RP500 Blood Gas Procedure

University of Virginia Health System
RAPIDPoint 500 POC C16.02
A. Principle of the Assay
The RAPIDPoint® 500Analyzer measures blood gases (pC02, pO2, and pH), electrolytes
[sodium (Na+), potassium (K+), ionized calcium (Ca++), and chloride (Cl-)], metabolites
(glucose and lactate), and oxygenation capability (hematocrit) in whole blood samples.
Measurement Cartridges contain the sensors, reagents and calibrators required to do the
tests. The wash solution and the fluid waste are contained in a Wash/Waste Cartridge.
The table below provides a brief summary:
Sensor Measurement Technology
pH, Na+, K+, Ca++, Cl- potentiometric method using standard ionselective electrode
(ISE) technology
reference silver/silver electrode in potassium chloride and silver chloride
pCO2 modified potentiometric method based on the principles of the
Severinghaus electrode
pO2 amperometric measurement based on the principles of the Clark
electrode
glucose amperometric method using an enzyme electrode that contains
glucose oxidase
lactate amperometric method using an enzyme electrode that contains
lactate oxidase
Hgb Spectral analysis
Co-oximetry Spectral analysis
These tests and this system are intended for use in situations where fast turnaround of test
results is helpful in optimizing care for patients whose status is rapidly changing. Such
patients may be in operating or recovery rooms, critical and intensive care units, or
emergency departments.
B. Acceptable Specimen Types and Processing
NOTE: All specimens are to be handled by the operator according to Standard

Precautions as written in the UVa Bloodborne Pathogens Exposure Control Plan.
The RAPIDPoint® 500 Analyzer uses whole blood as a sample - collected from arterial,
venous or capillary sources. The analyzer requires only 100 microliters of specimen for
analysis, however in order to maintain sample integrity, the minimum amount collected in
the sample collection device is determined by the volume required by that device.
Sample Collection Minimum Fill Preparation

Device Volume
Arterial Blood Syringe 200 L for 1 mL Expel air from the syringe
syringe and cap it immediately after
800 µL for 3 mL obtaining the sample. Do not
syringe use cork to cap the syringe.
1.5 mL for 5 mL Mix to distribute the
syringe anticoagulant.
Approved By: Doris Haverstick PhD Version: 1.0.4

Editor: Denise Eavers Uncontrolled When Printed
Version Date: 8/3/2017 Page 1 of 16
Venous or Mixed Syringe 200 L for 1 mL Expel air from the syringe
Venous blood syringe and cap it immediately after
800 µL for 3 mL obtaining the sample. Do not
syringe use cork to cap the syringe.
1.5 mL for 5 mL Mix to distribute the
syringe anticoagulant.
Capillary Blood Capillary Tube 100 L Fill the tube completely and
cap it securely. Do not use
clay or cork to cap the tube.
Do not use capillary tubes
containing mixing fleas. Mix
to distribute the
anticoagulant.
NOTE: Specimen must be labeled with two patient identifiers in the presence of the
patient. A bar code label with this information as well as the CSN number should be
used as the CSN number is required by the analyzer.
NOTES on specimen requirements
 Only calcium-titrated (balanced) heparin or lithium heparin should be used as
anticoagulants. Other anticoagulants may significantly alter the results.
 Air bubbles in a specimen should be considered a contaminant, as the blood gas values
may be affected. Also, air bubbles introduced into an analyzer may cause the sensor to
register incorrect results. For these reasons, any sample with froth in it should be
considered an unacceptable sample, and, where possible, another sample must be
drawn.
 Since the patients using these tests are often in emergency situations, no special patient
preparation is necessary. However, for radial artery sampling, the clinician drawing the
sample must assess collateral circulation if the patient is deemed to be at risk for injury.
If a formal test is performed, such as an Allen’s test, this should be documented in the
medical record.
C. EQUIPMENT AND MATERIALS:

a. All reagents and materials required to do testing on the RAPIDPoint®
500Analyzer are contained in the Measurement and Wash/Waste cartridges
b. Materials Required But Not Provided

Materials for collecting and storing samples, including:
• syringes
• anticoagulant
• needles
• materials for sterilizing the collection site
• lancets
• capillary tubes
• stoppers for syringes and capillary tubes
c. Storage requirements:
Cartridges are shipped with appropriate labels describing the package
contents, lot numbers, and expiration dates. Cartridges may be stored
packaged as received.
d. Measurement cartridges (M)

