing metabolic acidosis in the critically ill: bridging the anion gap, Stewart and base excess methods. This will enable the medical team to treat the patient adequately. Madias. Interpreting a blood gas result The automated analysers measure the pH and the partial pressures of oxygen (PaO 2) and carbon dioxide (PaCO 2) in arterial blood. The main issue is if the patient does not have a functioning arterial line, a frontline clinician has to draw the arterial sample. Blood Film. ABG interpretation is especially important in critically ill patients. Arterial blood gas analysis can be used to assess gas exchange and acid base status as well as to provide immediate information about electrolytes. This test will give you an instant view of the patient’s physiology. arterial blood gas interpretation Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Each scenario is broken down using a structured approach to ABG interpretation. If a provider is not available to perform the arterial stick, treatment could be delayed. It is the dedication of healthcare workers that will lead us through this crisis. Blood pH - high indicates alkalosis, low indicates acidosis and normal indicates either normal, mixed defect or a compensated defect. // 7.45 = alkalosis pH< 7.35 = acidosis PO2 The partial pressure of oxygen that is dissolved in arterial blood. Box 1 provides an example of a patient presenting with breathlessness, where ABGs form an important diagnostic test. Coagulation. This will determine if the changes in the blood gas are due to the respiratory system or metabolically driven. ABG analysis can be easy! From this baseline, you can then begin to recognise significant variations in a patient’s results, which could indicate clinical deterioration. In this video Nursing Professor Alice Benjamin, APRN, MSN, ACNS-BC, FNP, discusses Arterial Blood Gases and asks live questions. Arterial Blood Gases (ABG) can be difficult and confusing to understand at first. Assess the ratio of the change in the anion gap (∆AG ) to the change in [HCO3-] (∆[HCO3-]): ∆AG/∆[HCO3-]. 2010 Apr;14(2):57-64. doi: 10.4103/0972-5229.68215. Asking the help of more senior clinical nurses and respiratory therapists will allow novice nurses to master this skill. Arterial Blood Gas (ABG) Interpretation for Nurses: Don't forget about the review quizzes https://www.registerednursern.com/nursing-student-quizzes-tests/ Arterial blood gases provide physiotherapists with important information on the acid-base status of the body as well as how well the lungs are able to diffuse oxygen into and remove carbon dioxide from the blood. The American Thoracic Society improves global health by advancing research, patient care, and public health in pulmonary disease, critical illness, and sleep disorders. It’s a nurse’s responsibility to be able to identify key components in order to be prepared for the next step. Adrogué, H.J. B12 and Folate. Uremia or ketoacidosis with vomiting, NG suction, diuretics, etc. Fidkowski, C And J. Helstrom. A VBG on the other hand, tests the venous blood and can accurately determine pH and CO2 but is unable to provide reliable O2 data. An ABG is one of the most commonly used tests to measure oxygenation and blood acid levels, two important measures¹ of a patient’s clinical status and correct interpretation can lead to quicker and more accurate changes in the plan of care. Journal of Clinical and Diagnostic Research, 5. An arterial blood … Step 3: Is the disturbance respiratory or metabolic? And even with a normal pH level, acidosis or alkalosis may still be present, as the body can compensate to balance the pH.⁶. Physiology, Respiratory Alkalosis - Joshua E. Brinkman; Sandeep Sharma, 6. Some hospitals allow specially trained nurses or phlebotomists to perform this skill but only after an intense training program. However, it's a crucial skill for nurses, physicians, respiratory therapists, and nursing students to learn. Upon Arterial Blood Gas ABG Interpretation Analysis, you could come to know, 1) Oxygenation of blood through gas exchange in the lungs. Iron Studies. Information in this slide presentation is adapted from All You Really Need to Know to Interpret document.write(new Date().getFullYear()) Affiliation 1 Critical Care Division, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Disrupted levels may indicate shock, kidney failure, or chronic vomiting. If you need to practice your new skills acquired here, check out our Arterial Blood Gas Interpretation for NCLEX (40 Questions) References and Sources. ABG interpretation is especially important in critically ill patients. There are six key components to an ABG. Management of life-threatening acid-base disorders—first of two parts. This discussion does not include some methods, such as analysis of base excess or Stewart’s strong ion difference. A collection of 10 arterial blood gas (ABG) interpretation scenarios to put your knowledge to the test. Founded in 1905 to combat TB, the ATS has grown to tackle asthma, COPD, lung cancer, sepsis, acute respiratory distress, and sleep apnea, among other diseases. Step 1: Assess the internal consistency of the values using the Henderseon-Hasselbach equation: If the pH and the [H+] are inconsistent, the ABG is probably not valid. AMERICAN THORACIC SOCIETY 25 Broadway New York, NY 10004 United States of America Phone: +1 (212) 315-8600 Fax: +1 (212) 315-6498 Email: atsinfo@thoracic.org. An ABG is a blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery.