두 가지 동맥혈가스분석용 안전주사기 평가
Evaluation of Two Safety Syringes for Arterial Blood Gas Analysis
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배경: 동맥혈가스분석은 생명이 위급한 환자에게 혈액가스 및 산-염기 평형, 전해질 수치를 제공하는 매우 중요한 검사이며 정확한 결과가 요구된다. 동맥혈가스분석용 주사기의 여러 요인이 결과에 영향을 미칠 수 있지만 주사기를 도입하기 전에 이를 평가하는 임상 검사실은 거의 없다. 우리는 임상 검사실에서 널리 사용되고 있는 동맥혈가스분석용 안전주사기인 Greenmedi 헤파린안전주사기(GRS; SANG-A FRONTEC, Korea) 및 Portex 동맥혈용안전주사기(POS; Smiths Medical, USA)에 대해 성능을 평가하였다. 방법: 서울아산병원 진단검사의학과 중앙검사실로 접수된 검체를 대상으로 응괴 발생률, 용혈 발생률을 평가하였고, 3가지 농도의 정도관리물질을 사용하여 가스투과도, 검체량에 의한 영향, 정밀도, 일치도를 평가하였다. 정도관리물질을 실온 보관 후 pO2, pCO2, pH를 측정하여 가스 투과도를 평가하였고. 여러 용량의 정도관리물질로 검체량에 의한 영향을 평가하였다. 검사를 반복하여 정밀도를 평가하였고, 두 주사기의 결과값의 일치도를 분석하였다. 결과: 응괴 발생률은 호흡기내과 일반병동에서 GRS로 채취했을 때 1.07% (51/4,769)로 허용범위를 넘었고, 중환자실에서 POS로 채혈했을 때 0% (0/387)였다. 용혈 발생률은 GRS 14.9% (14/94), POS 10.0% (8/80)로 둘 다 허용범위보다 높았다. GRS, POS 주사기 둘 다 최대허용보관시간은 10분 미만이며, 최소허용검체량은 0.6 mL 초과였다. 정밀도는 모두 우수한 결과를 보였으나 pO2는 두 주사기 간 비교적 낮은 일치도를 보였다. 결론: 두 제품 모두 정밀도는 우수하였으나, 용혈 발생률이 높았다. 또한 결과값의 낮은 상관관계 및 보관시간 및 채취용량에 의한 영향도 확인되었으므로 사용 시 유의해야 한다. 각 검사실에서는 주사기를 도입 전에 주사기의 품질 평가를 선행할 것을 제안한다.
Abstract
Background: Arterial blood gas (ABG) analysis is a crucial test providing vital information for patients who are critically ill. Accurate results are essential; however, pre-implementation evaluation of ABG syringes is uncommon. We evaluated the performance of the Greenmedi heparin syringe (GRS; SANG-A FRONTEC, Korea) and the Portex arterial blood sampling kit (POS; Smiths Medical, USA), which are widely used in clinical laboratories. Methods: Samples from Asan Medical Center were assessed for clotting rate and hemolysis rate. Gas permeability, sample volume impact, precision, and concordance were evaluated using quality control materials. Gas permeability was assessed by measuring pO2, pCO2, and pH after storing the materials for different time periods. The influence of sample volume was tested at various quantities. Precision was evaluated through repeated tests, and concordance between the two syringes’ results was analyzed. Results: GRS had a clotting rate of 1.07% (51/4,769), exceeding the acceptable range, whereas POS had no clotted samples (0/387). Hemolysis rates were 14.9% (14/94) for GRS and 10.0% (8/80) for POS, both higher than the acceptable rate. Both syringes had a storage time of less than 10 minutes and required a minimum sample volume above 0.6 mL. Precision was noteworthy, but there was a relatively weak concordance between pO2 values obtained with the two syringes. Conclusions: Both syringes demonstrated notable precision but had high hemolysis rates. Results showed low concordance and were influenced by storage time and sample volume. Caution should be exercised when using these syringes, and it is recommended to assess their quality before implementation in each laboratory.
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