Home National surveys on internal quality control for blood gas analysis and related electrolytes in clinical laboratories of China
Article
Licensed
Unlicensed Requires Authentication

National surveys on internal quality control for blood gas analysis and related electrolytes in clinical laboratories of China

  • Min Duan , Wei Wang , Haijian Zhao , Chuanbao Zhang , Falin He , Kun Zhong , Shuai Yuan and Zhiguo Wang EMAIL logo
Published/Copyright: May 1, 2018
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 11

Abstract

Background:

Internal quality control (IQC) is essential for precision evaluation and continuous quality improvement. This study aims to investigate the IQC status of blood gas analysis (BGA) in clinical laboratories of China from 2014 to 2017.

Methods:

IQC information on BGA (including pH, pCO2, pO2, Na+, K+, Ca2+, Cl−) was submitted by external quality assessment (EQA) participant laboratories and collected through Clinet-EQA reporting system in March from 2014 to 2017. First, current CVs were compared among different years and measurement systems. Then, percentages of laboratories meeting five allowable imprecision specifications for each analyte were calculated, respectively. Finally, laboratories were divided into different groups based on control rules and frequency to compare their variation trend.

Results:

The current CVs of BGA were significantly decreasing from 2014 to 2017. pH and pCO2 got the highest pass rates when compared with the minimum imprecision specification, whereas pO2, Na+, K+, Ca2+, Cl− got the highest pass rates when 1/3 TEa imprecision specification applied. The pass rates of pH, pO2, Na+, K+, Ca2+, Cl− were significantly increasing during the 4 years. The comparisons of current CVs among different measurement systems showed that the precision performance of different analytes among different measurement systems had no regular distribution from 2014 to 2017. The analysis of IQC practice indicated great progress and improvement among different years.

Conclusions:

The imprecision performance of BGA has improved from 2014 to 2017, but the status of imprecision performance in China remains unsatisfying. Therefore, further investigation and continuous improvement measures should be taken.

Keywords: blood gas analysis; coefficient of variation; imprecision; performance specification; quality control

Acknowledgments

We appreciate those participant laboratories and institutions that took part in the EQA schemes and submitted their IQC data of blood gas analysis for this survey. We are also grateful for the staff of Clinet Website (www.clinet.com.cn) who provided the technical support for establishing the network platform and relevant services for this survey.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Seifter JL, Chang HY. Disorders of acid-base balance: new perspectives. Kidney Diseases 2017;2:170–86.10.1159/000453028Search in Google Scholar PubMed PubMed Central

2. Singh V, Khatana S, Gupta P. Blood gas analysis for bedside diagnosis. Natl J Maxillofac Surg 2013;4:136–41.10.4103/0975-5950.127641Search in Google Scholar PubMed PubMed Central

3. Dukić L, Simundić AM. Institutional practices and policies in acid-base testing: a self-reported Croatian survey study on behalf of the Croatian society of clinical biochemistry and laboratory medicine working group for acid-base balance. Biochem Med 2014;24:281–92.10.11613/BM.2014.031Search in Google Scholar PubMed PubMed Central

4. CLSI. Blood gas and pH analysis and related measurements; approved guideline – second edition. CLSI Document C46-A2. Wayne, PA, USA: Clinical and Laboratory Standards Institute, 2009.Search in Google Scholar

5. CLSI. Procedures for the collection of arterial blood specimens; approved standard – fourth edition. CLSI document GP43-A4 (former H11-A4). Wayne, PA, USA: Clinical and Laboratory Standards Institute, 2004.Search in Google Scholar

6. Cembrowski GS, Xu Q, Cembrowski AR, Mei J, Sadrzadeh H. Impaired clinical utility of sequential patient GEM blood gas measurements associated with calibration schedule. Clin Biochem 2017;50:936–41.10.1016/j.clinbiochem.2017.03.014Search in Google Scholar PubMed

7. Metzger LF, Stauffer WB, Krupinski AV, Millman RP, Cembrowski GS, Pack AI. Detecting errors in blood-gas measurement by analysis with two instruments. Clin Chem 1987;33:512–7.10.1093/clinchem/33.4.512Search in Google Scholar

8. Westgard J, Groth T, Moran R. Performance validation of blood gas instruments using three levels of controls for pH, PCO2 and PO2 – procedure and assessment by interactive computer simulation. Meeting of the IFCC Expert Panel on Ph and Blood Gases 1980.Search in Google Scholar

