ABL5 Blood Gas Analyser & Blood Gas Analysis

ABL5 Blood Gas Analyser
& Blood Gas Analysis

Assoc. Prof. Faridah Abdul Rashid
Dept. of Chemical Pathology
School of Medical Sciences
Universiti Sains Malaysia
[email protected]
18 February 2005
Part 1
• Blood Gas Analysers
– pO2 Measurement
A Concise Review of
– pCO2 Measurement Clinical Laboratory
– pH Measurement Science. Joel D.
Hubbard. Williams &
– Bicarbonate Values Wilkins Co. 1997.
– Oxygen Saturation Chapter 1, page 25
QY18.2 H875 1997
Blood Gas Analysers
• Blood gas analysers determine acid-base balance
through the measurement of partial pressure of oxygen,
carbon dioxide, and pH
• Analysers use electrodes as sensing devices, and

bicarbonate and other parameters are calculated from
the previously mentioned measurements using the
Henderson-Hasselbalch equation
• Oxygen saturation is calculated as well

• Analysers typically measure arterial blood gases (ABG)
ABL5 Blood Gas Analyser
Radiometer Copenhagen
pO2 Measurement
• pO2 is measured
amperometrically
– Oxygen diffuses across an
electrode tip through an
electrolyte solution to the
cathode at a rate that is
directly proportional to the
amount of oxygen present
– The pO2 electrode is a
current electrode
– The signal from the pO2
electrode is measured in
pA
pCO2 Measurement
• pCO2 is measured
potentiometrically
– Carbon dioxide diffuses
across a membrane
through bicarbonate buffer,
eventually forming
hydrogen ions that are
measured by an electrode
– The signal from the pCO2
electrode is measured in
mV
pH Measurement
• pH is measured
potentiometrically by two
electrodes: pH electrode
and a reference electrode
– Hydrogen ions diffuse into a
glass membrane,
developing a potential that is
proportional to the difference
in the concentration of
hydrogen ions between the
sample and the buffer within
the electrode.
ABL5 Wet Section
Electrodes (left to right):

pH Reference, pH measuring, pCO2, and pO2
The electrodes are kept at a constant

temperature of 37 °C±0.2 °C
Electrode Signals
• Electrode signals are amplified and then
converted to the accurate pH, pCO2, and
pO2 values for the unknown sample
Acid-Base Relationships
• Acid-base disorders are considered in
terms of the Henderson-Hasselbalch
equation, which states acid-base
relationships:
pH = pK + log([A-]/[HA])
where A- is the proton acceptor (base) and

HA is the proton donor (acid)
Bicarbonate Values
• Bicarbonate values are calculated using
the Henderson-Hasselbalch equation:
[HCO3-] = 0.031 PCO2 x 10(pH-6.1)
[HCO3-] in mmol/L
PCO2 in mm Hg
Oxygen Saturation
• Oxygen saturation is the percentage of
total hemoglobin that has bound oxygen
and is calculated from pO2 and pH
measurements
Part 2
• Principle (http://www.lhsc.on.ca/resptherapy/policies/a-10artp.htm)
• Policy
• Specimen requirements
Principle
• Arterial blood is obtained anaerobically by
inserting a short-beveled, sharp needle
into an artery
• A device, such as a syringe, is attached

either directly or via a short piece of tubing
plus an adapter (winged infusion set) to
the needle
Principle
• When repeated measurements of arterial
blood gases are required, a needle
cannula or catheter may be inserted and
fixed in the artery and left there for several
days
• Indwelling arterial cannulae and catheters

should be removed as soon as possible
Principle
• An arterialized blood specimen may also
be obtained from properly warmed
capillary puncture sites
• All sampling systems should be leakproof;

and after blood collection, free of air
bubbles
Policy
• The Respiratory Therapist will perform
arterial punctures for the collection of
arterial blood upon a physician’s order
• The sample site is confined to the radial

and femoral arteries
Policy
• Femoral punctures are only to be
performed in emergencies when the
patient has low blood pressure that does
not produce a palpatable radial pulse, or
upon a physician’s order
• Femoral punctures are contraindicated in

patients with femoral grafts and cellulitis
Policy
• All patients will be tested for collateral
circulation prior to an arterial puncture
• Blood samples with appropriately

completed labels and requisitions will be
left at the unit desk for transport to the
laboratory in a sealed package
Policy
• The Respiratory Therapist will ensure that
samples for blood gas analysis contain the
proper date, F1O2 and their initials
• The Respiratory Therapist will ensure that

samples for blood gas analysis is
appropriately “iced” before it is sent to the
laboratory
Policy
• The Therapist will ensure that

precautions against accidental exposure
to blood is avoided by wearing gloves
when performing a puncture and not
recapping the needle after use
• The needle will be inserted into a cork,

or a rubber stopper provided with blood
gas kit, or self-capping syringe
Policy
• All blood samples must be drawn into
appropriate tubes and labeled
• A maximum of 3 attempts will be made to

obtain a sample if unsuccessful. After two
atttempts, the Therapist will consult with
another certified Therapist or the physician
to request their attempt for the sample
Policy
• An arterial puncture will not be performed
upon patients who:
a) Have circulatory disorders
b) Have PTT > 72 seconds or INR > 2.2
Normal PT 9.0 – 12.0 seconds

