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Background: Arterial blood gas (ABG) analysis is the gold standard for proper diagnosis and treatment of acid-base imbalances. However, the invasive nature of arterial puncture and its possible complications have resulted in a need for less-invasive diagnostic methods such as venous blood gas (VBG) analysis. Objectives: This integrative literature review sought to investigate and explore the agreement between commonly used parameters (pH, PCO2, PO2, HCO3, SO2 and BE) in arterial and venous blood values in order to determine if VBG could replace ABG in the assessment of patients in the emergency departments. Method: An integrative literature review was performed via a systematic search in the CINHAL and MEDLINE electronic databases using combination of keywords and a manual search was also conducted through the references of published articles to identify relevant research articles. Results: The outcomes of interest were agreement between ABG and peripheral VBG values for pH, PCO2, PO2, HCO3, SO2 and BE in emergency department. Forty-six studies were identified of which sixteen were relevant. An examination of the relationship between arterial and venous pH revealed that arterial pH tended to be lower than venous pH, and there was a very small variance between arterial and venous pH, although this difference was only 0.1 which is not clinically significant. With respect to PCO2 and HCO3, several studies have shown that arterial PCO2 and HCO3 were higher than venous PCO2 and HCO3 but the majority of studies have shown that arterial PCO2 and HCO3 were lower than venous PCO2 and HCO3. Considering PO2 and SO2, all studies demonstrated that arterial values for PO2 and SO2 were higher than venous values for PO2 and SO2. With respect to BE, arterial BE was slightly higher than venous BE in trauma patients, but in acute exacerbation of COPD, hypotensive and normotensive patients, arterial BE values were lower than venous BE values. Conclusion: Peripheral venous blood gas analysis for pH, PCO2, HCO3 and BE may be a reliable substitute for ABG analysis in the evaluation of patients presenting to the ED with diverse pathological conditions. However, the agreement between arterial and peripheral venous PO2, and SO2 is very poor; therefore, it is unpredictable to be clinically useful and to be able to replace ABG. Studying the precise effects of replacing ABG with VBG on the clinical decision-making and the following outcomes is worthwhile.
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