• Each M cartridge is stable for 28 days after installation on the system
when installed by the Install Date.
• M Cartridges shipped refrigerated and are recommended be stored
refrigerated at 2 - 8 °C.
• M Cartridges can be stored at room temperature, not to exceed 25°C, for
up to 30 days.
• M Cartridges can be installed on the system directly from the refrigerator
or from room temperature as long as the room temperature has not
exceeded 25oC.
e. Wash/Waste Cartridges
• Each Wash/Waste Cartridge is stable for 10 days after installation on the
system.
• Store at a room temperature (18 to 25 °C).
f. Automatic Quality Control Cartridges (AQC)

• Each AQC cartridge is stable for 28 days after the installation on the
system when installed by the Install Date indicated on the package.
• AQC Cartridges are shipped at room temperature and must be
refrigerated upon arrival and stored at 2 to 8 oC.
• AQC Cartridges can be installed on the system directly from the
refrigerator.
D. Procedure
a. CALIBRATION
No operator action is necessary for calibration. Calibration materials are in the

measurement cartridge and calibration is performed automatically by the
RAPIDPoint® 500 Analyzer:
• Every 30 minutes - a one-point calibration with adjustment of either the slope

or offset for a parameter (except Hct).
• Every 2 hours - a two point calibration with adjustment of both the slope and
the offset for a parameter (except Hct).
• Every 8 hours - a FULL two-point calibration with adjustment of the slope and
offset for each parameter, including Hct.
• Whenever a new measurement cartridge is installed.

• On demand calibration – from the Analysis screen, select the System

button, then select Calibrate.
The system will interrupt and defer calibration, up to the established maximum
allowable time, to allow a specimen to be analyzed. Calibration reports or system
status reports can be readily obtained by the operator or sent to a host computer.
b. QUALITY CONTROL
The RAPIDPoint® 500 Analyzer can be setup for “Required QC” or "AutomaticQC"
samples at a frequency specified in system setup. In either "Required QC" or
"AutomaticQC", results are automatically compared to expected levels as specified
in system setup. Use only Siemens RapidQC Complete or Siemens RapidQC Hct
for analysis.
• Three levels of automatic QC are performed every 8 hours of patient testing.

• When prompted by the system, analyze the indicated RapidQC Complete
quality control sample.
• If the system indicates that any result doesn’t meet the criteria entered at
setup, you may choose to:
o repeat the QC sample, or
o proceed with other tasks
• The system will disable result reporting for any parameter:
o that fails two consecutive “Required QC” analyses, or
o does not have the “Required QC” performed when scheduled.
• Absolute limits for the controls are those which have been provided on the
control Expected Value Chart.
• All values, not just the mean, must lie within the parameters established limits
on the Expected Value Chart.
c. SPECIMEN HANDLING
• It is important that the sample not be exposed to air during or after its
collection. Therefore, any bubbles should be expelled from the collection
device immediately after sample collection, and the collection device should
have an air-tight seal from the time of collection until it is analyzed.
• Syringe Management after peripheral, indwelling, or catheter collection

 Collect blood gas sample.
 Remove needle if necessary. Place vented cap (Filter Pro device) on
syringe and turn cap clock-wise.
 Hold syringe upright, tap air to top.
 Slightly depress the syringe plunger to evacuate air from the syringe,
stop when cap filter absorbs blood.
 NOTE: DO NOT put finger on top of vented cap as this may prevent
air removal from syringe.

• The sample should be analyzed within 10 minutes of collection. If it cannot be

analyzed in this time frame it should be placed in an ice-water slurry. It can be
stored in an ice-water slurry for up to 2 hours.
• Before analyzing the sample, the syringe or the capillary tube should be rolled
between your palms and gently inverted several times to mix the sample
thoroughly and to distribute the anticoagulant. Blood cells settle during storage,
and if the sample is not well mixed before analysis, the results obtained can be
falsely decreased or increased. Mix all samples using a consistent technique.
• If the sample is chilled the mixing time should be increased to ensure that the
sample is thoroughly mixed.
• Dispose of used sample collection devices as Biohazard material.
d. ANALYZING PATIENT SAMPLES (Syringe)
1. When prompted, enter or scan your employee ID.
Note: If you have a priority sample, but a message appears indicating

