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8StepGuidetoABGAnalysis:TicTacToeMethodNurseslabs
ByGilWayne,RN Jan21,2015
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An arterial blood gas (ABG) is a blood test that measures the acidity (pH) and the levels of oxygen
and carbon dioxide in the blood. Blood for an ABG test is taken from an artery whereas most other
blood tests are done on a sample of blood taken from a vein. This test is done to monitor several
conditions that can cause serious health complications especially to critically ill individuals.
Every day, a lot of nursing and medical students assigned in acute areas encounter ABG results,
which they may not necessarily be able to interpret with its knotty aspect. They struggle over the
interpretation of its measurements, but they are not especially complicated nor difficult if you
understand the basic physiology and have a step by step process to analyze and interpret them.
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There may be various tips and strategies to guide you, from mnemonics, to charts, to lectures, to
practice, but this article will tell you how to interpret ABGs in the easiest possible way. And once you
have finished reading this, youll be doing actual ABG analysis in the NCLEX with fun and excitement!
Here are the steps:
1.Knowthenormalvalues
Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to
remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3. Remember
also this diagram and note that paCO2 is really inverted for the purpose of this method.
2.DetermineifpHisunderacidosisoralkalosis
Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH
level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to
keep pH in balance.
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3.Determineifacidbaseisrespiratoryormetabolic
Next thing you need to determine is whether the acid base is Respiratory or Metabolic.
paCO2 = Respiratory
HCO3 = Metabolic
4.RememberROME
Still, it all boils down to mnemonics. The mnemonic RO-ME.
Respiratory Opposite
When pH is up, PaCO2 is down = Alkalosis
When pH is down, PaCO2 is up = Acidosis
Metabolic Equal
When pH is up, HCO3 is up = Alkalosis
When pH is down, HCO3 is down = Acidosis
5.TicTacToe
And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do is make a
blank chartsimilar to this:
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6.MarktheChart
Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample problem:
pH: 7.26, paCO2: 32, HCO3: 18
Using the normal values reference chart in the first step, determine where the values should be
under in the tic-tac-toe. In the given example, the solution is as follows:
pH of 7.26 is LOW = ACID so place pH under Acid
paCO2of 32 is LOW = BASE so place paCO2 under Base
HCO3of 18 is LOW = ACID so place HCO3 under Acid
Your chart should looklike this:
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7.Matchitup
In this step, determineat which column matches up with the pH. In the given example, HCO3 goes
with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so this example
implies Metabolic Acidosis.
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8.Determinecompensation
The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated.
Heres the trick:
If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated
If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated
If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated
Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .
By applying the steps above, interpret the following ABGs:
pH:7.44, PaCO2: 30, HCO3:21
pH is NORMAL = NORMAL so place pH under Normal
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Tryitoutwiththesequizzes
Want to try out the Tic-Tac-Toe method? Here are some sample ABG Analysis quizzes:
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GilWayne,RN
http://nurseslabs.com
GilWayneisaregisterednurseandacontributoratNurseslabs.com.Preferswriting,travelinganddiscoveringstuffs.Nota
fanofworkinginahospital,butenjoysexploringnursingoutsideitswalls!Ilikethecolorgray,butcantimaginemyselfin
grayscrubs...lol!
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