Comparison of arterial and venous blood gases and the effects of analysis delay and air contamination on arterial samples in patients with chronic obstructive pulmonary disease and healthy controls.
BACKGROUND
Arterial blood gases (ABGs) are often sampled incorrectly, leading to a 'mixed' or venous sample. Delays in analysis and air contamination are common.


OBJECTIVE
We measured the effects of these errors in patients with chronic obstructive pulmonary disease (COPD) exacerbations and controls.


METHODS
Arterial and venous samples were analyzed from 30 patients with COPD exacerbation and 30 controls. Venous samples were analysed immediately and arterial samples separated into non-air-contaminated and air-contaminated specimens and analysed at 0, 30, 60, 90 and 180 min.


RESULTS
Mean venous pH was 7.371 and arterial pH was 7.407 (p < 0.0001). There was a correlation between venous and arterial pH (r = 0.5347, p < 0.0001). The regression equation to predict arterial pH was: arterial pH = 4.2289 + 0.43113 · venous pH. There were no clinically significant differences in arterial PO₂ associated with analysis delay. A statistically significant decline in pH was detected at 30 min in patients with COPD exacerbation (p = 0.0042) and 90 min in controls (p < 0.0001). A clinically significant decline in pH emerged at 73 min in patients with COPD exacerbation and 87 min in controls. Air contamination was associated with a clinically significant increase in PO₂ in all samples, including those that were immediately analyzed.


CONCLUSIONS
Arterial and venous pH differ significantly. Venous pH cannot accurately replace arterial pH. Temporal delays in ABG analysis result in a significant decline in measured pH. ABGs should be analysed within 30 min. Air contamination leads to an immediate increase in measured PO₂, indicating that air-contaminated ABGs should be discarded.
Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland. terryoconnor@eircom.net
T M
TM
O'Connor
P J
PJ
Barry
A
A
Jahangir
C
C
Finn
B M
BM
Buckley
A
A
El-Gammal
D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution; D001158:Arteries / Q000378:metabolism; D001784:Blood Gas Analysis / Q000592:standards; D019091:Critical Pathways / Q000592:standards; D003951:Diagnostic Errors / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007494:Ireland; D007755:Laboratories, Hospital / Q000592:standards; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis; D012015:Reference Standards; D014680:Veins / Q000378:metabolism