ABG normal values and management

1. ARTERIAL BLOOD GAS
ANALYSIS
B.Sc Nursing IV year
Group V

2. INTRODUCTION
Arterial blood gases are an important routine
investigation to monitor the acid-base
make diagnosis ,indicate the severity
imbalance of the patient. They may help to
of
condition and help to assess treatment. Blood
for ABG analysis can be obtained by arterial
puncture usually from radial and femoral
artery. Bicarbonate helps in maintaining blood
pH value. Kidney and lungs work in our body
as compensatory mechanism.

4. PURPOSE
To determine the presence and
type of acid – base balance.
To check for severe breathing
problem and lungs diseases.
Assessment of the response to
the therapeutic intervention such
as mechanical ventilator.

5. INDICATION
Respiratory failure
Ventilated patient
Cardiac failure
Renal failure
Sepsis and Burn
Poisoning

8. Types of Acid-Base Imbalance
RespiratoryAcidosis
RespiratoryAlkalosis
MetabolicAcidosis
MetabolicAlkalosis

11. Causes of Respiratory
Acidosis
Hypoventilation
Neuromuscular Weakness
(Gullian Barre Syndrome)
Obesity
Asthma

12. Clinical Manifestation
Muscular Weakness
Tachypnea
Blurred Vision
Confusion
Memory loss
Restlessness

13. Management
 Pharmacological:-
• OpoidAntagonist:- Nalaxone
• β2Antagonist:- Formoterol,Albuterol
• Anticholinergic:- Ipratropium bromide
• Corticosteroids:Prednisone,Prednisolone

14. Non pharmacological:-
• Dialysis:- To clear the toxin from blood.
• Oxygen Therapy:- To minimize the chance
of hypoxemia.
• Ventilator Support:- To subside the
respiratory problem.

16. Causes
Hyperventilation
Fluid loss
Liver disease
Alteration in gas exchange
Pneumonia
Stress

17. Clinical Manifestation
Palpitation
Tetany (muscle spasm)
Convulsion
Paralysis
Chest pain

18. Management
Pharmacological:-
• Antibiotic: Levofloxin
•Antipyretic: Acetaminophen
•Anxiolytic: Benzodiazapam
 Non-pharmacological:-
• Breath into a paper bag.
•Restrict oxygen intake into the lungs.

19. •To reassure the patient who is anxious.
• Treat the underlying causes.
•If intubated, reduce minute ventilation
by adjusting rate ,tidal volume.

21. Causes
• Alcohol
• Cancer
• Diarrhea
• Liver failure
• Poisoning by aspirin and methanol
• Sever dehydration
• Seizure

22. Clinical Manifestation
 Diarrhea
 Chest pain
 Rapid breathing
 Hypotension
 Arrhythmia
 Joint pain

23. Management
 Pharmacological:-
• Ringer lactate
• Diuretics
• Administer bicarbonates
 Non-pharmacological:-
• To provide IV fluid.
• Stop drinking alcohol.
• To provide plenty of fluid.

25. Causes
• Alcohol abuse
• Hyperaldesteron
• Diarrhea and vomiting
• High fever
• Diuretic therapy
• Cystic fibrosis

26. Clinical Manifestation
Bradypnea( initial symptom)
 Apnea go on 15 sec and longer
 Decrease blood pressure
 Rapid heart rate
 Irritability
 Cyanosis
 Coma

27. Management
 Pharmacological:-
• Potassium sparing diuretics:Amiloride
• Antipyretic:-Acetazolamide
• Infuse HCL
 Non-pharmacological:-
• Dialysis
• To check vital sign of the patient.
• To provide antacid and laxative.

28. Nursing Management
• Impaired gas exchange
• Ineffective Breathing pattern
• Ineffective tissue perfusion
• Risk of infection at puncture site
• Risk of injury

29. Procedure of Arterial
Blood Gas analysis

30. Equipment Required
 Aclean tray containing:
• Gloves
• Antiseptic solution
• Local anesthesia
• 0.5 ml sodium heparin( 1:1000)
•2 – 3 ml syringe with 20, 23 and 25
gauze needle.
• Paper bag

32. Preparation of client
 To record the temperature of the client.
 Record inspired oxygen concentration
of the client.
Heparnised the syringe to
blood clotting.
 To reduce anxiety of the client.
 Allen’s test
prevent

35. Sample Collection
 Wash hands and wear gloves.
 Place pillow under the patient’s wrist.
 Palpate the artery i.e radial, brachial or
femoral to be punctured.
 Obliterate both radial and ulnar arteries at
wrist by pressing them with both thumbs.
 Ask the patient to clench and unclench the
fist until blanching of skin occurs.

36.  Release the pressure on the ulnar artery by
removing the thumb on it.
 Watch for return of circulation to skin with
in 15 sec.
 Palpate the radial artery for pulsation.
 Puncture the artery at 45-60° angle.
 The arterial blood rushes into the syringe
with a great force.
We should withdraw 2-3 ml of blood for
sample.

38.  Once the sample has been taken, withdraw
the needle and apply firm pressure over the
site of puncture with dry sponge.
 Remove the air bubble from syringe and
needle.
 Capping the needle.
 Place the capped syringe into an ice
container.
 Maintain firm pressure on puncture site for
5 min.
 If patient is on anticoagulants use the high pressure
dressing.

39. Follow-up
Send the collected sample to the
laboratory immediately.
Assess for cold hands or
numbness.
 Change the ventilator settings.

40. Complication of ABG
 Bleeding
 Infection at puncture site
 Blood accumulating under skin
 Local pain
 Thrombus in artery
 Feeling faint
Numbness of hand

41. Contraindication of ABG
 Coagulopathy
 Artherosclerosis
 Infection at insertion site
 Abnormal modifiedAllen’s test
 Use of thrombolytic agent