Gases, Venous
| 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, Venous | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GASV
Test Workstation :
MBG1
Specimen Type:
Blood
Tube Type:
Heparinized syringe or Green top (lithium heparin) macrotainer NO GEL SEPARATOR TUBES. NO MICROTAINER TUBES.
Collection Volume:
0.5 mL Heparinized syringe; 1.5 mL Green top (lithium heparin) tube
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.
Specimens collected in microtainer tubes or gel separator tubes will not be accepted.
>30 minutes from collection time.
Storage:
Room Temp
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. Must be received in lab within 30 minutes of collection time.
Lab/Phone:
330-746-9623
TAT:
30 minutes
Additional Info:
Reference range is available on patient report
CPT Code:
82803
Panel Includes:
Temperature, Hemoglobin, pH, pCO2, pO2, Tco2, O2 Saturation, O2 Hemoglobin, Std. Base Excess
Synonyms:
Venous Gases
Venous Blood Gases
