AARC Clinical Practice Guideline Blood Gas Analysis and Hemoximetry: 2013
AARC Clinical Practice Guideline Blood Gas Analysis and Hemoximetry: 2013
AARC Clinical Practice Guideline Blood Gas Analysis and Hemoximetry: 2013
We searched MEDLINE, CINAHL, and Cochrane Library database for articles published between
January 1990 and December 2012. The update of this clinical practice guideline is based on 237
clinical trials, 54 reviews, and 23 meta-analyses on blood gas analysis (BGA) and hemoximetry. The
following recommendations are made following the Grading of Recommendations Assessment,
Development, and Evaluation scoring system. BGA and hemoximetry are recommended for evaluating a patients ventilatory, acid-base, and/or oxygenation status. BGA and hemoximetry are
suggested for evaluating a patients response to therapeutic interventions. BGA and hemoximetry
are recommended for monitoring severity and progression of documented cardiopulmonary disease
processes. Hemoximetry is recommended to determine the impact of dyshemoglobins on oxygenation. Capillary BGA is not recommended to determine oxygenation status. Central venous BGA
and hemoximetry are suggested to determine oxygen consumption in the setting of early goaldirected therapies. For the assessment of oxygenation, a peripheral venous PO2 is not recommended
as a substitute for an arterial blood measurement (PaO2). It is not recommended to use venous PCO2
and pH as a substitute for arterial blood measurement of PaCO2 and pH. It is suggested that
hemoximetry is used in the detection and evaluation of shunts during diagnostic cardiac catheterization. Key words: blood gases; blood gas analysis; hemoximetry; guidelines. [Respir Care 2013;
58(10):1694 1703. 2013 Daedalus Enterprises]
Mr Davis is affiliated with the Adult Health and Nursing System, Virginia Commonwealth University, Richmond, Virginia. Mr Walsh is affiliated with Boston Childrens Hospital, Boston, Massachusetts. Mr Sittig is affiliated with the Mayo Clinic, Rochester, Minnesota. Dr Restrepo
is affiliated with the University of Texas Health Science Center at San
Antonio, San Antonio, Texas.
The authors have disclosed no conflicts of interest.
Correspondence: Michael D Davis RRT, Department of Adult Health
Nursing Systems, Medical College of Virginia, School of Nursing Building, Virginia Commonwealth University, Room 4010c, 1100 East Leigh
Street, Richmond VA 23298-0567. E-mail: [email protected].
DOI: 10.4187/respcare.02786
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should be cross-checked twice a year for correlation of results.54 However, oxygen saturation measurements have been shown to vary
significantly, even between identical devices,
in the setting of moderate to severe hypoxemia.78
8.3.1.5 Tonometry is the reference procedure
to establish accuracy for blood PO2 and PCO2.
If issues of true accuracy arise, tonometry
should be available.3,79
8.3.1.6 Electronic quality control monitors
only the equipment performance. The use of
non-electronic controls at periodic intervals
should also be employed to evaluate the testing process.3
8.3.1.7 Record keeping. Summarize all quality control data for a specified lot number.
Maintain and generate reports according to
regulatory and institutional policy.
8.3.2 External quality control or proficiency testing3 considerations
8.3.2.1 Proficiency testing is required by the
Clinical Laboratory Improvement Amendments of 200416 for each regulated analyte.
Specimens of unknown values from an external source are to be analyzed a minimum
of 3 times a year.
8.3.2.2 Proficiency-testing materials should
be obtained from an approved source to meet
regulatory requirements.
8.3.2.3 The proficiency testing survey report
should be carefully reviewed by the medical
director and laboratory supervisor. If the results are suboptimal, the medical director and
supervisor should promptly review their
equipment, procedures, and materials to ascertain the cause of the poor performance.80
8.3.3 With new equipment installation80:
8.3.3.1 the Clinical Laboratory Improvement
Amendments of 2004 require the evaluation
of equipment accuracy and imprecision prior
to analysis of patient samples.16
8.3.3.2 Tonometry is the reference method
for establishing accuracy for PaO2 and PaCO2,79
but unless the entire tonometry process is of
the highest quality, it too can have errors.
8.3.3.3 When an existing instrument is replaced, duplicate analysis must be performed
to compare the new instrument to the existing instrument.
8.3.4 Calibration verification80
8.3.4.1 Calibration verification is performed
prior to initial use and at 6-month intervals.
Calibration verification is completed by an-
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12.2 The laboratorys manager and its medical director should maintain communication and cooperation
with the institutions infection control service and the
personnel health service, to help assure consistency
and thoroughness in conforming with the institutions
policies related to immunizations, post-exposure prophylaxis, and job- and community-related illnesses
and exposures.56
12.3 Primary considerations include:
12.3.1 adequate hand-washing88,89
12.3.2 provision of prescribed ventilation, with
adequate air exchanges90,91
12.3.3 careful handling and thorough cleaning and
processing of equipment58
12.3.4 the exercise of particular care in scheduling and interfacing with the patient in whom a
diagnosis has not been established56,57
BGA 13.0 AGE-SPECIFIC ISSUES
This document applies to samples from neonatal, pediatric, adult, and geriatric populations.
BGA 14.0 RECOMMENDATIONS
The following recommendations are made following the
Grading of Recommendations Assessment, Development,
and Evaluation criteria.69
14.1 BGA and hemoximetry are recommended for
evaluating a patients ventilatory, acid-base, and/or
oxygenation status. (1A)
14.2 BGA and hemoximetry are suggested for evaluating a patients response to therapeutic interventions.
(2B)
14.3 BGA and hemoximetry are recommended for
monitoring severity and progression of documented
cardiopulmonary disease processes. (1A)
14.4 Hemoximetry is recommended to determine the
impact of dyshemoglobins on oxygenation. (1A)
14.5 Capillary BGA is not recommended to determine
oxygenation status. (1A)
14.6 Central venous BGA and hemoximetry are suggested to determine oxygen consumption in the setting of early goal-directed therapies. (2B)
14.7 For the assessment of oxygenation, a peripheral
venous PO2 is not recommended as a substitute for an
arterial blood measurement (PaO2). (1A)
14.8 It is not recommended to use venous PCO2 and
pH as a substitute for arterial blood measurement of
PaCO2 and pH. (2B)
14.9 It is suggested that hemoximetry is used in the
detection and evaluation of shunts during diagnostic
cardiac catheterization. (2B)
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