PAPER

PROCEDURE FOR TAKING ARTERIAL BLOOD FOR BGA EXAMINATION AND IT’S
INTEPRETATION
Designed to fulfill an assignment of Medical Surgical Nursing Course

Lecturer:
Shobirun, MN

Arranged by:
Vera Mus'adatun Nafar P1337420622083
Nasywa Afrilia Dhiyaa Ulhaq P1337420622106
Arkaan Abdurrahman Putra Nuriawan P1337420622107

INTERNATIONAL CLASS
BACHELOR OF APPLIED NURSING PROGRAM
NURSING DEPARTMENT SEMARANG
HEALTH POLYTECHNIC MINISTRY OF HEALTH SEMARANG
ACADEMIC YEAR 2023

ACNOWLEDGEMENTS
 Our gratitude goes to God Almighty, because of the abundance of grace we can finish
this paper on time without any significant obstacles and by expectations.
The medical surgical nursing paper entitled Procedure For Taking Arterial Blood For
BGA Examination And It’s Interpretation was conceived to broaden the knowledge for
readers and also be able to apply the knowledge while nursing care practice. Our thanks go to
Mr. Shobirun, MN. as lecturer in the Medical Surgical Nursing subject, who has helped us
provide direction and understanding in the preparation of this paper. Although this paper has
many deficiencies in the arrangement and explanation, the writers hope the criticism from the
readers can help the writers in perfecting the next paper.
Last but not least, hopefully, this paper can be used as a reference for the
reader to gain more knowledge for all those who need it.

Semarang, 27th August 2023

Group 9
 TABLE OF CONTENT

ACNOWLEDGEMENTS.........................................................................................................2
TABLE OF CONTENT..............................................................................................................3
CHAPTER I..............................................................................................................................4
INTRODUCTION.....................................................................................................................4
1.1 Background.......................................................................................................................4
1.2 Problems............................................................................................................................4
1.3 Objectives..........................................................................................................................4
CHAPTER II.............................................................................................................................6
DISCUSSION............................................................................................................................6
2.1 Definition..........................................................................................................................6
2.2 Purpose..............................................................................................................................6
2.3 Indication...........................................................................................................................6
2.4 Contraindication................................................................................................................7
2.5 Equipment.........................................................................................................................7
2.6 Preparation........................................................................................................................8
2.7 Things to watch out......................................................................................................9
2.8 Procedure....................................................................................................................10
2.9 Interpretation..............................................................................................................11
CHAPTER III.........................................................................................................................13
CLOSING................................................................................................................................13
3.1 Conclusion......................................................................................................................13
REFERENCES....................................................................................................................14
 CHAPTER I
INTRODUCTION
1.1 Background
The lungs and kidneys are the important organs responsible to maintain normal blood
pH. Disorders of acid-base balance is very important, because any interference can affect
the function of vital organs. Severe acid base imbalance can also be life threatening.

Oxygen disorder refers to a condition in which the body or a region of the body is
deprived of adequate oxygen supply at the tissue level that can be caused by various
factors, including lung disease, heart disease, carbon monoxide poisoning, anemia,
asthma, bronchitis, chronic obstructive pulmonary disease (COPD), interstitial lung
disease, and diffusion impairment. Pathological oxygen disorder can lead to symptoms
such as bluish skin, headache, changes in breathing and heart rate, confusion, shortness of
breath, poor judgment and decision making, memory loss, and seizures.

Diseases with impaired oxygenation require examination to measure blood gases in

the body. Blood gas analysis is performed to evaluate the status of oxygen and carbon
dioxide in arterial blood and measure its pH. Examination results are very important for
monitoring the results of client oxygenation nursing actions, oxygen therapy, and
evaluating the patient's response to the actions given.

The components that can be known from the BGA examination are pH, Carbon
Dioxide Partial Pressure (PCO2), Bicarbonate (HCO3-), Base Excess (BE), Oxygen
Pressure (PO2), Oxygen Content (O2) and Oxygen saturation (SO2). The best sample for
blood gas testing is using arterial blood (because it best reflects gas exchange status in
lungs). Arterial and venous blood differ in pH, PCO2, and PO2, the arterial pH usually
slightly higher than venous pH, oxygen saturation and arterial oxygen tension is also
higher than that of venous blood, whereas arterial carbon dioxide pressure is lower than
that of venous blood.

1.2 Problems
a. What is the meaning of BGA examination?
b. What are the purposes of BGA examination?
c. What are the indications of BGA examination?
d. What are the contraindications of BGA examination?
e. What equipment that used in BGA examination?
f. What are the preparations before doing BGA examination?
g. What are things to watch out for BGA examination?
h. What are the steps and procedure of taking arterial blood for BGA examination?
i. What are the interpretations of the result of BGA examination?