Normal PTT 26 – 37 seconds
Normal INR 0.9 – 1.1
Policy
c) Are receiving Warfarin/Coumadin
Always refer to PT/PTT’s
d) Are receiving I.V. Heparin
e) Are receiving thrombolytic therapy, i.e.,
Activase rt-pa or Streptokinase
f) Do not have collateral circulation through
the ulnar artery, verified by Modified
Allen’s test (radial puncture only)
Policy
g) Have platelet counts 20,000 and may be
done when the platelet count is 50,000,
upon consultation with physician
h) Are under six years of age
Specimen Requirements
• Specimen requirements for blood gas
analysis include the following.
(1) Arterial blood is collected in a glass or

plastic syringe. Capillary specimens
can also be used
(2) Lyophilized or liquid heparin is the

preferred anticoagulant
Specimen Requirements
(3) No air bubbles should exist in the sample
because they lower the pCO2 value
(4) The specimen must be placed in iced
water and transported to the laboratory in
15 minutes at 4°C and tested
immediately. Otherwise, pH values
decrease, and pCO2 values increase
(5) Blood clots are unacceptable
Part 3
Own reading
Laboratory procedures:
• ABG sample collection procedures and
analysis
• Principles of pH, PCO2, and PO2
measurements
ABL5 pH/Blood gas analyser
(Emergency request form)
Reporting ABG values
Measured
parameters
mmHg
correct
Calculated mmol/L units
parameters
incorrect units
Collection of blood for blood gas
analysis
• Obtaining the blood sample is usually
performed by the intensive care nurse
• Usually a sample of arterial blood is used

for the blood gas analysis
• Heparinised syringe is used for blood gas

analysis
Technique for drawing a blood sample
• The radial (or brachial) artery is often
chosen because of its accessibility
• The wrist is extended by positioning it over
a rolled towel
• After the skin has been sterilised, the
artery is stabilised with 2 fingers of one
hand while the arterial puncture is made
with the other hand using a heparinised
syringe
Technique for drawing a blood sample
• After 5 ml of blood has been drawn into
the syringe, air is removed and the syringe
is capped
• The syringe is placed inside an air tight
plastic bag
• The plastic bag containing the syringe is
placed in an ice-water slurry and taken
immediately to the Chemical Pathology
Routine Lab for blood gas analysis
ABG samples
ABG syringe in plastic bag
Factors affecting arterial blood gas
analysis
Collection stage:
• Venous blood sample
• Wrong syringe (non-heparinised)
• Wrong artery is chosen
• The wrist is not extended and positioned
properly
• Non-stabilised artery while the arterial
puncture is made
Factors affecting arterial blood gas
analysis
Transportation stage:
• Air is not removed from the syringe
• The syringe is not capped
• The syringe is not placed inside an air tight
plastic bag
• The plastic bag containing the syringe is
placed on ice but not in an ice-water slurry
Remove air bubbles from ABG syringe
Rub ABG syringe in palms
Inject blood sample into ABG analyser
Measured parameters in ABG
pH electrode system
Ion-selective electrodes
Reference and pH electrodes
PCO2 and PO2 electrodes

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ABL5 Blood Gas Analyser

& Blood Gas Analysis

• Analysers use electrodes as sensing devices, and

• Oxygen saturation is calculated as well

Electrodes (left to right):

The electrodes are kept at a constant

where A- is the proton acceptor (base) and

[HCO3-] = 0.031 PCO2 x 10(pH-6.1)

• A device, such as a syringe, is attached

• Indwelling arterial cannulae and catheters

• All sampling systems should be leakproof;

• The sample site is confined to the radial

• Femoral punctures are contraindicated in

• Blood samples with appropriately

• The Respiratory Therapist will ensure that

• The Therapist will ensure that

• The needle will be inserted into a cork,

• A maximum of 3 attempts will be made to

Normal PT 9.0 – 12.0 seconds

(1) Arterial blood is collected in a glass or

(2) Lyophilized or liquid heparin is the

• Usually a sample of arterial blood is used

• Heparinised syringe is used for blood gas

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