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Arterial Blood Gas (ABG) Test

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Arterial Blood Gas (ABG) Test


Author: Benjamin Daniel Liess, MD; Chief Editor: Vincent Lopez Rowe, MD more...
Updated: Aug 29, 2013

Products
Arteries are the large vessels that carry oxygenated blood away from the heart. The distribution of the systemic
arteries is like a ramified tree, the common trunk of which, formed by the aorta, commences at the left ventricle,
while the smallest ramifications extend to the peripheral parts of the body and the contained organs. For more
information about the relevant anatomy, see Arterial Supply Anatomy.
Arterial blood gas (ABG) testing is used to determine gas exchange levels in the blood related to respiratory,
metabolic, and renal function.

Category
ABG analyzer

Device details
Many ABG analyzers are commercially available. The examples listed below do not represent an all-inclusive list
and are in no specific order.
Abbott - Cell-Dyn 520 hematology analyzer
Roche Diagnostics - AVL Compact 2 blood gas analyzer
Instrumentation Laboratory - IL 682 Co-Oximeter System
Medica - Easy Blood Gas Analyzer
Siemens - 238 Blood Gas Analyzer System
Nova Biomedical - Stat Profile pHOx CO-Oximeter

Design Features
Blood may be drawn from the radial artery or, less commonly, the femoral artery or brachial artery for blood gas
analysis. Once the blood is sampled, visible gas bubbles should be eliminated, since they may dissolve into the
sample and lead to inaccurate results. The sample is then taken to a blood gas analyzer.[1, 2]
See the images below.

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ABG anatomy.

Right radial artery.

Results are usually available within 5-15 minutes. Aberrant results may result from contamination with room air,
resulting in abnormally low carbon dioxide and near-normal oxygen levels. Delays in analysis of the blood tube
allow for ongoing cellular respiration and may lead to errors with inaccurately low oxygen and high carbon dioxide
levels reported in the results.
The arterial blood gas (ABG) test may determine concentrations of lactate, hemoglobin, electrolytes,
oxyhemoglobin, carboxyhemoglobin, and methemoglobin.
Values at sea level include the following:
Partial pressure of oxygen (PO2) - 75-100 mm Hg
Partial pressure of carbon dioxide (PCO2) - 35-45 mm Hg
Arterial blood pH - 7.38-7.42
Oxygen saturation (SaO2) - 94%-100%
Bicarbonate (HCO3) - 22-26 mEq/L

Indications
Arterial blood gas (ABG) testing is used to determine gas exchange levels in the blood related to respiratory,
metabolic, and renal function. The results may indicate an underlying condition causing acidosis or alkalosis.

Clinical Implementation
During intensive care treatment, sampling and analysis of arterial blood gas (ABG) levels remains the criterion
standard for evaluating sufficient ventilatory support. These results help to determine if the patient is in
metabolic/respiratory alkalosis/acidosis with or without an anion gap.[3, 4] See the Anion Gap calculator.
ABG testing is the criterion standard for determining the adequacy of ventilatory support and the relationship
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between pH, pO2, pCO2, and HCO3 in the human body.


The pH level indicates whether a patient is acidemic (pH < 7.35) or alkalemic (pH >7.45). The partial pressure of
oxygen (pO2) shows the level of oxygenation in the body. The partial pressure of carbon dioxide (pCO2) indicates
the degree of CO2 production or elimination via the respiratory cycle. An elevated or decreased pCO2 (ie,
respiratory acidosis or respiratory alkalosis, respectively) is an indication of the appropriateness of ventilation.
The bicarbonate ion (HCO3) demonstrates the degree of a metabolic disturbance in a patient. For example, a low
HCO3 level suggests a metabolic acidosis, whereas a high HCO3 level suggests a metabolic alkalosis. A base
excess may then be determined to further delineate the underlying respiratory or metabolic disturbance via the
following equation:
Base excess = 0.93 X ([HCO3] - 24.4 + 14.8 X [pH - 7.4])
A base excess of more than +2 mEq/L indicates metabolic alkalosis (excess bicarbonate). Less than -2 mEq/L
indicates a metabolic acidosis (typically either excretion of bicarbonate or neutralization of bicarbonate by excess
acid).
The serum anion gap (AG) is then used to determine the underlying cause of a metabolic acidosis. The equation
used commonly is as follows:
AG = (Na) - (Cl+ HCO3)
Normal range is 8-16 mEq/L. For a discussion of underlying causes of the various types of alkalosis and acidosis,
please refer to additional articles or textbooks.[3, 4, 5]

Follow-up/Monitoring
Follow-up is as appropriate for patient monitoring and disease progression.

Complications
Bleeding, blood flow problems, and/or delayed bleeding at the puncture site
Bruising
Pain
Feeling light-headed or fainting
Hematoma
Infection

Contributor Information and Disclosures


Author
Benjamin Daniel Liess, MD Assistant Professor, Department of Otolaryngology, University of MissouriColumbia School of Medicine
Benjamin Daniel Liess, MD is a member of the following medical societies: American Academy of Otolaryngic
Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Rhinological
and Otological Society, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.
Chief Editor
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department
of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons,
American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society
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for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society
Disclosure: Nothing to disclose.

References
1. Kirmizis D, Kougioumtzidou O, Vakianis P. Diagnostic accuracy of arterial line blood gas measurements
as an estimate of arteriovenous fistula recirculation. Nephrology (Carlton). Jul 1 2013;[Medline].
2. Budak YU, Huysal K, Polat M. Use of a blood gas analyzer and a laboratory autoanalyzer in routine
practice to measure electrolytes in intensive care unit patients. BMC Anesthesiol. Aug 3 2012;12:17.
[Medline]. [Full Text].
3. Baillie JK. Simple, easily memorised "rules of thumb" for the rapid assessment of physiological
compensation for respiratory acid-base disorders. Thorax. Mar 2008;63(3):289-90. [Medline].
4. Dzierba AL, Abraham P. A practical approach to understanding Acid-base abnormalities in critical illness.
J Pharm Pract. Feb 2011;24(1):17-26. [Medline].
5. Sagy M, Barzilay Z, Boichis H. The diagnosis and management of acid-base imbalance. Pediatr Emerg
Care. Dec 1988;4(4):259-65. [Medline].
Medscape Reference 2011 WebMD, LLC

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