1.3 Objectives
a. To understand the meaning of BGA examination?
b. To know the purposes of BGA examination?
c. To know the indications of BGA examination?
d. To know the contraindications of BGA examination?
e. To know the equipment that used in BGA examination?
f. To know the preparations before doing BGA examination?
g. To know things to watch out for BGA examination?
h. To know the steps and procedure of taking arterial blood for BGA examination?
i. To know the interpretations of the result of BGA examination?
 CHAPTER II
DISCUSSION
2.1 Definition
Blood gas analysis (BGA) is a medical examination procedure that aims to:
measure pH (acid-base balance), oxygenation, carbon dioxide levels, bicarbonate
levels, oxygen saturation, and base excess or deficiency. Blood gas analysis can be
done using arterial or venous blood, but usually this examination uses arterial blood.
Examination of arterial blood gas and pH has been widely used as a guideline
management of acute and chronic severe disease patients. Blood gas analysis can also
describe the results of various supporting actions taken, however we cannot establish a
diagnosis only from the assessment of blood gas analysis and acid-base balance alone,
we have to relate it to the history of the disease, physical examination, and other
laboratory data.

2.2 Purpose
Examination Blood Gas Analysis (BGA) is an examination that aims to
measure primary lung function and acid-base balance in the blood.
Blood Gas Analysis (BGA) is a medical examination procedure that aims to
measure the amount of oxygen and carbon dioxide in the blood. ABG can also be used
to determine the level of acidity or pH of blood.

2.3 Indication
Blood gas analysis is done to find out if the blood is too acidic (acidosis) or
alkaline (alkalosis), and to find out if the oxygen pressure in the blood is too low
(hypoxemia) or the carbon dioxide pressure is too high (hypercarbia).
Indications for arterial blood gas analysis or AGD in general are the need to
evaluate ventilation status (PaCO2), oxygenation (PaO2 and oxygen saturation), and acid-
base (pH). Other indications for the AGD procedure are:
a. Diagnostic evaluation and setting of therapeutic goals, eg hypoxemia with
peripheral oxygen saturation/SpO2 <94%.
b. Assess response to therapeutic interventions, eg administration of supplemental
oxygen with or without mechanical ventilation.
c. Metabolic disturbances and response to corrective therapy, such as diabetic
ketoacidosis and sepsis.
 d. Assess the severity of disease course and exacerbations, eg shortness of breath
with a history of stable hypoxemia, eg chronic obstructive pulmonary disease
(COPD).
e. Patients with signs of inadequate peripheral circulation, such as septic shock, post
cardiopulmonary resuscitation.
f. Patients with a history of smoke inhalation/cyanide or carbon monoxide poisoning.
g. Patients with history of diabetic ketoacidosis, liver failure, heart failure, kidney
failure.
h. In addition to diagnosis, blood gas analysis can also be used to evaluate the
condition of patients using respirators.

2.4 Contraindication
Contraindications to blood gas analysis or ABG sampling are particularly the
presence of blood flow insufficiency, local infection, or arteriovenous (AV) fistula at
the collection site. Contraindications to ABG sampling can be divided into absolute
and relative contraindications, with consideration of the possibility of infection or
damage to the vascular structure.
a. Absolute Contraindication
Absolute contraindications for blood gas analysis include:
1) Sampling from the radial artery on a positive modified Allen test, in which
the collateral blood flow is inadequate in supplying the distal area; consider
having a blood sample taken at another location, such as the femoral or
brachial artery
2) Local infection of the sampling area
3) Anatomical disorders in the sampling area, such as burns, surgical
interventions, or congenital malformations, such as congenital cutis aplasia
(AKK)
4) Presence of arteriovenous fistula or vessel graft
5) Known or currently suspected presence of severe peripheral vascular
disease, such as cellulitis or acute limb ischemia, in the sampling area
b. Relative Contraindication
Relative contraindications to blood gas analysis include:
1) Severe coagulopathy
2) Patients on anticoagulant therapy, such as warfarin, heparin, or their
derivatives such as direct thrombin inhibitors or factor X inhibitors.
3) Patients taking thrombolytic agents, such as streptokinase or tissue
plasminogen activator (tPA).
4) Taking antiplatelets, such as aspirin and clopidogrel, is not a
contraindication to sampling in most cases.

