Arterial Blood Gas Analysis

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Slide 1 :

Arterial Blood Gas Analysis Terri Slifer Lynch, MSN, RN, BC Fall 2006

Slide 2 :

Purposes of Performing Blood Gas Analysis Identify specific acid-base disturbances Provides information on oxygenation Provides information on alveolar ventilation Usually based on an arterial blood sample

Slide 3 :

Acid-Base Balance Acid-base balance is crucial to effective functioning of body systems. Acids Substances that lose ions, ie. H+ All acids are positively charged Bases Substances that accept ions, ie. HCO3- All bases are negatively charged

Slide 4 :

Plasma pH – an inverse indicator of hydrogen ion concentration in blood. Normal values 7.35 - 7.45. An increase in H+ decreases pH. There is an increase in acidity. A decrease in H+ increases pH. There is a decrease in acidity (increase in alkalinity). pH below 6.8 or above 7.8 is incompatible with life.

Slide 5 :

Three Systems Which Maintain Normal Serum pH Buffer systems Lungs Kidneys

Slide 6 :

Buffer Systems Blood buffer systems Proteins Inorganic phosphates Hgb Bicarbonate-carbonic acid buffer system Normally 20 parts bicarbonate (HCO3-) to one part carbonic acid (H2CO3) When CO2 is dissolved in water, it becomes carbonic acid (CO2+H2O ? H2CO3 ? H+ + HCO3-) Kidneys and lungs are the major regulating organs

Slide 7 :

Lungs’ Role In Acid-Base Regulation Fast to respond Respond to changes in CO2 levels Rise in serum CO2 levels causes a decreased pH. This results in hyperventilation to compensate Fall in serum CO2 levels causes an increased pH. This results in hypoventilation to compensate

Slide 8 :

Kidneys’ Role In Acid-Base Regulation Slow to respond Either excrete or reabsorb HCO3- or H+ to compensate

Slide 9 :

Levels of Compensation Uncompensated – pH is abnormal - buffer systems and regulatory mechanisms have not begun to correct imbalance Partially compensated – pH is abnormal but buffers and regulatory mechanisms have begun to respond Compensated – pH is normal. Acid and base components are abnormal but balanced

Slide 10 :

Indicators for Determination of Acid-Base State pH – normal value 7.35-7.45 Gain acid or lose base, become more acid Gain base or lose acid, become more alkaline PaCO2 – normal value 35-45 mmHg Partial pressure of CO2 in arterial blood Lungs responsible for controlling excretion or retention of CO2 through ventilation Elevated PaCO2 is caused by hypoventilation Decreased PaCO2 is caused by hyperventilation

Slide 11 :

HCO3 – normal value 22 to 26 mEq/L Represents renal or metabolic component Influenced by metabolic processes Decreased with acidosis, increased with alkalosis Base excess – normal value + 2mEq/L Indirect reflection of bicarbonate concentration Base deficit or excess acid if < -2mEq/L Base excess or acid deficit if > 2mEq/L

Slide 12 :

Indicators of Oxygenation Status PaO2 – normal value 80-100 mmHg Partial pressure of O2 dissolved in arterial blood Hypoxemia – levels < 80mmHg SaO2 – normal value > 95% Percentage of oxygen combined with Hgb compared with amount it could carry Hgb – normal value 12 – 15 g/dL for women; 13.5 – 17g/dL for men. Major carrier of O2 in the blood Has an affinity or attraction for O2 molecules

Slide 13 :

The Affinity of Hgb for O2 Can Change Increased affinity O2 bonds more easily with Hgb Hgb does not want to give O2 up Oxyhemoglobin curve shifts to the left Decreased affinity O2 does not bind easily with Hgb Hgb gives up O2 more easily Oxyhemoglobin curve shifts to the right

Slide 14 :

Factors That Affect the Oxyhemoglobin Dissociation Curve Left Shift Alkalosis Hypothermia Hypocarbia Decreased 2,3 DPG Right Shift Acidosis Hyperthermia Hypercarbia Increased 2,3 DPG

Slide 15 :

Acid–Base Balance Determination Evaluate pH Evaluate PaCO2 Evaluate HCO3- Determine if compensation

Slide 16 :

Slide 17 :

Evaluation of Oxygenation Status Evaluate PaO2 Evaluate SaO2 Evaluate Hgb

Slide 18 :

Four General Classes of Acid-Base Imbalances Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Slide 19 :

Uncompensated Respiratory Alkalosis Criteria – pH > 7.45; PaCO2< 35mmHg Causes Fear Pain Fever Early salicylate intoxication Hypoxemia Central nervous system tumors

Slide 20 :

Clinical manifestations Lightheadedness Paresthesia Decreased concentration Tachycardia and other dysrhythmias Tetany

Slide 21 :

Medical management Slow deep breathing Relieve pain Correct hypoxemia

Slide 22 :

Uncompensated Respiratory Acidosis Criteria - pH<7.35; PaCO2>45mmHg Causes Pulmonary edema Pneumothorax Massive pulmonary embolus Severe pulmonary infection Neuromuscular disorders Chronic pulmonary diseases Oversedation

Slide 23 :

Clinical manifestations Dyspnea Restlessness Tachycardia and other dysrhythmias Elevated blood pressure Confusion Drowsiness Hyperkalemia

Slide 24 :

Medical management Diagnostic tests to determine cause Pulmonary hygiene Adequate hydration High Fowler’s position Mechanical ventilation Bronchodilators, antibiotics Supplemental oxygen

Slide 25 :

Uncompensated Metabolic Alkalosis Criteria – pH >7.45; HCO3->26 mEq/L Causes Vomiting, NG suction Hypokalemia Diuretics Hyperaldosteronism Cushing’s syndrome Excessive use of bicarbonate

Slide 26 :

Clinical manifestations Dizziness Lethargy Tetany Decreased respirations Atrial tachycardia and other dysrhythmias Paralytic ileus Hypoxemia Seizures, coma

Slide 27 :

Medical management Restore fluid volume with NaCl Carbonic anhydrase inhibitors

Slide 28 :

Uncompensated Metabolic Acidosis Criteria – pH<7.35; HCO3-< 22mEq/L Causes Renal failure Ketoacidosis Anerobic metabolism Starvation Late phase of salicylate intoxication Diarrhea Intestinal fistula

Slide 29 :

Clinical manifestations Headache Confusion Lethargy Hyperventilation Warm, flushed skin Hyperkalemia Nausea, vomiting Dysrhythmias

Slide 30 :

Medical management Administer bicarbonate cautiously Monitor K+ closely Monitor Ca+ levels

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Acid-base balance is crucial to effective functioning of body systems.Acid and base components are more Acid-base balance is crucial to effective functioning of body systems.Acid and base components are abnormal but balanced ... less
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