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Electrolyte-balanced heparin in blood gas syringes can introduce a significant bias in the measurement of positively charged electrolytes
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Miranda van Berkel
Published/Copyright:
December 14, 2010
Abstract
Background: Heparin binds positively charged electrolytes. In blood gas syringes, electrolyte-balanced heparin is used to prevent a negative bias in electrolyte concentrations. The potential pre-analytical errors introduced by blood gas syringes are largely unknown. Here, we evaluate electrolyte concentrations in non-anticoagulated blood compared with concentrations measured in electrolyte-balanced blood gas syringes.
Methods: Venous blood was collected into plain tubes. Ioni-zed calcium, potassium, sodium and hydrogen ions were analyzed directly using a blood gas analyzer and the remaining blood was collected into different blood gas syringes in random order: Preset (Becton Dickinson), Monovette (Sar-stedt) and Pico 50-2 (Radiometer).
Results: Ionized calcium and sodium concentrations were significantly lower in blood collected in Becton Dickinson and Sarstedt syringes compared to non-heparinized (NH) blood. The mean bias exceeded biological variation-based total allowable error, which in most cases leads to clinically misleading individual results. In contrast, ionized calcium concentrations in blood collected in Pico 50-2 syringes were identical to values obtained from NH blood. Sodium showed a minor, yet statistically significant, bias.
Conclusions: Despite the fact that blood gas syringes now contain electrolyte-balanced heparin, one should be aware of the fact that these syringes can introduce pre-analytical bias in electrolyte concentrations. The extent of the bias differs between syringes.
Keywords: blood gas syringes; electrolyte-balanced heparin; ionized calcium; potassium; pre-analytical errors; sodium
Received: 2010-2-11
Accepted: 2010-9-10
Published Online: 2010-12-14
Published in Print: 2011-02-01
©2011 by Walter de Gruyter Berlin New York
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Keywords for this article
blood gas syringes;
electrolyte-balanced heparin;
ionized calcium;
potassium;
pre-analytical errors;
sodium
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