that the system is busy, touch STAT to interrupt the system. If STAT option is
not available, wait until the message disappears to analyze the patient
sample.
2. Mix the sample. Roll the syringe between your palms and gently invert it
several times to thoroughly mix the sample. Inspect the sample for air
bubbles. Remove air bubbles from syringe using a tapping or flicking motion
only.
Express 2-4 drops of blood on a gauze pad and visually inspect for
signs of clotting.
 If clotting is present, discard the sample and recollect.
 If no clotting is present, proceed with step 3.
3. Touch the button for the patient sample type (arterial, venous) as necessary.
4. Deselect or select the analyte(s) you wish to test.
5. Scan the 10-digit billing ID. Verify the patient ID and the patient name
on the screen matches the patient ID on the label.
6. Insert the sample device in the sample port with a slight clockwise twist.
7. Touch Analyze. The system aspirates the sample.
8. Enter the physician PIC number in Physician prompt.
9. When prompted, remove the sample device from the sample port with a
slight counter-clockwise twist and touch Continue (the green arrow
prompt in lower right corner of screen). Do not discard the sample device.
10. View the results.

The values for the results appear in yellow when analysis is still in progress.
11. Touch Continue (the green arrow prompt) when you finish viewing results.
Discard the sample device in the CMC.
NOTE: FOR ADDITIONAL INFORMATION ON TEST PROCEDURE, SPECIMEN

COLLECTION, QUALITY CONTROL, INTERFERING SUBSTANCES AND OTHER
LIMITATIONS OF THE TEST, AND PERFORMANCE CHARACTERISTICS-SEE
OPERATOR’S MANUAL.
e. ANALYZING PATIENT SAMPLES (Capillary tube)
Use this procedure to analyze patient samples using a capillary tube.
Note: Always fill the capillary tube completely. Be sure to use the
recommended volume for the sampling mode and system model.
1. When prompted, enter or scan your employee ID.
Note: If you have a priority sample, but a message appears indicating

that the system is busy, touch STAT to interrupt the system. If STAT
option is not available, wait until the message disappears to analyze the
patient sample.
2. Roll the capillary tube between your palms and gently invert it
several times to thoroughly mix the sample.
3. Touch the capillary tube icon for the patient sample type.
4. Deselect or select the analyte(s) you wish to test.
5. Scan the 10-digit billing ID. Verify the patient ID and the patient
name on the screen matches the patient ID on the label.
6. Hold the capillary tube at the end closest to the sample port and insert the
capillary tube firmly into the sample port. Touch Analyze.
Caution: To prevent damage to the sample port, introduce only the

smooth end of a capillary tube into the sample port.
7. Enter the physician PIC number in Physician prompt.
8. When prompted, remove the sample device and touch Continue.

9. View the results.
10. Touch Continue when you finish viewing the results.
f. CALCULATIONS AND ADDITIONAL INTERPRETATION STEPS
There are no additional calculations or interpretation steps associated with this

procedure.

E. Reference Interval and Critical Values

a. Reference Intervals – The table below shows the reference intervals
(normal ranges). Where “arterial” is noted, there is no reference interval
for venous blood. All others are for either sample type. See Section K
below.
Analyte Reference Interval

pH (arterial) 7.35 – 7.45
(venous) 7.32 – 7.42
pCO2 (arterial) 35 – 45 mmHg
(venous) 41 – 51 mmHg
pO2 (arterial) 75 – 100 mmHg
(venous) >1y: 35 – 50 mmHg
0-1y: 25 – 40 mmHg
HCO3 (arterial) 21 – 29 mmol/L
(venous) 21 – 31 mmol/L
Na+ 135 – 148 mmol/L
K+ Female: 3.4 – 4.4 mmol/L
Male: 3.5 – 4.5 mmol/L
Ca++ (ionized) 4.4 – 5.5 mg/dL
Cl- 98 – 106 mmol/L
Glu 0-13Y: 60 – 99 mg/dL
>14Y: 74 – 99 mg/dL
LAI 0.7 – 2.1 mmol/L
tHbCH Male Female
>12y 14.0-18.0 12.0-16.0
6y 11.5-15.5 11.5-15.5
1y 10.5-13.5 10.5-13.5
1m 10.0-18.0 10.0-18.0
1d 14.5-22.5 14.5-22.5
HctCH Male Female
>12y 40.0-52.0 35.0-47.0
6y 35.0-45.0 35.0-45.0
1y 33.0-39.0 33.0-39.0
1m 31.0-55.0 31.0-55.0
1d 45.0-67.0 45.0-67.0
FO2Hb None established
FCOHb (arterial) 0.0 – 2.0 %
FMetHb (arterial) 0.4 – 1.5 %

