Foundations of Emergency Nursing: A Comparative Analysis of ABG vs VBG

This essay explores the foundations of emergency nursing practice, focusing on the comparative use of arterial blood gas (ABG) and venous blood gas (VBG) testing. It investigates whether ABGs are prioritized over VBGs by healthcare practitioners and examines significant issues associated with these nursing practices, emphasizing their relevance to emergency nursing, multidisciplinary teams, patient treatment, management, and nursing care. The discussion includes the benefits and drawbacks of both ABG and VBG testing, considering factors such as pain levels for patients, accuracy of results, and the time required for sample collection and analysis. The essay also integrates the Nursing and Midwifery Council's code of conduct and ethical considerations, highlighting the importance of evidence-based practice and patient-centered care. Clinical examples are used to support arguments, underscoring the need for continuous professional development and collaboration within multidisciplinary healthcare teams to enhance patient outcomes and reduce risks associated with sampling techniques. The conclusion advocates for a balanced approach to healthcare service delivery, emphasizing ethical and legal considerations within the UK healthcare system.

Running Head: FOUNDATIONS OF EMERGENCY NURSING PRACTICE
FOUNDATIONS OF EMERGENCY NURSING PRACTICE
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FOUNDATIONS OF EMERGENCY NURSING PRACTICE 1
Table of Contents
Introduction......................................................................................................................................2
Main Body.......................................................................................................................................2
Conclusion.......................................................................................................................................8
References........................................................................................................................................9

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Introduction
Some important practices in the Emergency Department include blood gas testing as it
assists the healthcare staff to assess the condition of the patients. The results of blood gas tests
help the clinician to get important information about the patients, for example, the pH levels,
PCO2, Lactates, electrolytes, and haematocrit (Al Ashry et al., 2018). Normally the data is used
to determine the acid-base status, anion gap and any presence hypo-perfusion tissues. Arterial
blood gas (ABG) and venous blood gas (VBG) testing techniques are generally used to measure
the blood gas level.
However, the question here is if ABGs has given importance over VBGs by healthcare
practitioners (Wong et al., 2018). The essay aims to outline if priority given over VBG to ABG,
significant issues associated with these nursing practices. It has also considered the fact if this
issue is relevant to emergency nursing practices. It has also outlined its relevance with the
multidisciplinary team, patients, treatment, management, and nursing care. The essay has also
linked the essay with clinical examples to support the research with practical arguments.
Main Body
Blood gas investigation is as often as possible asked for as a major aspect of the purpose
of of-care testing for crisis or basic care patients giving metabolic or respiratory variations from
the norm. Blood vessel blood gas investigation has a vital job in deciding corrosive base parity
and blood-gas status in precisely ventilated patients (McCanny, Bennett, Staunton, & McMahon,
2012). Regardless of its high viability in assessing a patient's reaction to treatment regimens, the
ABG test has a few entanglements. The most widely recognised difficulties related with blood
vessel cut are torment, blood vessel damage, and contamination, thrombosis with distal digit
ischemia, drain, and aneurysm development (Kelly & Klim, 2013). Another option in contrast to

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blood vessel gas examining is VBG inspecting acquiring venous blood is less demanding, and
the system is less confusing. Moreover, the venous blood test can be acquired when drawing
blood for another research facility (Goldwasser, Manjappa, Luhrs, & Barth, 2012).
As of late, ponders have demonstrated that estimations of acid-base status estimated in
fringe venous blood relate well with those deliberate in blood vessel blood, in any event for
estimations of pH, bicarbonate and carbon dioxide (PCO2). In an examination performed by
Kelly et al., venous pH estimation demonstrated a high level of relationship with the blood vessel
esteem (Woods & Hodgson, 2015). Another investigation analysed pH, and PCO2 levels got
from the blood vessel and venous blood tests and exhibited a noteworthy relationship. There is a
strong relationship for pH, PCO2, and HCO3, yet the precision of anticipating blood vessel
esteems was restricted, and they inferred that venous blood testing could not be utilised for
routine appraisal of corrosive base status. In patients with diabetic ketoacidosis, pH and PCO2
levels got from VBG have a great connection with ABG values (Wong et al., 2018).
The existence of the Nursing and Midwifery Council in the UK has worked to protect the
locals from outlining the practitioners in providing the healthcare practitioner and nurses to
outline the professional code of conducts according to the UK laws and regulations. Research
has been carried out for this essay to assess the code of conduct to set out the common standards,
conduct, and behaviour while providing a clear brief to nurses and healthcare practitioners
(Murdoch, 2019). The professional standards regulate specific knowledge and skills based on the
following codes to set limitations and opportunities for individuals. The codes include,
- Healthcare practitioners and nurses are encouraged to seek feedback from patients and service
user in order to improve care standards for them.

