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Egan's 18

ABG's

How can tissue O2 be measured By invasive probes-Tissue Oxygen (Pt)2) monitor, inserted directly into organs, tissue, and body fluids.
How do you prevent pre-anlytical errors in ABG samples? Make sure the sample is: Obtained anaerobically, properly anticoagulated, bubbles removed, analyzed within 10 to 30 minutes
How is CO2 transported? 45-55 ml of CO2 per 1 dl blood is transported by ionized bicarb, dissolved in plasma, and plasma protein transport.
How much blood is needed for an adequate ABG sample? 0.5 mL of blood. Usually enough to perform two tests.
For accurate ABG results what are the components of quality control? Record Keeping Performance validation Preventative maintenance and function checks Automated Calibration/Verification Internal Statistical quality control External quality control (proficiency testing Remedial action
Intra-arterial (In Vivo) continuous blood gas analysis is beneficial how? Real time monitoring Reduction in therapeutic decision making time Less blood loss Lower infection risk Improved accuracy Elimination of specimen transpor
Invasive procedures are Insertion of a monitoring device into a patient
Laboratory Analysis is discrete measurements of fluids or tissue that has been removed from the patient
Monitoring is defined as An ongoing process by which clinicians obtain and evaluate dynamic physiological processes in a timely manner (bedside)
Noninvasive procedures are external monitoring without insertion of devices INTO the patient
Possible anatomical sites for ABG's Radial Brachial Femoral Posterior Tibial Dorsalis Pedis
Pressure values for osygenation PaO2 80-100 mmHg normal 60-80 mmHg mildly hypoxemic 40-59 mmHg moderately hypoxemic < 40 mmHg severely hypoxemic SaO2 95-100% Normal CaO2 18-20 % Normal
Procedure for initiating indwelling catheterization First sample of indwelling catherter would be a waste sample
Reasons for drawing an ABG Sudden, unexplained dyspnea Acute shortness of breath/tachypnea Abnormal breath sounds Cyanosis Heavy sue of accessory muscles Changes in ventilator settings CPR Diffuse infiltrates in Chest Xray Sudden Cardiac arrhythmias Acute hypotension
What are common technical errors associated with capillary blood samplig? Inadequate warming and squeezing of punture site. Squeezing the puncture site may result in venous and lymphatic contamination of the sample
What are secondary values to ABGs that need to be CALCULATED? Bicarbonate (HCO3) Base Excess (BE) or deficit Hemoglobin saturation (HbO2)
What are the 2 most important factors influencing accuracy of transcutaneous measurements? Age and perfusion status
What are the benefits of indwelling catheters? (ie. A-Line) Provides ready access for blood sampling Allows for continuous monitoring of vascular pressures.
What are two site locations for indwelling catheters? Normal routes are preipheral arteries (radial, brachial, pedal), femoral artery, central vein, and pulmonary artery.
What are two techniques of capnometry? Mainstream technique places an analysis chamber in patients breathing circuit. Sidestream technique pumps small volume of gas from circut into nearby analyzer.
What an a good capillary blood gas sample provide and reflect? Estimated arterial oxygenation and PCO2
What can be used if frequent blood sampling is needed? Arterial Cannulation
What can PtO2 monitors indicate? Monitor brain tissue oxygen as an early sign of ischemia. Monitor adequacy of brain perfusion in patients with traumatic brain injury.
What do most bedside systems to measure FiO2 utilize? Electrochemical principles (O2 analyzers)
What does Extra-arterial (Ex Vivo) blood gas analysis provide? Eliminates all problems associated indwelling sensors. Provides quick results Determine further justification of costs and patient benefits.
What does oximetery measure? Hb saturation using spectrophotometry.
What does transcutaneous monitoring provide? Continuous, noninvasive estimates of PO2 and PCO2 using a skin sensor. Also PtcO2 levels.
What is the downfall of indwelling catheters? Infection and thrombosis are more likely than intermittent punctures.
What is Hb measurements expressed as and what is its O2 capacity when compared to what is dissolved in plasma Always expressed in grams/dl. dl=100 ml. The O2 capacity of Hb is 7x greater than what is dissolved in plasma.
What is hemoximetry? Laboratory analytical procedure requiring invasive sampling of arterial blood
Created by: rrtruett