b. Critical Values – The critical values for the analytes measured are shown
below. Where “arterial” is noted, there is no reference interval for venous
blood. All others are for either sample type. See Section K below.
Analyte Critical Value

pH (arterial) <7.2 and >7.6
pCO2 (arterial) <20 mmHg and >70 mmHg
pO2 (arterial) <40 mmHg
HCO3 None
Na+ <120 mmol/L and >160 mmol/L
K+ <2.5 mmol/L and >5.9 mmol/L
Ca++ (ionized) <3.0 mg/dL and >6.5 mg/dL
Cl- None
Glu <28d: <40 mg/dL and >300 mg/dL
>28d: <40 mg/dL and >600 mg/dL
LAI None
tHb < 1d: <6.0 and >24.0 g/dL
1d: <6.0 and >22.0 g/dL
1m: <6.0 and >20.0 g/dL
HCT < 1d: <18.0 and >74.9%
1d: <18.0 and >66.9%
1m: <18.0 and >59.9%
FO2Hb (arterial) None
FCOHb (arterial) None
FMetHb (arterial) None
F. Analytical Measurement Range/Clinical Reportable Range
The Analytical Measurement Range and Clinical Reportable Range for all analytes is
identical. There are no dilution or concentration protocols for this instrument.
The table below shows the Analytical Measurement Range for all analytes
Analyte Analytical Measurement Range

pH 6.500 – 7.800
pCO2 5.0 – 200.0 mmHg
pO2 10.0 – 700.0 mmHg
Na+ 100.0 – 200.0 mmol/L
K+ 0.50 – 15.0 mmol/L
Ca++ 0.8 – 20.0 mg/dL
Cl- 65 – 140 mmol/L
Glu 20 – 750 mg/dL
LAI 0.18 – 31.00 mmol/L
tHb 2.0 – 25.0 g/dL
FO2Hb 0.0 ± 200.0 %
FCOHb 0.0 ± 200.0 %

FMetHb 0.0 ± 200.0 %

FHHb 0.0 ± 200.0 %
G. Interferences/Limitations of the procedure
The major limitation of the use of the RAPIDPoint® 500 Blood Gas Analyzer is the
attempt to analyze a non-standard specimen type.
H. Cleaning and Disinfecting the RAPIDPoint® 500
a. Screen
Clean the touch screen as needed to remove dust, dirt, or splatters from
the screen and disinfect the screen surface. Follow this procedure:
1. Enter your employee ID.
2. Moisten the cloth with sodium hypochlorite solution so that the
cloth is wet, not dripping.
3. Select the System buttons and then select Clean Screen. The
Clean screen appears for 20 seconds. This allows you to wipe the
screen without activating any buttons.
NOTE: To disinfect the screen surface, wait 10 minutes after
applying the sodium hypochlorite solution the access the Clean
screen again and dry.
4. While the Clean screen displays, wipe the screen with the wet
cloth and then thoroughly dry the screen. After 20 seconds the
system returns to the System screen. Select the Continue button
to return to the Analysis screen
b. Exterior Surfaces
Clean the exterior surfaces as needed to remove dust, dirt, or splatters
from the surfaces and disinfect the surfaces.
1. Moisten the cloth with sodium hypochlorite solution so that the
cloth is wet, not dripping.
NOTE: To disinfect the exterior surfaces, wait 10 minutes after
applying the sodium hypochlorite solution before drying.
2. Wipe the exterior surfaces of the system with the wet cloth and
then thoroughly dry the surfaces.
I. Validation of the procedure
a. The performance of the RAPIDPoint® 500 was compared to that of the

