UCSF Clinical Laboratories Test Directory

Ordering

Ordering Recommendations

Follow the link for information about Blood Gas Panels that contain this test.

Available Stat

Yes

Performing Lab

Parnassus, Mission Bay and Mt Zion Chemistry

Performed

Test available 24 hours per day 7 days per week

Methodology

Direct ion selective electrodes (ISE), Radiometer ABL 90 FLEX Plus

Additional Information

This panel includes:

Sodium (NAWB), potassium (KSB), chloride (CLWB) and ionized calcium (CAIB)

Iodide, bromide, thiosulfate, salicylate and nitrate cause a positive interference on chloride measured by ABL blood gas analyzers.

Ha, L et al, Annals Clin Biochem, 2015, 52(2): 288-292
Wendroth, S et al, Clin Chim Acta, 2014, 431: 77-79
ABL90 Flex Plus Instructions for Use Manual, Radiometer.

All reported values are corrected to 37C unless otherwise specified. Results beyond the linear range of the instrument will be reported as < or > the extreme of the linear range. Samples containing small bubbles may be run at the laboratory's discretion. If analyzed, a comment will beadded to the result regarding the presence of bubbles in the sample.

Synonyms

sodium
potassium
chloride
ionized calcium
Na
K
Cl
iCa
ARTBGL
VENBGL
CVBGL
MVBGL
CAPBG
MVBGCX
CIRBGA
CIRBGV
Blood gas
ABG

Collection

Sample Type

Heparinized whole blood (Blood gas syringe only)

Collect

Plastic blood gas syringe containing approximately 70 IU dry heparin in a 3 mL syringe or 23 IU in a 1 mL syringe - or a capillary tube coated with 70 IU heparin (Radiometer Clinitube).

Amount to Collect

3 mL blood

Preferred Volume

3 mL blood

Minimum Volume

1 mL blood

Remarks

Arterial puncture:
Due to the risk of arterial damage and subsequent distal ischemia, prior to puncturing an artery the RN assesses the collateral circulation. If the radial artery is to be punctured, then the pulse of the ulnar artery is assessed. If the dorsalis pedis artery is to be accessed then the posterial tibial pulse is assessed and likewise if the posterial tibial approach is used the dorsalis pedispulse is assessed. The modified Allens's test may be used to assess collateral circulation of the ulnar artery before a radial artery puncture, but it does not always ensure adequate flow. A Doppler ultrasound flow indicator may be used to verify collateral circulation. If the collateral circulation is poor and the RN cannot palpate a pulse then the physician should be notified before proceeding. If for any reason the circulation is compromised to the extremity being assessed for arterial puncture then the physician should be notified prior to proceeding.

1. Palpate the radial artery and identify the site where the pulse is the strongest. Avoid areas with overlying veins to prevent venous admixture.
2. Prepare the patient's skin with an alcohol or 2% chlorhexidine wipe/swab.
3. Place two or three fingers along the course of the artery both to locate its position and direction, and to stabilize it.
4. Penetrate the skin smoothly holding the needle at 30-60 degree angle with the needle bevel up and pointed proximally. The angle of the "butterfly" IV catheter should not exceed 45° for pediatric patients.
5. Re-establish the position and direction of the artery by palpation.
6. Gently and slowly advance the needle or "butterfly", aiming directly for the area of maximum pulsation.
7. When the arterial lumen has been entered, less resistance is felt and blood appears in the syringe above the needle hub.
8 Obtain required amount of arterial blood for test(s).
9. If blood is not obtained on first attempt, withdraw the needle to just below the skin surface and advance needle at same angle but at 1 mm to either side of previous attempt.
10. Place the 2x2 gauze over the site of the puncture then withdraw the needle from the artery. Press firmly at the site for at least five minutes, or until the bleeding stops. Apply bandage or pressure dressing.
11. Expel any air bubble in the syringe with air filter cap placed on specimen syringe.
12. Label sample with patient's name, ID number and DOB.

