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Arterial Blood Gas

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Introduction

Diagnostic Test Brooke Griffith ABG and carboxyhemoglobin Arterial Blood Gas Indications: An ABG is ordered as a way to assess or manage a patient's respiratory and metabolic acid/base balance. The test assesses the pH of a patient's blood and is used as an indicator for the particular cause of the acidosis or alkalosis. An ABG is also used to measure adequacy of treatment for an acid/base balance. An ABG can also be used in the measurement of adequacy of oxygenation. Type of Test and testing procedure: An ABG is usually acquired through withdrawal of arterial blood. Babies can be tested using whole blood through capillary heel sticks. An ABG is usually collected from the radial artery. Before an ABG can be preformed, a circulation test must be preformed to protect the hand's collateral blood flow. This is called the Allen Test. Allen Test- Apply pressure to the radial and ulnar arteries, eliminating blood flow to the chosen hand. ...read more.

Middle

These are the main values used to detect acid/base imbalance. Most of these will be used to discuss various imbalances and their causation. pH- 7.35-7.45 HCO3- 22-26 PaO2- 70-100mmHg PaCO2- 35-45mmHg Base excess- -2/+2 SaO2- 95-100% How to Interpret Results: pH- measures the amount of hydrogen ions in the blood, which indicates the acid / base balance in the blood. When the pH increases, the body is alkaline. When the pH decreases, the body is more acidic. HCO3- the amount of bicarb in the blood, this indicates the amount of base. As HCO3 rises, so does pH. PaCO2- the partial pressure of CO2, this indicates the amount of acid in the blood. This has an inverse relationship with pH. PaO2- the partial pressure of oxygen molecules dissolved in the blood BE- represents the amount of metabolic buffering agents in the blood, try to compensate with imbalances in pH, indicates your buffering capacity This is a brief discussion of respiratory and metabolic acidosis/alkalosis. ...read more.

Conclusion

Additional information for a nurse practitioner: If a patient has COPD, their oxygen, CO2 exchange is impaired in the lungs. They live in a state of respiratory acidosis. This causes a change in their respiratory drive, change it from one of CO2 release, to one of O2 consumption, thus treating a COPD patient with high flow O2 can suppress their respiratory drive. If their PaCO2 is 55mmHg, do not treat it unless they are symptomatic. Carboxyhemoglobin One consideration that must be made when drawing an ABG is carboxyhemogloblin. Carboxyhemoglobin is the binding of carbon monoxide (CO) with the hemoglobin molecules in the blood. This occurs with carbon monoxide poisoning, fire, and long-term heavy smokers. The hemoglobin molecules bond much easier to CO than O2, thus causing the carboxyhemoglobin level to rise quickly. An increased carboxyhemoglobin level can cause a decreased pH, but a low PaCO2. Thus, if a practitioner suspects CO poisoning or fire a carboxyhemoglobin level must be drawn. Normal Level: 5% Interpreting Results: >5% and symptomatic, such as confusion, dyspnea and severe headache Treatment: High flow O2 and removal of causative agent. O2 will counteract the CO level quickly. ...read more.

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