Review article: Can venous blood gas analysis replace arterial in emergency medical care
- 8 December 2010
- journal article
- review article
- Published by Wiley in Emergency Medicine Australasia
- Vol. 22 (6), 493-498
- https://doi.org/10.1111/j.1742-6723.2010.01344.x
Abstract
The objectives of the present review are to describe the agreement between variables on arterial and venous blood gas analysis (in particular pH, pCO2, bicarbonate and base excess) and to identify unanswered questions. MEDLINE search of papers published from 1966 to January 2010 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO2, bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size with 95% limits of agreement. The weighted mean arterio–venous difference in pH was 0.035 pH units (n= 1252), with narrow limits of agreement. The weighted mean arterio–venous difference for pCO2 was 5.7 mmHg (n= 760), but with 95% limits of agreement up to the order of ±20 mmHg. For bicarbonate, the weighted mean difference between arterial and venous values was –1.41 mmol/L (n= 905), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio–venous difference is 0.089 mmol/L (n= 103). There is insufficient data to determine if these relationships persist in shocked patients or those with mixed acid‐base disorders. For patients who are not in shock, venous pH, bicarbonate and base excess have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO2 is too poor and unpredictable to be clinically useful as a one‐off test but venous pCO2 might be useful to screen for arterial hypercarbia or to monitor trends in pCO2 for selected patients.Keywords
This publication has 17 references indexed in Scilit:
- Point-of-Care Bedside Gas Analyzer: Limited Use of Venous pCO2 in Emergency PatientsThe Journal of Emergency Medicine, 2011
- Validity of venous blood gas analysis for diagnosis of acid-base imbalance in children admitted to pediatric intensive care unitWorld Journal of Pediatrics, 2008
- Correlation between acid–base parameters measured in arterial blood and venous blood sampled peripherally, from vena cavae superior, and from the pulmonary arteryEuropean Journal of Emergency Medicine, 2008
- Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessmentEmergency Medicine Journal, 2007
- The case for venous rather than arterial blood gases in diabetic ketoacidosisEmergency Medicine Australasia, 2006
- Validation of venous pCO2 to screen for arterial hypercarbia in patients with chronic obstructive airways diseaseThe Journal of Emergency Medicine, 2005
- Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency departmentEmergency Medicine Journal, 2001
- Comparison of Blood Gas and Acid-Base Measurements in Arterial and Venous Blood Samples in Patients with Uremic Acidosis and Diabetic Ketoacidosis in the Emergency RoomAmerican Journal of Nephrology, 2000
- The relationship between the arteriovenous carbon dioxide gradient and cardiac indexJournal of Critical Care, 1993
- Assessing Acid-Base Status in Circulatory FailureThe New England Journal of Medicine, 1989