2.5 Equipment
Healthcare professional should provide safety, they should wear gloves and eye
protection for the duration of the BGA sampling procedure. The operator should have
all the required equipment at the beside before beginning the procedure. The following
equipment that required for taking arterial blood for BGA examination:
 a. gloves and eye protector
b. syringe 2.5 cc
c. needle
d. heparin
e. alcohol swab
f. plaster and scissors
g. gauze pads
h. label
i. ice bag
j. sharp object container

2.6 Preparation
Preparation:
a. Check medical records. Includes: Reasons for taking blood specimens. Rationale
identifies the type of blood needed and how to collect it.
b. History of bleeding risk factors: anticoagulant therapy, bleeding disorders, low
platelet count. Rational reminds to prepare additional equipment for emphasis on
the puncture site after the action.
c. Contra-indicated factors for stabbing in an artery or vein: intravenous infusion or
conditions after radical mastectomy. Rationally identify areas that cannot be used
as a place for action procedures to be carried out.
d. Prepare laboratory forms.
e. Wash hands.
f. Prepare tools and materials.
g. For arterial blood collection: prepare an aspiration syringe of 0.5 ml of heparin at a
ratio of 1: 1000 units/ml from the vial; Then make an effort so that the heparin
touches all the inside walls of the syringe. Rationale prevents blood clots. This is
necessary for the accuracy of the blood analysis.
 Patient preparation:
a. Explain the purpose, procedure and length of action to be performed to the client.
Rational provide information on the client. Explain to the patient about the purpose
of this test and notice that this action can cause pain. (note: some institutions allow
anesthesia in the puncture area with 1% lidocaine (Xilocaine) to prepare the
patient, or an anesthetic spray/ointment applied to the baby.
b. Give the client the opportunity to ask questions.
c. Asking the client's main complaint.
d. Starting the action in a good way.
e. Maintain client privacy.
f. Bring the equipment closer to the client.
g. Adjust the client's position to be comfortable.
2.7 Things to watch out
Blood gas analysis is an important process in evaluating respiratory function and acid-
base balance in the body. Here are some things to consider when doing a blood gas
analysis:
1. Precise Specimen
Make sure the blood sample is taken from an artery, not a vein, because arterial
blood gives a more accurate picture of the balance of gases in the body. Selection of
the proper sampling site is also important to minimize complications such as
hematoma or arterial damage.
2. Proper Sample Handling
Blood gas samples need to be processed immediately after collection to prevent
changes in gas composition. Exposure to air can change the concentrations of oxygen
(O2) and carbon dioxide (CO2) in the blood, producing erroneous results.
3. Speed Analysis
Analysis should be carried out immediately after sampling to avoid gas changes in
the sample. If analysis cannot be carried out immediately, samples should be stored at
low temperature and away from air.
4. Temperature Compensation
Body temperature affects acid-base balance and gas concentrations in the blood.
Therefore, the temperature of the sample needs to be recorded and compensated for in
the analysis.
5. Pressure Correction
 Atmospheric pressure can affect the results of blood gas analysis. Results need to
be corrected based on atmospheric pressure at time of sampling. Usually, the partial
pressure of oxygen (PaO2) is corrected by a factor called the partial pressure of
oxygen in air (PbO2), which reflects the pressure of oxygen in the atmosphere.
6. Correction of Temperature and Ph
Since blood pH also depends on temperature, it is necessary to make a pH
correction for a temperature that is different from the normal temperature of the
human body (37°C or 98.6°F).
7. Examination of Other Abnormalities
The results of blood gas analysis must be viewed in the clinical context of the
patient as a whole. Other clinical data such as vital signs, medical history, and other
test results help in assessing the patient's condition.

