Capillary Blood Gas Sampling for Neonatal and Pediatric Patients

Publication Date: September 1, 2022
Last Updated: October 24, 2022

Summary of Recommendations

In the absence of an indwelling arterial catheter, capillary and venous blood gas measurements may be useful alternatives to arterial blood samples for infants and children who require close monitoring of pH and PCO2 but not PO2 measurements. (B)
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In the presence of alterations in body temperature, blood pressure, or peripheral perfusion, a correlation of a capillary or venous blood gas with an arterial sample is needed to determine whether changes in these physiologic conditions reduce reliability. (B)
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Perfusion to the sample site should be assessed, and preference given to blood gas sampling from a well-perfused site to minimize the propensity for pre-analytical errors. (B)
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Regardless of the sampling site (ie, arterial, venous, capillary), when the blood gas or analyte result interpretation does not align with the patient’s clinical presentation, consideration to redrawing the blood gas sample should be given before clinical decision making occurs. (B)
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A pneumatic tube system can be reliably used to transport blood gas samples collected in a syringe and capillary tube to a clinical laboratory from analysis. (B)
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Samples should be analyzed within 15 min of collection to avoid pre-analytic errors. (C)
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Samples collected in plastic capillary tubes should not be iced. (C)
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Gentle mixing of the sample at the time of collection and immediately before analyzing for effective coagulation. (C)
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Expel all air bubbles at the time of collection. (C)
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The capillary puncture procedure should be minimized when possible to reduce the cumulative pain effect and risk of complications. (B)
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Non-pharmacologic interventions should be used when performing heel puncture for capillary blood sampling to reduce the pain response. (B)
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Automatic lancets are preferred to manual lancets to reduce the pain response, procedure time, number of heel sticks, and bruising. (A)
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Use caution when applying heat to avoid cutaneous burns. (C)
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Because there were no studies extracted from the systematic review that directly related to the impact that the presence of dyshemoglobins have on pH, PCO2, and PO2, there are no recommendations at this time. (N)
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Recommendation Grading

Overview

Title

Capillary Blood Gas Sampling for Neonatal and Pediatric Patients

Authoring Organization

Publication Month/Year

September 1, 2022

Last Updated Month/Year

February 13, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

In the absence of an indwelling arterial catheter, capillary blood gas sampling may be used to evaluate the acid/base and ventilation status of neonatal and pediatric patients with cardiorespiratory conditions. These guidelines were developed from a comprehensive review of the literature to provide guidance for the collection, handling, and interpretation of blood obtained from an arterialized capillary sample. Capillary and venous blood gas measurements are a useful alternative to arterial blood gas measurements for neonatal and pediatric patients who do not require close monitoring of [Formula: see text] In the presence of alterations in body temperature, blood pressure, or peripheral perfusion, agreement between a capillary blood gas with an arterial sample is recommended to determine whether changes in these physiologic conditions reduce reliability. Perfusion to the sample site should be assessed and preference given to blood sampling from a well perfused site, and blood should be analyzed within 15 min of sampling to minimize the propensity for pre-analytical errors. Clinicians should consider re-collecting a blood sample, obtained from an artery, vein, or capillary, when the blood gas or analyte result interpretation does not align with the patient's clinical presentation. A pneumatic tube system can be reliably used to transport blood gas samples collected in a syringe and capillary tube to a clinical laboratory for analysis. To reduce the cumulative pain effect and risk of complications, the capillary puncture procedure should be minimized when possible. Non-pharmacologic interventions should be used to reduce pain associated with capillary blood gas sampling. Automatic lancets are preferred to puncture the skin for capillary blood gas collection.

Inclusion Criteria

Male, Female, Child, Infant

Health Care Settings

Ambulatory, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D001784 - Blood Gas Analysis

Keywords

blood gas analysis, blood draw, blood gas

Source Citation

Evans DL, Volsko TA, Capellari E, Strickland SL. AARC Clinical Practice Guidelines: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients. Respir Care. 2022 Sep;67(9):1190-1204. doi: 10.4187/respcare.10151. PMID: 36002161.

Supplemental Methodology Resources

Data Supplement, Data Supplement

Methodology

Number of Source Documents
58
Literature Search Start Date
January 18, 2018
Literature Search End Date
August 30, 2021