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ABG Download v2F - Study Guide for ABG step by step instructions

Study Guide for ABG step by step instructions

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Nursing Care of Older Adult (NUR 2214)

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Rasmussen University

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Arterial

Bld

Gas (abg)

made simple

x

o

x

Understanding Acid/Base

balance through ABG’s

studentnurseplanner

hi! my name is Arty!

?

Arty’s normal acid/base (pH) balance is between 7-7.

If Arty becomes criticay i, his body may leave normal pH range and become either acidotic or alkalotic.

His body responds to these changes thru the lungs or the kidneys.

To figure out Arty’s pH and his body’s reaction to his iness, we can draw an arterial bld gas (abg) sample usuay taken from the wrist via artery. Yes, venous blood gas samples do exist but there are some differences. pH and HCO3 are reliable but O2 and CO2 will have different ranges.

A: diabetic ketoacidosis, because a patient is in metabolic acidosis (as long as there are no s/s of respiratory distress).

WHat is an example of a situation where a VBG might be acceptable over an ABG?

BONUS QUESTION!!

Acidosis normal pH Alkalosis

anything less than 7- 7 anything greater than

more thoughts...

####### Did the sample come out really dark in color?

####### Is the PaO2 really low without respiratory issues?

####### if something seems off, take another sample!

####### The draw may have been venous or mixed blood.

the abg deets

the aen test

got the sample? Yay!

who:

what:

when:

where:

how:

####### An ABG can be drawn by an RN or respiratory therapist

####### depending on your hospital policy

####### The ABG can be taken from an arterial line if

####### present. Otherwise, a needle draw must be done.

####### ABG’s are done per MD order. Some reasons include: s/s of respira-

####### tory failure, acid-base imbalance (example: DKA), after intuba-

####### tion, after vent setting changes (usually 30-60 minutes), etc.

####### Most common site is the radial artery (wrist).

####### Other sites include brachial or femoral arteries,

####### typically accessed by the MD!

Expel any excess air from the syringe before capping. (most places use heparinzed syringe) Include patient’s current temperature and amount of supplemental O2. Put on ice if not running sample immediately.

####### Check for collateral circulation on the hand when

####### taking a radial artery sample, AKA the allen test.

Occlude both radial & ulnar arteries with your fingers, tell the patient to pump his/her wrist, release the ulnar side when the hand becomes pale and watch for return of color/ warmth.

Pass on the allen test= good collateral circulation and safe to do radial sample. Fail = find an alternate site

Radial artery Ulnar artery

The ABG result determines: ph, PaC02, HC03. Using the Reference chart below and a standard ‘tic-tac-toe’ board, plug in the ABG results. Once you get “3-in-a-row” you can determine if arty is acidotic or alkalotic.

Always start with a labeled tic-tac-toe board! (this will count as a mark in the game)

next plug in the data one result at a time If the PH is 7.

If the PH is 7.

Quick Version:

ph ph

Art y is in acidosis. Art y is in alk alosis. The paco2 and hco3 will tell us if he is in metabolic acidosis or respiratory acidosis.

the paco2 and hco3 will tell us if he is in metabolic alkalosis or respiratory alkalosis.

because we have three in a row, we know arty is in respiratory acidosis, regardless of the hco3.

because we have three in a row, we know arty is in respiratory alkalosis, regardless of the hco3.

Three in a row= Combined acidosis. Three in a row = metabolic alkalosis.

remember the paco2 numbers are flipped since more PaCo2 is Acidic

Normal

pH 7-7.

PaCo2 45-

HCo3 22-

Acidosis Alkalosis

pH PaCo HCo

41 34

pH PaCo HCo

55 15

pH PaCo2 pH

PaCo

N B

A N B pH

PaCo

A N B

pH PaCo

A N B PaCo2 pH

A N B

Acid

pH PaCo

HCo

Normal Base

Acid Normal Base Acid Normal Base

interpretation station

Also Known As: (fuy compensated)

The acid/base balance is at a “normal” range because the kidneys and lungs are functioning together to maintain the normal pH balance range. This doesn’t mean the problem is fixed. Compensation can eventually fail, so we address the cause! How do you know if the problem is Respiratory or Metabolic? The patient’s condition or diagnosis will help you determine this!

When the pH is NORMAL, you have compensation.

