Chapter 19 Flashcards
What is the difference between invasive and non invasive analyzing and monitoring?
NONinvasive gathers data externally
Invasive requires insertion of sensor or collection device into body
What are the sites for arterial puncture and the preferred site?
Radial, femolar, brachial and ulnar arteries. Radial Artery is preferred method
What are the indications for blood gas sampling?
Sudden unexplained dyspnea, Cyanosis, Abnormal breath sounds, Severe unexplained tachypnea, Changes in ventilator settings, CPR, Acute hypotension, Acute deterioration in neurologic function
What are the known complications and precautions for ABG?
Hemorrhage, Air or clotted blood emboli, Trauma to vessel, patient or sampler contamination, vasovagal response, hematoma and pain
What are the supplies needed for ABG
Gloves, Safety goggles, Pre-heparinized blood gas kit system, short bevel 20-22 gauge needle w clear hub, label, isopropyl alcohol, sterile gauze, ice slush and needle capping device
Should you do an ABG if there are abnormal Allen test results?
No, that means there is no collateral circulation in the arteries
What can you associated PaCO2 with? What is the normal range?
Lungs. 35-45 mmHG
What do you associated bicarbonate (HCO3-)? What is the normal range?
Associate it with kidneys. 22-36 mEq/L
What levels are checking for acid base status?
pH,CO2 and HCO3-
What is the normal PaO2?
80-100 mmHg
What does PaO2 mean?
Checking of oxygenation status
What is the range for Mild Hypoxemia?
60-79 mmHg
What is the range for Moderate Hypoxemia?
40-59 mmHg
What is the range for severe hypoxemia?
< 40 mmHg
Can hyperventilation cause changes in ABG results while doing the procedure? What is the time to return to steady states for healthy lungs ? What about lungs that aren’t healthy? IE lung disease?
yes it will change the values. Healthy lungs take 5 minutes or so
Lungs with dieases may take up to 30 min
What are some preanalytical errors with arterial blood?
Air in sample, Excess anticoagulant, venous admixture, and metabolic effects
What happens when there is air in the ABG sample?
pH INCREASES
PCO2 Decreases toward 0 mm HG
PO2 increase/decrease towards 150 mmHg (room air)
What happens when there is excess anticoagulant in ABG samples?
pH DECREASES, PCO2 decreases towards 0 mmHg
PO2 increases/decreases toward 150 mmHg
What happens to ABG sample when venous admixture occurrs?
pH decreases
PCO2 increases
PO2 decreases
What metabolic effects are seen with ABG samples?
\
pH decreases, PCO2 increases, PO2 decreases
What is the amount of blood required for arterial blood sampling?
0.5 to 1 mL
What is the recommended time for analysis?
15 minutes
What is the advantage of point of care testing?
Reduces turnaround time, which improve care and lowers costs, used for blood chemistry and hematology parameters
Define the purpose of transcutaneous monitoring and gases monitored? Is it invasive or noninvasive?
It is noninvasive. It is used to continuously monitor adequacy of arterial oxygenation or ventilation
Real time responses to diagnostic and therapeutic interventions as evidenced by PtCO2 or PtcCO2 values
What are the common sites for Transcutaneous monitoring?
Abdomen, Chest and lower back
What are the indications/contraindications or hazards for TM?
Indications: need to monitor continuously the adequacy of arterial oxygenation or ventilation, or real time responses to diagnostic/therapeutic
Contraindications: N/A, adhesive allergies, poor skin integrity alt devices should be considered.
Hazards: false neg/false pos results and tissue injury from heat may occur at measuring site
define capillary blood gases (CBG)
can accurately reflect and provide clinically useful estimates of arterial pH and PCO2 levels
What are the indications for CBG’s
ABG is indicated but unavailable
Noninvasive readings are abnormal
A change in pt status is detected by history or physical assessment
Monitoring the severity and progression of a documented disease process is desirable
What are complications/hazards for CBG’s
Not to be done on anyone younger than 24 hours, contamination and infection of the patient, burns, hematoma, bruising, scarring, bleeding
What is pulse oximetry? is it invasive or noninvasive?
NONinvasive procedure performed at bedside that provides estimates of SaO2. (SpO2 > 95% on room air is normal)
What is HbCO and what problems does it cause when monitoring pulse oximetry?
Carboxyhemoglobin. Can read normal SpO2 levels even if there is zero O2 and carbon monoxide poisoning is occurring
What other oximetry can be used if carbon monoxide is suspected?
Hemoximetry (cooximetry)
Lab analytical procedure requiring invasive sampling of Arterial blood. Provides values for abnormal hemoglobin
What is capnometry?
The measurement of Co2 in respiratory gases
What is mainstream sampling in capnometry?
Placing an analysis chamber in patients breathing circuit
What is the sidestream technique in capnometry?
Pumps small volume of gas from circuit into nearby analyzer
What are the phases of a capnograph
Phase 1: shows PCo2 of zero at start of expiratory breath
Phase 2: the PCO2 level rises sharply
Phase 3: The level plateaus as alveolar gas is exhaled
Phase 4: End Tidal PCO2 (PETCO2) is used to estimate dead space ventilation and normally averages 3-5 mm Hg less than PaCO2