RAPIDPoint® 1265 Blood Gas Analyzer in use in the UVA Medical
Laboratories Core Lab.
b. Validation data are available through UVa Medical Laboratories.
J. Reporting of Results

a. Quality Control – All Quality Control results are automatically sent to the
RapidComm computer terminal. There is no entry of QC results into the
LIS.
b. Patient Results – All patient results are automatically sent to the

RapidComm computer terminal and immediately transferred to the LIS
for inclusion into the patient’s electronic medical record.
c. If Critical Values are provided via phone to a physician or care-giver, then

the individual receiving the results should read back patient identification
information and the critical analyte and value. This must be documented
in the patient’s medical record/flow sheet.
K. Clinical Significance
pH: Acidosis (low pH) stems from either respiratory failure (high pCO2) or from metabolic
causes (including ketoacidosis, lactic acidosis, uremia, severe diarrhea, hypoaldosteronism,
renal tubular disease, drug effects, or poisoning from several specific agents). Alkalosis
(high pH) stems from hyperventilation (low pCO2) or from metabolic causes (including
excessive vomiting, gastric drainage, drug effects, hyperadrenocorticism, potassium
depletion, or excessive alkalai intake). Extreme abnormalities of pH reflect a potentially life-
threatening pathophysiologic state that must be corrected promptly.1,2
pCO2: This analyte reflects the overall respiratory status. Thus high pCO2 indicates
respiratory suppression or failure, whereas low pCO2 indicates hyperventilation (which in
turn may stem from hypoxia, anxiety, fever, cerebral disease, cirrhosis, or excessive
mechanical ventilation). Extreme abnormalities of pCO2 reflect a potentially life-threatening
pathophysiologic state that must be corrected promptly.1,2
pO2: This analyte reflects the ability of the lungs to deliver oxygen to the blood. Hypoxia
(low pO2) may occur despite adequate respiration due to parenchymal lung diseases
(pneumonia, asthma, pulmonary edema, and pulmonary fibrosis) due to pulmonary shunting
of blood. Extremely low pO2 is a potentially life-threatening pathophysiologic state that must
be corrected promptly.1,2
Sodium: Abnormal concentrations of Na+ stem from deficit or overload of total body water or
of sodium itself. These abnormal concentrations arise from diverse clinical conditions, such
as congestive heart failure, liver disease (cirrhosis), renal disease, neuropsychiatric
disorders (causing abnormal fluid intake), intravenous fluid therapy, excessive fluid loss
(vomiting, diarrhea, heat stroke), drug therapy (diuretics), diabetes mellitus (causing osmotic
diuresis), and imbalances of hormones (ADH, mineralcorticoid, glucocorticoid) that regulate
sodium and water excretion. An extremely abnormal plasma sodium concentration may itself
directly cause altered mental status, stupor, coma, seizures, brain swelling, brain
dehydration leading to cerebral hemorrhage or, ultimately, death. Thus extreme
abnormalities of sodium reflect a potentially life-threatening pathophysiologic state that must
be corrected promptly.1,3

Potassium: High concentrations of K+ commonly stem from renal insufficiency (or failure),
excessive potassium replacement, drug effects (including some diuretics), hemolytic
disease, or crush injury. Low concentrations stem from gastrointestinal loss, dietary
insufficiency, or drug effects (most diuretics). Other metabolic imbalances (acid-base,
mineralcorticoid, glucocorticoid, insulin effects) also cause abnormal potassium
concentrations. An extremely abnormal plasma potassium concentration may itself directly
cause neuromuscular paralysis, respiratory failure, cardiac arrhythmia, or cardiac arrest.
Thus extreme abnormalities of potassium reflect a potentially life-threatening
pathophysiologic state that must be corrected promptly.1,3
Chloride: This assay is used most commonly to distinguish high-anion-gap acidoses

