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Lab Manual for Moffitt-Long and Mount Zion

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Blood Gas Panel Information

Item Value
Available Stat? No
Test code
Performed by Neonatal Clinical Physiology Laboratory
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 blood gas syringe containing 100 U of dry heparin or capillary tube.
Sample type Heparinized whole blood
Preferred volume 3 mL whole blood
Min. Volume 95 µL (55 µL for NLHCT)
UCSF Rejection Criteria Received > 30 minutes after collection.
Normal range
Critical value See entries for: Blood gases, Whole blood electrolytes, Cooximetry, Lactase and Glucose
Synonyms pH; pCO2; pO2; O2 Saturation; O2 Sat; Base excess; A-a gradient; HCO3-; ABG; BG; BE; oxygen; carbon dioxide; bicarbonate; electrolytes; glucose; lactate; hemoximetry, cooximetry; hemoglobin; hematocrit
Stability < 30 minutes
Additional information The following panel of tests are available from the NCPL:

NGAS Blood Gas Only
NGLYT Blood Gas + Electrolytes
NGLA Blood Gas + Lactate
NGLYLA Blood Gas + Electrolytes + Lactate
NCOOX Cooximetry Only
NGCOX Blood Gas + COOX
NGLYCX Blood Gas + Electrolytes + Cooximetry
NGLCXL Blood Gas + Electrolytes + Cooximetry + Lactate
NLYTE Electrolytes Only
NLYCX Electrolytes + Cooximetry
NLYTLA Electrolytes + Lactate
NGCXLA Blood Gas + Cooximetry + Lactate
NLACT Lactate Only
NCXLA Cooximetry + Lactate
NGLU Glucose Only
NGGLU Blood Gas + Glucose
NGLGLU Blood Gas + Electrolytes + Glucose
NLYGLU Electrolytes + Glucose
NLHCT Hematocrit Only
NGHC Blood Gas + HCT
NGLHCT Blood Gas + Electrolytes + HCT
NGLLAH Blood Gas + Electrolytes + Lactate + HCT
NORG Blood Gas, electrolytes, glucose, total hemoglobin
NORGCX Blood Gas + Electrolytes + Glucose + Hemoglobin + Cooximetry
NORGCL Blood Gas + Electrolytes + Glucose + Hemoglobin + Cooximetry + Lactate
NORGL Blood Gas + Electrolytes + Glucose + Hemoglobin + Lactate


For ordering purposes this table may help:

Panel code Blood gas Electrolytes (Na, K, Cl, iCa) Glucose Lactate Cooximetry Hct Hgb
NGAS Y
NGLYT Y Y
NGLA Y Y
NGLYLA Y Y Y
NCOOX Y
NGCOX Y Y
NGLYCX Y Y Y
NGLCXL Y Y Y Y
NLYTE Y
NLYCX Y Y
NLYTLA Y Y
NGCXLA Y Y Y
NLACT Y
NCXLA Y Y
NGLU Y
NGGLU Y Y
NGLGLU Y Y Y
NLYGLU Y Y
NLHCT Y
NGHCT Y Y
NGLHCT Y Y Y
NGLLAH Y Y Y Y
NORG Y Y Y Y
NORGCX Y Y Y Y Y
NORGCL Y Y Y Y Y Y
NORGL Y Y Y Y Y

Last Updated 4/17/2013 12:28:44 PM
Entry Number 1535
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