Venous samples:
1. Avoid excessive venous stasis from prolonged tourniquet application or clenching of the fist prior to sample collection.
2. For central line draws make sure to waste a full red top tube then draw via the blood gas syringe as noted above.
3. Fill syringe completely, remove needle (in peripheral draws), cap sample, expel all bubbles (while holding syringe upright) until blood hits the top of cap.
4. Label sample with patient's name, ID number and DOB.

Capillary Samples:
1. The following are recommended sampling sites: earlobe, fingertip, big toe, heel. The heel and big toe are more suitable for use on neonates and infants.
2. Warm the area or puncture site for 5 to 10 minutes prior to actual sampling. This accelerates flow for blood to be representative of general status of patient.
3. Make a puncture using a lancet or similar device. Do not squeeze the area to avoid tissue juice from mixing into blood sample.
4. Wipe off the first drop of blood. Take the sample from the center of the second drop of blood and hold the capillary at a slightly downward angle for an uninterrupted blood flow. Avoid getting air bubbles in the specimen.
5. Refrain from squeezing or milking the puncture site as this may result in faulty measurements or cause hemolysis of blood sample and cause elevated K+ readings.
6. Apply accompanying caps to both ends of the capillary tube and mix the sample with the heparin immediately after collection to prevent blood from clotting. The manufacturer recommends the use of a mixing wire and magnet for capillary samples.
7. Label sample with patient's name, ID and DOB.

Stability (from collection to initiation)

10 min.

Processing

Test Code

NLYTE

Performing Lab

Parnassus, Mission Bay and Mt Zion Chemistry

Preferred Volume

3 mL blood

Minimum Volume

1 mL blood

Stability (from collection to initiation)

10 min.

Result Interpretation

Units

mmol/L

Reference Interval

Please follow the following hyperlinks for reference intervals:

Sodium

Potassium

Chloride

Ionized Calcium

Critical Values

See hyperlinks above.

Note: Panic values from Post-filter samples are not called.

Additional Information

This panel includes:

Sodium (NAWB), potassium (KSB), chloride (CLWB) and ionized calcium (CAIB)

Iodide, bromide, thiosulfate, salicylate and nitrate cause a positive interference on chloride measured by ABL blood gas analyzers.

Ha, L et al, Annals Clin Biochem, 2015, 52(2): 288-292
Wendroth, S et al, Clin Chim Acta, 2014, 431: 77-79
ABL90 Flex Plus Instructions for Use Manual, Radiometer.

All reported values are corrected to 37C unless otherwise specified. Results beyond the linear range of the instrument will be reported as < or > the extreme of the linear range. Samples containing small bubbles may be run at the laboratory's discretion. If analyzed, a comment will beadded to the result regarding the presence of bubbles in the sample.

Administrative

LOINC Codes

55231-5

Complete View

Available Stat

Yes

Ordering Recommendations

Follow the link for information about Blood Gas Panels that contain this test.

Test Code

NLYTE

Performing Lab

Parnassus, Mission Bay and Mt Zion Chemistry

Performed

Test available 24 hours per day 7 days per week

Methodology

Direct ion selective electrodes (ISE), Radiometer ABL 90 FLEX Plus

Remarks

Arterial puncture:
Due to the risk of arterial damage and subsequent distal ischemia, prior to puncturing an artery the RN assesses the collateral circulation. If the radial artery is to be punctured, then the pulse of the ulnar artery is assessed. If the dorsalis pedis artery is to be accessed then the posterial tibial pulse is assessed and likewise if the posterial tibial approach is used the dorsalis pedispulse is assessed. The modified Allens's test may be used to assess collateral circulation of the ulnar artery before a radial artery puncture, but it does not always ensure adequate flow. A Doppler ultrasound flow indicator may be used to verify collateral circulation. If the collateral circulation is poor and the RN cannot palpate a pulse then the physician should be notified before proceeding. If for any reason the circulation is compromised to the extremity being assessed for arterial puncture then the physician should be notified prior to proceeding.

