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Wednesday, September 23, 2009

Are capillary blood gases coming back?

When I started working as an RRT I was instructed on the correct method of doing a capillary blood gas (cbg) on a neonate. When I was told I had to cut the foot with a blade and drip blood into a tube I cringed, "I don't' want to do that."

For a couple years thereafter I gulped every time my pager went off that I had to go to OB for a bad baby. Just the thought that I might have to do one of those CBG things made my cringe.

After I had been here five years it occur ed to me the pediatricians who work here had never ordered a CBG. Yippy! I never had to do one of those dreaded things. Then one day I noticed that the CBG kids were gone too. It was clear I would never have to do one.

A few days ago, however, I was talking with a pediatrician from Spectrum Health in Grand Rapids, Michigan, and he said to me, "Do you guys to capillary blood gases where you work?"

"No!" I said, "and thankfully so."

"Do you even have kits anymore?"

"No. The pediatricians must have realized those things are pretty much useless."

"Well," he said, "the reason I asked is because we do CBGs now at Butts. Too many studies show that umbilical lines cause to many infections, so we try to stay away from them wherever possible."

Oh, I thought. So you're not on my side. "Oh! So you're recommending that we do ABGs?"

"Yes. I know most hospitals got rid of them, but now we've pretty much decided that a venous pH, along with a sat monitor, can give you a pretty decent estimate of what is going on with the baby."

Actually that does make sense to me. I've debated with doctors in our ER for years that a venous pH is not much different from an arterial. And we all try to convince doctors that a sat is all that is needed to confirm hypoxia.

"Do you guys have the capacity to do them," he asked, "I mean on your ABG machine?"

"Yes. I think we do."

He said, "The procedure is much better than it used to be. All we do now is prick them they same way you prick someone when you are going to check their sugar. It's not as bad as it used to be."

"Well that shouldn't be so bad then," I said. "And since we send all our bad babies to you guys, all our protocols are based on your protocols anyway. So, if you recommend we do CBGs, I bet we'll probably do CBGs"

"Good deal," he said.

So, will CBG kits find their way back to hospitals? Do you guys do CBGs where you work? Does anyone have any research on the value of CBGS, or studies that show UV lines cause too many infections to make CBGs worthwhile?


Anonymous said...

I am a nurse and a mther of a 3 mo preemie baby who is 12yo now but has multiple "slash'scars" on both of her heels. It sounds like the numbers are a bit different and the other concern is infection when taken from the umilicus? It sucks to do it, but in the long run, I feel that it is better to take from the foot/heel/
Jolene, Idaho

Anonymous said...

as an RT student on the Sunrise side doing a peds rotation - it seems CAP gases never left this side of the Mitten!

Marcus said...

I am a NICU/PICU RT in north carolina and we do plenty of them in the NICU. Most babies there get one at least 2 or 3 times a week. Not so much with the bigger kids.