Determine the cause of the acidosis or alkalosis by looking at the pco2 and hco3if ph neonatal pediatric lecture 2. Accurate interpretation of blood gases is paramount in clinical management in the nicu. Blood gas interpretation in the neonate what do you need. As well, in a normal abg, the hco 3 and p co 2 a move in the same direction. Original article pathogenesis of metabolic acidosis in.
When one thinks of abg analysis, oxygenation may come to mind first. Because the ph is abnormal, you know compensation is not complete. Continuous regular abg monitoring and recording for trends. This is a common cause of metabolic acidosis, particularly in the extremely premature infant. Use of umbilical cord blood gas analysis in the assessment ncbi. Agree to merge, but with the abg sampling article as a sectional redirect to the abg article.
To prepare the healthcare professional to interpret and respond to abg results in the neonate. The purpose of this course is to provide the learner with basic information on how to interpret arterial blood gas results. Therefore, it provides more specific information about a patients immune system than the wbc count alone. The ph and co 2 are both acidotic, so the co 2 is a primary cause. See respiratory support, oxygen delivery, and oxygen monitoring in the newborn, section on pulse oximetry and respiratory support, oxygen delivery, and oxygen monitoring in. Steps to abg interpretation fully compensated acidbase disorders v v normal, but 7. Abg values based on neonatal age prebirth 5 min 17 days scalp after birth after birth. The blood may be collected from the radial artery in the wrist, the femoral artery in the.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Once the neonatal resuscitation team is summoned to the delivery room, it is important. That makes the interpretation of these abg results is uncompensated respiratory acidosis. In cases where blood gas values do not fall into any of the above classifications.
Basic care of the neonate university of hertfordshire. Abg interpretation ppt if this is your first visit, be sure to check out the faq by clicking the link above. The blood gas machine measures ph, pco2 and po2 and may measure glucose and lactate. Abg values vary with age of neonate and even with gestational age table iii, iv. Arterial blood gas analysis is a common investigation in emergency departments and intensive care units for monitoring patients with acute respiratory failure. So looking at blood gases means looking at absolute values and patterns. For example, they are used to guide the adjustment of ventilator parameters on. Ideal artery for sampling in newborn is radial or umbilical artery. Each hemoglobin molecule contains four atoms of iron and therefore can combine with four molecules of oxygen.
We need to consider the numerical results of the blood gas in relation to previous blood gases and take in to account the patients history. Abg includes a specific set of tests performed on an arterial blood sample to evaluate acidbase balance, pulmonary function, and oxygenation. To adequately use this information, one must have a basic understanding of gas transportation and acidbase physiology. Blood gases is a measurement of how much oxygen and carbon dioxide is in your blood. The cause of the acidosis is the p a co 2, which is the respiratory component of the abg results. Acidbase physiology and blood gas interpretation in the. Orlando health is an approved provider of continuing nursing education by the florida board. Jan 29, 20 kristine antonelli karlsen is a neonatal nurse practitioner who has been involved in neonatal care in a variety of settings including transport, education, and patient care for 30 years. Postresuscitation management of asphyxiated neonate. Blood gases medical tests ucsf benioff childrens hospital. This table is able to classify most clinical blood gas values but not all.
Determine the cause of the acidosis or alkalosis by looking at the pco2 and hco3if ph interpretation of blood gases. Blood gas interpretation for neonates better safer care. Blood gas analysis is one of the most important diagnostic tools in the neonatal intensive care unit nicu. Use of umbilical cord blood gas analysis in the assessment of the newborn. Christopher geoffrey alexander aiken, pathogenesis of metabolic acidosis in preterm infants indian journal of neonatal medicine and research. Recall that each change in pco2 of 10 mm hg results in a ph change of 0. A recent meta analysis has shown a good correlation of cord abg abnormalities ph neonatal resuscitation program, which was initiated in 1987 to identify infants at risk of needing resuscitation and provide highquality resuscitation, underwent major updates in 2006 and 2010. Because fetal carbon dioxide is removed from the umbilical arterial blood in the. Arterial blood gases play an important role in the workup and management of critically ill patients and patients with a variety of pulmonary complaints and disorders. Therefore, ph changes that occur because of changes in bicarbonate concentrations are termed metabolic.
