Venous blood gas parameters, electrolytes, glucose and lactate concentration in sick neonatal foals: Direct venipuncture versus push-pull technique.
Authors: Del Prete Chiara, Lanci Aliai, Cocchia Natascia, Freccero Francesca, Di Maio Chiara, Castagnetti Carolina, Mariella Jole, Micieli Fabiana
Journal: Equine veterinary journal
Summary
# Editorial Summary When managing critically ill neonatal foals requiring prolonged intravenous therapy, clinicians face a tension between minimising pain and thrombophlebitis risk through catheter-based sampling versus obtaining reliable diagnostic data. Del Prete and colleagues (2021) directly compared the push-pull (PP) technique—whereby blood is aspirated and reinfused through an indwelling jugular catheter three times before collection—against standard direct venipuncture in 18 hospitalised foals, sampling at catheter placement and 24 hours post-insertion. Results demonstrated strong agreement between techniques for blood gas parameters, electrolytes, glucose and lactate, with intraclass correlation coefficients exceeding 0.794 at 24 hours; notably, haematocrit and partial venous oxygen tension (PvO₂) showed less reliable concordance and should be interpreted cautiously when obtained via the PP method. For practitioners balancing diagnostic accuracy against patient welfare in the neonatal intensive care setting, these findings support using the push-pull technique for serial blood gas and metabolite monitoring, thereby reducing the frequency of needle sticks whilst maintaining clinically acceptable data quality—though direct venipuncture remains preferable when isolated haematocrit or oxygen parameters are critical to clinical decision-making.
Read the full abstract on PubMed
Practical Takeaways
- •The push-pull technique via existing jugular catheters is clinically reliable for monitoring blood gases, electrolytes, glucose and lactate in sick neonatal foals—reducing stress and infection risk from repeated needle sticks
- •Do not rely on push-pull sampling for haematocrit or PvO2 values; use direct venipuncture when these parameters are critical to clinical decisions
- •The technique requires proper flushing protocol (aspirate and reinfuse 2.4 mL three times before collecting sample) to minimize catheter artifact
Key Findings
- •Push-pull technique via jugular IVC produced high agreement with direct venipuncture for blood gas parameters, electrolytes, glucose and lactate (ICC >0.794 at T24, >0.907 at T0)
- •Haematocrit showed clinically unacceptable bias between methods (−3.52 at T0, −2.44 at T24)
- •PvO2 demonstrated suboptimal agreement (ICC 0.669–0.733), below the 0.8 threshold for clinical acceptability
- •Push-pull technique eliminates need for repeated venipuncture in hospitalized neonatal foals while maintaining diagnostic accuracy for most parameters