A critical look at the preanalytical considerations of blood gases
Keywords:
preanalytical phase, blood gases, preanalytical errorsAbstract
Introduction: one of the least discussed issues and that little is understood about it, is patient safety. It has recently become a ubiquitous and controversial issue, especially for some medical organizations.
Objective: to systematize theoretical references related to the particularities of the process of sample taking and analysis of blood gases.
Method: the main elements that gravitate in this phase are analyzed for the blood gas analysis, as well as the influence that these can have on the quality of the results and the clinical and laboratory practices to optimize it.
Development: the preanalytical phase is the one that precedes the performance of a trial or laboratory study and includes the preparation of the patient, the preparation of the analysis request and the care for obtaining the samples. The attention that the attending physician and laboratory staff give to this phase is directly proportional to the quality of the results that will be obtained.
Conclusions: the analysis of pH and blood gases should always be considered as an emergency study. The sample should not remain for more than ten minutes at room temperature and when the analysis takes more than 15 minutes, the sample should be stored in ice water.
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References
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2. Plebani M, Sciacovelli L, Aita A, Pelloso M, Chiozza ML. Performance criteria and quality indicators for the pre-analytical phase. Clin Chem Lab Med [en línea]. 2015 [citado 1 Mar 2019]; 53(6):943-48. DOI: 10.1515/cclm-2014-1124
3. Lima-Oliveira G, Guidi GC, Guimaraes AVP, Correa JA, Lippi G. Preanalytical non conformity management regarding primary tube mixing in Brazil. J Med Biochem [en línea]. 2017 [citado 1 Mar 2019]; 36(1):39-43. DOI: 10.1515/jomb-2016-0032
4. Lima-Oliveira G, Volanski W, Lippi G, Picheth G, Guidi GC. Preanalytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest [en línea]. 2017 [citado 1 Mar 2019]; 77(3):153-63. DOI: 10.1080/00365513.2017.1295317
5. Plebani M. The quality indicator paradox. Clin Chem Lab Med [en línea]. 2016 [citado 1 Mar 2019]; 54(7):1119-22. DOI: 10.1515/cclm-2015-1080
6. Plebani M, Sciacovelli L, Aita A, Pelloso M, Chiozza ML. Performance criteria and quality indicators for the pre-analytical phase. Clin Chem Lab Med [en línea] 2015 [citado 1 Mar 2019]; 53(6):943-8. DOI: 10.1515/cclm-2014-1124
7. Kristensen GB, Aakre KM, Kristoffersen AH, SandbergS.How to conduct External Quality Assessment Schemes for the pre-analytical phase? Biochem Med (Zagreb) [en línea]. 2014 [citado 1 Mar 2019]; 24(1):114-22. DOI: 10.11613/BM.2014.013
8. Plebani M, Sciacovelli L, Aita A, Padoan A, Chiozza ML. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Chim Acta [en línea]. 2014 May [citado 1 Mar 2019]; 432:44-8. DOI: 10.1016/j.cca.2013.07.033
9. Plebani M, Sciacovelli L, Aita A, Chiozza ML. Harmonization of pre-analytical quality indicators. BiochemMed (Zagreb) [en línea]. 2014 [citado 1 Mar 2019]; 24(1):105-13. DOI: 10.11613/BM.2014.012
10.Oh MS. New perspectives on acid-base balance. Semi Dial [en línea]. 2000 [citado 1 Mar 2019]; 13(4):212-19. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/10923347
11.Kraul JA. Approach to patients with acid-base disorders. Respir Care [en línea]. 2001 [citado 1 Mar 2019]; 46(4):392-403. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/11262558