1. Palpate the radial artery and identify the site where the pulse is the strongest. Avoid areas with overlying veins to prevent venous admixture.
2. Prepare the patient's skin with an alcohol or 2% chlorhexidine wipe/swab.
3. Place two or three fingers along the course of the artery both to locate its position and direction, and to stabilize it.
4. Penetrate the skin smoothly holding the needle at 30-60 degree angle with the needle bevel up and pointed proximally. The angle of the "butterfly" IV catheter should not exceed 45° for pediatric patients.
5. Re-establish the position and direction of the artery by palpation.
6. Gently and slowly advance the needle or "butterfly", aiming directly for the area of maximum pulsation.
7. When the arterial lumen has been entered, less resistance is felt and blood appears in the syringe above the needle hub.
8 Obtain required amount of arterial blood for test(s).
9. If blood is not obtained on first attempt, withdraw the needle to just below the skin surface and advance needle at same angle but at 1 mm to either side of previous attempt.
10. Place the 2x2 gauze over the site of the puncture then withdraw the needle from the artery. Press firmly at the site for at least five minutes, or until the bleeding stops. Apply bandage or pressure dressing.
11. Expel any air bubble in the syringe with air filter cap placed on specimen syringe.
12. Label sample with patient's name, ID number and DOB.

Venous samples:
1. Avoid excessive venous stasis from prolonged tourniquet application or clenching of the fist prior to sample collection.
2. For central line draws make sure to waste a full red top tube then draw via the blood gas syringe as noted above.
3. Fill syringe completely, remove needle (in peripheral draws), cap sample, expel all bubbles (while holding syringe upright) until blood hits the top of cap.
4. Label sample with patient's name, ID number and DOB.

Capillary Samples:
1. The following are recommended sampling sites: earlobe, fingertip, big toe, heel. The heel and big toe are more suitable for use on neonates and infants.
2. Warm the area or puncture site for 5 to 10 minutes prior to actual sampling. This accelerates flow for blood to be representative of general status of patient.
3. Make a puncture using a lancet or similar device. Do not squeeze the area to avoid tissue juice from mixing into blood sample.
4. Wipe off the first drop of blood. Take the sample from the center of the second drop of blood and hold the capillary at a slightly downward angle for an uninterrupted blood flow. Avoid getting air bubbles in the specimen.
5. Refrain from squeezing or milking the puncture site as this may result in faulty measurements or cause hemolysis of blood sample and cause elevated K+ readings.
6. Apply accompanying caps to both ends of the capillary tube and mix the sample with the heparin immediately after collection to prevent blood from clotting. The manufacturer recommends the use of a mixing wire and magnet for capillary samples.
7. Label sample with patient's name, ID and DOB.

Collect

Plastic blood gas syringe containing approximately 70 IU dry heparin in a 3 mL syringe or 23 IU in a 1 mL syringe - or a capillary tube coated with 70 IU heparin (Radiometer Clinitube).

Amount to Collect

3 mL blood

Sample Type

Heparinized whole blood (Blood gas syringe only)

Preferred Volume

3 mL blood

Minimum Volume

1 mL blood

Units

mmol/L

Reference Interval

Please follow the following hyperlinks for reference intervals:

Sodium

Potassium

Chloride

Ionized Calcium

Critical Values

See hyperlinks above.

Note: Panic values from Post-filter samples are not called.

Synonyms

sodium
potassium
chloride
ionized calcium
Na
K
Cl
iCa
ARTBGL
VENBGL
CVBGL
MVBGL
CAPBG
MVBGCX
CIRBGA
CIRBGV
Blood gas
ABG

Stability (from collection to initiation)

10 min.

Additional Information

This panel includes:

Sodium (NAWB), potassium (KSB), chloride (CLWB) and ionized calcium (CAIB)

Iodide, bromide, thiosulfate, salicylate and nitrate cause a positive interference on chloride measured by ABL blood gas analyzers.

Ha, L et al, Annals Clin Biochem, 2015, 52(2): 288-292
Wendroth, S et al, Clin Chim Acta, 2014, 431: 77-79
ABL90 Flex Plus Instructions for Use Manual, Radiometer.

All reported values are corrected to 37C unless otherwise specified. Results beyond the linear range of the instrument will be reported as < or > the extreme of the linear range. Samples containing small bubbles may be run at the laboratory's discretion. If analyzed, a comment will beadded to the result regarding the presence of bubbles in the sample.

LOINC Codes

55231-5