9. ISO. Clinical laboratories requirements for quality and competence. ISO 15189:2012. Geneva: International Organization for Standardization, 2012.Search in Google Scholar

10. Sandberg S, Fraser CG, Horvath AR, Jansen R, Jones G, Oosterhuis W, et al. Defining analytical performance specifications: consensus statement from the 1st Strategic Conference of the European Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med 2015;53: 833–5.10.1515/cclm-2015-0067Search in Google Scholar PubMed

11. Fraser CG, Hyltof Petersen P, Libeer JC, Ricos C. Proposals for setting generally applicable quality goals solely based on biology. Ann Clin Biochem 1997;34:8–12.10.1177/000456329703400103Search in Google Scholar PubMed

12. Ricos C, Alvarez V, Cavas F. Desirable specifications for total error, imprecision, and bias, derived from intra-and inter-individual biological variation. http://www.westgard.com/biodatabase1.htm. Accessed: 29 April 2014.Search in Google Scholar

13. Cao J, Edwards R, Chairez J, Devaraj S. Validation of capillary blood analysis and capillary testing mode on the epoc Point of Care system. Pract Lab Med 2017;19:24–7.10.1016/j.plabm.2017.07.003Search in Google Scholar PubMed PubMed Central

14. Sacks DB, Bruns DE, Goldstein DE, Bruns DE, Horvath AR, Kirkman MS, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011;57:436–72.10.1373/clinchem.2011.163634Search in Google Scholar PubMed

15. Giovannini S, Zucchelli GC, Iervasi G, Iervasi A, Chiesa MR, Mercuri A, et al. Multicentre comparison of free thyroid hormones immunoassays: the Immunocheck study. Clin Chem Lab Med 2011;49:1669–76.10.1515/CCLM.2011.647Search in Google Scholar PubMed

Supplementary Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2018-0155).

Received: 2018-02-10
Accepted: 2018-03-27
Published Online: 2018-05-01
Published in Print: 2018-10-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. New biomarkers and traditional cardiovascular risk scores: any crystal ball for current effective advice and future exact prediction?
  4. Reviews
  5. Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes
  6. Updated review of postmortem biochemical exploration of hypothermia with a presentation of standard strategy of sampling and analyses
  7. Long non-coding RNA-mediated regulation of signaling pathways in gastric cancer
  8. Opinion Paper
  9. Long story short: an introduction to the short-term and longterm Six Sigma quality and its importance in laboratory medicine for the management of extra-analytical processes
  10. EFLM Paper
  11. The European Federation of Clinical Chemistry and Laboratory Medicine syllabus for postgraduate education and training for Specialists in Laboratory Medicine: version 5 – 2018
  12. General Clinical Chemistry and Laboratory Medicine
  13. Early availability of laboratory results increases same day ward discharge rates
  14. Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices
  15. Improved prospective risk analysis for clinical laboratories compensated for the throughput in processes
  16. National surveys on internal quality control for blood gas analysis and related electrolytes in clinical laboratories of China
  17. Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients
  18. A quantitative LC-MS/MS method for insulin-like growth factor 1 in human plasma
  19. Development and validation of a mass spectrometry-based assay for quantification of insulin-like factor 3 in human serum
  20. Anti-ganglioside antibodies: experience from the Italian Association of Neuroimmunology external quality assessment scheme
  21. Reference Values and Biological Variations
  22. Improving IBD diagnosis and monitoring by understanding preanalytical, analytical and biological fecal calprotectin variability
  23. Establishing normal values of total testosterone in adult healthy men by the use of four immunometric methods and liquid chromatography-mass spectrometry
  24. Cancer Diagnostics
  25. Exploring the potential of mucin 13 (MUC13) as a biomarker for carcinomas and other diseases
  26. Cardiovascular Diseases
  27. Prognostic implications of detectable cardiac troponin I below the 99th percentile in patients admitted to an emergency department without acute coronary syndrome
  28. Osteocalcin value to identify subclinical atherosclerosis over atherosclerotic cardiovascular disease (ASCVD) risk score in middle-aged and elderly Chinese asymptomatic men
  29. Infectious Diseases
  30. Comparison of four methods of establishing control limits for monitoring quality controls in infectious disease serology testing
  31. Letter to the Editor
  32. Letter to the Editor relative to Clin Chem Lab Med 2018;56(3):360–372
  33. Update in diagnosis and management of primary aldosteronism: reply to a Letter to the Editor
  34. Can calculated total nitrogen replace Kjeldahl total nitrogen measurements in 24-h urine samples?
  35. Analytical performance of the single well titer function of NOVA View®: good enough to omit ANA IIF titer analysis?
  36. Assessment of Architect cSystems Abbott® for the colorimetric measurement of lithium in urines and dyalisates
  37. β-Trace protein in hemodialysis – comparison of different therapy modalities and high flux dialyzers
  38. Orbitrap™ high-resolution mass spectrometry for the identification of amoxicillin crystalluria
  39. High fluorescence cell count in ascitic body fluids for carcinomatosis screening
  40. The International Society for Enzymology: a glorious history, a golden legacy
  41. Congress Abstracts
  42. 10th National Congress of the Portuguese Society of Clinical Chemistry, Genetics and Laboratory Medicine
  43. 5th EFLM-UEMS European Joint Congress in Laboratory Medicine
https://doi.org/10.1515/cclm-2018-0155
Keywords for this article
blood gas analysis; coefficient of variation; imprecision; performance specification; quality control

