Low Ionized calcium on blood gas samples
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An RN in our Trauma unit had three different blood gas samples in a row from three different patients come back with absurdly low ionized calcium results (0.13 mmol/L, 0.14 mmol/L, 0.33 mmol/L). All other blood gas results from the samples were normal. I repeated the last sample on a different analyzer and obtained the same result. I then ran some heparinized whole blood from LiHep vacutainers on both of the analyzers and the ionized calcium results were normal. Subsequent samples run on the analyzers did not repeat the issue. I did not observe her collect the samples, but she demonstrated that she collected the samples from a venipuncture into blood gas syringe, and no other blood draws were collected. I feel like this has to be a sample collection issue, but I am at a loss as to the cause. Any thoughts?
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EDTA contamination was my first thought too, but the potassiums were not elevated (one was actually below our normal range), and she says she collected directly from the vein and no other tubes collected. I feel there has to be some contamination somewhere, I just don't know where or how.
And wow, I just noticed you said it was three different patients. Has to be collection equipment.
As part of my investigation I did draw up blood from the vacutainer using their syringes and the result was normal, however I did not get the syringe from the same drawer the nurse used, so maybe the supplies she used were contaminated somehow. I will have to check that possibility out.