BASIC ARTERIAL BLOOD GAS (ABG)

INTERPRETATION

By: Jesus Mario A Lopez Jr., R.T.,R.N.

Common Arterial Blood Gas Puncture

Sites

Obtaining ABG Puncture Sites

Adult

Child (> 24
months)

Neonate(< 12
months)

1* - Radial A.
2* - Brachial A.
3* - Femoral A.

1* - Radial A.
2* - Brachial A.

1* Brachial A.
2* Umbilical V.
3* Capilliary
and Heel Stick
samples
(opitional)

4* -Dorsalis
Pedis A.

5* - Posterior
Tibial A.

30-40

Radial

90

Femoral

45-60
10-20

Dorsalis P. & Posterior T.

Brachial

Modified Allens Test

Sampling Hazards
-

Disruption of blood flow (e.g.

Hematoma)
Clotting
Bleeding
Vessel spasm
Fistulas
Tissue trauma
Under Anticoagulant Therapy
Poor skin healing (underlying dse.)

Sampling Problems
-

Air Bubbles
* PaCo2
* Pa02 or
* pH
Improper cooling (> 1 hr.)
* PaCo2
* Pa02
* pH
Too much heparin
*pH

Factors may alter ABG results

1.
2.
3.
4.
5.
6.

Post suctioning
Nebulization (after?)
Movement (Turning)
Medications (I.V.)
Activity/Procedures
Handling of sample

Normal Values:
Parameters

Range

Absolute

Mixed Venous

7.35-7.45

7.40

7.31-7.41

PaCO2

35-45 mmHg

40 mmHg

41-51 mmHg

PaO2

80-100 mmHg

95 mmHg

37-43 mmHg

HCO3

22-26 mmHg

24 mEq/L

22-26 mEq/L

-2 to +2
mEq/L

0 mEq/L

-2 to +2
mEq/L

> 95%

98%

68-75 %

pH

BE/BD
O2 Sat %

pH - <7.35=Acidotic
>7.45=Alkalotic
HCO3 - <22mEq/L=Acidotic
>26mEq/L=Alkalotic
BE/BD - <-2 Acidotic
>+2 Alkalotic
PaCO2 - > 45mmHg=Acidotic
< 35mmHg=Alkatotic

Organs involved in ABG

Respiratory Component = Lungs PaCo2
- minutes to compensate
Metabolic Component = Kidneys HCO3
- days/weeks to compensate

Primary and Compensatory response

for acid-base disorders:
Primary Event

Compensatory Response

PaCO2

HCO3

PaCO2

HCO3

Arterial Oxygenation Status (PaO2)

With Hypoxemia @ R.A.

With Hypoxemia @ O2

Normal/adequate Oxygenation

Overcorrected oxygenation
= > 100mmHg
Corrected oxygenation
= 80-100mmHg
Uncorrected/inadequate
oxygenation
= <80mmHg

= 80-100mmHg
Mild Hypoxemia
= 60-79mmHg
Moderate Hypoxemia
= 40-59mmHg
Severe Hypoxemia
= < 40mmHg

* Note for individuals over age of 60 y/o, 1mmHg should be subtracted

from the lower limits of mild and moderate hypoxemia for each year over
60 y/o. At any age a PaO2 < 40mmHg indicates severe hypoxemia, and a
PaO2 of <60-65mmHg is always considered hypoxemic.

Monitoring of O2 & CO2 status

ABG analysis (Confirmatory!!!)

Pulse oximetry (least)
EtCO2 monitoring (spot check/transport
vent )

Capillary gas determination(infants only)

Transcutaneous monitoring
Oxygenation indices

Steps in ABG Interpretation:

1.
2.

3.
4.

Determine the pH
Determine whether respiratory or
metabolic in origin
Determine the compensation
Determine the Oxygenation Status

________
3

_______ _______ ________

1

pH= 6.90
PaCO2=70mmHg
PaO2=39mmHg
HCO3= 23mEq/L
BE/BD= -4mEq/L
O2 Sat= 90%
Age: 20 y/o
Fi02: R.A.
Interpretation: Uncompensated Respiratory
Acidosis w/ Severe Hypoxemia

ABG: RESPIRATORY ACIDOSIS

Causes (mainly airway obstruction &

resp. depression)
COPD: Asthma, Bronchiectasis,
Bronchitis, Emphysema
Atelectasis
Brain trauma
Hypoventilation
Sedatives, narcotics, anesthetics
Pulmonary edema

ABG: RESPIRATORY ACIDOSIS

S/Sx
RR & depth
HA, visual disturbance,
restlessness, drowsiness, confusion
Diaphoresis
Cyanosis
Hyper K
dysrhythmias (VF)

