Gases, Arterial

Laboratory - : Chemistry

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Gases, Arterial
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

GASES

Test Workstation :

MBG1

Specimen Type:

Blood

Tube Type:

Heparinized syringe or Green top (lithium heparin) macrotainer NO GEL SEPARATOR TUBES.

Collection Volume:

0.5 mL heparinized syringe

Minimum Volume:

0.5 mL syringe; 1.5 mL macrotainer.

Preferred Volume:

1 mL syringe; 1.5 mL macrotainer.

Cause for Rejection:

Clotted, air bubbles, Gel separator tube.

Storage:

Room Temperature

Availability:

Daily, 24 hours; STAT

Methodology:

Ion selective electrode/Calculations

Special Instructions:

Air bubbles should be expelled from the syringe. Notify lab if patient's temperature is other than 37C to correct results (temperature dependent). Deliver to lab immediately at room temperature.

Lab/Phone:

330-746-9623

TAT:

30 minutes

Additional Info:

Reference range is available on patient report

CPT Code:

82803

Panel Includes:

Total Hgb, pH, PCO2, pO2, HCO3, TCO2, O2 Saturation, O2 Hgb, Std Base Excess

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Gases, Arterial

Laboratory - : Chemistry

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