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Rapid Responses: Rapid Responses published:
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Modern arterial blood gas analysers
- Julian Millo (8 October 2001)
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Developing guidelines for Blood gases in the ICU
- Samar Bhutoria (21 March 2007)
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Julian Millo, Specialist Registrar Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU
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Modern arterial blood gas analysers Merlani et al.1 found that a multifaceted quality improvement program based around an agreed local protocol could safely decrease the frequency of arterial blood gas (ABG) measurement. In addition to measuring blood gases, modern machines measure an ever-increasing range of biochemical species, including electrolytes, lactate, chloride and glucose. New blood gas analysers, capable of measuring these parameters and thus allowing calculation of anion gap and strong ion difference, were introduced locally in 1998. We conducted two audits in our twelve-bedded general medical and surgical teaching hospital Intensive Care Unit. The audits were conducted over one-week periods in 1997 and 2001. Whenever nursing staff measured arterial blood gases they completed a data collection form, stating one primary indication for that measurement. In the first one-week period, ABG analysis was performed on 233 occasions (mean 6.6 per patient per day). In the more recent one-week period, ABG analysis was performed on 465 occasions (mean 5.8 per patient per day). The majority of all ABG measurements were performed before or after a change in ventilation. A surprisingly large number of specimens were drawn primarily to measure potassium (19% in 1997 and 11% in 2001). The introduction of a blood gas analyser capable of measuring additional indices including lactate did not lead to an increase in the number of ABG measurements performed. Although the quantity of information available from blood gas analysis has increased, the number of measurements performed does not need to follow suit. Regular audit and education play an important role in preventing an uncontrolled increase in the number of tests performed. Julian Millo Paul Holloway 1. Merlani P, Garnerin P, Diby M, Ferring M, Ricou B. Quality improvement report: Linking guideline to regular feedback to increase appropriate requests for clinical tests: blood gas analysis in intensive care. BMJ 2001;323:620-4. (15 September.) |
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Samar Bhutoria, SHO in Accident and Emergency Good Hope Hospital, Sutton Coldfield, West Midlands, BR75 7RR
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The problem remains that a large number of arterial blood gases are taken on a daily basis on the Intensive Care Unit. Excessive blood gases contribute to anaemia in critically ill patients and leads to the misuse of resources. While working as a Senior House Officer in the Intensive Care Unit at Southmead Hospital in Bristol, UK, I worked on an audit to assess the knowledge of indications for blood gases among the members of the staff. A questionnaire for the medical and nursing staff was devised and data collected. Analysis of data showed some discrepancy as to the indications for arterial blood gases. This can be attributed to the fact that written guidelines for the indications of blood gases do not exist in most intensive care units. The fact remains that in order to reduce the number and increase the appropriateness of requests for blood gases, one needs to provide teaching to staff members and develop written guidelines for the indications for blood gases in the intensive care setting. Competing interests: None declared |
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