1.

Air in Sample:

● Effect on Parameters:
○ ↓ PCO₂: The partial pressure of carbon dioxide (PCO₂) decreases because the air in the
sample can dilute the CO₂ in the blood.
○ ↑ pH: An increase in pH occurs due to the reduction in PCO₂, which makes the blood
more alkaline.
○ ↑ low PO₂: The partial pressure of oxygen (PO₂) might increase if the PO₂ in the air is
higher than in the blood sample, especially when the initial PO₂ is low.
○ ↓ high PO₂: Conversely, if the PO₂ in the blood is high, exposure to air can decrease it as
oxygen diffuses out of the blood.
● How to Recognize:
○ Visible bubbles or froth: Presence of bubbles in the sample is a clear indicator that air
has contaminated the sample.
○ Low PCO₂ inconsistent with patient status: If the PCO₂ level is unexpectedly low
compared to the patient’s clinical condition, air contamination should be suspected.
● How to Avoid:
○ Discard frothy samples: Samples with visible air bubbles should be discarded.
○ Fully expel bubbles: Make sure to remove any air bubbles before mixing the sample.
○ Mix only after air is expelled: Proper mixing should occur only after the air is removed.
○ Cap syringe quickly: To minimize air contamination, the syringe should be capped
immediately after drawing the sample.

2. Venous Admixture:

● Effect on Parameters:
○ ↓ PCO₂: Mixing venous blood with arterial blood can lower the PCO₂ since venous blood
typically has lower CO₂ levels.
○ ↓ pH: The pH can decrease due to the higher concentration of CO₂ in venous blood,
which forms carbonic acid and lowers pH.
○ Can greatly lower PO₂: PO₂ can be significantly reduced as venous blood contains less
oxygen than arterial blood.
● How to Recognize:
○ Failure of syringe to fill by pulsations: In arterial sampling, the syringe should fill with
pulsating pressure. A lack of pulsation may indicate venous sampling.
○ Patient has no symptoms of hypoxemia: If the PO₂ is unexpectedly low but the patient
shows no signs of hypoxemia, a venous admixture might be the cause.
● How to Avoid:
○ Avoid brachial and femoral sites: These sites have a higher risk of venous admixture,
so it's better to avoid them.
○ Do not aspirate sample: Arterial blood should fill the syringe naturally due to arterial
pressure; aspiration might draw in venous blood.
○ Use short-bevel needles: These are less likely to penetrate a vein after entering an
artery.
 ○ Avoid artery "overshoot": Care should be taken not to push the needle through the
artery into an adjacent vein.
○ Cross-check with SpO₂: Comparing arterial blood gas results with pulse oximetry (SpO₂)
can help identify discrepancies due to venous admixture.

3. Excess Anticoagulant (Dilution):

● Effect on Parameters:
○ ↓ PCO₂: Excess heparin, used as an anticoagulant, can dilute the blood sample, leading
to a decrease in measured PCO₂.
○ ↑ pH: The dilution effect can also increase pH by lowering CO₂ levels.
○ ↓ low PO₂ and ↓ high PO₂: The PO₂ levels may be either falsely low or falsely high
depending on the original oxygen content of the blood and the extent of dilution.
● How to Recognize:
○ Visible heparin remains in syringe before sampling: If heparin is visibly present in the
syringe, the sample may be over-diluted.
● How to Avoid:
○ Use premade lyophilized (dry) heparin blood gas kits: These kits reduce the risk of
adding too much liquid heparin.
○ Fill dead space only: Only the necessary amount of heparin should be used to fill the
dead space in the syringe, avoiding dilution of the blood sample.
○ Collect >2 mL (adults) and >0.6 mL (infants): Ensuring a sufficient volume of blood is
collected can minimize the dilution effect.

4. Metabolic Effects:

● Effect on Parameters:
○ ↑ PCO₂: If there is a delay in analyzing the sample, cellular metabolism continues,
producing CO₂ and increasing PCO₂ levels.
○ ↓ pH: The ongoing production of CO₂ leads to increased carbonic acid in the blood, which
lowers the pH.
○ ↓ PO₂: As cells consume oxygen over time, the PO₂ level in the sample can decrease.
● How to Recognize:
○ Excessive time lag since sample collection: If there’s a significant delay between
collecting the sample and analyzing it, metabolic changes can occur.
○ Values inconsistent with patient status: If the blood gas values do not match the
patient’s clinical condition, metabolic effects due to delays should be considered.
● How to Avoid:
○ Analyze within 15 min: Prompt analysis of the blood sample within 15 minutes helps
avoid metabolic effects.
○ Place sample in ice slush: Cooling the sample in ice slush slows down metabolic
activity, preserving the integrity of the blood gases until analysis.
Venous Blood and CO₂:

● Venous Blood: Typically, venous blood contains higher levels of CO₂ compared to arterial blood. This is
because, after blood delivers oxygen to tissues, it picks up carbon dioxide as a waste product from cellular
metabolism. Therefore, the PCO₂ in venous blood is usually higher than in arterial blood.

Corrected Explanation:

1. ↓ PCO₂ (Partial Pressure of Carbon Dioxide):

○ Reason: In venous blood, the PCO₂ is generally higher than in arterial blood. However, when
venous blood contaminates an arterial sample, the effect on PCO₂ can vary depending on the
proportion of venous blood in the sample. The overall PCO₂ might be falsely low if the venous
sample is relatively small and is mixed with arterial blood, particularly if there’s air contamination or
dilution involved. This situation is rare, but in some cases, venous admixture might slightly lower
the observed PCO₂ due to the mixing and potential dilution effects.
2. ↓ pH:
○ Reason: Venous blood contains more CO₂ than arterial blood, which leads to the formation of more
carbonic acid (H₂CO₃). This increased acid load can lower the pH of the sample, making it more
acidic. The reduction in pH is a direct result of the higher CO₂ content in venous blood.

How to Avoid Venous Admixture:

1. Avoid Brachial and Femoral Sites:

○ Reason: These sites are closer to veins and have a higher risk of venous blood contamination. The
radial artery is typically preferred for arterial blood sampling because it is easier to access and less
likely to result in venous admixture.
2. Do Not Aspirate the Sample:
○ Reason: Arterial blood should naturally enter the syringe due to the pressure in the artery. If the
clinician aspirates (pulls back on the syringe plunger), it can inadvertently draw venous blood into
the sample, especially if the needle has penetrated a vein after passing through the artery.
3. Use Short-Bevel Needles:
○ Reason: Short-bevel needles are less likely to pass through the arterial wall into an adjacent vein,
reducing the risk of venous admixture. These needles are designed to limit the depth of
penetration.
4. Avoid Artery "Overshoot":
○ Reason: If the needle passes completely through the artery and enters a nearby vein, it can result
in venous blood being mixed with the arterial sample. Careful technique and knowledge of anatomy
can prevent this from happening.
5. Cross-Check with SpO₂:
○ Reason: Pulse oximetry (SpO₂) measures the oxygen saturation of hemoglobin in the blood and
provides a non-invasive way to assess oxygen levels. If there is a significant discrepancy between
the SpO₂ reading and the PO₂ measured in the arterial blood gas (ABG), venous admixture should
be suspected. For example, a low PO₂ on the ABG with a normal SpO₂ may indicate that venous
blood contaminated the sample.