ABG: RESPIRATORY ACIDOSIS

Tx
Semi-Fowlers,

O2, coughing

Hydration
Suction

secretions
WOF RR distress, hyper K
Antibiotics & other meds as
ordered

pH= 7.60
PaCO2=52mmHg
PaO2=77mmHg
HCO3= 28mEq/L
BE/BD= +3mEq/L
O2 Sat= 94%
Age: 35 y/o
Fi02: 50% Simple Face Mask
Interpretation: Partially compensated
Respiratory Alkalosis w/ uncorrected
oxygenation

ABG: RESPIRATORY
ALKALOSIS

Causes (mainly overstimulation of the

respiratory system)
Hyperventilation
Fever
Hypoxia
Hysteria
Overventilation by mech vent.
Pain
Salicylates

ABG: RESPIRATORY
ALKALOSIS

S/Sx
RR & depth then RR
HA, light-headedness, vertigo
Hypo Ca: paresthesia, tetany,
convulsion
Hypo K

pH= 7.00
PaCO2=40mmHg
PaO2=88mmHg
HCO3= 29mEq/L
BE/BD= -8mEq/L
O2 Sat= 90%
Age: 54y/o
Fi02: 2LPM Via nasal cannula
Interpretation: Uncompensated metabolic
acidosis w/ corrected oxygenation

ABG: METABOLIC ACIDOSIS

Causes
DM & DKA
ASA toxicity
High fat diet
Insufficient CHO metabolism
Malnutrition
RF
Severe diarrhea

ABG: METABOLIC ACIDOSIS

S/Sx
RR, Kussmauls respiration
HA, N/V/diarrhea
Fruity-smelling breath
CNS depression
Twitching, convulsion
Hyper K

ABG: METABOLIC ACIDOSIS

Tx
NaHCO3 IV
Sz precaution
For DKA: NS & Regular Insulin
IV
For RF: CHON, calorie diet;
dialysis

pH= 7.48
PaCO2= 42mmHg
PaO2= 73mmHg
HCO3= 30mEq/L
BE/BD= +8.8mEq/L
O2 Sat= 96.21%
Age: 10 y/o
Fi02: R.A.
Interpretation: Uncompensated Metabolic
Alkalosis w/ mild hypoxemia

ABG: METABOLIC ALKALOSIS

Causes
Diuretics
Excessive vomiting or GI
suctioning
Hyperaldosteronism
Excessive NaHCO3 intake
Massive BT (citrate converted to
HCO3)

ABG: METABOLIC ALKALOSIS

S/Sx
RR & depth
N/V/diarrhea
Restlessness
Paresthesia, twitching
HypoK, HypoCa
HR, dysrhythmias

Case Studies:
1. A 20 y/o female with known DM II entered the ER
with Kussmauls breathing and irregular pulse. 02
@ 4Lpm via nasal prong, V/S and ABG were
taken.
V/S = RR-25 bpm
CR-108 bpm
BP- 100/50 mmHg

ABG = pH 7.12
PaCO2 35mmHg
PaO2- 101mmHg
HCO3- 13 mEq/L
O2 Sat%- 99.0%

Interpretation: Uncompensated metabolic acidosis

w/ over corrected oxygenation.

Case Studies:
2., A client recovering from surgery in the post-anesthesia
care unit (PACU) is difficult to arouse two hours following
surgery. The nurse in the PACU has been administering
Morphine Sulfate intravenously to the client for complaints
of post-surgical pain. The clients respiratory rate is 7 per
minute and demonstrates shallow breathing. The patient
does not respond to any stimuli
.
V/S = RR- 8 bpm
CR- 40bpm
BP- 50 palp
O2 3lpm n.c.

ABG = pH 7.10
PaCO2 60mmHg
PaO2- 41mmHg
HCO3- 29mEq/L
O2 Sat%- 85%

Interpretation: Partially compensated respiratory acidosis w/

moderate hypoxemia.

Case Studies:
3. A two-year-old is admitted to the hospital with a diagnosis
of asthma and respiratory distress syndrome. The father
of the infant reports to the nurse that he has observed
slight tremors and behavioral changes in his child over the
past three days. The attending physician orders routine
ABGs following an assessment of the ABCs. The ABG
results are:
V/S = RR-25 bpm
CR-135 bpm
BP- 175/110 mmHg
O2 7lpm tusk mask

ABG = pH 7.40
PaCO2 47mmHg
PaO2- 115mmHg
HCO3- 39mEq/L
O2 Sat%- 100.0%

Interpretation: Compensated metabolic alkalosis w/

over corrected oxygenation.