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Lab Manual for Moffitt-Long and Mount Zion

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Whole Blood Electrolytes

Item Value
Approval req'd? No
Available Stat? Yes
Test code
NLYTE NCPL Na, K, Cl, iCa
BLYTE MtZ Na, K, iCa
Performed by Neonatal Clinical Physiology Laboratory and Mt. Zion Clinical Laboratory
In House Availability Test available 24 hours per day 7 days per week
Method Ion specific electrodes:
NCPL Radiometer ABL 800
Mt Zion Gem Premier 3500
Collection Instructions 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 pedis
pulse 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.

Deliver samples immediately to lab for testing. Send samples via pneumatic tube to NCPL (station #916) at Parnassus. Hand deliver samples to Mount Zion Lab, B bldg, second floor.
Container type Plastic syringe containing 100 U of dry heparin
Amount to Collect 3 mL blood
Sample type Heparinized whole blood (Blood gas syringe only)
Preferred volume 3 mL blood
Min. Volume 1 mL blood
Processing notes Contains the following test codes: NAWB, CAIB, KSB
Units mmol/L
Normal range Sodium 136-146 mmol/L

Potassium:
0-6 months 3.0-5.4 mmol/L
> 6 months 3.4-4.5 mmol/L


Chloride: 98-106 mmol/L


Ionized Calcium:
0-6 months 0.95-1.50 mmol/L
> 6 months 1.15-1.29 mmol/L
Critical value
Sodium < 125 mmol/L o > 155 mmol/L
Potassium < 3.0 mmol/L or > 6.0 mmol/L
Ionized Calcium < 0.80 mmol/L or > 1.55 mmol/L


Note: Panic values from Post-filter samples are not phoned.
Stability 10 min.
LOINC code 55231-5
Last Updated 3/18/2013 11:58:14 AM
Entry Number 1224

If you have additional questions regarding this test, please call: 415-353-1667

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