Sources of error in acid-base analysis from a blood gas analyser result: a narrative review

Kadwa, Abdur Rahmaan; Grace, Justin; Zeiler, Gareth Edward

doi:10.36303/jsava.163

Cited by 5 publications

(3 citation statements)

References 73 publications

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“…Therefore, the more common preanalytical errors in blood gas analysis include identification errors, inappropriate sample collection (e.g. incorrect syringe filling), contamination with other exogenous fluids, air exposure (and incorporation), inappropriate management (e.g., inaccurate mixing), clotting, hemolysis, and incorrect storage time and temperature when bedside testing is not possible, and samples need to be transported to another testing site (6,7).…”

Section: Introductionmentioning

confidence: 99%

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Pighi,

Salvagno,

Ferraro

et al. 2024

Preprint

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Background. Minimizing air aspiration by carefully filling blood gas syringes is crucial to prevent air contamination from causing undesirable variations in gasses and other molecules. While some previous studies investigated this aspect, these are now outdated and only analyzed a limited number of blood gas parameters. Thus, we investigated the effects air contamination in the syringe using a modern blood gas analyzer. Methods. We sampled venous blood from 17 laboratory workers (mean age: 46 ± 11 years; 10 women), filling two consecutive blood gas syringes. The first was filled exactly to its nominal volume (i.e., 1.0 mL), while the second was filled with 0.8 mL of blood and 0.2 mL of ambient air. Blood gas analysis was performed in each syringe using an identical analyzer. Results. In the syringe with the air bubble, we found statistically significant increase in pH (0.1%), pO2 (10.8%), SO2 (11.2%), total hemoglobin (3.0%), and hematocrit (2.7%), while values of pCO2 (-4.8%), sodium (-0.5%), and ionized calcium (-1.3%) were significantly reduced. With exception of pH, all these changes exceeded the performance specifications. Potassium, chloride, glucose, lactate, COHb and MetHb values remained unchanged. Conclusion. These findings confirm that air bubbles must be removed as soon as possible after sampling from blood gas syringes to prevent artifactual test results and misleading clinical judgment and inappropriate treatment. When blood gas syringes are received in the laboratory with air bubbles inside, the most vulnerable parameters (i.e., pO2, SO2, pCO2, sodium, ionized calcium, hematocrit and hemoglobin) should be suppressed.

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Section: Introductionmentioning

confidence: 99%

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Pighi,

Salvagno,

Ferraro

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Therefore, the more common preanalytical errors in blood gas analysis include identification errors, inappropriate sample collection (e.g. incorrect syringe filling), contamination with other exogenous fluids, air exposure (and incorporation), inappropriate management (e.g., inaccurate mixing), clotting, hemolysis, and incorrect storage time and tempe rature when bedside testing is not possible, and samples need to be transported to another testing site (6,7).…”

Section: Introductionmentioning

confidence: 99%

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Lippi,

Pighi,

Salvagno

et al. 2024

J Med Biochem

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Background. Minimizing air aspiration by carefully filling blood gas syringes is crucial to prevent air contamination from causing undesirable variations in gasses and other molecules. While some previous studies investigated this aspect, these are now outdated and only analyzed a limited number of blood gas parameters. Thus, we investigated the effects air contamination in the syringe using a modern blood gas analyzer. Methods. We sampled venous blood from 17 laboratory workers (mean age: 46±11 years; 10 women), filling two consecutive blood gas syringes. The first was filled exactly to its nominal volume (i.e., 1.0 mL), while the second was filled with 0.8 mL of blood and 0.2 mL of ambient air. Blood gas analysis was performed in each syringe using an identical analyzer. Results. In the syringe with the air bubble, we found statistically significant increase in pH (0.1%), pO2 (10.8%), SO2 (11.2%), total hemoglobin (3.0%), and hematocrit (2.7%), while values of pCO2 (-4.8%), sodium (-0.5%), and ionized calcium (-1.3%) were significantly reduced. With exception of pH, all these changes exceeded the performance specifications. Potassium, chloride, glucose, lactate, COHb and MetHb values remained unchanged. Conclusion. These findings confirm that air bubbles must be removed as soon as possible after sampling from blood gas syringes to prevent artifactual test results and misleading clinical judgment and inappropriate treatment. When blood gas syringes are received in the laboratory with air bubbles inside, the most vulnerable parameters (i.e., pO2, SO2, pCO2, sodium, ionized calcium, hematocrit and hemoglobin) should be suppressed.

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“…Like all lab tests, ABG results can be affected by analytical, pre-analytical and post-analytical factors. But blood gases are particularly sensitive to a number of pre-analytical factors that contribute most significantly in causing an error 4 . Apart from physiological factors like ongoing cellular metabolism in the blood specimen, proper sample collection also plays a major role in affecting patient results 5 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of arterial blood gas results obtained using two types of Heparinized Syringes

Mahmood¹

2023

Isra Med J

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Objective: The objective of this study was to compare the arterial blood gas results obtained using syringes heparinized with liquid heparin and syringes containing lyophilized balanced heparin. Study Design: Comparative cross sectional. Place and Duration: This study was conducted in the Chemical Pathology department at Combined Military Hospital, Lahore for a period of six months from November 2022 to March 2023. Methodology: A total of 100 arterial blood samples were taken from 50 patients admitted in ICU using a regular plastic syringe flushed with 5000 IU/ mL liquid heparin and another containing lyophilized heparin. Samples were analyzed immediately after collection on Roche Cobas b121 ABG analyzer. Three of the measured parameters (pH, pCO2 and pO2) were then compared among both syringe groups. pH, pO2 and pCO2 were compared using mean difference. Results: The difference of means for pH was insignificant (p- Value >0.05). But pCO2 and pO2 showed significant difference in means with p- Values <0.05 (0.007 and 0.037, respectively). Bland Altman plots were also plotted for all three parameters. 12% of the pH values, 8% pco2 and 6% pO2 values exceeded the total allowable error. Conclusion: Arterial blood pH was comparable between the two types of syringes used. The pCO2 and pO2 differed significantly and where found to be lower in blood samples collected in the liquid heparin syringes. Keywords: Liquid Heparin, Lyophilized Heparin, Arterial Blood Gas, pH, pO2, pCO2. How to Cite This: Mahmood A, Sattar A, Shaheen S, Ahmad S, Hafeez A. Comparison of arterial blood gas results obtained using two types of Heparinized Syringes. Isra Med J. 2022; 14(4): 161-164. DOI: https://doi.org/10.55282/imj.oa1379

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Sources of error in acid-base analysis from a blood gas analyser result: a narrative review

Cited by 5 publications

References 73 publications

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Comparison of arterial blood gas results obtained using two types of Heparinized Syringes

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