ABG Procedure and Precautions

Site- (Ideally) Radial Artery

Brachial Artery
Femoral Artery
Ideally - Pre-heparinised ABG syringes
- Syringe should be flushed with 0.5ml of 1:1000
Heparin solution and emptied.
DO NOT LEAVE EXCESSIVE HEPARIN IN THE
SYRINGE
HEPARIN
HCO3

DILUTIONAL
EFFECT

PCO2

 Ensure No Air Bubbles. Syringe must be sealed

immediately after withdrawing sample.
ABG Syringe must be transported at the earliest
to the laboratory for EARLY analysis via COLD
CHAIN

Acid Base Balance

TERMINOLOGY
Normal pH of body fluids = 7.35-7.45
ACIDOSIS
presence of a process whichtends to pH by virtue of gain of
+
H
or loss of HCO3ALKALOSIS
presence of a process which tends to pH by virtue of loss of
H+ or gain of HCO3If these changes, change pH, suffix emia is added
ACIDEMIA reduction in arterial pH (pH<7.35)
ALKALEMIA increase in arterial pH (pH>7.45)
pH is determined by hydrogen ion concentration [H+]

Sources of Hydrogen Ions

Most hydrogen ions originate from cellular metabolism;
-

Breakdown of proteins releases phosphoric acid into the

ECF

Anaerobic respiration of glucose produces lactic acid

Fat metabolism yields organic acids and ketone bodies

(ketoacidosis)

Transporting carbon dioxide in blood as bicarbonate

releases hydrogen ions.

A
C
I
D
B
A
S
E

Acid Base Balance

Concentration of hydrogen ions is
regulated sequentially by:

CHEMICAL BUFFER
SYSTEM
Acts in few seconds

RESPIRATORY
REGULATION
Acts in few minutes

RENAL
REGULATION
Acts in hours to days

Chemical Buffer Systems

Act to quickly temporarily bind H+

Raise pH but do not remove H+
Most consist of weak acid and salt of that acid functioning
as weak base
Three major chemical buffer systems;
- Bicarbonate (HCO3-) buffer system
- Phosphate (P04-3) buffer system
- Protein (albumin & hemoglobin) buffer system

Any drifts in pH are resisted by the entire chemical

buffering system

Respiratory and Renal

Compensations

Acid-base imbalance due to inadequacy of a physiological

buffer system is compensated for by the other system;

The respiratory system will attempt to correct metabolic

acid-base imbalances (hypoventilate or
hyperventilate)

The kidneys will work to correct imbalances caused by

respiratory disease (H+ secretion into urine/ HCO3balance)

Renal Regulation of Acid Base Balance

In response to acidosis:
- Kidneys generate bicarbonate ions and add them to the
blood
- An equal amount of hydrogen ions are added to the urine

Reabsorption
Secretion of H+
of HCO3
tubules
PCO2
in blood in ECF
H+ ion
excretion
Proximal Convulated
ECF Volume

Tubules (85%)
Thick Ascending Limb
of Loop of Henle (10%)
Distal Convulated
Tubule
Collecting Tubules(5%)

ions in
K+

and

Aldostero
ne
Angiotensin II

Chemical buffers can tie up excess acids or bases, but they

cannot eliminate them from body

The lungs can eliminate carbonic acid (H2CO2)by

eliminating carbon dioxide

Only the kidneys can rid the body of metabolic acids

(phosphoric, uric, and lactic acids and ketones) and prevent
metabolic acidosis

The ultimate acid-base regulatory organs are the

kidneys

Respiratory Acidosis and Alkalosis

Results from failure of the respiratory system to balance pH

pCO2 is the single most important indicator of respiratory

inadequacy

pCO2 levels in arterial blood

Normal pCO2 fluctuates between 35 and 45 mm Hg
Values above 45mm Hg signal respiratory acidosis
Values below 35mm Hg indicate respiratory alkalosis

Respiratory Acidosis
inadequate alveolar ventilation

Central respiratory depression &

other CNS problems

drug depression of respiratory center

(e.g. by opiates, sedatives,
anaesthetics)
CNS trauma, infarct, haemorrhage or
tumour
hypoventilation of obesity (e.g.
Pickwick syndrome)
cervical cord trauma or lesions (at or
above C4 level)
high central neural blockade
poliomyelitis
tetanus
cardiac arrest with cerebral hypoxia

Guillain-Barre syndrome
Myasthenia gravis
muscle relaxant drugs
toxins e.g. organophosphates, snake
venom
various myopathies

acute on COPD
chest trauma -contusion,
haemothorax
pneumothorax
diaphragmatic paralysis
pulmonary oedema
adult respiratory distress
syndrome
restrictive lung disease
aspiration

Airway disorders

Nerve or muscle disorders

Lung or chest wall defects

upper airway obstruction

laryngospasm
bronchospasm / asthma

External factors

Inadequate mechanical ventilation

Rare causes
Over-production of CO2 in hypercatabolic
disorders
malignant hyperthermia
sepsis

Increased intake of CO2

re-breathing of CO2-containing expired gas
addition of CO2 to inspired gas
insufflation of CO2 into body cavity (e.g. for
laparoscopic surgery)

Metabolic Acidosis
METABOLIC
ACIDOSIS

Bicarbonate ion
(HCO3-)
pH

Metabolic acidosis is the second most common cause of

acid-base imbalance
Typical causes are ingestion of too much alcohol and
excessive loss of bicarbonate ions (diarrhea, kidney
dysfunction)
Other causes include accumulation of lactic acid, shock,
ketosis in diabetic crisis, starvation (breaking down
proteins)

Metabolic Alkalosis
METABOLIC
ALKALOSIS

Bicarbonate ion
(HCO3-)
pH

Typical causes are:

Vomiting of the acid contents of the stomach
Intake of excess base (e.g., from antacids)
Constipation, in which excessive bicarbonate is
reabsorbed

Steps to ABG
ANALYSIS

STEP 1

ACIDEMIA OR
ALKALEMIA?

IS THE PH NORMAL?
Look at pH
<7.35 - acidemia
>7.45 alkalemia

RESPIRATORY or
METABOLIC?

STEP 2

IS THE CO2 NORMAL?

pH

PCO2

or pH

PCO2

or pH

PCO2

METABOLIC

pH

PCO2

RESPIRATORY

STEP 3

RESPIRATORYACUTE/CHRONIC?

IF RESPIRATORY, IS IT ACUTE OR CHRONIC?

Acute respiratory disorder - pH(eacute) = 0.008x Pco2

Chronic respiratory disorder - pH(echronic)= 0.003x pCO2

STEP 4

ADEQUATE
COMPENSATION?

IS THE COMPENSATORY RESPONSE ADEQUATE OR

NOT?

METABOLIC DISORDER

PCO2expected

PCO2measured PCO2expected
DISORDER
RESPIRATORY DISORDER
chronic

MIXED

pHexpected acute-