Can peripheral venous blood gases replace arterial blood gases in emergency department patients?

Abstract

Objective: To determine if peripheral venous blood gas values for pH, partial pressure of carbon dioxide (Pco(2)) and the resultant calculated bicarbonate (HCO(3)) predict arterial values accurately enough to replace them in a clinical setting.

Methods: This prospective observational study was performed in a university tertiary care emergency department from June to December 1998. Patients requiring arterial blood gas analysis were enrolled and underwent simultaneous venous blood gas sampling. The following data were prospectively recorded: age, sex, presenting complaint, vital signs, oxygen saturation, sample times, number of attempts and indication for testing. Correlation coefficients and mean differences with 95% confidence intervals (CIs) were calculated for pH, Pco(2) and HCO(3). A survey of 45 academic emergency physicians was performed to determine the minimal clinically important difference for each variable.

Results: The 218 subjects ranged in age from 15 to 90 (mean 60.4) years. The 2 blood samples were drawn within 10 minutes of each other for 205 (96%) of the 214 patients for whom data on timing were available. Pearson's product-moment correlation coefficients between arterial and venous values were as follows: pH, 0.913; Pco(2), 0.921; and HCO(3), 0.953. The mean differences (and 95% CIs) between arterial and venous samples were as follows: pH, 0.036 (0.030-0.042); Pco(2), 6.0 (5.0-7.0) mm Hg; and HCO(3), 1.5 (1.3-1.7) mEq/L. The mean differences (+/- 2 standard deviations) were greater than the minimum clinically important differences identified in the survey.

Conclusions: Arterial and venous blood gas samples were strongly correlated, and there were only small differences between them. A survey of emergency physicians suggested that the differences are too large to allow for interchangeability of results; however, venous values may be valid if used in conjunction with a correction factor or for trending purposes.