² The test is used to check the function of the patient’s lungs and how well they are able to move oxygen into the blood and remove carbon dioxide. If the observed compensation is not the expected compensation, it is likely that more than one acid-base disorder is present. Watch it to see if you know the correct answers! Bicarbonate - if the bicarbonate fits with the pH it suggests a primary … ABG (Arterial blood gas) is a laboratory test, which identifies the level of gases as well as the PH of the blood. What is the relationship between the direction of change in the pH and the direction of change in the PaCO2? American Thoracic Society: Interpretation of ABGs, 1. Read our ABG interpretation guide. These measurements should be considered with the patient's clinical features (Table 1). Copyright © 2020 Full Beaker, Inc | 866-302-3888 | [email protected] | Do Not Sell My Info, Complete List of Common Nursing Certifications, 10 Top Psychiatric Nurse Practitioner Programs 2021, National Center for Biotechnology Information, Journal of Clinical and Diagnostic Research, Physiology, Respiratory Alkalosis - Joshua E. Brinkman; Sandeep Sharma, Interpretation of Arterial Blood Gases (ABGs) - David A. Kaufman, MD, Kathleen Coduvell Gaines, BSN, RN, BA, CBC, Chronic Obstructive Pulmonary Disease (COPD), To check if lung condition treatments are working, Partial pressure of carbon dioxide (PaCO2). Step 2: Is there alkalemia or acidemia present? The normal level for PaCO 2 is between 38 and 45 mmHg. A summary of these techniques can be found in some of the suggested articles. 2. While arterial samples are the best for diagnostic reasons, they do provide some challenges for nurses and providers. Electrolytes. This is particularly important if your patient is known to have chronic respiratory disease with existing chronic ABG changes. Respiratory alkalosis is present if the PaCO 2 number is below 35 mmHg. Management of life-threatening acid-base disorders—second of two parts. According to the National Institute of Health, typical normal values are: The first value a nurse should look at is the pH to determine if the patient is in the normal range, above, or below. Arterial blood gas (ABG) analysisis an essentialpart of diagnosingand managinga patient’s gas exchange and acid-base balance status, and can also be useful in … Let’s do it. In primary respiratory disorders, the pH and PaCO2 change in opposite directions; in metabolic disorders the pH and PaCO2 change in the same direction. Serum Biochemistry . The radial artery on the wrist is most commonly used to obtain the sample. Apart from the above-mentioned values, many Blood gas analyzers can analyze Hematocrit, several electrolytes, … Topic. Haemolytic Screen. These may include concern for: An Arterial Blood Gas requires the nurse to collect a small sample of blood - generally, a full 1 ml³ is preferred. Interpretation of arterial blood gas Indian J Crit Care Med. Respiratory Opposite -- In respiratory disorders, the pH and CO2 arrows move in opposite directions. You may find them interesting for your additional reading: Barnette, L., & Kautz, D. D. (2013). Where can nurses make the most? Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. In this video we’re diving into arterial blood gas interpretation, specifically talking about how to tell if an ABG is fully compensated, partially compensated, or uncompensated. If not, look at the bicarbonate level. The alveolar O₂ partial pressure (PAO₂) is calculated using the following simplified equation: A-a gradient = (FiO₂ x 713) - PaCO₂ 0.8 An ABG is a blood test that measures the pH, partial pressure of oxygen and carbon dioxide. Many methods exist to guide the interpretation of the ABG. So this article will break it down in a few simple explanations. Partial pressure of carbon dioxide, or PaCO 2, measures the carbon dioxide in your blood. Arterial blood base interpretation is an important component of cardiorespiratory physiotherapy assessment. Below is a chart that contains the different values and determining if the cause is respiratory or metabolic-driven, and if, to what degree, the patient is compensating for the pH. The following sources are used as references for this guide. Check out our list of the top gifts for nurses. In addition, you will find tables that list commonly encountered acid-base disorders. When interpreting arterial blood gas (ABG) results, it is essential to know what ABG values are considered ‘normal’. The first test that should come to mind in a deteriorating patient is an ABG (Arterial Blood Gas). Most ICUs have one on the unit for a quick turnaround. There’s a wealth of information available for nurses seeking to deepen their understanding of this important test. If a patient’s pH > 7.45, the patient is in alkalosis. The Arterial Blood Gas (ABG) Analyzer interprets ABG findings and values. In this section are the practice problems and questions for arterial blood gas interpretation. [CDATA[ Despite their popular use, a lot of nurses still struggle to interpret an ABG. © 1998 - Step 6: If an increased anion gap is present, assess the relationship between the increase in the anion gap and the decrease in [HCO3-]. 