The flush solution within the catheter dead space must be removed to prevent dilution of the sample.
Ensure stopcock is positioned to 45 degrees between syringe changes.
Placement of the stopcock in the 45 degree position is "off" in all directions. This will prevent any flush solution from entering the tubing between syringe changes.
Assess Oxygenation and Ventilation
Identify the patient's SpO2 reading at the time of blood sampling. If the patient is mechanically ventilated, record the minute volume (minute ventilation or Ve) from the ventilator. Record the minute volume when the patient is calm.
The SaO2 result from the blood gas sample should be compared to the SpO2 that was obtained at the time the sample was drawn.
The acid base balance is used to determine whether ventilation is adequate. A respiratory acidosis indicates that the total minute volume is not meeting the patient's needs, whereas, a respiratory alkalosis indicates that the minute volume is too high. To be meaningful, the gases should be compared to the minute volume that was obtained at the time the sample was drawn.
Withdraw Blood Gas Sample
Slowly withdraw 1-2 mL into a heparinized blood gas syringe. Ensure that the syringe is securely attached to the access port.
A heparinized syringe is required to prevent clotting of the specimen.
This is a clean procedure.
Prevent Air Entry
Hold the sample upright at a STRICT 90 degree angle with a gauze square over the top to prevent blood spatter. Gently tap any air bubbles to the top and expel into the gauze.
Apply a cap to prevent blood contamination or air entry into the syringe.
Do not draw air into the syringe to "level the air bubble" as you might with a medication.
The PaO2 of room air is 140 mmHg; an air bubble will falsely increase the PaO2.
Label and Transport
Label the syringe. Either take the sample to the point of care testing machine (GEM) or send the sample on ice to the lab in a biohazardous bag.
Ice is only required for samples older than 30 minutes.
Flush the System
Flush the catheter, stopcock and needleless access cap as per the Procedure for Blood Withdrawal.
Replace the needleless access cap if blood cannot be completely cleared. Apply a new antiseptic sampling cap.
Inadequate catheter flushing can lead to thromboembolism and loss of line patency.
Thrombus formation is also a risk factor for vascular line infection.
Residual blood in the stopcock or needleless access devices poses an infection risk.
Complete the Lab Requisition
Correctly identify whether the sample is arterial, venous or capillary. If venous, identify under comments if the sample is mixed venous, central venous or peripheral.
Enter the patient's ventilator and vital signs information into the lab requisition (for core lab samples) or the GEM program.
Include the following patient information for the core lab:
Ventilator mode and rate
Include the following patient information for Point of Care testing in the core lab:
Ventilator settings enable correct interpretation of the patient's acid base balance and response to treatment.
Blood gases are corrected to temperature.
Document results in the graphic record and communicate any significant findings to the physician and respiratory therapist.
To ensure appropriative interventions are made.
Developed: November 1988 (Morgan, B) Revised: March 23, 2013 (GS) Last Update: June 30, 2016 (BM); revised August 17, 2018