2.8 Procedure
Allen's test is an assessment test of blood circulation in the hands which is done by:

1. Ask the patient to make a fist

2. The nurse is pressing on the radial artery and the ulnar artery
3. The patient is asked to open and clench several times until the palms look pale
4. Release the pressure on the artery and evaluate the color of the patient's palms
5. The patient's palms should be red in 3-7 seconds (positive Allen's test). If the
palms are not reddened (negative Allen's test) and sampling at that location is
not recommended
Works procedure
1. Greet the patient
2. Tell the patient the purpose of the action, procedure and length of action to be
performed to the client.
3. Give the client the opportunity to ask questions.
4. Prepare the tools
5. Wash your hands and wear gloves
6. Choose the site for arterial puncture
7. Position the patient's palms facing upwards
8. Do the Allen's test
9. Palpate the radial artery using the index and middle fingers to determine the
puncture site
 10. Disinfect the puncture site around the maximum pulsation with an alcohol
swab in a circular motion from the inside out or with one-way wiping.
Rationale prevent the entry of microorganisms into the arteries and vascular
system
11. Hold the alcohol cotton with your fingers and palpate the pulse again. Keep
fingers in the proximal area and the puncture site. Rational ensures the
accuracy of needle insertion, preventing the entry of microorganisms in the
blood
12. Hold the syringe at a 45 degree angle, observe for a pulsation
13. Insert the needle slowly until a stream of blood enters the syringe, holding it in
that position
14. Let the syringe fill with about 1-2 ml of blood or as needed
15. Pull out the syringe and press the puncture site using gauze to stop bleeding
then cover it with gauze
16. The tip of the needle is inserted into the cork
17. Place the syringe in the container of ice and attach an identity label (patient
name, date, time, body temperature at collection, room) on the syringe.
18. Monitor the puncture site for bleeding by inspecting it; And palpation.
Rationally identify a hematoma or bleeding.
19. Apply pressure dressing if the bleeding continues.
20. Tidy up the equipment.
21. Take off the gloves.
22. Evaluation of the results achieved (subjective and objective)
23. Give positive reinforcement to the client.
24. End the meeting well.
25. Wash hands.
26. Document the actions that have been taken. What needs to be documented
includes:
• Time of procedure.
• Type of inspection performed
• Skin conditions (redness, excessive bleeding)

2.9 Interpretation
The result of BGA examination can be interpreted as:
a. Blood pH
 Serum pH describes the acid-base balance in the body. Sources of hydrogen ions in
the body include volatile acids and mixed acids such as lactic acid and keto acids.
Normal blood pH: 7.35 - 7.45

b. Partial Pressure of Carbon Dioxide (PaCO2)

PaCO2 describes the pressure generated by CO2 dissolved in the plasma. Can be used
to determine the effectiveness of ventilation and acid-base state in the blood. Normal
PaCO2: 35 - 45 mm Hg

c. Oxygen Partial Pressure (PaO2)

PaO2 is a measure of the partial pressure produced by the amount of oxygen dissolved
in the plasma. This value indicates the ability of the lungs to provide oxygen to the
blood. Normal PaO2: 80 - 100 mm Hg

d. Oxygen Saturation (SaO2)

The amount of oxygen carried by hemoglobin, written as the percentage of total
oxygen bound to hemoglobin. Normal SaO2 : 95% - 100%

e. Bicarbonate (HCO3-)
Bicarbonate is a weak base that is regulated by the kidneys as part of acid-base
homeostasis. In arterial blood bicarbonate reflects a metabolic component of arterial
blood. Together, CO2 and HCO3- act as metabolic and respiratory buffers. HCO3-
normal : 22 - 26 mEq/L

f. Base Excess (BE)

BE is a metabolic component of acid-base balance. BE is derived from pH and PaCO2
values. It is defined as the amount of acid needed to return each liter of blood to its
normal pH. Normal Base Excess : -2.0 to 2.0 mEq/L
 CHAPTER III
CLOSING
3.1 Conclusion
Blood gas analysis (BGA) is a medical examination procedure. The
components that can be known from the BGA examination are pH, Carbon Dioxide
Partial Pressure (PCO2), Bicarbonate (HCO3-), Base Excess (BE), Oxygen Pressure
(PO2), Oxygen Content (O2) and Oxygen saturation (SO2). Blood Gas Analysis
(BGA) is a medical examination procedure that aims to measure the amount of oxygen
and carbon dioxide in the blood. ABG can also be used to determine the level of
acidity or pH of blood.
Blood gas analysis is done to find out if the blood is too acidic (acidosis) or
alkaline (alkalosis), and to find out if the oxygen pressure in the blood is too low
(hypoxemia) or the carbon dioxide pressure is too high (hypercarbia). Imbalance
between oxygen, carbon dioxide, and blood pH levels can indicate a disease or
medical condition related to oxygenation.
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Iza Netiasa Haris. 2019. Perbandingan Hasil Analisis Gas Darah Arteri Antara Alat Point-Of
Care Testing dan Laboratory Blood Gas Analyzer.
Masyuni, Putu Utamia. (2016) Analisa Gas Darah
Manokharan, Prabakaran. (2017). Analisis Gas Darah dan Aplikasinya di Klinik
Muhlisin, Amad. 2017. Analisa Gas Darah: Definisi, Pemeriksaan, Nilai Normal
NHS Greater Glasgow and Clyde. Adults Therapeutic Handbook, Guidelines for Blood Gas
Analysis. NHSGGC, 2022.