92 ANESTHESXA . . . Current Researches VOL.51, No. I, JAN.-FEB.

,1972
AXD ANALGESIA

WILLIAM EVERS, M.D., M.Sc.

GABOR B. RACZ, M.B., Ch.B.
ASHLEY A. LEVY, Ph.D.
Syracuse, N e w 'fork"

T HE introduction of disposable plastic
syringes poses a problem in the area of
blood-gas analysis, for which glass syringes
have previously been used. Presently, glass
is being phased out in many institutions for
reasons of economy and convenience. The
uncertainty about how a new syringe mate-
rial may idhence the gas exchange between
blood samples and room air is a cause for
concern.
This study was undertaken to determine
whether plastic (polypropylene) syringes
are suitable and convenient for blood-gas
analyses. Assessing the permeability of the
plastic syringe to oxygen and carbon diox-
ide was the most important aspect. The
question of availability was also investi-
gated. Also, the tightness of fit between
plungers and barrels becomes a considera-
tion in arterial flow-back.
MATERIAL
One hundred paired sets of blood samples
were analyzed, using 500 each of the fol-
lowing syringes:
1. Monoject 512, 10 ml., polypropylene
(Sherwood Medical Industries) .
2. Interchange 4N, 10 ml., glass (Eisele
Company). All syringes had standard Luer
tips (not Luer locks).
METHOD
To simplify and to speed up sampling,
as well as to insure maximal uniformity of
compared samples, the following method
was used: 50 ml. of venous blood was drawn
into a 100 ml. heparinized syringe and ex-
posed to a 9O:lO mixture of 0xygen:carbon
dioxide. The syringe was gently rotated for
a period of 5 minutes, after which the blood
was transferred via a sealed multiconnedor

*Department of Anesthesiology, State University Hospital, State University of New York, Upstate Medi-
cal Center, Syracuse, New York 13210.
Syringes for Blood-Gas Analysis . . . Evers, et a1 93

FIG.1. Technique of distribution of blood samples.

to five glass and five plastic sample syringes
(fig. 1).The 10 sample syringes were then
divided into five groups, each consisting of
a glass syringe and a plastic syringe. PO,,
Pco,, and p H were determined on an In-
strumentation Laboratories p H gas anal-
yzer, Model No. 113, using a Severinghaus-
type carbon dioxide electrode and the Clark
polarographic oxygen electrode. Precision
gas mixtures were used for calibration.
Readings were made according to the fol-
lowing schedule:
Group 1: Immediately after sampling.
Groups 2 through 5: Syringes were stored
in a constant-temperature refrigerator (4 to
4.4" C.) and read a t 1/2, 1, 2, and 4 hours,
respectively.
The mean, standard deviation and stan-
dard error of the mean were calculated for
each group of measurements. The difference
in Po, was calculated between the glass and
plastic syringe of each group. This differ-
ence is shown by the symbol A.
For statistical analysis, the following as-
sumptions were made:
1. Since plastic syringes are the "new-
comers" to this work, the values obtained
from the glass syringes were taken as base-
lines, and it was assumed that differences
between the glass and plastic values could
be ascribed to the greater permeability of
the plastic syringes, as well as to random
error.

II
I
* WILLIAM EVERS,M.D., Professor of Anesthesiology a t
the State University of New York, Upstate Medical Cen-
ter, Syracuse, New York, received his medical degree from
the Federal Institute of Medicine in Samarcand, U.S.S.R.
I
He was a Resident in Anesthesiology a t the University
: of Minnesota Graduate School of Medicine, Minneapolis,
I where he earned the degree of M.S. in Anesthesiology.
94 ..
AND ANALGESIA Current Researches VOL.51, No. 1,JAN.-FEB.,
ANESTHESIA 1972

2. Atmospheric Po, was taken as 150
torr. For values of Po, in the glass syringes
greater than 150 torr, diffusion from the cor-
responding plastic syringes would be out-
ward. Conversely, for Po, values below 150
torr, diffusion would be inward. Conse-
quently, Po, A values were treated as
“glass minus plastic” above Po., values of
150 torr, and “plastic minus glass” below
150 torr.
3. For syringes in group 1, differences
between glass and plastic should have a
mean of zero, if the only effect is random
error.
4. If plastic syringes are, in fact, more
permeable than glass, A values should be
zero at Po, = 150 torr, and should become
progressively greater as PO, values diverge
from 150 torr in either direction. Thus, plot-
ting A values against Po, values of the
glass syringe should give a straight line, the
slope of which will be dependent on the
relative permeability of the plastic syringe.
This is an obvious corollary of the rate of
diffusion being proportional to the concen-
tration gradient, other factors being con-
stant.
5. Furthermore, the quantity of gas dif-
fusing in or out will be proportional to the
duration of storage, as long as the change
in partial pressure is small enough not to
alter the concentration gradient significant-
ly. Thus, the slope of the plot of the a

