Safeguarding accuracy in ABG testing: Managing preanalytical errors and meeting POCT standards under ISO 15189:2022

Background

In patients with cardiac failure, arterial blood gas (ABG) testing provides critical insights into oxygenation, acid–base balance, and tissue perfusion. These results often guide immediate therapeutic interventions such as oxygen therapy, ventilation strategies, or diuretic adjustments. However, accuracy is highly vulnerable to preanalytical errors. Mislabeling, contamination, heparin-induced bias, air entrapment, delayed processing, and poor sample handling can produce misleading results, leading to inappropriate treatment decisions and poorer outcomes in this high-risk group.

Methods

This talk reviews preanalytical challenges in ABG testing with a specific focus on cardiac failure. Practical safeguards—such as strict patient identification, balanced heparin anticoagulation, standardized sampling and mixing protocols, and sharps-safety devices—are outlined. Updates in ISO 15189:2022 regarding point-of-care testing (POCT) are integrated, highlighting requirements for competency-based training, documentation, traceability of personnel, and participation in external quality assessment programs. Standardized protocols would have prevented this error. Broader adoption of such safeguards reduces variability, improves result reliability.

Results

Adopting structured preanalytical protocols enhances sample integrity, reduces error-induced variability, and ensures that ABG results remain reliable for guiding the delicate hemodynamic and ventilatory management of cardiac failure patients. Integration of ISO 15189:2022 requirements for POCT assures that bedside results achieve laboratory-level quality, supporting timely clinical decisions in acute care settings. In emergency care, a patient with acute decompensated heart failure presented with severe dyspnea. ABG analysis initially suggested metabolic alkalosis, leading to inappropriate therapy. On review, the sample had been contaminated with flush solution, invalidating results.

Conclusions

In cardiac failure, where therapeutic windows are narrow and decisions are time-sensitive, the value of ABG testing depends on both accuracy and speed. Strengthening preanalytical vigilance and adhering to ISO-driven quality frameworks transform ABG testing into a safer, more dependable tool, ultimately improving patient safety and optimizing outcomes in this vulnerable population.

Prof. (Dr) Pradeep Kumar Dabla is an experienced Chairperson with a demonstrated history of more than 25yrs of Leadership & Administration while working in the hospital & health care industry. He is a laboratory physician skilled in Medical Devices, Molecular Biology, Biotechnology, Laboratory Medicine, Clinical Research& Artificial Intelligence. A strong research professional who also support the NABL, as Lead & Technical Assessor ISO 15189:2022& ISO 17043:2023 focused in Medical Laboratories, NABL, Quality Council, Govt. of India. Due to keen interest in research and laboratory medicine, he has been awarded Thrice for his research work in “Postmenopausal Women CAD Risk & Gene Polymorphism” and “Diabetic CAD Risk” and received another Five International Awards& Travel Grants. He has been invited several times as speaker, chair at National & International congresses.He received Eminent Teacher Award from Delhi Medical Association, Fellowship ACBI(Association of Clinical Biochemists of India), Fellowship IMSA (International Medical Sciences Academy), and Member- National Academy of Medical Sciences (MAMS),Honorary Fellowship GAPIO 2024 (Honorary GAPIO Global Association of Physicians of India Origin), Awarded GAPIO Excellence in Diagnostics Award 2024. He has 105 research papers to his credit in reputed National & International journals. In addition he also published 5 book chapters, 2 books, 2 Patents (in Artificial Intelligence) and more than 60 abstracts as a part of invited talks and papers presented.