Arterial Blood Gas Sampling

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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
Sorry
• That is incorrect
Congratulations
• That is correct
A modified Allen's test is only
required for patient’s with poor
circulation?
• True
• False
Sorry
• That is incorrect
Congratulations
• That is correct
If unsuccessful withdraw to
epidermis and redirect?
• True
• False
Sorry
• That is incorrect
Congratulations
• That is correct
Place the abg on ice
and tube to lab?
• True
• False
Sorry
• That is incorrect
Congratulations
• That is correct
Happy nurses and patient make
for an awesome shift?
• Absolutely
• Not really
Sorry
• That is incorrect
Congratulations
• That is correct
Analysis
• Part of diagnosis
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
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
FIRST
MIDDLE
Compensated
Uncompensated
Respiratory
Metabolic
LAST
Acidosis
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
Example One
Jane Doe is a 45 year-old female admitted
to the nursing unit wit 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 despite the use of antiemetics. His
arterial blood gas result is as follows:
pH – 7.50
CO2 – 42
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%
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
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is Her ABG Compensated or
Uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Mr. P is in trauma 2 with vomiting and diarrhea.
His ABG results: pH – 7.45, PCO2 – 55, HCO3 - 36
What is the acid base disturbance?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
What test is used to assess collateral
circulation prior to obtaining an ABG?
• Semmes-Weinstein Test
• The Allen test
• The snuffbox technique
Sorry
• That is incorrect
Congratulations
• That is correct
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
Sorry
• That is incorrect
Congratulations
• That is correct
The preferred site for arterial
puncture?
• Brachial
• Femoral
• Radial
• ulnar
Sorry
• That is incorrect
Congratulations
• That is correct
True or False: during specimen
collection blood will auto fill the
syringe?
• True
• False
Sorry
• That is incorrect
Congratulations
• That is correct
Post procedure, how long do you apply
direct pressure to puncture site?
• 10 minutes
• 30 seconds
• None needed just apply dressing
• 5 minutes
Sorry
• That is incorrect
Congratulations
• That is correct
Mr. J is in room 6 with history
of IDDM. ABG results:
pH – 7.25, PCO2 – 35, HCO3 - 18
What is his acid base disturbance?
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is his ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
What are some causes of a low
PaO2?
• Low supply of o2
• Decreased cardiac output
• Anemia
• Carbon monoxide poisoning
• All the above
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.47, PCO2 – 30, HCO3 - 24
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.30, PCO2 – 75, HCO3 - 22
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.36, PCO2 – 32, HCO3 - 16
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.48, PCO2 – 46, HCO3 - 28
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.38, PCO2 – 50, HCO3 - 27
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
Interpret the following ABG’s:
pH – 7.50, PCO2 – 35, HCO3 - 32
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
Sorry
• That is incorrect
Congratulations
• That is correct
Is this ABG compensated or
uncompensated?
• Compensated
• Uncompensated
Sorry
• That is incorrect
Congratulations
• That is correct
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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