ABG, O2 analyzers, Capnography

Question 1

-ABG Kit

Answer 1

-Most ABG kits come prepackaged and contains all necessary equipment

	-The things you will find in kit

		-Gauze

		-Band-aid

		-Provided Label (if you dont have anything from the chart then write PT info on label

		-Alcohol Prep and lodine

		-Needle cap and bung

		-Syringe with heparin and vented so blood feels the syringe

		-1.23 gauge needle and 1.18 gauge needle

Question 2

Possible hazards when drawing an ABG

Answer 2

• Hematoma-Not holding correct amount of pressure.

• Cutting of the artery/Arterial laceration

• Hemorrhage-Clot breaking lose or not allowed to clot then therapist leaves the room.

• Vasovagal reaction/nerve response.

• The artery has a cluster of nerves that wrap around the artery, thus when drawing from the radial artery— those nerves causes tremendous amounts of pain.

Causing the sympathetic nervous system response to pain

• Losing a limb is the biggest complication when drawing an ABC. The patient can lose the limb is the artery is sliced.

Question 3

Best Places to stick

Answer 3

-1st choice Radial

-2nd Choice Brachial

-3rd Femoral

Question 4

Site Selection

Answer 4

-Prior to sticking with an ABG all therapists must obtain a modified Allen’s test which is used to ensure the PTs have collateral circulation/ blood flow at the wrist. Can also use ( anesthesia medication) if PT or doctor request it.

Question 5

The Angles of ABG

Answer 5

-Radial Artery 45 degrees

-Brachial Artery 60 to 90 degrees

-Femoral Artery 90 degrees

Question 6

How long to hold pressure

Answer 6

-Site must have continuous pressure for at least 5 minutes

-Up to 30 minutes on PT on blood thinners

Question 7

Erroneous Values from Air Bubble

Answer 7

Handling

• Blood gas specimen should collected anaerobically

• Expel air bubbles immediately

In Vivo Values Air Contamination

pH. 7.40 To 7.45

PCO2. 40. To. 30

PO2. 95. To. 110

Question 8

• The amount of blood should be at least

Answer 8

1 - 2cc within the syringe.

Question 9

• Therapist should run sample ASAP.

Answer 9

• If sample is placed in ice it will keep longer.

• Glass syringe-1 hour

• Plastic syringe-15 minutes

Question 10

When moving the ABG

Answer 10

• Transport ABG to the run location in a biohazard bag.

Question 11

Internal parts of ABG machine.

Electrodes

Answer 11

• Utilized to Measure values of ABC

pH, PC02, РОг

All other blood gas values are Calculated

Question 12

The pH Electrode

Answer 12

• Called Sanz Electrode

Question 13

PCO2 Electrode

Answer 13

• Called Severinghaus Electrode

Question 14

PO2 Electrode

Answer 14

Called Clark Electrode

• Labeled as a polarographic electrode

• Sometimes cleaning of the tip with pumice may be required, because the polypropylene attracts protein thus causing buildup.

Question 15

Calibration Process

Answer 15

• 2-Point Calibration

• Uses low concentration and a high concentration range is used at both ends of the physiological range to be measured (every 30 minutes)

• Multiple-Point Calibration (3 or more points)

• Used to Verify whether the gas analyzer is linear/within range or not. (Every shift)

Question 16

• Has two separate buffers that provide approximate values of:

Answer 16

• 6.840 buffer

• referred to as the zero point or low point buffer

• 7.384 buffer

• high point or slope point buffer

Question 17

• Standard deviation for pH is

Answer 17

+ .005 or 99.5

Question 18

PO2 & PCO2 Electrode

Answer 18

• Tank One

• Low CO2 (5%) - balance

• High 02 (12% or 20%)

• Balance Nitrogen

• Tank Two

• High CO2 (10%) - slope

• 02 (0%)

• Balance Nitrogen

• Must convert tank concentration from % to mmHg

(Pe - PH2O) x tank concentration = mm Hg

(760 - 47) x 0.12 = 85.65 mm Hg

Question 19

Quality Control Plotting

Answer 19

• In control

• Trend

• Random Error

• Out of Control

Question 20

Quality control l • In control

Answer 20

• All QC runs are within the acceptable SD

Question 21

Quality Control• Trend

Answer 21

• All QC runs within the acceptable +SD but trending towards one side of the SD

Question 22

Quality Control • Random Error

Answer 22

• All QC runs within the acceptable +SD except for one run

Question 23

Quality Control • Out of control

Answer 23

• Two or more QC runs are out of the acceptable +SD

Question 24

Oxygen Analyzers

Answer 24

Oxygen analyzers are a huge part of developing and maintaining appropriate care. They measure the concentration of oxygen before or while patients are using oxygen. If the oxygen isn’t correctly delivered, then the patient is receiving the correct amount.. Polarographic analyzers use a Clark electrode to measure oxygen. Although it actually measures PO2, the polarographic analyzer usually displays the percent oxygen.

These devices are accurate at any altitude, provided the instrument is calibrated at that altitude.

Question 25

Polarographic

Answer 25

 Operation is very similar to a galvanic fuel cell analyzer except for the presence of a battery. This analyzer is compared to the Clark electrode. Things that affects the reading are: altitude, water, and high pressure. Calibrating can be accomplished by is allowing the electrode to room air (21% oxygen) or 100% oxygen.

Question 26

The galvanic cell.

Answer 26

Things that affect the reading are high system pressures, altitude, and water on the sensor. The most common analyer used is the galvanic fuel cell.

Question 27

The paramagnetic analyzers

Answer 27

The paramagnetic analyzers works through a Pauling principle, which figures oxygen as a paramagnetic gas. The Wheatstone bridge principle of oxygen analysis is completely dependant on how well oxygen cools a heated wire.

Question 28

In the zirconium analyzer

Answer 28

In the zirconium analyzer, The cell must be heated to 700 degrees Celsius to 800 degrees Celsius,

Question 29

Capnography

Answer 29

Monitoring of Exhaled Carbon Dioxide Otherwise known as • ECO2, ETCO2, PetCO2...end of tidal volume level of exhaled carbon dioxide

Question 30

Capnography Indications

Answer 30

• Verification of artificial airway placement • Assessment of pulmonary circulation and respiratory status • Optimization of mechanical ventilation • Evaluation of capnogram • May be useful in detecting rebreathing of CO2, obstructive disease, NMBA, and effectiveness of compressions during CPR Capnography Contraindications • None

Question 31

Capnometers use two different methods to sample the respiratory gases

Answer 31

• Mainstream sampling uses infrared  • Sidestream sampling uses tubbing

Question 32

Normally the PetCO2 will be lower than the arterial PaCO2 - 1-5 mmg difference

Answer 32

• PaCO2 = 40 mmHg • PetCO2 = 35 mmHg • Can be displayed at a percent...normal value is 3-5 • Pay careful attention to the gradient difference between the two...trending

Question 33

Factors affecting PetCO2

Answer 33

- An increase in the PetCO2 would indicate a decrease in ventilation (ventilatory failure) • A decrease in the PetCO2 would indicate an increase in ventilation or decreased perfusion - Low PetCO2 readings immediately following intubation would indicate that the ET tube is in the esophagus