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. New biomarkers and traditional cardiovascular risk scores: any crystal ball for current effective advice and future exact prediction?
  4. Reviews
  5. Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes
  6. Updated review of postmortem biochemical exploration of hypothermia with a presentation of standard strategy of sampling and analyses
  7. Long non-coding RNA-mediated regulation of signaling pathways in gastric cancer
  8. Opinion Paper
  9. Long story short: an introduction to the short-term and longterm Six Sigma quality and its importance in laboratory medicine for the management of extra-analytical processes
  10. EFLM Paper
  11. The European Federation of Clinical Chemistry and Laboratory Medicine syllabus for postgraduate education and training for Specialists in Laboratory Medicine: version 5 – 2018
  12. General Clinical Chemistry and Laboratory Medicine
  13. Early availability of laboratory results increases same day ward discharge rates
  14. Evaluation of the clinical implementation of a large-scale online e-learning program on venous blood specimen collection guideline practices
  15. Improved prospective risk analysis for clinical laboratories compensated for the throughput in processes
  16. National surveys on internal quality control for blood gas analysis and related electrolytes in clinical laboratories of China
  17. Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients
  18. A quantitative LC-MS/MS method for insulin-like growth factor 1 in human plasma
  19. Development and validation of a mass spectrometry-based assay for quantification of insulin-like factor 3 in human serum
  20. Anti-ganglioside antibodies: experience from the Italian Association of Neuroimmunology external quality assessment scheme
  21. Reference Values and Biological Variations
  22. Improving IBD diagnosis and monitoring by understanding preanalytical, analytical and biological fecal calprotectin variability
  23. Establishing normal values of total testosterone in adult healthy men by the use of four immunometric methods and liquid chromatography-mass spectrometry
  24. Cancer Diagnostics
  25. Exploring the potential of mucin 13 (MUC13) as a biomarker for carcinomas and other diseases
  26. Cardiovascular Diseases
  27. Prognostic implications of detectable cardiac troponin I below the 99th percentile in patients admitted to an emergency department without acute coronary syndrome
  28. Osteocalcin value to identify subclinical atherosclerosis over atherosclerotic cardiovascular disease (ASCVD) risk score in middle-aged and elderly Chinese asymptomatic men
  29. Infectious Diseases
  30. Comparison of four methods of establishing control limits for monitoring quality controls in infectious disease serology testing
  31. Letter to the Editor
  32. Letter to the Editor relative to Clin Chem Lab Med 2018;56(3):360–372
  33. Update in diagnosis and management of primary aldosteronism: reply to a Letter to the Editor
  34. Can calculated total nitrogen replace Kjeldahl total nitrogen measurements in 24-h urine samples?
  35. Analytical performance of the single well titer function of NOVA View®: good enough to omit ANA IIF titer analysis?
  36. Assessment of Architect cSystems Abbott® for the colorimetric measurement of lithium in urines and dyalisates
  37. β-Trace protein in hemodialysis – comparison of different therapy modalities and high flux dialyzers
  38. Orbitrap™ high-resolution mass spectrometry for the identification of amoxicillin crystalluria
  39. High fluorescence cell count in ascitic body fluids for carcinomatosis screening
  40. The International Society for Enzymology: a glorious history, a golden legacy
  41. Congress Abstracts
  42. 10th National Congress of the Portuguese Society of Clinical Chemistry, Genetics and Laboratory Medicine
  43. 5th EFLM-UEMS European Joint Congress in Laboratory Medicine
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 8.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2018-0155/html
Scroll to top button