Laboratory based quantitative scoring system for pre-analytical quality indicators in arterial blood gas analysis

Area of Science:

• Clinical Chemistry
• Laboratory Medicine
• Emergency Medicine

Background:

• Arterial blood gas (ABG) analysis is critical for assessing respiratory and metabolic status in emergency settings.
• Pre-analytical errors significantly compromise the reliability of ABG testing, accounting for up to 70% of laboratory errors.

Purpose of the Study:

• To evaluate pre-analytical quality indicators (QIs) of ABG testing in an emergency laboratory.
• To identify common pre-analytical errors in ABG sample collection and handling.

Main Methods:

• A descriptive study involving manual assessment of 205 ABG requisition forms and samples over one year.
• Evaluation of parameters including patient identification, requisition completeness, syringe type, labeling, sample volume, transport time, and sample integrity.

Main Results:

• Major deficiencies were found in documentation, with high rates of omitted collection time (97.07%) and ventilator/oxygen status (98.04%).
• All samples used inappropriate syringes, and significant issues were noted with tip sealing (89.27%), labeling (95.61%), and transport delays (>30 min) (23.41%).
• Clotting (14.15%), sedimentation (17.07%), and inadequate sample volume (20%) were also prevalent.

Conclusions:

• Significant pre-analytical errors in documentation, collection, and transport severely affect ABG reliability.
• Implementing standardized requisition forms, staff training, and adherence to transport protocols are essential.
• Improving pre-analytical quality is vital for enhancing ABG result accuracy and patient safety.