Croatian national guidelines for blood gas testing

Blood gases/acid-base Preanalytical phase Process optimization Quality assurance

Summarized from Dukic L, Kopcinovic L, Dorotic A et al. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochemia Medical 2016; 26: 318-6

Nationwide harmonization of clinical laboratory practice is a stated strategic goal of the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM). In 2013, a CSMBLM working group conducted a nationwide survey of all aspects of blood gas testing practice in Croatian hospital laboratories.

This revealed considerable variation in practice, highlighting the need for expert national guidance/recommendation. That expert guidance has now been formulated by the CSMBLM working group, and is recently published.

Lending from other current guidelines on blood gas testing and related matters, such as those produced by the Clinical and Laboratory Standards Institute (CLSI) in the US, as well as a reading of relevant recent study and review articles, this paper provides an up-to-date account of best practice in blood gas testing, that has relevance for laboratory and non-laboratory staff involved in blood gas testing, both in Croatia and beyond.

The guidelines/recommendations are presented under five main headings: "Sample types used for blood gas analysis"; "Responsibilities in blood gas testing"; "Procedure for blood gas sampling" and "Blood gas sample analysis".

The "sample type" section is principally concerned with arterial blood (the gold standard sample) and "arterialized" capillary blood (the more easily obtained, and most frequently used sample in Croatia). There is very brief reference to the use of venous blood.

The "responsibilities in blood gas testing" section defines the healthcare workers who are mandated by Croatian regulatory bodies to perform the different aspects of blood gas testing (blood sampling, analysis, etc.). (This brief section has minimal relevance outside of Croatia).

Topics considered under the two final headings include: sample collection technique; sample handling and transport; time between sampling and analysis; the process of analysis; blood gas analyzer calibration and maintenance; and finally, internal and external quality control.