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EP.041
Arterial blood gas sampling within Critical Care: An audit of practice.

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Arterial blood gas sampling in Critical Care: an audit of practice 

 

Jones, A (ACCP), Quinton, S  (Consultant Nurse), Palmer, M (ACCP), Arora, N (Intensive Care Consultant)                                       

 

UHB, HGS,  Birmingham

 

 

Within the NHS there is an ongoing drive to reduce expenditure while increasing efficiency. Reducing cost continues to be a challenge for critical care. Critical care is a unique clinical setting where physiological variables are required to support therapy to those whom are critically ill using arterial blood gas monitoring. Over-sampling arterial blood gas (ABG) is associated with pain, iatrogenic anaemia and is a considerable cost.  

As an experienced practitioner within the critical care department, it appeared that the team were not  following the critical care guideline of three arterial blood gas samples per 24 hours (stable patient), so an audit aimed at determining if the critical care team comply with existing arterial blood gas sampling guidelines was performed.

Method:

Single site adult critical care
19 critical care beds
Manually audited 500 patient charts, daily over 6 week period, January -February 2018
Electronic audit data collection form utilised
Audit of compliance to Trust arterial blood gas sampling guideline

Inclusion criteria:

Mechanically, invasively ventilated >24 hours
Max. single vasopressor support (<0.125mcg/kg/min)
No renal support
Age > 18

Results:

224 patient charts eligible for audit
1,393 arterial blood gases were performed
An average of 6.21 arterial blood gases were performed per patient/24hrs
Trust guidelines recommend 3 per patient/24hrs
86% of ABGs resulted in no change in FiO2
86% of charts had no target SpO2parameters set
75% of charts had documented saturations of 99-100%
Current practice costings over 6 week period = £7,912 compared to guideline practice = £3,816 (£5.68 per arterial blood gas) Overspending by £4,0961

Discussion:

The results show non-compliance of arterial blood gas sampling within the critical care compared to the current Trust guideline2
The audit supports findings of other studies3
Greater awareness of the use of physiological target parameters is required (end-tidal CO2, pulse oximetry monitoring) to guide oxygen therapy and arterial blood gas sampling4
The audit has revealed an over-reliance on arterial gas sampling rather than less invasive methods
Re-education, re-training and an update of existing guidelines are recommended

Limitations:

The audit was only performed in a single centreunit.
Patient outcome was not audited
Other indications for arterial gas sampling, such as metabolic derangement, were not considered
The audit was performed during winter pressures, this could have had an impact on results due to no adjustment to the winter variable

Arterial blood gas oversampling comes at a cost of potentially £35,498 per year           


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