pH on an arterial blood gas is Acidotic if less than 7.35 and Alkalotic if greater than 7.45
In primary respiratory disorders, the pH and PaCO2 change in opposite directions
In metabolic disorders the pH and PaCO2 change in the same direction
The acronym ROME is used to help remember
Respiratory Opposite
Metabolic Equal
You can determine what an appropriate PaO2 for a healthy lung would be by multiplying FiO2 by 5 (FiO2 = 21%, then PaO2 = 100 mmHg)
Base Excess
A high base excess (greater than +2mmol/L) indicates
That there is a higher than normal amount of HCO3- in the blood, which may be due to a primary metabolic alkalosis or a compensated respiratory acidosis
A low base excess (less than -2mmol/L) indicates
There is a lower than normal amount of HCO3- in the blood, suggesting either a primary metabolic acidosis or a compensated respiratory alkalosis
Compensation
No compensation
pH remains abnormal, and the ‘other’ value, where the problem isn’t occurring, i.e. CO2 or HCO3, will remain normal or has made no attempt to help normalize the pH
Partial compensation
pH is still abnormal, and the ‘other’ value is abnormal to help normalize the pH
Full compensation
The pH is normal, as the ‘other’ value is abnormal and has been successful in normalizing the pH
Specimen collection
All samples should have a patient label with initials, time of collection, and collection site on an additional sticker unless preforming the analysis at bedside
If running a sample from OR, Transport, or Ecmo circuit remember to document “NC” in the “patient location” box on rapidcom to ensure the patient does not get charged for these samples
Sample Analysis/Documentation
Information needed to run a gas on the Bench top:
Patient name and ID should be pulled over from scanning of label
Draw time, Collection time, Run time should be at least 1 minute difference between each time
Sample Draw Site
Sample Blood Source
Allen’s Test
Sample Collector
If CV notifying individuals information and time of notification
Information needed to run a gas on the Epoc:Patient ID
Sample Blood Source
Sample Draw Site
Allen’s Test
Sample Collector and Time
If CV notifying individuals information
All “Mixed Venous” samples must be ran on the benchtop for accurate values
Maintenance
Bench top machine
QC and maintenance done at 0000-0200, 0800-1000, 1600-1800 and entered into Rapidcom
If any have “failed” re-run the QC to ensure a “pass” then document on the failed QC in rapidcom that the QC was reran and passed
QDay Log Room temperature and all fridge temperatures in Share Point
EPOC
QC done on the 1st Thursday of each month
Dayshift does 1,2,3
Night shift does A, B, C
Qday Temperature log
To hard reset any Epoc remove host from the reader and lay on a hard surface hold down the the number 1, number 9 and red on/off switch simultaneously for 10 seconds
Blood Gas Edits
Urgent/STAT:
Examples
Assigned sample to wrong patient
Invalid patient ID
Incorrect Blood Source
Accidentally Rejected Test
Page the blood gas support person and relay all the necessary information to fix the mistake
ERS must be entered
Non-Urgent :
Fill out form found in blood gas room and give to your charge so they have all the information necessary to fix the mistakes
Critical Value (CV) Reporting
The specific last name, first name, and credentials, of the person notified must be documented as well as the time of the notification
Epoc
If value is flagging as a CV when it is actually and acceptable value for hat patients age range, in the action field select other and in notify field scan the bar code on the base or free type “Per Policy No CV”
You will receive a result of CNC
Bench top
If your parameter is outside of the instruments measuring capability on the bench top you will receive dashed with double arrows up and down