Venous blood gases and other alternatives to arterial blood gases
- Arthur C Theodore, MD
Arthur C Theodore, MD
- Associate Professor of Medicine
- Boston University School of Medicine
An arterial blood gas (ABG) is the traditional method of estimating the systemic carbon dioxide tension and pH, usually for the purpose of assessing ventilation and/or acid-base status. However, the necessary sample of arterial blood can be difficult to obtain due to diminished pulses or patient movement. Diminished pulses may reflect poor peripheral circulation or low blood pressure, while patient movement is frequently caused by the pain associated with arterial puncture.
A venous blood gas (VBG) is an alternative method of estimating systemic carbon dioxide and pH that does not require arterial blood sampling. Performing a VBG rather than an ABG is particularly convenient in the intensive care unit, since most patients have a central venous catheter from which venous blood can be quickly and easily obtained.
The sites from which venous blood can be sampled, measurements that can be performed on venous blood, and correlation of venous measurements with arterial measurements are reviewed here. Other alternatives to ABGs for estimating systemic carbon dioxide and pH are also described, including end-tidal carbon dioxide and transcutaneous carbon dioxide. ABGs, capnography, and mechanisms of oxygenation are reviewed separately. (See "Arterial blood gases" and "Carbon dioxide monitoring (capnography)" and "Oxygenation and mechanisms of hypoxemia".)
VENOUS BLOOD GASES
Sampling sites — A VBG can be performed using:
●A peripheral venous sample (obtained by venipuncture)
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jul 06, 2017.References
- Tavakol K, Ghahramanpoori B, Fararouei M. Prediction of Arterial Blood pH and Partial Pressure of Carbon dioxide from Venous Blood Samples in Patients Receiving Mechanical Ventilation. J Med Signals Sens 2013; 3:180.
- Byrne AL, Bennett M, Chatterji R, et al. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology 2014; 19:168.
- Kelly AM, Klim S, Rees SE. Agreement between mathematically arterialised venous versus arterial blood gas values in patients undergoing non-invasive ventilation: a cohort study. Emerg Med J 2014; 31:e46.
- Cengiz M, Ulker P, Meiselman HJ, Baskurt OK. Influence of tourniquet application on venous blood sampling for serum chemistry, hematological parameters, leukocyte activation and erythrocyte mechanical properties. Clin Chem Lab Med 2009; 47:769.
- Malinoski DJ, Todd SR, Slone S, et al. Correlation of central venous and arterial blood gas measurements in mechanically ventilated trauma patients. Arch Surg 2005; 140:1122.
- Walkey AJ, Farber HW, O'Donnell C, et al. The accuracy of the central venous blood gas for acid-base monitoring. J Intensive Care Med 2010; 25:104.
- Ramakrishna MN, Hegde VD, Kumarswamy GN, et al. Impact of preoperative mild renal dysfunction on short term outcome in isolated Coronary Artery Bypass (CABG) patients. Indian J Crit Care Med 2008; 12:158.
- Ladakis C, Myrianthefs P, Karabinis A, et al. Central venous and mixed venous oxygen saturation in critically ill patients. Respiration 2001; 68:279.
- Tsaousi GG, Karakoulas KA, Amaniti EN, et al. Correlation of central venous-arterial and mixed venous-arterial carbon dioxide tension gradient with cardiac output during neurosurgical procedures in the sitting position. Eur J Anaesthesiol 2010; 27:882.
- Gokel Y, Paydas S, Koseoglu Z, et al. Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patients with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol 2000; 20:319.
- Brandenburg MA, Dire DJ. Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med 1998; 31:459.
- Malatesha G, Singh NK, Bharija A, et al. Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment. Emerg Med J 2007; 24:569.
- Chu YC, Chen CZ, Lee CH, et al. Prediction of arterial blood gas values from venous blood gas values in patients with acute respiratory failure receiving mechanical ventilation. J Formos Med Assoc 2003; 102:539.
- Kelly AM, Kyle E, McAlpine R. Venous pCO(2) and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease. J Emerg Med 2002; 22:15.
- Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J 2001; 18:340.
- Mallat J, Lazkani A, Lemyze M, et al. Repeatability of blood gas parameters, PCO2 gap, and PCO2 gap to arterial-to-venous oxygen content difference in critically ill adult patients. Medicine (Baltimore) 2015; 94:e415.
- McKeever TM, Hearson G, Housley G, et al. Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study. Thorax 2016; 71:210.
- Kelly AM, Kerr D, Middleton P. Validation of venous pCO2 to screen for arterial hypercarbia in patients with chronic obstructive airways disease. J Emerg Med 2005; 28:377.
- Lim BL, Kelly AM. A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department. Eur J Emerg Med 2010; 17:246.
- Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J 2006; 23:622.
- Yildizdaş D, Yapicioğlu H, Yilmaz HL, Sertdemir Y. Correlation of simultaneously obtained capillary, venous, and arterial blood gases of patients in a paediatric intensive care unit. Arch Dis Child 2004; 89:176.
- Adrogué HJ, Rashad MN, Gorin AB, et al. Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med 1989; 320:1312.
- Weil MH, Rackow EC, Trevino R, et al. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med 1986; 315:153.
- Tobin MJ. Respiratory monitoring in the intensive care unit. Am Rev Respir Dis 1988; 138:1625.
- Falk JL, Rackow EC, Weil MH. End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl J Med 1988; 318:607.
- Severinghaus JW, Astrup P, Murray JF. Blood gas analysis and critical care medicine. Am J Respir Crit Care Med 1998; 157:S114.
- Bendjelid K, Schütz N, Stotz M, et al. Transcutaneous PCO2 monitoring in critically ill adults: clinical evaluation of a new sensor. Crit Care Med 2005; 33:2203.
- Senn O, Clarenbach CF, Kaplan V, et al. Monitoring carbon dioxide tension and arterial oxygen saturation by a single earlobe sensor in patients with critical illness or sleep apnea. Chest 2005; 128:1291.
- Vivien B, Marmion F, Roche S, et al. An evaluation of transcutaneous carbon dioxide partial pressure monitoring during apnea testing in brain-dead patients. Anesthesiology 2006; 104:701.
- Hurley RA, Fisher R, Taber KH. Sudden onset panic: epileptic aura or panic disorder? J Neuropsychiatry Clin Neurosci 2006; 18:436.
- Cuvelier A, Grigoriu B, Molano LC, Muir JF. Limitations of transcutaneous carbon dioxide measurements for assessing long-term mechanical ventilation. Chest 2005; 127:1744.
- Nicolini A, Ferrari MB. Evaluation of a transcutaneous carbon dioxide monitor in patients with acute respiratory failure. Ann Thorac Med 2011; 6:217.