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Blood Gases by RCP's or Med Techs?

By Michael Nibert posted 05-17-2010 01:18

  
Hello AARC friends,
  I just returned from a national meeting in which I worked as a clinical consultant in a vendors booth. I was totally amazed at how many RC departments did not analyze and report their own blood gases. These departments allowed the Med Techs to perform the analytical and post analytical parts of the blood gas process intervention while the RCP's performed the pre analytical component. The RCP's did not know the results in a timely manner and waited on results to be sent by the lab to the unit and in many cases the RCP's were not notified. In other hospitals, the RCP's performed the pre analytical AND analytical process interventions and the Med Techs would then perform the post analytical process intervention in line with their other lab reports pending. In almost all these cases, the lab had the analyzer physically located in the lab. Many RCP's did not know the full range of analytes that they were able to report or what brand of blood gas analyzer they were using. Very few RCP's knew about lactate and SvO2 anayte reporting with sepsis protocols. The departments that had the blood gas analyzers under their control were as a whole more well versed in all aspects of blood gas operations and how this affected their departmental productivity.
   What are your thoughts on this split approach to blood gas operations? Are there any studies or best practice data to support one way or another? This Blog will certainly generate some responses and I look forward to your thoughts. The intent of this blog is to generate discussion about patient outcomes and best practice so please accept my blog for this professional reason.
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Lois Rowland
05-21-2010 22:15

At our facility, RT draws, analyzes, and reports the blood gas values. I don't think there is a right/wrong process due to reasons others have posted; different operations work well in different ways. What I think IS wrong is a delay in results reaching the caregivers, whether nurses, RTs, MDs, or others. If there is a lack of knowledge regarding lactate, SvO2, dyshemoglobinemias, etc., that is not solved by being responsible for the analysis/reporting. Continuing education is very important on these topics.
P.S. Several studies published in the last year are shining the light of skepticism using a central line sat measurement as a surrogate for mixed venous sat. I am aware that the surviving sepsis campaign international standards state that differences are clinically insignificant based on earlier studies - jury may be out on a break right now.

Rita Allen
05-20-2010 10:16

We used to draw & run our own ABG's but the machine was in a different area so we did have to leave the patient. I was told by a Pediatrician caring for a critical newborn once that someone else could run the gases & that I was to stay with the baby Made me feel good. But the expense of keeping up the machine made the RT Dept let it be t-ferred to Lab which also had the money to buy a 2nd machine. RT still draws the gases. Lab can only do the heel sticks in the nursery. Only RT & ICU RN can draw actual arterial blood gases

Joseph Ozog
05-20-2010 06:59

Thats because when you have your own analyzers you also have your own state lab license on the wall. With the state lab permit comes all the state regulations (hundreds) and CAP regulations(hundareds) and it takes a full time person to deal with these. It also requires a MD to put therir name on the lab permit and take that legal responsibility. The added permit also costs the hospital $$.
We still have all these items but we are a rare bird. Out only saving grace is that the lab is a mess.

James Goodmar
05-19-2010 17:01

I have another way of looking at it. If I am taking care of a sick patient, I have to leave the patient in order to run the gas, unless I have a point of care device with me. However, this could be an issue if the blood gas machines are in a central location.

Suezette Musick Hicks
05-17-2010 09:14

I find this is just one more area where we are being squeezed out by other hospital personnel. I have several hospitals in our clinical facilities that do not draw or run the blood gases. I feel it is necessary to have a handle on your patient situation and ABG results are relevant to modification of therapy. Waiting on someone else to give you results defeats the purpose of being on the cutting edge of patient care. This is my opinion. I have seen lab techs draw ABGs from brachial arteries with vacutainers and the like. I do not like it. To say this bothers me would be an understatement. To be able to take care of the patient properly and adjust therapeutic modalities, we need to be drawing and running the blood gases.