Venous blood gas
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When evaluating pO2. That's about it.
When your pulse ox isn't giving a great waveform and you want to know about oxygenation or for p to f ratio to determine if ards (primarily in icu)
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When your hospitalist won't listen to science and logic...
As an IM resident... because it's a PITA to get at my hospital. The RNs complain that they can't draw gases, the RTs claim they can't do a venous stick and 4 hours later when I don't have a result I say, "Fornicate this," cancel the order and just order an ABG. The patient's radial artery be damned.
In the ED? No.
wait, what?
It's a POC/istat test ran from a green top. Anyone who can draw blood can fill a green top, take it to the RT, have them run a VBG. takes 5 minutes.
Here's a quick primer for you: VBG versus ABG • LITFL: Life in the Fast Lane Medical Blog
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deleted109597
Clearly the place where you work has a thing called common sense. It's sorely lacking at my hospital.
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deleted547339
When I was an EM resident, I drank the koolaid. Now as a CCM fellow, I definitely see the utility of ABG over VBG.
A VBG is a great screen in the ED, but if a patient is going to the ICU, an ABG can be helpful. In extremes, the correlation can get worse - particularly in severe shock. An ABG helps establish a P:F ratio to trend. Also, winters formula isn't validated in VBG so you don't necessarily have an appropriate understanding of the acid/base physiology.
I think if you have a good intensivist group and patients go to the ICU quickly, it doesn't matter. It you are boarding patients for a while, am ABG may be helpful.
A VBG is a great screen in the ED, but if a patient is going to the ICU, an ABG can be helpful. In extremes, the correlation can get worse - particularly in severe shock. An ABG helps establish a P:F ratio to trend. Also, winters formula isn't validated in VBG so you don't necessarily have an appropriate understanding of the acid/base physiology.
I think if you have a good intensivist group and patients go to the ICU quickly, it doesn't matter. It you are boarding patients for a while, am ABG may be helpful.
1. We don't generally run iSTATs for floor patients.
2. Given the mismatch between the iSTAT lactate and lab lactate and iSTAT chem panel and lab chem panel at my hospital, I don't trust the iSTATs further than I can throw them.
You realize ABGs are run on the same machines as VBGs, right?
An ABG machine (same brand that my hospital uses. It also runs VBGs):
iSTAT:
The post I was responding to specifically mentions using an iSTAT for running the lab.
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