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VOLUME 17 , ISSUE 6 ( December, 2013 ) > List of Articles

RESEARCH ARTICLE

Use of liquid heparin for blood gas sampling in pediatric intensive care unit: A comparative study of effects of varying volumes of heparin on blood gas parameters

Rajni Sharma, Pallavi Goyal, Viswas Chhapola, Sandeep Kumar

Keywords : Blood gas analysis, liquid heparin, pre-analytic error

Citation Information : Sharma R, Goyal P, Chhapola V, Kumar S. Use of liquid heparin for blood gas sampling in pediatric intensive care unit: A comparative study of effects of varying volumes of heparin on blood gas parameters. Indian J Crit Care Med 2013; 17 (6):350-354.

DOI: 10.4103/0972-5229.123443

License: CC BY-ND 3.0

Published Online: 01-09-2014

Copyright Statement:  Copyright © 2013; The Author(s).


Abstract

Background and Aims: Pre-analytical errors in sample collection affect the reliability of blood gas (BG) analysis. Amount of liquid heparin as anticoagulant in samples for BG can affect results by its dilutional direct binding and compositional effects. The aim of this study was to examine the effect of varying amounts of heparin in blood samples on results. Materials and Methods : The prospective study was conducted on 15 children at a pediatric intensive care unit (PICU). Three different heparinized syringes were used containing minimal, 60 IU and 120 IU of heparin. A total volume of 1 ml blood in each syringe was taken and was analyzed by blood gas analyzer. Statistical analysis used related samples Friedman′s test and Wilcoxon signed ranks test for paired comparisons. The observed bias was also compared with the desirable bias according to specifications by Ricos et al. Results: There was a significant difference (P < 0.05) in values of pH, pCO 2, HCO3, Hb and Na + in the three syringes. The pCO 2, HCO3 and Na + levels decreased with the increasing amount of heparin. The observed percentage bias was more than desirable percentage bias specifications for pCO 2, HCO3, Hb, Na +, K + and Cl levels. Conclusions: Syringes with minimal liquid heparin are most appropriate for studying BG parameters as they have the least effect on these parameters. There is a need to standardize the procedure of syringe preparation for BG analysis. Further studies are needed to compare minimal amounts of heparin with commercially available dry balanced heparin syringes.


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  1. Baird G. Preanalytical considerations in blood gas analysis. Biochem Med (Zagreb) 2013;23:19-27.
  2. Higgins C. Capillary blood gases: To arterialize or not. MLO Med Lab Obs 2008;40:44-7.
  3. Higgins C. The use of heparin in preparing samples for blood-gas analysis. MLO Med Lab Obs 2007;39:16-8, 20.
  4. Burnett RW, Covington AK, Fogh-Andersen N, Külpmann WR, Maas AH, Müller-Plathe O, et al. International Federation of Clinical Chemistry (IFCC). Scientific Division. Committee on pH, Blood Gases and Electrolytes. Approved IFCC recommendations on whole blood sampling, transport and storage for simultaneous determination of pH, blood gases and electrolytes. Eur J Clin Chem Clin Biochem 1995;33:247-53.
  5. Ricós C, Alvarez V, Cava F, García-Lario JV, Hernández A, Jiménez CV, et al. Current databases on biological variation: Pros, cons and progress. Scand J Clin Lab Invest 1999;59:491-500.
  6. Hamilton RD, Crockett RJ, Alpers JH. Arterial blood gas analysis: Potential errors due to the addition of heparin. Anaesth Intensive Care 1978;6:251-5.
  7. Hedberg P, Majava A, Kiviluoma K, Ohtonen P. Potential preanalytical errors in whole-blood analysis: Effect of syringe sample volume on blood gas, electrolyte and lactate values. Scand J Clin Lab Invest 2009;69:585-91.
  8. 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 2006;51:732-6.
  9. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Different manufacturers of syringes: A new source of variability in blood gas, acid-base balance and related laboratory test? Clin Biochem 2012;45:683-7.
  10. 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.
  11. Hutchison AS, Ralston SH, Dryburgh FJ, Small M, Fogelman I. Too much heparin: Possible source of error in blood gas analysis. Br Med J (Clin Res Ed) 1983;287:1131-2.
  12. Simmons DH. The effect of heparin dilution on arterial blood gas analysis. West J Med 1984;141:525-6.
  13. Morimatsu H, Rocktäschel J, Bellomo R, Uchino S, Goldsmith D, Gutteridge G. Comparison of point-of-care versus central laboratory measurement of electrolyte concentrations on calculations of the anion gap and the strong ion difference. Anesthesiology 2003;98:1077-84.
  14. Chhapola V, Kanwal SK, Sharma R, Kumar V. A Comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care unit. Indian J Pediat2013 Feb [cited 2013 Jun 17]. Available from: link.springer.com/content/pdf/10.1007%2Fs12098-013-0977-z.
  15. Yip PM, Chan MK, Zielinski N, Adeli K. Heparin interference in whole blood sodium measurements in a pediatric setting. Clin Biochem 2006;39:391-5.
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