(ketoacidosis, lactic acidosis, uremia, poisoning from several specific agents) from
hyperchloremic acidoses (loss of alkalai as in severe diarrhea, hypoaldosteronism,
potassium-sparing diuretics, renal tubular acidosis). In the absence of acidosis, changes in
plasma chloride concentration tend to parallel those of sodium. Thus chloride is high in
dehydration and low in overhydrated states.2,4
Ionized calcium: Ca++ abnormalities typically stem from parathyroid disease, vitamin D
imbalance, renal disease, pancreatitis, drug effects, abnormalities of magnesium or
phosphorus, malignancy, or sarcoidosis. An extreme abnormality of Ca++ may cause
neuromuscular symptoms, tetany, altered mental status, seizures, heart failure, or
arrhythmias. Thus extreme abnormalities of ionized calcium reflect a potentially life-
threatening pathophysiologic state that must be corrected promptly.1,5
Glucose: Glucose is elevated in any of the forms of diabetes mellitus, including Type 1,
Type 2, Gestational, or any of the 50 Other Specific Types. More moderate elevations occur
in pre-diabetic conditions known as impaired glucose levels. Diabetics sometimes suffer
acute, life-threatening metabolic crises, such as diabetic ketoacidosis that is typical in Type
1 or hyperglycemic hyperosmolar nonketotic state that is typical in Type 2. Low glucose
levels most commonly stem from insulin overdose, but also from a number of disorders
collectively known as hypoglycemic disorders. Examples of the latter include insulinoma,
IGF2-secreting tumor, factitious hypoglycemia, postprandial syndrome, severe hepatic
disorders, endocrine disorders characterized by deficiencies in gluconeogenic hormones,
and some post-surgical gastric states. Extreme abnormalities of glucose reflect a potentially
life-threatening pathophysiologic state that must be corrected promptly.1,6,7
Lactate: Lactate is the ionic (electrically charged) form of lactic acid. Lactate is produced by
muscle cells, red blood cells, brain, and other tissues during anaerobic energy production,
and is usually present in low levels in the blood.
Hyperlactatemia is the condition that occurs when lactic acid levels increase significantly in
the blood. At an advanced stage, this condition is known as lactic acidosis. Lactic acidosis
can be severe enough to disrupt a person’s acid/base (pH) balance. This can result in
symptoms such as muscular weakness, rapid breathing, nausea, vomiting, sweating, and in
extreme cases, coma.
Total hemoglobin: Hemoglobin is low in anemia. There are numerous specific types of
anemia, but each stems from one of three basic causes: Blood loss, destruction of red blood
cells, or failure to produce new red blood cells. Hemoglobin is high in polycythemia, which
may be primary, secondary to hypoxia, secondary to dehydration, or a complication of over-

transfusion. Polycythemia may lead to circulatory complications as a result of increased
blood viscosity. Extreme abnormalities of hemoglobin reflect a potentially life-threatening
pathophysiologic state that must be corrected promptly.1,8,9
Oxyhemoglobin: This is the fraction of hemoglobin that is actually delivering oxygen to

body tissues.10
Deoxyhemoglobin (Reduced hemoglobin): This is the fraction of hemoglobin that could

deliver more oxygen to body tissues if pulmonary oxygenation were improved.10
Carboxyhemoglobin: This is the fraction of hemoglobin that cannot deliver oxygen to body
tissues and is formed when carbon monoxide is inhaled.10
Methemoglobin: This is a fraction of hemoglobin that cannot deliver oxygen to body tissues
and is elevated in certain metabolic diseases.10
Sulfhemoglobin: This is a fraction of hemoglobin that cannot deliver oxygen to body tissues
and may be elevated in some patients taking sulfur-containing drugs or with certain
infections.10
L. References
1 Emancipator K. Critical values. ASCP practice parameter. Am J Clin Pathol
1997;108:247-253.
2 Levinsky NG. Acidosis and alkalosis. Ch 46 in Isselbacher KJ et al. Harrison’s

Principles of Internal Medicine, 13th Ed. New York: McGraw-Hill, 1994:253-262.
3 Levinsky NG. Fluids and electrolytes. Ch 45 in Isselbacher KJ et al. Harrison’s

Principles of Internal Medicine, 13th Ed. New York: McGraw-Hill, 1994:242-253.
4 Tietz NW. Clinical Guide to Laboratory Tests, 3rd Ed. Philadelphia: Saunders,
1995:124-127.
5 Toffaletti JG. Calcium, magnesium, and phosphate. Ch 47 in Lewandrowski K. Clinical

Chemistry. Laboratory Management & Clinical Correlations. Philadelphia: Lippincott
Williams & Wilkins, 2002:710-724.
6 Emancipator K. Glucose and carbohydrates. Ch 38 in Lewandrowski K. Clinical

Chemistry. Laboratory Management & Clinical Correlations. Philadelphia: Lippincott
Williams & Wilkins, 2002:561-574.
7 Tietz NW. Clinical Guide to Laboratory Tests, 3rd Ed. Philadelphia: Saunders,
1995:268-273.
8 Bunn HF. Anemia. Ch 56 in Isselbacher KJ et al. Harrison’s Principles of Internal

Medicine, 13th Ed. New York: McGraw-Hill, 1994:313-317.

