Unpredictable fluctuations in transcutaneous pCO2 from capillary blood gas determinations

Transcutaneous pCO2 electrode response time was optimized by use of a new electrode filling solution composed of NaCl/NaHCO3 electrolyte buffer (100 and 20 mmol/L, respectively) in an equivolume mixture of glycerol and water. The 95% response time to a step change in pCO2 was 49.9 +/- 2.8 s (mean +/- SD) when there was no spacer between the membrane and glass of the electrode. Use of this filling solution during monitoring of severely ill premature infants with cardiopulmonary disease allowed identification of large, unpredictable transient changes in transcutaneous pCO2, and therefore presumably in arterial pCO2, that occurred during capillary blood gas sampling. The changes, which occurred in 19 of 20 samplings, ranged from -1.06 + 2.53 kPa (-8 to +19 Torr). The maximum relative change observed was +29%. These results indicate that the standard protocol for capillary blood collection induces significant transient fluctuations in blood gas tensions. We believe these fluctuations decrease the reliability of capillary pCO2 values for use in clinical management in patient populations similar to ours.