Analyze Blood for ABGs

By Abu Jandal
BS MLT KMU-IPMS
Acid base Physiology
• The normal human diet is almost neutral.
• contain only a, small amount of titratable acid.
• However, metabolic processes in the body result in the
production of relatively large amounts of carbonic, sulfuric,
phosphoric, and other acids.
For example, during a 24-hour period, a person weighing 70 kg
disposes of about 20 mol of C02 (the volatile form of carbonic acid)
through the lungs and about 70 to 100 mmol of titratable,
nonvolatile acids (mainly sulfuric and phosphoric acids) through the
kidneys.
• These products of metabolism are transported to the lungs and
kidneys via the ECF and blood without producing any
appreciable change in the plasma pH and with only a minimal
pH difference between arterial (pH 7.35 to 7.45) and venous
(pH 7.32 to 7.38) blood. This is accomplished by the buffering
capacity of blood and by respiratory and renal regulatory
mechanism.
Acid base measurement
Summary:
• Clinical management of respiratory and metabolic disorders depends on rapid, accurate
measurements of oxygen and carbon dioxide in blood.
• Vigorous measures to support life in patients with cardiopulmonary impairment depend largely
on assisted ventilation using mixtures of gases that are tailored in response to laboratory blood
gas and acid-base results.
• Determination of blood gases also plays an important part in the detection of acid-base
imbalance and in monitoring therapy.
• Acid-Base Measurement: The measurement of whole blood pH and blood gases.
• Blood Gases: PCO2 and PO2 (the partial pressures of carbon dioxide and oxygen) usually in
hole blood.
Respiratory Acidosis:
 A pathological process that leads to the
accumulation of carbon dioxide that raises the
PCO2, and decreases the PH; usually caused by
emphysema or hypoventilation
Respiratory Alkalosis:
 A pathological process that leads the excessive
elimination of carbon dioxide which lowers the
PC02 and increases the pH; hyperventilation.
Acidemia: An arterial blood pH <7.35.
Alkalemia: An arterial blood pH >7.45.
 DESCRIPTION:
 Blood is drawn anaerobically from a

Blood Analysis for peripheral artery (radial, brachial, femoral, or

dorsalis pedis)

ABGs  via a single percutaneous needle puncture, or

from an indwelling arterial cannula or
catheter for multiple samples.
 Either method provides a blood specimen for
direct measurement of partial pressures of
carbon dioxide (PaCO2) and oxygen (PaO2),
hydrogen ion activity (pH),
 total hemoglobin (Hbtotal), oxyhemoglobin
saturation (HbO2), and the dyshemoglobins
carboxyhemoglobin (COHb) and
methemoglobin (MetHb)
SETTING:
 Sampling may be performed by trained health
care personnel(6-8) in a variety of settings
including (but not limited to) hospitals, clinics,
physician offices, extended care facilities, and
the home
Recommended equipment:
Single puncture:
 Appropriate anticoagulant, sterile glass or plastic (low diffusibility) syringe with
needle.
 Patient label, 70% isopropyl alcohol or other suitable antiseptic solution, gauze
squares or similar material
 well-fitting latex gloves, puncture resistant container, syringe cap, 'cork' and
device to remove needle from syringe.

Indwelling catheter:
 Sterile glass or plastic (low diffusibility) syringe that has been appropriately
anticoagulated, 'waste' syringe, syringe cap, protective eyewear and outerwear (in
the RETIRED anticipation of splashing)
 well-fitting latex or vinyl gloves, and patient labels(6-8) (local anesthetic is
recommended for arterial line insertion)
 Container of ice and water (to immerse syringe barrel if specimen will not be
analyzed within 15 min)
 A detailed institutional protocol incorporating current OSHA (Occupational Health
and Safety Administration) and CDC (Centers for Disease Control) guidelines
should be in place
• Personnel: Arterial blood sampling should be performed under the direction of a physician
specifically trained in laboratory medicine, pulmonary medicine, anesthesia, or critical care.
MONITORING:
 The following should be monitored as part of arterial blood sampling
 Proper application of patient device (eg, mask or cannula)
 Mode of supported ventilation and relevant ventilator settings
 Presence or absence of air bubbles or clots in syringe or sample
 Patient's respiratory rate
 Patient's clinical appearance
 Appearance of puncture site after direct pressure has been applied and before application of
pressure dressing for potential hematoma formation
FREQUENCY:
• The frequency with which sampling is
repeated should depend on the clinical
status of the patient and the indication
for performing the procedure and not
on an arbitrarily designated time or
frequency.
• Repeated puncture of a single site
increases the likelihood of hematoma,
scarring, or laceration of the artery.
• Care should be exercised to use
alternate sites for patients requiring
multiple punctures.
• An indwelling catheter may be indicated
when multiple sampling is anticipated
for ABGs.
INFECTION CONTROL:
 Universal Precautions as published by the Centers for Disease Control and directives issued by the
Department of Labor concerning occupational exposure to blood-borne pathogens
 must be applied in all circumstances involving blood or blood contaminated collection devices in the
immediate area.
 Aseptic technique must be employed whenever blood is sampled from an indwelling arterial catheter.
 Prior to a single puncture, the site should be cleaned.
 Blood specimens, contaminated needles, and syringes must be disposed of in appropriate
containers.
 Needle sticks are the most frequent source of transmission of blood-borne diseases in health care
workers.
 Needles used for blood sampling should be sheathed only with a technique that utilizes a one-hand
device or by careful insertion into a cork, rubber plug, that prevents the sharp point from being
accessible.
 Gloves provide little protection from needle punctures but should be worn to prevent splashing of
blood on sores or other skin breaks.
Blood gas Analyzer
• Blood is collected from the patient and introduced into the analyzer.
• The analyzer aspirates the blood into a measuring chamber which has Ion
Selective Electrodes (IE electrodes that are sensitive only to the
measurement of interest).
• The pH electrode compares a potential developed at the electrode tip with
a reference potential, the resulting voltage is proportional to the
concentration of hydrogen ions, [H+].
• The pCO2 electrode is a pH electrode with a Teflon or silicone rubber CO2
semi permeable membrane covering the tip.
• CO2 combines with H2O in the space between the membrane and the
electrode tip to produce free hydrogen ions in proportion to the partial
pressure of CO2.
• The voltmeter, although actually measuring [H+], is calibrated in pCO2.
 • For pO2, oxygen permeates a polypropylene
membrane and reacts chemically with a
phosphate buffer.
• The O2 combines with water in the buffer,
producing current in proportion to the number
of oxygen molecules.
• The current is measured and expressed as
Continue.. partial pressure of oxygen.
• After measurement, the blood is automatically
expelled into a waste container and the sample
path is cleaned, ready for the next sample.
Results may be printed, displayed and sent to
the Laboratory Information System.
Units of measurement:

Millimeters of mercury (mmHg)

Typical values PH of blood is normally maintained

within the very narrow range 7.38 to 7.44.

Typical values for pCO2 in adult male arterial

blood are 34 to 35 mmHg.

Typical values of pO2 in a resting male arterial

blood sample are 80 to 90 mmHg.
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