TABLE 1
Storage Data
Po? linear regression equation* Pcoz linear regression equation”
Duration of Slope t 95 percent Constant Slope f 95 percent Constant
storage, minuter confidence interval confidence interval
~

0 0.0157 r+ 0.0199 -0.003 0.0412 k 0.0516 -1.322

30 0.0282 t 0.0179 -1.288 -0.0273 +- 0.0545 0.127
60 0.0338 t 0.0158 -3.691 -0.0309 f 0.0532 -0.048
120 0.0397 2 0.0142 -2.559 0.0024 20.0549 -1.352
240 0.0345 t 0.0203 -1.702 -0.0201 k 0.0542 -0.552
:%near regression equation has the form A = slopex p (gas) + constant.

0.04
I
r
e,“f

0.01

I d 30 €30 120 240

Duration of Storage, minutes

FIG.2. PO,slopes and 95% confidence intervals.

Syringes for Blood-Gas Analysis . . . Evers, et a1
0.12
0.08
0.04
0"
To -0.0
-0.0
0 30 60
Duration of Storage, minutes
FIG.3. pC09 slopes and 95% confidence intervals.
against Po, should increase almost linearly
with duration of storage.
6. The above assumptions hold equally
for the Pco, measurements, except that at-
mospheric Pco, has been taken as zero.
These effects were measured statistically,
and the results are given in table 1. For the
Po, measurements, there is a definite non-
zero slope, statistically distinguishable from
zero for all periods of storage, except for
group 1, which is statistically not distin-
guishable from zero. Figure 2 shows the
slopes with their 95 percent confidence in-
tervals as a function of storage time. It can
be inferred that after 4 hours of refrigera-
tion, the slope of the A Po, graph will be
0.04. This means, to take a rather extreme
example, that if a blood sample with a Po,
of 750 torr were to be stored in a plastic
syringe for 4 hours under refrigeration, A
would have a value of 0.04 x (750-150) =
24 torr, a reading 3.2 percent lower than
would be obtained in a glass syringe.
The Pco, measurements negate the con-
sequences of assumptions 4 and 5. There-
fore, it is concluded that measurements in
glass and plastic syringes cannot be dis-
tinguished statistically, in view of the fail-
ure to demonstrate statistically significant
95
120 240
slopes of the A Pco2 graphs for any of the
five groups (fig. 3 ) . The improvement in
performance of the plastic syringes when
dealing with Pco, over Po, measurements
may be ascribed to the far smaller range of
Pco, values dealt with. Slopes of the A
Po, graphs obtained were statistically in-
distinguishable from zero, reinforcing the
conclusion that over such relatively limited
ranges, A values do not change significant-
ly, whether for Po, or for Pco?.
RESULTS
Diffusion of Gases.-Values shown in
table 2 are interpreted as follows:
1. pH: The blood in both the glass and
plastic syringes showed a regular but slight
drop in pH, with the drop somewhat more
rapid in the plastic syringes. However, the
magnitude of the drop (0.009 for glass,
0.014 for plastic, both over 4 hours) is com-
parable with the standard error (typically
0.009) and statistically not significant.
2. Pco2: This value in both types of
syringe showed a similar pattern: a fall in
the first 30 minutes, followed by a steady
rise. However, differences between glass
and plastic syringes were too small to be
significant.
96 . . . Current Researches VOL.51, No. 1, JAN.-FEB.,
ANESTHESIAAND ANALGESIA 1972

TABLE 2
Diffusion of Gases
Glass Syringes
A 30 min. 1 hr. 2 hr. 4 hr.

PH 7.352 7.352 7.351 7.348 7.343

0.096 0.141 0.097 0.103 0.098
0.009 0.013 0.009 0.010 0.009
PCOJ 41.48 39.52 39.64 40.55 42.06
12.08 11.54 11.76 11.63 12.02
1.13 1.08 1.10 1.09 1.13
Po, loo%* 94.87 93.13 95.34 95.20
0 18.42 22.04 25.56 35.92
0 1.72 2.05 2.37 3.34
Plastic Syringes
PH 7.351 7.349 7.346 7.343 7.337
0.097 0.097 0.098 0.095 0.096
0.009 0.009 0.009 0.009 0.009
Pco. 41.04 40.49 41.20 41.81 43.43
11.99 11.72 11.82 11.72 12.28
1.12 1.10 1.11 1.10 1.15
Po, 100%” 97.07 95.35 96.00 96.91
0 18.00 17.91 19.31 24.66
0 1.67 1.67 1.79 2.29
*See text for interpretation of results.
Values tabulated: mean, standard deviation, and standard error of mean.

