Published Apr 28, 2005
We just obtained a new ABG Analyzer and are realizing that sample handling may need to be improved. We are seeing clotting issues that we did not notice with our previous analyzer. Especially with Premies. I am looking for ideas on procedures that you feel are critical to getting a good sample and how do yu get people to realize they need imporvement. Thanks for any guidance.
BittyBabyGrower, MSN, RN
We really never had a problem all the time, but warming the heel first helps a lot. Also, do you use a "flea" in your tube? It is a little piece of metal that goes into the tube before you fill it.
Gompers, BSN, RN
We've found that if the heel isn't properly warmed, it takes forever to get a good sample and therefore the blood gets clotted in the tube before you even take it to the lab. If a baby has poor perfusion it's especially important. For the bigger kids, we have to make sure we're using the right sized lancet because the little preemie ones barely break their skin, so again it takes a long time to get blood from them.
We don't have the tubes with the metal in them. We have the regular ABG syringes with the little white ball of anticoagulant in them (I'm guessing that's what that is!) and the regular capillary tubes with the rubber ends. For those, we've been told that if we mobilize the tube after obtaining a sample, it helps prevent clotting. So they taught us to roll the tube between our fingers, and then gently twist our wrist like we're moving the tube upside down, right side up, like what you'd do with an hourglass timer. It's supposed to help, so it's worth a try!
If our machine is broken and we have to send samples to the main lab, both ABG syringes and capillary blood glass tubes both get double bagged and placed in ice.
we do it just like gompers.....
dawngloves, BSN, RN
Ander, are ou by any chance usig the GEM system. We have huge clotting problems with it.
KRVRN, BSN, RN
We do it like Gompers too.
I actually used to work in a stat lab before I was a nurse and I pretty much just ran ABGs all day. Preemies tend to have a higher Hct so the samples are more viscous by nature. You may need to deproteinize the analyzer more often. We never used "fleas" in our cap tubes. We did have "clot catchers" that were optional to use...I was one of the few to not routinely use them. Also, with a new analyzer, you probably switched to using their cap tubes...that might be the real problem. You don't have to use theirs. Try some of your old ones for a while and see if that makes a diff. Hope that helps.
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