Quiz
Arterial Blood Gases
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Questions in this quiz (18)
1Arterial puncture of peripheral [blank_start]artery[blank_end] to obtain arterial blood for direct measure of [blank_start]pH[blank_end], [blank_start]PACO2[blank_end], and PO2
To assess [blank_start]ventilation[blank_end] and [blank_start]oxygenation[blank_end]
3 Primary Sites: [blank_start]Radial[blank_end] (1st choice d/t accessibility and collateral blood flow), [blank_start]Brachial[blank_end], [blank_start]Femoral[blank_end] (last choice)- Aartery
- BpH
- CPACO2
- Doxygenation
- Eventilation
- FRadial
- GBrachial
- HFemoral
2Capillary Stick
Used in [blank_start]infants[blank_end]
Wrap area in warm wet cloth 5-7 min to [blank_start]arterialize[blank_end] the site
Consistent correlation with Arterial [blank_start]pH[blank_end] and [blank_start]PCO2[blank_end]
Do not use for [blank_start]O2[blank_end] monitoring – values will not match- Ainfants
- Barterialize
- CpH
- DPCO2
- EO2
3ABG Kit
5 mL [blank_start]heparinized[blank_end] syringe
Needles [blank_start]20[blank_end]-[blank_start]25[blank_end] ga
Rubber stopper or needle capping device
Adhesive Strip
Alcohol prep
Gauze
Plastic Bag
Container for [blank_start]Ice[blank_end]
Lidocaine if ordered
Label
Sharps- Aheparinized
- B20
- C25
- DIce
4Modified Allen’s test
[blank_start]Positive[blank_end] allen’s test confirms that [blank_start]collateral[blank_end] blood flow is present
1. Hand should pink up within in [blank_start]2[blank_end] seconds
2. If color does not return in [blank_start]5[blank_end] seconds use a different site
3. Do not attempt [blank_start]radial[blank_end] or [blank_start]brachial[blank_end] on pt with dialysis shunt- APositive
- Bcollateral
- C2
- Dradial
- Ebrachial
- F5
5Hazards/Complications
Disruption of blood flow. [blank_start]Hematoma[blank_end]
Clotting
Bleeding, hold pressure for [blank_start]5[blank_end] min
Vessel [blank_start]spasm[blank_end]
Tissue [blank_start]trauma[blank_end]
Anticoagulation [blank_start]therapy[blank_end]- AHematoma
- B5
- Cspasm
- Dtrauma
- Etherapy
6Problems
Air bubble in ABG :
PaCO2 will [blank_start]decrease[blank_end] toward 0.
PaO2 will [blank_start]increase[blank_end] or decrease towards [blank_start]150[blank_end].
pH will [blank_start]increase[blank_end]- Adecrease
- Bincrease
- C150
- Dincrease
7Improper Cooling of Sample
PaCO2 will [blank_start]increase[blank_end]
PaO2 will [blank_start]decrease[blank_end]
pH will [blank_start]decrease[blank_end]- Aincrease
- Bdecrease
- Cdecrease
8Excess Heparin
PaCO2 will [blank_start]decrease[blank_end] towards 0
PaO2 will [blank_start]increase[blank_end] towards [blank_start]150[blank_end]
pH will [blank_start]decrease[blank_end] towards [blank_start]7.0[blank_end]- Adecrease
- Bincrease
- C150
- D7.0
- Edecrease
9Flush Solution Dilution
PaCO2 will [blank_start]decrease[blank_end]
PaO2 will [blank_start]increase[blank_end]
pH will [blank_start]decrease[blank_end]- Adecrease
- Bincrease
- Cdecrease
10Assessing Ventilation
Respiratory [blank_start]Rate[blank_end]
[blank_start]Tidal[blank_end] Volume
Chest [blank_start]movement[blank_end]
Breath Sounds
PaCo2
EtCo2
Ventilation: [blank_start]PaCO2[blank_end]
Abnormal CO2 with normal pH – [blank_start]do not[blank_end] increase ventilation or start mechanical vent