A recent meta analysis has shown a good correlation of cord abg abnormalities ph correct and quick responses j anesth crit care j anesth crit care open access 55. Blood gas and lactate analysis in the umbilical cord or in the new. Apr 03, 2010 steps to abg interpretation fully compensated acidbase disorders v v normal, but 7. Laboratory tests interpretation nurses learning network. Abg measurements may change during percutaneous punctures as the infant responds to the procedure, so clinicians should be mindful of this in interpreting the results. Sood et al 9 summarize abg interpretation in this manner. Blood gas interpretation in the neonate what do you need to. Important signs and symptoms tachypnea using accessory muscles of respiration paradoxical abdominal movements with breathing inability to talk wo gasping for air stages of abgs ph pco 2 po 2 stage 0 7. Juretschke, phd, rncnpt, apnnnpbc, ccns founderpresident, nicu solutions, inc. I have a fair bit of firsthand experience with abg sampling. These abg values reveal metabolic acidosis with partial compensation. It calculates hco3, base excess and oxygen saturation. No compensation ph not normal uncompensated mixed acidosis.
She is active in the national association of neonatal nurses and. Application of modified henderson equation in abg interpretation. Spo 2 oxygen saturation as measured by pulse oximetry. The wbc differential evaluates the distribution and morphology of white blood cells. Boniface general hospital, winnipeg, manitoba, canada. These disorders are termed complex acidbase or mixed disorders. However, the more complicated and in some ways more important part of abg analysis is ph regulation. Review of the literature reveals general agreement that cbg po2 values are of little use in predicting arterial po2 and that cbg ph values are reliable predictors of. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. The hco 3 is not providing any compensation against the high co 2. Agree with above, and i would be pleased to assist. Figo consensus guidelines on intrapartum fetal monitoring. The 1986 tpn regimen with the greater excess of chloride, regimen x, tended to cause worse mineral acidosis, although this difference was not significant.
Measurements that are inaccurate, including hb and oxygen saturation, should not be used to decide therapy although newer machines contain cooximetry and are very accurate. Kristine antonelli karlsen is a neonatal nurse practitioner who has been involved in neonatal care in a variety of settings including transport, education, and patient care for 30 years. So, a rise of 30 mmhg in pco2 should lower the ph by 0. As well, in a normal abg, the hco 3 and pco 2 a move in the same direction. Mar 31, 2008 we use your linkedin profile and activity data to personalize ads and to show you more relevant ads. As it is unable to combine with oxygen and it also decreases the oxygen carrying. Guidelines for the interpretation of the neonatal electrocardiogram a task force of the european society of cardblogy p. Arterial blood gas abg analysis allows full assessment of patient acidbase status predominantly via the following three parameters generated during the analysis.
Blood gas analysis is a routine procedure performed on newborn babies receiving respiratory support in the neonatal intensive care. Interpretation of the arterial blood gas selflearning packet. Articles and journal scans about blood gasesacidbase. His paco2 is lower than normal, reflecting the lungs attempt to compensate. The ph indicates a severe acidosis, and a pco2 of 72 is definite hypercarbia. Goals of abg in newborn is to characterize the type of disorder, quantify the magnitude and assess the nature and extent of compensation.
Accurately interpreting the arterial blood gas abg results helps establish a diagnosis, guides the treatment plan, assists in ventilator management strategies, and improves acidbase management. The be is not providing any compensation against the high co 2. For example abgs with an alkalemic ph may exhibit respiratory acidosis and metabolic alkalosis. This interpretation should be based on a sound understanding of acidbase.
Neonatal oxygen consumption per kg is 23 times that of the adult. Before making an interpretation of an abg it is always ofwise to check for the consistency of the report bicarbonateby the modified henderson equation. She is an awardwinning author and founder of the internationally recognized s. Heel puncture capillary blood gas cbg measurements continue to be used in neonates for estimating arterial blood gas values. Possible dialysis to remove excess lactate, manipulation of ventilation settings to adjust co2 levels, but always maintaining tissue perfusion. The usefulness of this diagnostic tool is dependent. In a normal abg, ph and pco 2 a move in opposite directions. One must perform allen test to ensure collateral blood supply by ulnar artery before puncturing radial artery. Neonatal nurse practitioner the ronald mcdonald childrens hospital at loyola university medical center objectives at the end of this lecture, the participant will be able to. Unfortunately, their closing volume the volume at which alveoli begin to close, producing a shunt is within the range of normal tidal volumes, thus small changes in lung volume ex. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Interpretation of the results of the differential must always be done with the total number of wbcs in mind. Abg interpretation steps to abg interpretation step 1. Umbilical cord blood gas analysis is now recommended in all high. Arterial blood gas analysis is an essential part of diagnosing and managing a patients oxygenation status and acidbase balance. The combination of invasive and noninvasive assessment of ventilation and oxygenation enables clinicians appropriately to modify respiratory care according to each individual babys rapidly changing clinical status.
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