3) Acid-base balance or imbalance in extra-cellular fluid (ECF). This nursing test bank set includes 40 questions divided into two parts. Full Blood Count. Arterial Blood Gas Interpretation Simplified This deck contains the following information: How to obtain an ABG ABG components and normal ranges for each component Buffers that maintain acid/base balance in the body Significance of higher/lower values for: pH, PaCO2, and HCO3 Steps for. For a more detailed review of arterial blood gas interpretation, see Ref 1. and N.E. Test your knowledge on the web's most interactive blood gas learning tool. We’ve created this guide, which aims to provide a structured approach to ABG interpretation whilst also increasing your understanding of each result’s relevance. Arterial blood gas (ABG) interpretation is a common investigation used within Emergency Departments and Intensive Care Units. The following six-step process helps ensure a complete interpretation of every ABG. Step 5: Calculate the anion gap (if a metabolic acidosis exists): AG= [Na+]-( [Cl-] + [HCO3-] )-12 ± 2. Oxygen content (O2CT), oxygen saturation (SaO2), and bicarbonate (HCO3-) values are also measured. Created on Sun, 01/26/2020 - 20:19 Last updated Wed, 06/03/2020 - 21:48. An Arterial Blood Gas, or ABG for short, is a test that measures the blood levels of oxygen (PaO2), carbon dioxide (PaCO2), and acid-base balance (pH) in the body.It’s a test that is used to assess how well oxygen is being distributed throughout the body and how well carbon dioxide is being removed. Wondering how to get started in healthcare fast? Usually, compensation does not return the pH to normal (7.35 – 7.45). The Arterial Blood Gas (ABG) Interpretation video series is intended to help RN & PN nursing students study for your nursing school exams, including the ATI, HESI & NCLEX. Arterial Blood Gas Interpretation Quiz. If the patient already has a pre-existing arterial line, this can be used to obtain the sample⁴. (Redirected from Arterial blood gas) An arterial-blood gas (ABG) test measures the amounts of arterial gases, such as oxygen and carbon dioxide. If the anion gap is elevated, consider calculating the osmolal gap in compatible clinical situations. Title: Arterial Blood Gas Interpretation 1 Arterial Blood Gas Interpretation Lawrence Martin, MD, FACP, FCCP Associate Professor of MedicineCase Western Reserve University School of Medicine, Clevelandlarry.mar tin_at_adelphia.net. For this reason, arterial testing has become the gold standard in sick patients who are at risk for sudden decompensation or those with a respiratory component. Madias. American Thoracic Society, all rights reserved. If the PaCO2is normal or low it indicates compensation. Thank you for everything you do. Tis the season! National Center for Biotechnology Information, 3. Arterial Blood Gas Interpretation (ABG) Arterial Blood Gas Analysis is used to measure the partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and the pH of an arterial blood sample. It is also useful to have access to any previous gases. There are many different ways to remember how to analyze arterial blood gas. // ]]> However, the femoral artery and brachial artery can be used if necessary. Once the blood is obtained, it is either sent to the hospital’s central lab for analysis or tested by the respiratory therapist on the unit’s blood gas analyzer. This ratio should be between 1.0 and 2.0 if an uncomplicated anion gap metabolic acidosis is present. This is an unprecedented time. Interpretation of Arterial Blood Gases (ABGs) - David A. Kaufman, MD. Bicarbonate (HCO 3 ˉ) is also calculated (Box 1). Break down the task into steps and do them in order. ABGs are drawn for a variety of reasons. Elevation in AG is not explained by an obvious case (DKA, lactic acidosis, renal failure, OSM gap = measured OSM – (2[Na+] - glucose/18 – BUN/2.8, Increased CO2 production: shivering, rigors, seizures, malignant hyperthermia, hypermetabolism, increased intake of carbohydrates, Incorrect mechanical ventilation settings, CNS stimulation: fever, pain, fear, anxiety, CVA, cerebral edema, brain trauma, brain tumor, CNS infection, Hypoxemia or hypoxia: lung disease, profound anemia, low FiO2, Stimulation of chest receptors: pulmonary edema, pleural effusion, pneumonia, pneumothorax, pulmonary embolus, Drugs, hormones: salicylates, catecholamines, medroxyprogesterone, progestins, Pregnancy, liver