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Background   Measurements of ionized calcium (Ca 2+ ) at concentrations less than 0.3 mmol/L are required for postfilter control in patients who receive extracorporeal circulation with sodium citrate anticoagulation. This study evaluates the stability of the Ca 2+  measurements at such concentrations.Methods   The stability of the Ca 2+  measurements was tested by measuring daily the external standard Qualicheck concentration 3 s7950, Radiometer (0.22–0.25 mmol/L) by blood gas instruments ABL800 and ABL90, Radiometer. Two different Ca 2+  membrane lots were tested for the usual membrane lifetime of 12 weeks at ABL800 instruments. For the ABL90 instrument, the sensor cassette (with Ca 2+  membrane and electrode) was replaced after four weeks as required.Results   We observed over 40% Ca 2+  increase within the usual 12 weeks lifetime of the Ca 2+  membrane at the ABL800 instruments. Measurements of Ca 2+  at concentrations less than 0.3 mmol/L were within acceptable limits for both ABL800 and ABL90 instruments when Ca 2+  membrane and sensor cassette were replaced after four weeks.Conclusions   For ABL800 instruments, it is necessary to use an extra quality control (&lt;0.3 mmol/L) in addition to the usual quality controls to monitor Ca 2+  measurements below 0.3 mmol/L. The acceptable stability of the Ca 2+  measurements can be achieved by the Ca 2+  membrane and sensor cassette replacement after four weeks. If the usual 12 weeks of Ca 2+  membrane lifetime is maintained, it may result in a clinically significant overestimation of Ca 2+  by ABL800 instruments.

annals of clinical biochemistry

Stability of ionized calcium measurements at concentrations less than 0.3 mmol/L by point-of-care blood gas instruments: application for postfilter calcium quality control in patients with citrate anticoagulation during extracorporeal circulation