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- Nurses and other healthcare staff can work together with doctors and professionals to promote
safe and effective practices in their placement
- The codes determine that the health facility staff should support their staff in upholding the
standards as a part of their management structure to regulate effective services.
- The management can work together in understanding the registered code of conduct in achieving
their targeted performance standards (Barber, 2019).
Other important standards designed by the UK legal system is to follow basic work
standards. Some of the standards include,
- To treat service users as equal and uphold their dignity
- Communicating with the service user, responding to their preferences and concerns related to
their treatment plan
- Making sure that nursing staff meet the physical, social, and psychological needs of service users
- Acting towards the best interest of service user
- Resting the service’ user’s privacy and confidentiality (Barber, 2019)
Collaboratively speaking, the nursing standards of practice and code of ethics determined
under the nursing values are based on basic standards such as baccalaureate education, human
dignity, integrity, autonomy, altruism, and social justice. However, in the case of selecting ABGs
or VBGs in nursing practice are supposed to be undertaken based on the nursing code of ethics
(Grace, Stockhausen, Patton, & Innes, 2019). Researches have determined that normally nursing
staff work with ABGs to assess PAO2/Oxygen and other electrolyte levels, however, the
procedure is extremely painful for patients. On the contrary, VBGs can help the practitioners to
measures every possible electrolyte level except for accurate oxygenation level; it is even
quicker for nurses to take the service user’s samples and analyse the results (Barber, 2019).

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There are other researches that criticise over the pain level of VBGs over ABGs, for example, it
has been determined that a VBG can take time to take samples, especially in an Emergency
Department, healthcare practitioners are keen to use Cannula while taking samples (McCanny,
Bennett, Staunton, & McMahon, 2012).
While on the other hand, nurses believe that using ABGs can be less painful if the nursing
staff are using a local anaesthetic, both the methods are analysed in the same way, though the
level of time it takes to assess its results might be different. Nursing professionals have focused
on the fact that the use of ABGs assist the staff in reflecting the patient's physiological conditions
while they are taking the sample (Al Ashry et al., 2018). For example, if the patients are being
postured, or given nebuliser, their oxygen level will be changed, hence will affect their results.
Therefore, nurses are keen to wait for some time if the patient is nebulised (at least 20 minutes)
to achieve accurate results (Wong et al., 2018). Meanwhile, nurses are given the training to
handle the ABGs samples appropriately, for example, the sample should be kept in ice to reduce
its metabolic activity and gas exchange so that it can be analysed within an hour. Meanwhile, the
non-iced samples are supposed to be checked within 15 minutes (Barber, 2019).
It is recommended for hospital management to train their healthcare staff with competence;
for example, the sample takers are required to take the sample as painless as they can. For that,
healthcare practitioners are supposed to be efficient enough to know the tactics and take a sample
in one attempt (McCanny, Bennett, Staunton, & McMahon, 2012). Meanwhile, in order to take
ABGs, a modified Allen Test should be performed on the patient to ensure that there is adequate
blood flow in the ulnar artery. It is essential for nurses to take care of patients with complex
ABG results (with mixed results and combined acid-base imbalance) to adopt a systematic
approach to interest the complicated and uncomplicated results (Woods & Hodgson, 2015).

