Arterial Blood Gas Procedure Power Point

Arterial Blood Gas Procedure (ABG) By: Reymond E. Bicariato, RN

Objectives: By the end of this session students will: 1. Understand ABG and its terms? 2. Know some of the indications and contraindications for performing an arterial puncture. 3. Be able to demonstrate the technique for performing an arterial puncture.

What is an ABG    

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Arterial Blood Gas Drawn from artery- radial, brachial, femoral It is an invasive procedure. Caution must be taken with patient on anticoagulants. Helps differentiate oxygen deficiencies from primary ventilatory deficiencies from primary metabolic acid-baseabnormalities.

Common terms:     

PCO2 PO2 HCO3 BE SaO2

Partial pressure CO2 Partial pressure O2 Bicarbonate Base excess Oxygen Saturation

Normal ABG values      

pH PCO2 PO2 HCO3 BE SaO2

7.35 – 7.45 35 – 45 mmHg 80 – 100 mmHg 22 – 26 mmol/L -2 - +2 >95%

Information Obtained from an ABG:  

Acid base status Oxygenation  

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Dissolved O2 (pO2) Saturation of hemoglobin

CO2 elimination Levels of carboxyhemoglobin and methemoglobin

Indications: 

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Assess the ventilatory status, oxygenation and acid base status. Assess the response to an intervention.

Contraindications:   

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Bleeding diathesis AV fistula Severe peripheral vascular disease, absence of an arterial pulse Infection over site

Complications: The most common complication from an arterial puncture is hematoma at the site. Less common but important complications are thrombus in the artery and infection at the site.

Allen test for collateral flow:

Which Artery to Choose? 

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The radial artery is superficial, has collaterals and is easily compressed. It should almost always be the first choice. Other arteries (femoral, dorsalis pedis, brachial) can be used in emergencies.

Preparing to perform the Procedure:  

Make sure you and the patient are comfortable. Assess the patency of the radial and ulnar arteries

Equipment:

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Prior to performing an arterial puncture all the necessary equipment should be ready at the bedside. Equipment includes: Gloves Heparinized arterial blood gas syringe kit Alcohol swabs 2x2 gauze Tape Patient label (put on syringe prior to putting in ice bag) Bag of ice for transport to lab

Heparinized arterial blood gas syringe kit

Performing the Procedure:  

Put on gloves Prepare the site  

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Drape the bed Cleanse the radial area with a alcohol

Position the wrist (hyper-extended, using a rolled up towel if necessary) Palpate the arterial pulse and visualize the course of the artery. If you are going to use local anesthetic, infiltrate the skin with 2% xylocaine. Open the ABG kit

Performing the Procedure (cont.) 

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Line the needle up with the artery, bevel side up. Enter the artery and allow the syringe to fill spontaneously. Withdraw the needle and hold pressure on the site. Protect needle Remove any air bubbles Gently mix the specimen by rolling it between your palms Place the specimen on ice and transport to lab immediately.

Note: 

The radial artery at the wrist is very superficial and in fact this is one of the reasons it is so frequently used for arterial blood gas sampling. One of the most common reasons for missing a puncture is that the nurse misses the artery on the way through. This is often followed by attempts to find the artery even deeper by "poking around". This will be unsuccessful and much to the displeasure of the patient. If you don't encounter the artery in the superficial subcutaneous tissue you should pull the needle back and try again.

The End

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