12.Mahto HL, Sasikumar S. Blood gas sampling - Pre-analytical issues. Indian J Resp Care [en línea]. 2017 [citado 1 Mar 2019]; 6(1):758-61. Disponible en: http://www.ijrconline.org/article.asp?issn=2277-9019;year=2017;volume=6;issue=1;spage=758;epage=761;aulast=Mahto;type=0
13.Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care [en línea]. 2013 Oct [citado 1 Mar 2019]; 58(10):1694-703. DOI: 10.4187/respcare.02786
14.Plebani M, O'Kane M, Vermeersch P, Cadamuro J, Oosterhuis W, Sciacovelli L. The use of extra-analytical phase quality indicators by clinical laboratories: the results of an international survey. Clin Chem Lab Med [en línea]. 2016 [citado 1 Mar 2019]; 54(11): e315-7. DOI: 10.1515/cclm-2016-0770
15.Neogi SS, Mehndiratta S, Gupta DP. Pre-analytical phase in clinical chemistry laboratory. J Clin Sci Res [en línea]. 2016 [citado 1 Mar 2019]; 5(3):171-178. DOI: 10.15380/2277-5706.JCSR.15.062
16.Zaninotto M, Tasinato A, Vecchiato G, Legnaro A, Pinato A, Plebani M. Performance specifications in extra-analytical phase of laboratory testing: sample handling and transportation. Clin Biochem [en línea]. 2017 [citado 1 Mar 2019]; 50(10-11):605-11. Disponible en: http://dx.doi.org/10.1016/j.clinbiochem.2017.04. 008
17.Knowles TP, Mullin RA, Hunter JA, Douce FH. Effects of syringe material, sample storage time, and temperature on blood gases and oxygen saturation in arterialized human blood samples. Respir Care [en línea]. 2006 [citado 1 Mar 2019]; 51(7):732-736. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/16800906
18.Martins JM, MartinelloF. Assessment of the pre-analytical phase of a clinical analyses laboratory. J Bras Patol Med Lab [en línea]. 2018 [citado 1 Mar 2019]; 54(4):232-240. http://dx.doi.org/10.5935/1676-2444.20180040
19.Giménez-Marín A, Rivas-Ruiz F, del Mar Pérez-Hidalgo MDM, Molina-Mendoza P. Pre-analytical errors management in the clinical laboratory: a five-year study. Biochem Med. 2014; 24(2):248-57.
20.Mehndiratta M, Puri D. Adopting role playfor training medical interns about sample collection and processing for laboratory investigations. Indian J Med Biochem. 2015; 19:24-27.
21.Mehndiratta M, Gupta S,Puri D. Roleplay: a method of teachingbiochemistry to medical undergraduates. Indian J Med Biochem.2015; 19:39-41.
22.van Beest PA, Lont MC, Holman ND, Loef B, Kuiper MA, Boerma EC. Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients. Intensive Care Med [en línea]. 2013 [citado 1 Mar 2019]; 39(6):1034-1039.DOI: 10.1007/s00134-013-2888-x
23.Kenrick B, Aiko PJ, Rijk OB. PhysiologicalApproach to Assessment of Acid–Base Disturbances. N Engl J Med [en línea]. 2014 [citado 1 Mar 2019]; 371(15):1434-45. DOI: 10.1056/NEJMra1003327
24.Berend K. Bedside rule secondary response in metabolic acid-base disorders isunreliable. J Crit Care [en línea] 2013 [citado 1 Mar 2019]; 28(6):1103. DOI: 10.1016/j.jcrc.2013.04.014
25.Berend K. Acid-base pathophysiology after 130 years: confusing, irrational and controversial. J Nephrol [en línea] 2013; 26(2):254-65. DOI: 10.5301/jn.5000191
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Published
2019-05-15
How to Cite
1.
Quevedo Palomo I, Ley Paz E, Estevan Soto JA, Díaz Trujillo E. A critical look at the preanalytical considerations of blood gases. Rev Inf Cient [Internet]. 2019 May 15 [cited 2025 Jun. 2];98(2):294-306. Available from: https://revinfcientifica.sld.cu/index.php/ric/article/view/2239
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