This means you will not get a full tic tac toe, but the co2/Hco3 are still abnormal.

the pH is still abnormal, but moving closer to Normal range. We can see the body is in Metabolic Acidosis given our tic tac toe, but our Co2 is starting to become Alkalotic to help the acidosis, which creates partial compensation.

the pH is abnormal. The body is unable to respond or hasn’t had enough time to respond.

example (A) the Co2 is normal so it has not entered in an alkalotic state to help the acidosis of the metabolic system, making no type of effort or compensation.

Example (B) the body is an acidotic state and likely due to mixed disorders. Because the pH, HCo3, and PaCo2 are all acidotic, this is uncompensated.

compensated

compensation

uncompensated a.

b.

partiay compensated

Respiratory Acidosis with compensation

pH A PaCo2 PaCo2 pH HCo

HCo

7 N B 61 30

####### Metabolic Acidosis

partially compensated

pH A PaCo2 pH PaCo HCo HCo

7 N B 33 12

####### uncompensated

####### Metabolic Acidosis

pH A PaCo2 pH PaCo HCo HCo

7 N B 43 19

####### Combined Acidosis

####### Uncompensated

pH A PaCo2 pH HCo3 PaCo2HCo

7 N B 46 19

interpretation station

When one system moves in the opposite direction than the other to try to restore normal pH. For example, if we are in respiratory acidosis, the kidneys may retain bicarb to counteract it. In DKA (metabolic acidosis) the body will hyperventilate to Blow off extra Acid (Co2), aka “Kussmaul’s Respirations”.

Normal

pH 7-7.

PaCo2 45-

HCo3 22-

Paco2 is Acidic

Acidosis Alkalosis

A pH PaCo HCo

#16 N B

80 26

A pH PaCo HCo

#17 N B 7. 44 21

A pH PaCo HCo

#18 N B 7. 45 23

A pH PaCo HCo

#19 N B 7. 49 29

A pH PaCo HCo

#20 N B 7. 25 19

A pH PaCo HCo

#21 N B 7. 43 19

A pH PaCo HCo

#22 N B 7. 55 36

A pH PaCo HCo

#23 N B 7. 53 34

A pH PaCo HCo

#24 N B 7. 55 23

A pH PaCo HCo

#25 N B 7. 44 38

A pH PaCo HCo

#26 N B 7. 33 12

A pH PaCo HCo

#27 N B 7. 39 35

A pH PaCo HCo

#28 N B

36 33

A pH PaCo HCo

#29 N B 7. 30 18

A pH PaCo HCo

#30 N B 7. 31 21

Normal

pH 7-7.

PaCo2 45-

HCo3 22-

Paco2 is Acidic

Acidosis Alkalosis

A pH PaCo HCo

#31 N B 7. 49 25

A pH PaCo HCo

#32 N B 7. 59 22

A pH PaCo HCo

#33 N B 7. 44 20

A pH PaCo HCo

#34 N B 7. 39 25

A pH PaCo HCo

#35 N B 7. 30 14

A pH PaCo HCo

#36 N B 7. 32 16

A pH PaCo HCo

#37 N B 7. 42 15

A pH PaCo HCo

#38 N B 7. 50 30

A pH PaCo HCo

#39 N B 7. 48 29

A pH PaCo HCo

#40 N B 7. 44 18

A pH PaCo HCo

#41 N B 7. 43 35

A pH PaCo HCo

#42 N B 7. 33 17

A pH PaCo HCo

#43 N B

43 25

A pH PaCo HCo

#44 N B 7. 29 21

A pH PaCo HCo

#45 N B 7. 51 32

normal balance
Partially Compensated metabolic acidosis
Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
Uncompensated Metabolic Acidosis
fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
Uncompensated Metabolic Acidosis
Uncompensated Metabolic Alkalosis
Partially Compensated metabolic acidosis
normal balance
Partially Compensated Respiratory Alkalosis, because pH isn’t within range
fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
Partially Compensated metabolic acidosis
Uncompensated Metabolic Acidosis
normal balance
Uncompensated Metabolic Alkalosis
normal balance
Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
Partially Compensated metabolic acidosis
Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
Uncompensated Metabolic Acidosis
Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
unCompensated Respiratory Acidosis
Uncompensated Metabolic Alkalosis
Partially Compensated metabolic acidosis
uncompensated metabolic alkalosis
uncompensated metabolic alkalosis
Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
Partially Compensated Respiratory Alkalosis, because pH isn’t within range
Partially Compensated Respiratory Alkalosis, because pH isn’t within range
Uncompensated respiratory acidosis
Uncompensated respiratory acidosis
Uncompensated Metabolic Acidosis

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