PRH ED ABG Sampling and Analysis

Transcript PRH ED ABG Sampling and Analysis

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

• Part of diagnosis

Analysis

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

Look at pH to determine the first and last name of your ABG Look at CO2 and HCO3 to determine which one has same last name

FIRST MIDDLE LAST Compensated Respiratory Acidosis Uncompensated Metabolic Alkalosis

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

Metabolic Acidosis Respiratory Alkalosis 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 Just apply dressing 30 seconds 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