3. Po,: In view of the large range of
Po2 covered by the blood samples in the
study (54 to 490 torr) , each value of Po2
was adjusted to a percentage based on the
value for the zero time blood sample being
100 percent. This had the effect of reducing
the standard deviations and standard errors
to values small enough to be meaningful.
From both the glass and plastic syringes,
there was a loss of oxygen from the zero
time level within the first 30 minutes. Once
this loss occurred, there seemed to be no
further marked change in Po,. Further, the
plastic syringes seemed to lose slightly less
oxygen than the glass, although the differ-
ence was not statistically significant.
Ease of 0b ta ining Samp1es.-Plas tic syr-
inges: The plunger moved fairly easily in
the syringe barrel once the “suction-cup”
effect was broken. The latter proved quite
annoying and required preliminary “crack-
ing,” that is, disengagement of the plunger
from the closed position.
DISCUSSION
The change from reusable glass syringes
to disposable plastic has been rapid. Al-
though plastics are permeable to gases, the
permeability varies from one plastic mate-
rial to another.1 When disposable plastic
syringes first appeared on the market, they
were mainly of polystyrene. However, since
1965, polypropylene syringes, which are
lighter, stronger, more flexible, and more
impact-resistant, have been replacing poly-
styrene.
Few documented data are available on
the gas diffusion between plastic syringes
and room air. Fletcher and Jergen,z com-
paring glass with polystyrene syringes,
found a threefold greater oxygen loss from
the plastic syringes. Laver and Seifen,3 on
the other hand, stated that plastic syringes
can be used for blood-gas analysis if no de-
lay in reading the results is foreseen.
The main causes for blood-gas changes,
once the blood is drawn into a syringe, are:
1. Diffusion through syringe walls: Dif-
fusion through standard glass syringe walls
is slower than through plastic. In plastic
syringes, the diffusion varies with the ma-
terial and thickness of syringe walls (table
3).
Syringes for Blood-Gas Analysis . . . Evers, et a1
TABLE 3
Comparison of Some Chemical and Physical Properties of
Polypropylene and Polystyrene
-
Specific gravity
Permeability t o gases m1./100 sq. in./mni. thickness
24 hr./atmosphere at 25” C.
Carbon dioxide
Oxygen
W a t e r absorption 24 hr./percent
Resistance rating
Strong acids
Strong alkalies
2. Leakage between syringe plunger and
barrel: In plastic syringes fitted with flex-
ible neoprene stoppers on the plungers,
leakage along the barrel-plunger interface
appears much less than in the “multifit”
glass type.,
3. Continuing cellular metabolism, which
contributes to a lowered Po, and pH and
increased Pco2: This process slows down
rapidly as the blood sample is chilled.
CONCLUSIONS
No statistically significant difference was
seen in blood-gas data obtained with poly-
propylene and glass syringes. Diffusion of
gases through the syringe wall is not a sta-
tistically or clinically significant problem.
Obtaining arterial blood samples, on the
other hand, is more difficult, as the “suc-
t i o n - ~ effect
~ ~ ’ in
~ plastic syringes prevents
free back-flow. Therefore, a glass syringe
may still be preferred for the single arterial
blood sample. However, the current trend
in continuous patient monitoring, using in-
dwelling arterial cannulae, makes plastic
syringes convenient and acceptable. In these
instances, the traction necessary to initiate
blood flow will not dislodge the arterial
cannula.
The hours t h at make us happy make us wise.
97
Polypropylene polystyrene
0.885 to 0.895 1.05 to 1.06
800 900
240 350
c0.005 0.04 to 0.06
Excellent Good
Excellent Exeellent
SUMMARY
Five hundred paired serial PO?, Pco,,
and pH determinations on 100 arterialized
blood samples were made, using glass and
polypropylene syringes. No statistically sig-
nificant differences in data were found be-
tween the two types of syringes. The auth-
ors conclude that polypropylene syringes
can be used in lieu of glass syringes where
the inconvenience of the “suction-cup” ef-
fect is not a factor.
ACKNOWLEDGMENT
The authors wish to express their grati-
tude to Sherwood Medical Industries, Inc.,
for a grant-in-aid that made this study pos-
sible, and to Dr. B. L. Valentine, Director
of Biological Safety of Sherwood, for his
assistance in supplying the technical data.
REFERENCES
1. Modern Plastics Encyclopedia 1969-70. New
York, McGraw-Hill Book Company, vol 46, p 988
2. Fletcher G, Jergen LB: Effect of sampling
technique on the determination of Pao, during
oxygen breathing. J AppI PhysioI 21:463-468, 1966
3. Laver MB, Seifen A: Measurement of blood
oxygen tension in anesthesiology. Anesthesiology
26: 73-101, 1965
-John Mascfield