Comprehensive NBRC Review

PaCO2

• Acceptable Range: 35-45 mmHg

• Used to Determine if Ventilation is Adequate

Acceptable Range for PaCO2

35 - 45 mmHg

Ways to Improve PaCO2

1. Improve Ventilation

   1. Deep Breathing Coaching

   2. Incentive Spirometry

2. Assist Ventilation

   1. Non-invasive Ventilation (NIV, NIPPV, BiPAP)

   2. Pressure Support Ventilation (CPAP and PS)

3. Full Ventilatory Support

   1. Mechanical Ventilation

PaO2

• Acceptable Range: 80-100 mmHg

• Determines Adequacy of Oxygenation

At What Value for PaO2 is Intervention Required?

PaO2 < 80 mmHg

At What Value for PaCO2 is Intervention Required?

PaCO2 > 45 mmHg

What Should You Do with a Patient with a pH of 7.25 or Less and a High PaCO2?

The patient is considered to be in Ventilatory Failure and requires full ventilatory support (mechanical ventilation).

HCO3-

• Acceptable Range: 22-26 mEq/L

• Low HCO3- is a clear indicator for sodium bicarbonate administration

Hemoglobin (Hb)

• Acceptable Range: 12-16 gm/dL

• If Hb is Very Low, the patient is hypoxic, regardless of PaO2 value and SpO2

• Hb < 7, requires blood transfusion (usually)

CO-oximetry

• Determines the Type and Quantity of Different Forms of Hemoglobin

• Can Detect:

  • Oxyhemoglobin (O2Hb)

  • Deoxyhemoglobin (HHb)

  • Carboxyhemoglobin (COHb)

  • Methemoglobin (MetHb)

Oxyhemoglobin (O2Hb)

hemoglobin that is carrying oxygen

Deoxyhemoglobin (HHb)

hemoglobin not carrying oxygen

Carboxyhemoglobin (COHb)

hemoglobin bound to carbon monoxide (CO)

Methemoglobin (MetHb)

• dysfunctional hemoglobin that has been oxidized and cannot carry oxygen effectively

• can cause Methemoglobinemia

  • Tx: Methylene Blue

What are the Preferred Sample Sites for ABGs?

1. Radial

2. Brachial

3. Femoral

If the Arm BP Cuff and the Art Line BP reading are different, which one should you reference?

The Arm BP Cuff

What can cause the Arm BP Cuff and the Art Line BP Readings to Differ?

1. Transducer Dome may have an Air Bubble

2. Air Bubble in the Line or Transducer

3. The Radial Artery is Higher or Lower than the Heart

4. The Cuff Size is Inappropriate or is Placed in the Wrong Position

5. Clot or Physical Occlusion in the Line

Neonatal Sampling Sites

1. Umbilical Artery Catheter (UAC)

2. Capillary Blood Gas

What is Capillary Blood Gas Good for Monitoring?

• CO2

• pH

Neonatal Blood Gases Values

• pH: 7.35 - 7.45

• PaCO2: 35 - 45

• PaO2: 60 - 80 (50 in premature neonates)