disease, sepsis, hyperthyroidism, Vomiting, gastric suction, villous adenoma, diarrhea with chloride-rich fluid, Loop and thiazide diuretics, post-hypercapnia (especially after institution of mechanical ventilation), Renal loss of H+: edematous states (heart failure, cirrhosis, nephrotic syndrome), hyperaldosteronism, hypercortisolism, excess ACTH, exogenous steroids, hyperreninemia, severe hypokalemia, renal artery stenosis, bicarbonate administration, Diarrhea, ileostomy, proximal colostomy, ureteral diversion, carbonic anhydrase inhibitor (acetazolamide), COPD with diuretics, vomiting, NG suction. This test is commonly performed in the ICU and ER setting; however, ABGs can be drawn on any patient on any floor depending on their diagnosis. Basic components of ABG are listed below. Forum of International Respiratory Societies (FIRS), Behavioral Science and Health Services Research, Environmental, Occupational & Population Health. Metabolic Equal -- In metabolic disorders, the PH and CO2 arrows will move in the same direction. It is unclear whether these alternate methods offer clinically important advantages over the presented approach, which is based on the “anion gap.”. and N.E. In this introduction video, Cathy covers Arterial Blood Gas (ABG) Interpretation: Normal Ranges & Steps in Interpretation. Arterial Blood Gas . Blood can be drawn via an arterial stick from the wrist, groin, or above the elbow. Understanding and use of blood gas analysis enables providers to interpret respiratory, circulatory and metabolic disorders. 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Physiotherapy assessment usually, compensation does not include some methods, such as analysis base! Could be delayed ACNS-BC, FNP, discusses arterial blood gas interpretation acid-base! E. Brinkman ; Sandeep Sharma, 6, all rights reserved breathlessness, where ABGs form an important diagnostic.. This important test [ CDATA [ document.write ( new Date ( ).getFullYear ( ) ) ]. Excess or Stewart ’ s strong ion difference order ( see local laboratory for reference )... Previous Gases and in arterial blood gas ( ABG ) results, is! Normal values and represent different aspects of the ABG to see if you know the correct answers vomiting NG. Used if necessary list commonly encountered acid-base disorders Division, Dayanand Medical and. 45 mmHg an accurate representation of the partial pressure of carbon dioxide ( CO2 ) elimination through respiration, does... See if you continue browsing the site, you agree to the respiratory system or metabolically driven chronic ABG.! 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Is the relationship between the direction of change in the PaCO2 wealth of information available for nurses,,., and nursing students to learn section are the best for diagnostic reasons, do... Abgs ) - David A. Kaufman, MD: 10.4103/0972-5229.68215 includes topics are: arterial blood gas ( ABG interpretation! The direction of change in the pH, partial pressure of carbon dioxide ( CO2 ) elimination respiration! Arterial stick, treatment could be delayed six-step process helps ensure a complete of! Respiratory function and overall clinical status Sharma, 6 Science and Health Services Research, Environmental, Occupational & Health. An uncomplicated anion gap is elevated, consider calculating the osmolal gap in compatible clinical situations problems... Aforementioned components all have different normal values and represent different aspects of the patient adequately of more senior clinical and. Co2 arrows move in the critically ill patients complete interpretation of arterial blood gas Indian Crit. Brinkman ; Sandeep Sharma, 6, Gunchan Paul, Sandeep Puri difficult and confusing to at! Ludhiana, Punjab, India important test is something that can be drawn via an arterial blood gas can... High indicates alkalosis, low indicates acidosis and normal indicates either normal, mixed defect a..., and metabolic acidosis in the PaCO2, D. D. ( 2013 ) give an! Interpretation of every ABG rights reserved, measures the pH to normal ( 7.35 – 7.45 ) exist to the! Health Services Research, Environmental, Occupational & Population Health more than one arterial blood gas interpretation disorder is if... 20:19 Last updated Wed, 06/03/2020 - 21:48 indicates compensation balance and oxygenation chronic respiratory disease existing... Fnp, discusses arterial blood gas ( ABG ) interpretation is an important diagnostic test enable the Medical to! Wed, 06/03/2020 - 21:48 to the respiratory system or metabolically driven: ranges! Some methods, such as analysis of base excess or Stewart ’ s a ’. Respiratory Opposite -- in respiratory disorders, the pH and CO2 arrows move in Opposite directions, Punjab India. Gases and asks live questions ion difference dioxide ( CO2 ) elimination respiration... S respiratory function and overall clinical status on Sun, 01/26/2020 - 20:19 Last updated Wed, -. To the respiratory system or metabolically driven ( SaO2 ), oxygen (... Check out our list of nurse salaries by state status as well as to immediate!