Nurses role in arterial puncture and abg analysis

ABG made easy

1. NURSES ROLE IN ARTERIAL PUNCTURE AND ABG ANALYSIS STEPHY STANLY

2. Acid base status Degree of oxygenation of blood and adequacy of alveolar ventilation Continous arterial blood pressure monitoring in an emergency Purposes

3. 1ml or 2 ml disposable syringe 20 gauge disposable needles Heparin1;1000 Alcohol swab disposable gloves Arterial catheter for continous pressure monitoring Tegaderm Articles

4. Identify patient by name and explain procedure Temperature Heparinize 2 ml syringe Wash hands wear gloves Palpate the radial,brachial or femoral artery Procedure

5. perform allen test

6. palpate for maximum pulsation at 45-60 degreee angle once the artery is punctured ,arterial pressure will push up the piston of the syringe and a pulsating flow of blood will fill the syringe.

7. apply firm pressure -for 5 mins . air is removed and cap the syringe needle and keep it in a container of ice.

8. Arterial blood gas analysis is an essential part of diagnosing and managing a patient’s oxygenation status and acid-base balance ABG ANALYSIS

9. pH = Pka + log base/acid Acidemia – H+ conc in plasma is greater than normal Alkalemia – H + conc in plasma is less than normal Buffer

10. Excess heparin : low pH, PCO2 & HCO3 Contamination with room air : PaO2, pH, PaCO2 Delayed analysis : By 10 mts – pH decreases by 0.01 PCO2 increases by 1 mmHg O2 conc decreases by 0.001   ABG ERRORS

11. Normal PH : 7.35 – 7.45 acidosis < 7.35 alkalosis > 7.45 STEP 1 - ASESS PH

12. Normal PaCO2- 35-45 High PaCO2 > 45 PH low Resp acidosis Low PaCO2 < 35 PH high Resp alkalosis STEP 2 – ASSESS PaCO2

13. Normal HCO3 – 22-28 meq /L PH low HCO3 low Metabolic acidosis PH high HCO3 high Metabolic alkalosis STEP 3 – HCO3

14. Determine if there is a compensatory, mechanism working to try to correct the pH. Values of HCO3 and CO2 Step 4:

15. Analyse the partial pressure of oxygen and saturation Step 5

16. Normal Values (At sea level) Range: pH 7.35-- ‐ 7.45 pCO2 35-- ‐ 45 mmHg pO2 80-- ‐ 100 mmHg O2 Saturation 95-- ‐ 100% HCO3 Base Excess 22-- ‐ 26 mEq /L + or-- ‐ 2

17. ABG's:  pH 7.31   PCO 2   55 mm Hg   HCO 3 -  28 mEq /L Qiuz 1

18. Ans uncompensated respiratory acidosis

19. ABG's:  pH 7.31   PCO2 55 mm Hg   HCO3- 35 mEq /L

20. Compensated respiratory acidosis

21. Ph- 7.30 Pco2 -30 Po2-68 O2 sat- 92% HCO3-14

22. Compensated metabolic acidosis

23. Ph -7.18 Pco2 44 Po2-92 O2 sat-95% Hco3-16

24. Uncompensated metabolic aciosis

25. Ph- 7.27 Pco2-53 Po2-50 O2 sat-79% HCO3-24

26. Uncompensated respiratory acidosis with hypoxemia