ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

Effective Date: 2014 Version #1

Chapter 15

Procedure Name: Percutaneous Arterial Blood Sampling

Purpose or Principle Every individual performing arterial punctures must know the dangers of the procedure and the precautions that minimize hazards to the patient, or healthcare worker, and the factors that alter the test results. Related policies that define qualifications, training, and competency reviews for individuals who obtain arterial blood specimens and analyze them for blood gas or related values must be followed. All individuals approved for this procedure are required to successfully complete a structured and documented training program that is specifically designed for this procedure. Records of such training and certification will be kept on file as required by the College of American Pathologists (CAP), Joint Commission on the Accreditation of Hospitals (JCAHO), and The Clinical Laboratory Act of 1988 (CLIA’88). All training and certification must be under the guidance and direction of the laboratory medical director. Only personnel certified by the laboratory medical director should perform arterial punctures. The physician’s order should be validated by referring to the patient’s chart. Blood is drawn anaerobically from a peripheral artery (radial or brachial) via a single percutaneous needle puncture. This provides a blood specimen for direct measurement of the partial pressure of arterial carbon dioxide (Pa CO 2 ) and the partial pressure of arterial oxygen (Pa O 2 ), hydrogen ion activity (pH), total hemoglobin (tHb), oxyhemoglobin (O 2 Hb), and the dyshemoglo- bins, carboxyhemoglobin (COHb) and methemoglobin (MetHb). Additional analytes may also be obtained from whole blood specimens (e.g., electrolytes). The proper collection of specimens is the first step to reliable test results. The specimen for blood gas analysis should be collected in a suitable heparinized plastic syringe. The blood must be anticoagulated to prevent clotting within the analyzer. For convenience, kits are available that contain a preheparinized syringe, needle, needle protec- tion guard to avoid recapping, syringe cap, skin preparation solutions, gauze sponge, adhesive bandage, specimen labels, and transport bag. Not all brands of blood gas syringes are compatible with all blood gas analyzers. The preheparinized syringes are evaluated by the blood gas analysis device manufacturer for anticoagulation effectiveness and analyte interference. Thus, it is important to follow the analyzer manufacturer’s recommendation for heparin compatibility with the analytes being measured. Before plastic syringes became customary, glass syringes were used for blood gas specimen collection. The syringe was immersed in an ice-water bath to slow the white blood cell metabolism, thereby retarding oxygen (O 2 ) consumption. Syringes made of plastic are more gas permeable than glass, and when cooled they can accelerate a

169

© 2016 AmericanThoracic Society www.thoracic.org