{
  "id": "medical/art-line-blood-gas-heparin",
  "signature": "AI instructs to use heparinized syringe for arterial blood gas from an arterial line, causing inaccurate results",
  "signature_zh": "AI指示使用肝素化注射器从动脉导管采动脉血气，导致结果不准确",
  "regex": "(?i)(arterial\\s*blood\\s*gas|ABG|arterial\\s*line|a-line).*(heparin|heparinized|dilut|inaccur)",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Arterial line dead space contains heparinized flush solution; aspirating 3-5 mL discard before sample is mandatory. Using heparinized syringes for the discard or adding excess heparin can dilute the sample, causing falsely low pCO2, pO2, and electrolytes.",
  "root_cause_type": "generic",
  "root_cause_zh": "动脉导管死腔含有肝素化冲洗液；必须在采样前抽出3-5 mL弃去。对弃去液使用肝素化注射器或添加过多肝素可能稀释样本，导致pCO2、pO2和电解质假性降低。",
  "versions": [
    {
      "version": "Radiometer ABL90 FLEX",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Siemens RAPIDPoint 500",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "GEM Premier 5000",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "BD Vacutainer PST",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Excessive discard volume can cause iatrogenic anemia in small patients and does not fix the heparin contamination if the syringe itself is heparinized.",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "This can cause hemolysis and air bubble introduction, further corrupting pO2 and potassium values.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Use a non-heparinized syringe for the discard sample. After discarding 3-5 mL (or 2x dead space), attach a fresh non-heparinized syringe to collect the ABG sample. If using a pre-heparinized syringe, ensure the liquid heparin is fully expelled before filling with blood.",
      "success_rate": 0.95,
      "how": "Use a non-heparinized syringe for the discard sample. After discarding 3-5 mL (or 2x dead space), attach a fresh non-heparinized syringe to collect the ABG sample. If using a pre-heparinized syringe, ensure the liquid heparin is fully expelled before filling with blood.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Alternatively, use a balanced heparin syringe (e.g., PICO70) with minimal liquid heparin, and fill to the exact mark without excess. Do not use additional liquid heparin.",
      "success_rate": 0.9,
      "how": "Alternatively, use a balanced heparin syringe (e.g., PICO70) with minimal liquid heparin, and fill to the exact mark without excess. Do not use additional liquid heparin.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "使用非肝素化注射器采集弃去样本。弃去3-5 mL（或2倍死腔体积）后，连接新的非肝素化注射器采集ABG样本。如果使用预肝素化注射器，确保在采集血液前完全排出液体肝素。",
    "或者，使用平衡肝素注射器（如PICO70），其液体肝素含量极少，并精确填充至标记线，不要过量。不要额外添加液体肝素。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.radiometer.com/en-us/blood-gas-testing/arterial-blood-gas-sampling",
  "official_doc_section": null,
  "error_code": "ABG-HEPARIN-DILUTION",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.9,
  "resolvable": "true",
  "first_seen": "2024-08-22",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}