CO2: [blank_start]35[blank_end] – [blank_start]45[blank_end]: Normal – Do not change settings. Do not initiate mechanical ventilation
CO2: >[blank_start]45[blank_end]: Not ventilating – [blank_start]Initiate[blank_end] ventilation. Remove or reduce deadspace. Increase ventilation
CO2: <[blank_start]35[blank_end]: Hyperventilation – Don’t initiate mechanical ventilation. Decrease [blank_start]ventilation[blank_end]. Consider cause.- ARate
- BTidal
- Cmovement
- DPaCO2
- Edo not
- F35
- G45
- H45
- I35
- Jventilation
- KInitiate
11Oxygenation assessment:
[blank_start]Heart[blank_end] rate
Color
Sensorium
PaO2
SaO2
Oxygenation: [blank_start]PaO2[blank_end], FiO2
PaO2: [blank_start]80[blank_end] - [blank_start]100[blank_end] on FiO2 of .21 – 1: Acceptable. Maintain settings
PaO2: <[blank_start]80[blank_end] on FiO2 of .21 - .59: Poor Ventilation if PaCO2 in increased. Increase ventilation, increase FiO2 up to 60%
PaO2: <[blank_start]80[blank_end] on FiO2 of .60+ - [blank_start]Shunting[blank_end], Refractory Hypoxemia, Venous admixture. Start CPAP or increase PEEP
PaO2: >[blank_start]100[blank_end] on FiO2 of .22 – 1: Over oxygenation. Decrease FiO2, [blank_start]PEEP[blank_end] or CPAP.- AHeart
- BPaO2
- C80
- D100
- E80
- F80
- G100
- HPEEP
- IShunting
12Acid Base Balance: pH
[blank_start]7.35[blank_end] – [blank_start]7.45[blank_end] : Acceptable
<[blank_start]7.35[blank_end] : Acidosis. Uncompensated if CO2 is increased or HCO3- is decreased.
>[blank_start]7.45[blank_end] : Alkalosis. Uncompensated if CO2 is decreased or HCO3- is increased.
Uncompensated vs Compensated
[blank_start]Compensated[blank_end]: If pH is in acceptable range
[blank_start]Uncompensated[blank_end]: pH is out of range
Respiratory Acidosis/Alkalosis
pH is abnormal because of a change in the [blank_start]PaCo2[blank_end]
Metabolic Acidosis/Alkalosis
pH is abnormal because of a change in the [blank_start]HCO3-[blank_end]
Partially Compensated
pH is out of range and both the [blank_start]CO2[blank_end] and [blank_start]HCO3-[blank_end] are moving in the same direction
Examples:
Respiratory Acidosis: pH 7.3 CO2 and HCO3- are [blank_start]high[blank_end]
Metabolic Alkalosis: pH is 7.5 CO2, and HCO3- are [blank_start]high[blank_end]- A7.35
- B7.45
- C7.35
- D7.45
- ECompensated
- FUncompensated
- GPaCo2
- HHCO3-
- ICO2
- JHCO3-
- Khigh
- Lhigh
13Troubleshooting
If pt is on room air: Add PaO2 and PaCO2 together. Should be [blank_start]110[blank_end]-[blank_start]140[blank_end] torr
[blank_start]Decreased[blank_end] PaO2 – VQ Mismatch, Diffusion defect, shunting
[blank_start]Increased[blank_end] PaO2 – supplemental O2, bubbles- A110
- B140
- CDecreased
- DIncreased
14Type #1 Special Pathology: ABG looks good but pt looks and feels bad
[blank_start]CO Poisoning[blank_end]: Measure COHb with co-oximeter. Treat with 100% O2 and hyperbaric O2
[blank_start]Anemia[blank_end]: Watch for low Hb. Treat with O2 and transfusion
[blank_start]Pulmonary Embolism[blank_end]: Increased deadspace. Vd/Vt is increased. Look for in post op, bed ridden, Hx of DVT, pregnancy, obesity, venous stasis, varicose veins, trauma, atrial fibrillation. Treat with support ventilation and oxygenation, thrombolytics
[blank_start]Nitrate Poisoning[blank_end]: Accidental ingestion. Causes methemoglobanemia. Increased levels of methemoglobin interferes with co-oximeter.