9 Braunwald E. Hypoxia, polycythemia, and cyanosis. Ch 32 in Isselbacher KJ et al.

Harrison’s Principles of Internal Medicine, 13th Ed. New York: McGraw-Hill, 1994:178-
183.
10 Morris MW, Davey FR. Basic examination of blood. Ch 24 in Henry JB. Clinical
Diagnosis and Management by Laboratory Methods, 19th Ed. Philadelphia: Saunders,
1996:549-593.
• RAPIDPoint® 500 Analyzer Operator’s Manual.

• NCCLS, Clinical Laboratory Technical Procedure Manuals – Second Edition,
Document GP2-A2, Vol. 12 No. 10. Approved Guideline, NCCLS, Villanova, PA.,
July 1992.
• Malley, William J., Clinical Blood Gases, Application and Noninvasive Alternatives.
W. B. Saunders Co., Philadelphia, 1990.
• Code of Federal Regulations, Title 42, Chapter IV, Part 493 - Laboratory
Requirements. 10/1/95 Edition.
• Tietz, Norbert W. Textbook of Clinical Chemistry. Philadelphia. W.B. Saunders Co.,
Philadelphia, 1986.

GUIDELINE: ARTERIAL BLOOD GAS SAMPLING
PURPOSE:
To describe the procedure followed to obtain an arterial blood gas sample by
arterial puncture.
SKILL LEVEL:
Register Respiratory Therapist, Certified Respiratory Therapist
CONTRAINDICATIONS:
Per AARC Clinical Practice Guideline – Sampling for Arterial Blood Gas
Analysis, August 1992 http://www.rcjournal.com/cpgs/sabgacpg.html
IMPLEMENTATION/PROCEDURE:
1. UVA Acute Care and Peds (Nursing) Policies and Procedures – Arterial
Puncture for Blood Gas Analysis, Pediatric (Lippincott, Revised March 31,
2010)
http://procedures.lww.com/lnp/view.do?pId=54547&s=p&fromSearch=tr
ue&searchQuery=arterial%20blood%20gas with the following exceptions:
A. This procedure applies to both adult and pediatric patients.
B. Needle gauge can range from 21 to 25 gauge depending on patient.
C. The sample only needs to be placed in a bag if it will be transported
outside the unit where it was collected for analysis.
D. The sample will only be placed on ice if it cannot be analyzed within 30
minutes of sample collection.
E. The puncture site will only be anesthetized if the patient is identified as
being pain intolerant.
F. Adhesive bandages will only be applied to the site following puncture
when needed.
G. Patient information required for sample analysis will include FIO2,
oxygen delivery system or mechanical ventilation settings (if
applicable).

2. UVA Critical Care Policies and Procedures – Guideline 79 Arterial Puncture

(can be found on each Critical Care Unit and at the TCH) – with the
following exceptions:
A. Any antiseptic skin solution can be used to prepare the site – 2%
chlorhexidine-based solution, alcohol, etc.
B. The puncture site will only be anesthetized if the patient is identified as
being pain intolerant.
C. PPE required will include only gloves.
D. The sample will only be placed on ice if it cannot be analyzed within 30
minutes of sample collection.
E. Adhesive bandages will only be applied to the site following puncture
when needed.
F. Sample collection volume can range from 0.3 ml to 1 ml.
3. The performance of an arterial puncture using the radial artery requires

an assessment of collateral circulation by the practitioner. One method
that can be used by the practitioner to assess collateral circulation is the
performance of a Modified Allen Test.
REFERENCES:
American Association for Respiratory Care. Clinical Practice Guidelines. “Sampling for
Arterial Blood Gas Analysis,” Respir Care 1992(8); 37: 891–897.
Lippincott’s Nursing Procedures and Skills. “Arterial Puncture for Blood Gas Analysis,
Pediatric,” revised March 31, 2010.
UVA Health System Adult Critical Care (Nursing) Procedure Manual. Procedure 79, Arterial
Puncture, page 630.
Clinical decision tools are general and cannot take into account all of the
circumstances of a particular patient. Judgment regarding the propriety of
using any specific procedure or guideline with a particular patient remains
with that patient's physician, nurse, or other health care professional, taking
into account the individual circumstances presented by the patient.
Date of Origin: January 12, 2011

