Gases, Capillary

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, Capillary
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

GASC

Test Workstation :

MBG1

Specimen Type:

Blood

Tube Type:

Deliver to lab immediately 2 Heparinized Capillary tubes

Collection Volume:

(2) 125 uL capillary tubes

Minimum Volume:

(2) 125 uL capillary tubes

Preferred Volume:

(2) 125 uL capillary tubes

Cause for Rejection:

Clotted, air bubbles

Storage:

Room Temperature

Availability:

Daily, 24 hours; STAT

Methodology:

Ion selective electrode/Calculations

Special Instructions:

Notify lab if patient's temperature is other than 37C to correct results (temperature dependent). If collecting blood in capillary tubes from a finger or heel, place a warm, moist towel on hand or foot for 10 minutes prior to lancet puncture. Deliver to lab immediately. For Outpatients, test should only be drawn in outpatient locations within the Hospital on the Beeghly campus.

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, Capillary

Laboratory - : Chemistry

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