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Air bubbles in blood gas syringe

  • Giuseppe Lippi
  • Laura Pighi Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
  • Gian Luca Salvagno Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
  • Roberta Ferraro Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
  • Giovanni Celegon Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
  • Brandon M. Henry Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
DOI: https://doi.org/10.5937/jomb0-49870

Sažetak


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 While some previous studies investigated this aspect, these are now outdated and only analyzed a limited number of blood gas parameters.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.

Reference

1. Berend K, Duits AJ. The role of the clinical laboratory in diagnosing acid-base disorders. Crit Rev Clin Lab Sci 2019;56:147-69.
2. Casagranda I. Point-of-care testing in critical care: the clinician's point of view. Clin Chem Lab Med 2010;48:931-4.
3. Auvet A, Espitalier F, Grammatico-Guillon L, Nay MA, Elaroussi D, Laffon M, et al. Preanalytical conditions of point-of-care testing in the intensive care unit are decisive for analysis reliability. Ann Intensive Care 2016;6:57.
4. Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D, et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011;49:1113-26.
5. Plebani M, Lippi G. Point of care testing: evolving scenarios and innovative perspectives. Clin Chem Lab Med 2014;52:309-11.
6. Baird G. Preanalytical considerations in blood gas analysis. Biochem Med (Zagreb) 2013;23:19-27.
7. Kadwa AR, Grace JF, Zeiler GE. Sources of error in acid-base analysis from a blood gas analyser result: a narrative review. J S Afr Vet Assoc 2022;93:89-98.
8. Madiedo G, Sciacca R, Hause L. Air bubbles and temperature effect on blood gas analysis. J Clin Pathol 1980;33:864-7.
9. Biswas CK, Ramos JM, Agroyannis B, Kerr DN. Blood gas analysis: effect of air bubbles in syringe and delay in estimation. Br Med J (Clin Res Ed) 1982;284:923-7.
10. Astles JR, Lubarsky D, Loun B, Sedor FA, Toffaletti JG. Pneumatic transport exacerbates interference of room air contamination in blood gas samples. Arch Pathol Lab Med 1996;120:642-7.
11. Lu JY, Kao JT, Chien TI, Lee TF, Tsai KS. Effects of air bubbles and tube transportation on blood oxygen tension in arterial blood gas analysis. J Formos Med Assoc 2003;102:246-9.
12. O'Connor TM, Barry PJ, Jahangir A, Finn C, Buckley BM, El-Gammal A. Comparison of arterial and venous blood gases and the effects of analysis delay and air contamination on arterial samples in patients with chronic obstructive pulmonary disease and healthy controls. Respiration 2011;81:18-25.
13. Clinical and Laboratory Standards Institute. Blood Gas & pH Analysis & Related Measurements. Approved Guideline--Second Edition, C46A2 2/1/2009. Wayne, PA, USA.
14. Woolley A, Hickling K. Errors in measuring blood gases in the intensive care unit: effect of delay in estimation. J Crit Care 2003;18:31-7.
15. Kuster N, Bargnoux AS, Badiou S, Dupuy AM, Piéroni L, Cristol JP. Multilevel qualification of a large set of blood gas analyzers: Which performance goals? Clin Biochem 2019;74:47-53.
Objavljeno
2024/05/21
Broj časopisa
Vol. 43 Br. 5 (2024): Journal of Medical Biochemistry
Rubrika
Original paper

Sva prava zadržana (c) 2024 Giuseppe Lippi, Laura Pighi, Gian Luca Salvagno, Roberta Ferraro, Giovanni Celegon, Brandon M. Henry

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