Vol. 18 •Issue 14 • Page 27
Getting Up to Speed on ABG Interpretation
Most respiratory care practitioners find it easy to interpret arterial blood gases. In fact, it is part of our bread and butter. Perhaps that is why it is difficult for us to understand why other health care practitioners are mystified by the process. Complicating the matter is there is no uniform way to teach ABG interpretation. And ever since the American Heart Association removed it from the Advanced Life Support Curriculum, there isn’t even a mandate or test that suggests practitioners need to know what an ABG is. So what is an RCP to do?
In truth, practitioners are taught a variety of ways to interpret an ABG. Some are taught by rote memorization with little understanding of the logic behind the numbers, i.e., pH 7.35- 7.45, good; lower than 7.35, give H2CO3 or increase respiratory rate. Higher than 7.45, decrease respiratory rate. This is the sum total of the acid/base knowledge of many practitioners.
Chances are the cheat sheet they memorized was given to them by a well-intentioned instructor who understood the meaning of the values. What many therapists have been taught is actually a very simplified version of Romanski’s 1986 step-by-step method. But this does teach the meaning of the values, normal ranges and the implications of abnormal ranges from a physiologic perspective.
But it is basically a little scary to know most RCPs are taught little more than the watered-down version.
In fairness, not all modifications to the Romanski interpretation methodology are bad. An article appearing in Medical/Surgical Nursing in August 2000 teaches the Romanski method and adds color to the mix so the concept actually makes sense. The author instructs the reader to evaluate the numbers and uses red to depict acid; blue, base; and black, neutral. The interpreter color codes each number and determines which ones correlate with the pH.
Some Alternative Methods
One similar, though unpublished method, uses arrows instead of colors but works on the same principle. Yet another method uses a straight line drawing with the line being normal and the values being plotted either above or below. Above the line is alkalosis and below is acidosis.
While it still could be argued the practitioner incorporating such methods does not necessarily understand acid/base balance, the methods cited above are certainly better than the: “pH, Bad” method.
But seriously what is an RCP supposed to do when faced with an obstacle in the form of a co-worker?
An RCP cannot single out physicians and ask them to wear ABG dunce hats because they do not understand blood gas readings, tempting though it might be. The RCP cannot hang up a nurses’ picture enclosed inside a red circle with a slash line through it and some title like “Caution! Non-ABG Nurse” under it. Testing nursing staff knowledge of ABGs across the board will also be met with resistance.
The underlying implication is that nurses may not know what they are supposed to know and this could have serious political and legal ramifications. What you can do as an RCP in this type of situation is develop an ABG competency and training program. And if you develop it as a CEU credit, both therapists and nurses are likely to take it. We all need to document competency for JCAHO accreditation, and in most states we need CEUs, so creation of an in-service is not a far-fetched concept at all.
Plan on Wide Scale
If you do want to develop a successful ABG education program, start small. Speak to the educational coordinator of nursing services or to the manger of your ICU or ER. Target the program specifically for that specialized area.
Most managers will welcome the opportunity to work collaboratively in developing and documenting competencies. This approach also serves as a good way to build a stronger multi-disciplinary care team.
Information can be presented in various ways. For instance, it can be given as part of a formal class offered to each shift, at a monthly staff meetings or even as a take-home packet with a post test. If your facility has the capability, the information can be presented online via your hospital intranet.
Regardless of how you present the information, provide resources and establish some sort of a mechanism so individuals can ask questions and obtain further assistance.
Once the program has been initiated in one unit and has been judged successful, it can be expanded to include other areas of your facility. But start small and learn from there.
In most instances, it is good to review the basics of acid base balance. Approach it as a review, keeping in mind that for some caregivers, ABG interpretation may be new territory entirely. Once you have reviewed the basics, clinical applications are always useful. Give them case studies and examples.
It is also a good idea to follow up the initial program with case studies and refresher sessions at six months and at one year to ensure that the knowledge has been retained. And one final word of caution: Before you implement a competency program that includes nursing, make sure it also includes respiratory. The idea is to be collaborative.
Margaret Clark is a Georgia practitioner.
