Demonstration of compatibility of multiple arterial blood gas syringes with current multi-parameter analyzers

Abstract

Objective:

Since there is a lack of current evidence to support the compatibility of the most commonly used arterial blood gas syringes with the latest multi-parameter analyzers, the objective of this study was to assess the agreement of analyte values between three heparinized arterial blood gas syringes using three different analyzers.

Methods:

Venous blood from 25 healthy volunteers was drawn into the study syringes (BD Drihep A-Line, PICO50, and Portex Line Draw Plus) by four clinician volunteers in a random order (441 total) and immediately (<15 minutes) analyzed (ABL800 FLEX, RAPIDPoint 500, i-STAT System) in a randomized order. The Bland–Altman method was used to assess agreement of analyte values between the syringes for each analyzer. The results by analyte and analyzer were compared across syringes using one-way ANOVA, and Tukey’s approach was used to identify statistically significant differences between pairs of syringes.

Results:

Comparison of the syringes’ mean differences and standard deviations showed close agreement for all three analyzers. There were no statistically significant differences between syringes in 14 of the analytes for any of the analyzers (p > 0.05). For RAPIDPoint and i-STAT, the Ca²⁺ value was significantly less for A-Line than for the other syringes. The value for Na⁺ was significantly greater for the PICO50 than the A-Line and Line Draw syringes with the i-STAT. Both results were within two standard deviations of the mean of the other two syringes and are not considered clinically significant; however, comparisons were not made between the values from the different analyzers.

Conclusions:

Dry-balanced lithium heparin ABG syringes used for blood draws should provide reliable results, regardless of syringe type, provided that the clinicians use proper pre-analytical techniques.

Keywords::

• Analyte
• Analyzer
• Blood gas
• Compatibility
• Syringe

Transparency

Declaration of funding

Smiths Medical ASD Inc. provided funding for this study.

Declaration of financial/other relationships

L.E.S. and L.M.C. have disclosed that they are employees of Smiths Medical. Bionostics Inc. was paid by Smiths Medical to conduct the blood analyses, and the RCRI Inc. biostatisticians are also paid consultants.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are grateful to all study participants, clinicians, volunteer subjects, testing facility staff, and Smiths Medical personnel, including Olena Davis, Christine DiMartinis, Jordan Greenberg, Karen Tomlin, and Thomas Wortham, that made the study possible. The authors would like to specifically acknowledge Randy Byrd at Bionostics Inc. for his contributions to the study and Peggy Pereda, Wei Cao, and Kristina Vick at RCRI Inc. for their statistical planning, analysis, and expertise.

Notes

*Drihep and A-Line trademarks are the property of Becton Dickinson Company, Franklin Lakes, NJ, USA

^†Portex is a registered trade name of Smiths Medical ASD Inc., St. Paul, MN, USA

^‡RapidPoint is a registered trade name of Siemens Corporation, Tarrytown, NY, USA

^§i-STAT is a registered trade name of Abbott Point of Care, Princeton, NJ, USA