Approved: D.M. Haverstick, PhD 1/19/2011
Revised: D.M. Haverstick, PhD 9/18/2011 to reflect renumbering of
procedure only. Reviewed 6/13/2012 (new RAPIDPoint®500 procedure).


RP500 Blood Gas Procedure

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RP500 Blood Gas Procedure

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University of Virginia Health System

RAPIDPoint 500 POC C16.02

A. Principle of the Assay

B. Acceptable Specimen Types and Processing

NOTE: All specimens are to be handled by the operator according to Standard

Sample Collection Minimum Fill Preparation

Approved By: Doris Haverstick PhD Version: 1.0.4

C. EQUIPMENT AND MATERIALS:

b. Materials Required But Not Provided

d. Measurement cartridges (M)

f. Automatic Quality Control Cartridges (AQC)

No operator action is necessary for calibration. Calibration materials are in the

• Every 30 minutes - a one-point calibration with adjustment of either the slope

• Whenever a new measurement cartridge is installed.

Approved By: Doris Haverstick PhD Version: 1.0.4

• On demand calibration – from the Analysis screen, select the System

• Three levels of automatic QC are performed every 8 hours of patient testing.

• Syringe Management after peripheral, indwelling, or catheter collection

Approved By: Doris Haverstick PhD Version: 1.0.4

• The sample should be analyzed within 10 minutes of collection. If it cannot be

• Dispose of used sample collection devices as Biohazard material.

d. ANALYZING PATIENT SAMPLES (Syringe)

1. When prompted, enter or scan your employee ID.

Note: If you have a priority sample, but a message appears indicating

4. Deselect or select the analyte(s) you wish to test.

7. Touch Analyze. The system aspirates the sample.

8. Enter the physician PIC number in Physician prompt.

10. View the results.

NOTE: FOR ADDITIONAL INFORMATION ON TEST PROCEDURE, SPECIMEN

e. ANALYZING PATIENT SAMPLES (Capillary tube)

Use this procedure to analyze patient samples using a capillary tube.

1. When prompted, enter or scan your employee ID.

Note: If you have a priority sample, but a message appears indicating

4. Deselect or select the analyte(s) you wish to test.

Caution: To prevent damage to the sample port, introduce only the

7. Enter the physician PIC number in Physician prompt.

8. When prompted, remove the sample device and touch Continue.

Approved By: Doris Haverstick PhD Version: 1.0.4

9. View the results.

10. Touch Continue when you finish viewing the results.

f. CALCULATIONS AND ADDITIONAL INTERPRETATION STEPS

There are no additional calculations or interpretation steps associated with this

Approved By: Doris Haverstick PhD Version: 1.0.4

E. Reference Interval and Critical Values

Analyte Reference Interval

Approved By: Doris Haverstick PhD Version: 1.0.4

Analyte Critical Value

F. Analytical Measurement Range/Clinical Reportable Range

Analyte Analytical Measurement Range

Approved By: Doris Haverstick PhD Version: 1.0.4

FMetHb 0.0 ± 200.0 %

G. Interferences/Limitations of the procedure

H. Cleaning and Disinfecting the RAPIDPoint® 500

I. Validation of the procedure

a. The performance of the RAPIDPoint® 500 was compared to that of the

Approved By: Doris Haverstick PhD Version: 1.0.4

b. Patient Results – All patient results are automatically sent to the

c. If Critical Values are provided via phone to a physician or care-giver, then

Approved By: Doris Haverstick PhD Version: 1.0.4

Chloride: This assay is used most commonly to distinguish high-anion-gap acidoses

may be primary, secondary to hypoxia, secondary to dehydration, or a complication of over-

Oxyhemoglobin: This is the fraction of hemoglobin that is actually delivering oxygen to

Deoxyhemoglobin (Reduced hemoglobin): This is the fraction of hemoglobin that could