Specimen Requirements

Patient should be sent to Saint Luke's Hospital Laboratory to have this test performed.

Procedure: 

1. Note the patient’s systolic (upper number) blood pressure which has been entered when the order was placed.
    
2. Without applying a tourniquet: Draw a baseline venous Ammonia (green top) and Lactic acid (green top) in 3ml. tubes and place tubes immediately on ice.
    
3. Control patient’s bleeding and place tape on patient’s arm.
    
4. Place blood pressure cuff on the drawing arm.
    
5. Inflate the sphygmomanometer 20-30 mm Hg above the patient’s systolic blood pressure.  Deflate cuff immediately if acute cramps develop.
    
6. With the cuff inflated, have the patient vigorously exercise his/her drawing arm hand by fully extending fingers and squeezing every two (2) seconds until the patient is completely fatigued or two minutes.  The patient may require encouragement to successful attain the necessary level of fatigue and should exercise for at least 60 seconds.
    
7. Deflate the blood pressure cuff.  Without a tourniquet, immediately draw ammonia and lactic acid tubes and place on ice.  This is time zero.  Repeat at 1, 2, 5 and 10 minutes.  The 0, 1, and 2 minute collections can be performed with a single butterfly needle set left in place for all 3 time points.

Specimen Collection:

Draw blood in a green-top (lithium heparin) tubes and send both tubes. (Sodium citrate or hemolyzed specimen is not acceptable.) Immediately place specimens on wet ice. Tubes should be filled completely. Keep specimen anaerobic (do not open or transfer).

Note:  Label each specimen with patient’s name (first and last), date of birth, and date and actual time of draw.