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Basic Respiratory Therapy Procedures And Lab > BRTP08 Sampling, Analysis & Hemoximetry > Flashcards

BRTP08 Sampling, Analysis & Hemoximetry Flashcards

1
Q

Primary purpose of taking arterial blood gases (ABG’s)

A

Determine adequacy of oxygenation and ventilation.

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2
Q

Major hazards of ABGs

A

Bleeding
Obstruction of vessel
Infection

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3
Q

Criteria for site selection

A
  1. Collateral blood flow
  2. Vessel accessibility
  3. Peripheral structures
  4. Hemodialysis fistula (fistula shunt)
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4
Q

Preferred sites for ABGs

A
  1. Radial artery
  2. Brachial artery
  3. Umbillical artery (commonly used in newborns)
  4. Femoral artery
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5
Q

What errors are shown in vitals when there is air in a sample?

A

Lower PaCO2
Raises pH
Raises low PaO2
Lowers high PaO2

(Will lower or raise PaO2 depending on O2 in blood)

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6
Q

What error is showed in vitals when venous admixture occurs?

A

Raises PaCO2
Lowers pH
Can greatly lower PaO2

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7
Q

What happens when there is excess anticoagulation?

A

Lowers PaCO2
Raises pH
Raises low PaO2
Lowers high PaO2

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8
Q

Effect of metabolic effects?

A

Raised PaCO2
Lowers pH
Lowers PaO2

Sample must be put on ice for 30 mins

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9
Q

What are the known pH values we will be using?

A

6.82 to 7.383

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10
Q

Acceptable drift limits equal to two standard deviations for pH, PaCO2, PaO2?

A

pH (+/-) .04
PaCO2 (+/-) 3mmHg
PaO2 (+/-) 3mmHg

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11
Q

How long does it take to reach steady state for normal lungs?

A

5-10 mins

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12
Q

How long does it take to reach steady state for COPD?

A

20-30 mins

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13
Q

How long should you wait to draw ABGs from a patient with COPD after making a change in oxygen percentage?

A

20-30 mins

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14
Q

ABGs reflect lung function and?

A
  1. Adequacy of oxygenation

2. Adequacy of ventilation

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15
Q

What is the most sensitive indicator of oxygenation directly measured?

A

PaO2

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16
Q

High PaCO2 is related to what?

A

Drowsiness

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17
Q

What is the best way to evaluate the adequacy of ventilation?

A

PaCO2

18
Q

What are non respiratory values typically referred to as metabolic values?

A 
HCO3
Base Excess (BE)
19
Q

Contraindications to ABG sampling?

A

Thrombolytic therapy (clot buster)
No collateral blood flow
Surgical arteriovenous shunt (dialysis shunt) (AV)
Lesions
Infection
Evidence of PVD aka peripheral vascualr disease

20
Q

Hazards of ABG Sampling

A 
Bleeding and hemorrhage
Artery laceration (most serious)
Hematoma and bruising
Low platelet count (thrombocytopenia)
Anticoagulants
Obstruction of blood flow
Infection of the puncture site
21
Q

Other hazards of ABG sampling

A 
Nerve damage 
Pain
Air or clotted blood
Vasovagal response (someone strains and passes out)
Self puncture
22
Q

What is the preferred site for an ABG and why?

A 
Radial artery
Safest
Superficial (near surface)
Collateral circulation
Not near any large veins
23
Q

Second most common site if ABG and why?

A

Brachial artery

Requires additional training and riskier due to insufficient collateral circulation

24
Q

Riskiest ABG site?

A

Femoral artery

Typically Only performed by physicians

Additional training

25
Q

Alternate site or 3rd in line for ABG?

A

Dorsal pedis artery or pedal artery

Has collateral flow

Additional training

26
Q

What indicates a positive allens test?

A

After squeezing ulnar and radial artery, color (flushing) returns to hand

27
Q

What size needle is used for ABG in adults

A

22-25 gauge needle

28
Q

How do you assess for a puncture site?

A

Allens test

Ensure no AV shunt

29
Q

What is a flash?

A

A spurt of blood

30
Q

If you see a flash but it stops prematurely what happened?

A

The needle went through the artery

31
Q

Air bubbles effect on PaCO2?

A

Air bubbles will ALWAYS decrease PaCO2

32
Q

What 3 things do blood gas analyzers measure?

A

pH
PaCO2
PaO2

33
Q

Values calculated durint blood gas analyzation?

A 
Hb saturation
Plasma bicarbonate (HCO3)
Base Excess (BE)
34
Q

What electrode measures pH?

A

Sanz Electrode

35
Q

What electrode measures PCO2?

A

Severinghaus or Stowe

36
Q

What electrode measures PO2?

A

Clark polarographic electrode

37
Q

“In vivo” meaning

A

Analzying INSIDE the artery

38
Q

“In vitro” meaning?

A

Removing blood then analyzing

Outside of body

39
Q

What is used for quality control?

A

Levey-jennings chart

40
Q

How do random errors occurs in levey jennings chart and how do you correct them?

A

Can just happen, or caused by sample contamination or mishandling

Will be a singular error

Recalibrate, rerun controls and samples

41
Q

How do systematic errors occur and how ste they corrected?

A

Can be caused by contaminated buffets, incorrect gas concentrations, component failure.

To correct, check function, repair or replace failed components

Will be a group of errors

42
Q

What are the two types of systematic errors?

A

Trend- gradual loss of reliability (subtle change) will look like a slope

Shift- abrupt movement outside of acceptable range

Basic Respiratory Therapy Procedures And Lab (11 decks)

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