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However, nurses have required take notes over the patient’s oxygenation, ventilation, and acid-
base balance using systematic interpretation to perform conjunction with the patient’s history and
its physical examination. Nursing professionals determine that taking ABG assessment is easy
for them, but painful for patients, it is the reason that senior physicians are told to take special
care for patients (Murdoch, 2019).
The key risk in taking ABG sampling for the patient include hematoma, a complication from
an arterial puncture at the sample site. Meanwhile, the least common risk include thrombus in
artery or infection that would require an antibiotic course. It is the reason that the UK health and
social care structure promote the multidisciplinary team, it encourages the exchange of skills,
and record interaction between nurses and healthcare professionals thus reduces the risk of error
towards service user (Al Ashry et al., 2018). It also promotes the learning of skills that reduce the
pain risk for patients due to sample taking. Generally speaking, a multidisciplinary healthcare
team entails a group of health workers, for example, psychiatrist, social workers, nurses, and
others (Goldwasser, Manjappa, Luhrs, & Barth, 2012). These individuals work together in
getting specific service standards for patients while coordinating their plan to achieve a specific
set of goals. To support nursing practices in regards to prioritising ABGs over VBGs, it will be
beneficial for healthcare professionals to work with evidence-based practices (Kelly & Klim,
2013).
These standards have been set over three factors (normally called as Pillars of EBP), patient’s
values, clinical expertise, and relevant research. It is recommended to a healthcare professional
to continuously invest their time in looking for new ways in setting their services in a manner
that promote patient’s rights, comforts, and requirements (McCanny, Bennett, Staunton, &
McMahon, 2012). In the current environment, hospitals are encouraged to adopt a patient-centric

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service user framework in improving their work standards. It encourages the healthcare
professions to communicate with the patients, understand their needs, demand, and plan their
service plan accordingly (Grace, Stockhausen, Patton, & Innes, 2019). Researches have been
carried out over the use of ABGs and VBGs, even though the majority of the healthcare
professionals are in favour of ABGs, most researches have investigated the validity of venous
blood using a common design and a simple method. It is determined that the blood sample
results gained using ABGs are compared with samples collected used VBGs. The samples were
analysed considering a short time frame but with the same analyser to understand its validity
(Kelly & Klim, 2013).
Meanwhile, healthcare professionals have supported ABGs by determining that it allows the
practitioners to have a direct measurement of variables gained from the samples directly from the
organ functions. Case in point, a 74-year-old man in hospital admission with a U&E profile
(using ABGs), has resulted in CO2 (bicarbonate) reduction to about 10 mmol/L which has
increased anion gap. The high gap metabolic acidosis has resulted in evidence of low renal
function which is because of raise urea and creatinine (Barber, 2019). Meanwhile, the test using
VBGs done next day has determined the reference gap of bicarbonate to approximately 24
mmol/L, and inconsistent acidosis diagnosis. The investigation determines that the measured
results were spuriously low which might be due to the unidentified substance in the sample
serum and reagent in enzymatic method leading the total estimation of CO2 (Goldwasser,
Manjappa, Luhrs, & Barth, 2012).
Conclusion
To conclude, it can be said that nursing practices in the UK according to the legal
healthcare system promote multidisciplinary team setting to promote collaborative practices. It

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supports the healthcare professionals to seek opportunities in promoting their services, look for
efforts in service user, and improve them for patients. However, this has supported with relevant
frameworks in nursing and healthcare to gain opportunities in terms of the legal and ethical code
of conduct. The essay has outline the professional and ethical code of conduct for nursing
according to the UK legal system in outlining practices for nurses in setting their work standards.
This strengthens the role of nurses in the work setting, while on the other hand, support balanced
healthcare service providing. The essay has supported the general information using the
approach of nurses using ABGs over VBGs. It has also been determined that nurses are supposed
to work with the three basic pillars of evidence-based practices – patient’s values, clinical
expertise, and relevant research to set their standards of services and achieve their required
results.

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References
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Blum, F. E., Lund, E. T., Hall, H. A., Tachauer, A. D., Chedrawy, E. G., & Zilberstein, J. (2015).
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Goldwasser, P., Manjappa, N., Luhrs, C., & Barth, R. (2012). Discordance between measured and
calculated bicarbonate - a case study. Retrieved from https://acutecaretesting.org/en/journal-
scans/discordance-between-measured-and-calculated-bicarbonate-a-case-study
Grace, S., Stockhausen, L., Patton, N., & Innes, E. (2019). Experiential learning in nursing and allied
health education: Do we need a national framework to guide ethical practice? Nurse education in
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