Type #2 Special Pathologies: ABG looks bad but patient feels fine
[blank_start]COPD[blank_end]: Chronic respiratory acidosis with decreased [blank_start]PaO2[blank_end]
High FiO2 can cause O2 induced [blank_start]hypoventilation[blank_end]- ACO Poisoning
- BAnemia
- CPulmonary Embolism
- DCOPD
- EPaO2
- Fhypoventilation
- GNitrate Poisoning
15O2 – Hb Disassociation Curve
[blank_start]P50[blank_end] is method of expressing position of the curve
Left Shift: <[blank_start]27[blank_end] P50
[blank_start]Increased[blank_end] O2 affinity
Decreased H+ (increased pH)
Decreased [blank_start]PCO2[blank_end]
Decreased Temp
Decreased 2-3 DPG
Right Shift: > [blank_start]27[blank_end] P50
[blank_start]Decreased[blank_end] O2 Affinity
[blank_start]Increased[blank_end] H+ (decreased pH)
[blank_start]Increased[blank_end] PCO2
Increased Temp
Increased 2-3 DPG- AP50
- B27
- CIncreased
- DPCO2
- E27
- FDecreased
- GIncreased
- HIncreased
16Oximetry
SpO2 – Pulse [blank_start]Oximeter[blank_end]
Most appropriate non invasive method
Probe attaches to patient and transmits light through capillary beds
Normal: [blank_start]93[blank_end] – [blank_start]97[blank_end]%
Needs good [blank_start]perfusion[blank_end]
Affected by: poor [blank_start]perfusion[blank_end], erythema, bright ambient lights.
Clean probe with alcohol
Will read higher if [blank_start]CO[blank_end] poisoning is present
Overnight POX
Assesses O2 sats [blank_start]overnight[blank_end]
Sleep related breathing disorders, Sleep apneaUse the [blank_start]shortest[blank_end] time interval for measurement
Co-Oximeter/hemoximeter
Diagnses [blank_start]CO[blank_end] poisoning
Normal is 0-2% but is higher in smokers ([blank_start]5[blank_end]-[blank_start]10[blank_end]%)
CO Poisoning is >[blank_start]20[blank_end]% SaO2 is calculated in ABG so it won’t be [blank_start]accurate[blank_end]- AOximeter
- B93
- C97
- Dperfusion
- Eperfusion
- FCO
- Governight
- Hshortest
- ICO
- J5
- K10
- L20
- Maccurate
17Capnography
Methods/Procedures
Measures exhaled CO2 content with [blank_start]infrared[blank_end] spectrophotometer or mass [blank_start]spectrometer[blank_end].
Calibrated every [blank_start]8[blank_end] hours using low and high [blank_start]CO2[blank_end] concentrations
EtCO2 %: Normal is [blank_start]3[blank_end] - [blank_start]5[blank_end]%
PetCO2 will read lower than [blank_start]PaCO2[blank_end]
Monitoring PetCO2
[blank_start]Increased[blank_end] PetCO2 means there is a decrease in ventilation.
[blank_start]Decreased[blank_end] PetCO2 means there is an increase in ventilation or a decrease in [blank_start]perfusion[blank_end].
Troubleshooting
Moisture or secretions can obstruct tube and give false readings
Condensation can [blank_start]slow[blank_end] sample flowrate
[blank_start]Long[blank_end] sampling lines will dampen waveform
Low sampling [blank_start]rates[blank_end] will dampen waveform- Aspectrometer
- Binfrared
- C8
- DCO2
- E3
- F5
- GPaCO2
- HIncreased
- IDecreased
- Jperfusion
- Kslow
- LLong
- Mrates
18Quality assurance
ABG Controls
2 Types of commercially prepared controls
[blank_start]Blood[blank_end] Based
Aqueous/[blank_start]Flourocarbon[blank_end] Based
ABG methodology
3 commonly used levels of controls: [blank_start]Acidotic[blank_end], normal, [blank_start]alkalotic[blank_end]
All Ran [blank_start]once[blank_end] per day
[blank_start]Westgaurd[blank_end] Roles encompass all situations encountered in determining whether a specific value is in or out of control.
Gas Analyzers
2 parameters: [blank_start]Physiologic[blank_end] range to be measured and [blank_start]sampling[blank_end] conditions of test.
[blank_start]2[blank_end] point cal is most common. Multipoint calibration will verify if it is [blank_start]linear[blank_end] or not.
Involve 1 of 2 techniques: Known concentration of the gas, using lung volume or DLCO simulator.
Other QC methods
[blank_start]Profeciency[blank_end] testing: unknown control specimens are sent to different labs using same make and model of analyzers
[blank_start]Multi Machine Analysis[blank_end]: Labs that have more than 1 ABG analyzer can process samples on 2 or more and compare results.
[blank_start]Gas exchange validation[blank_end]: Tonometry, allows precision gas mixtures to be equilibrated with whole blood or buffer solution- ABlood
- BFlourocarbon
- CAcidotic
- Dalkalotic
- Eonce
- FWestgaurd
- GPhysiologic
- Hsampling
- I2
- Jlinear
- KProfeciency
- LMulti Machine Analysis
- MGas exchange validation
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- User has deleted their subject information Quiz on Arterial Blood Gases, created by Deleted user on 19/08/2016.
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