Venøs blodgasanalyse i akutmodtagelsen

Forfattere

DOI:

https://doi.org/10.7146/akut.v1i1.97249

Nøgleord:

Arteriel blodgasanalyse, venøs blodgasanalyse, V-gas, VBG

Resumé

Baggrund
Blodgasanalyse er et vigtigt redskab i en akutmodtagelse. Flere vestlige lande som USA og Australien er idag begyndt at erstatte den traditionelle arterielle blodgasanalyse med en venøs. Dette kan nedsætte smerten vi udsætter patienterne for, og de risici en arteriepunktur medfører.

Formål
Formålet med denne statusartikel er at opsummere hvordan en venøs blodgas analyse skal fortolkes i forhold til en arteriel, og foreslå i hvilke kliniske situationer V-gas kan erstatte A-gas.

Resultater
Baseret på metaanalyser er der fundet god overensstemmelse mellem arteriel og venøs pH-værdi. For pO2 er der stor forskel på arteriel og venøs, denne kan dog ofte estimeres ud fra transkutan saturation. pCO2 er også med stor usikkerhed, dog kan en værdi i normalområdet udelukke hyperkapni. Bicarbonat og laktat i V-gas kan sige om arterielt niveau er lavt, højt eller normalt, men dog ikke forudsige den præcise værdi. Base-excess er ikke undersøgt nok, men resultaterne antyder en god overensstemmelse.

Konklusion
Venøs blodgasanalyse er en upræcis gengivelse af de arterielle forhold. V-gas kan dog i mange tilfælde erstatte arteriel blodgasanalyse, hvis den bruges fokuseret og sammen med det kliniske billede. Det er vigtigt at patientsikkerheden opretholdes, og er man i tvivl om tolkningen af en V-gas bør man supplere med en A-gas.

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Background
Blood gas analysis is an important tool in the emergency department. Several western countries e.g. the USA and Australia have started to replace the traditional arterial blood gas analysis with a venous blood gas analysis. It can lower the pain inflicted on the patient as well as the risks of an arterial puncture.

Purpose
The purpose of this status article is to summarize the interpretation of a venous blood gas analysis (V-gas) compared to an arterial blood gas analysis (A-gas) and suggest in which clinical situations V-gas can replace A-gas.

Results
Based on meta-analyses, a good compliance between the arterial and venous PH-values has been found. For pO2, there is a significant difference between the two, however, this difference can be estimated using transcutaneous saturation. pCO2 is also a fairly uncertain measurement, although, a value within normal range can exclude hypercapnia. Bicarbonate and lactate in a V-gas can show if the arterial level is low, high or normal, but it cannot predict the exact value. Base-excess has not been sufficiently investigated but results indicate good compliance.

Conclusion
Venous blood gas analysis is an imprecise translation of the arterial conditions. However, in many cases V-gas can replace an arterial blood analysis if it is used in a focused manner and in correlation with the clinical situation.

Forfatterbiografi

Jeppe Henriksen, Fælles Akut Afdeling, Aarhus Universitets Hospital.

KBU-læge

Referencer

1. Kelly AM. Can VBG analysis replace ABG analysis in emergency care? Emergency medicine journal : EMJ. 2016;33(2):152-4 DOI: 10.1136/emermed-2014-204326.

2. Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2014;21(2):81-8 DOI: 10.1097/MEJ.0b013e32836437cf.

3. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology (Carlton, Vic). 2014;19(2):168-75 DOI: 10.1111/resp.12225.

4. Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Medical devices (Auckland, NZ). 2014;7:231-9 DOI: 10.2147/mder.s47319.

5. Kelly A. Agreement between arterial and venous blood gases in emergency medical care: a systematic review. Hong Kong Journal of Emergency Medicine. 2013;20(3):166 (ingen DOI)

6. Benitez Cantero JM, Jurado Garcia J, Ruiz Cuesta P, Gonzalez Galilea A, Munoz Garcia-Borruel M, Garcia Sanchez V, et al. [Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory]. Medicina clinica. 2013;141(8):332-7 DOI: 10.1016/j.medcli.2012.07.018.

Publiceret

2018-01-18 — Opdateret d. 2022-02-17

Versioner

Citation/Eksport

Henriksen, J., & Karlsson, C. M. (2022). Venøs blodgasanalyse i akutmodtagelsen. Dansk Tidsskrift for Akutmedicin, 1(1), 4–7. https://doi.org/10.7146/akut.v1i1.97249 (Original work published 18. januar 2018)

Nummer

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Statusartikler