I-stat point of care testing

[amyl]

Does anybody in pp use the I-stat poct abg machine? If so do you have your own clia license? My hospital has one but they don't want anesthesiologists to use it, only perfusionists, who we rarely ever use. They say we can't use it because I would have to go on the pathologists clia license - anybody know anything about all this?

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[bostonblaz]

We have it. The or nurses run the samples in the room. All I have to do it ask for it, they get it from the core and start it. I draw blood and hand them the syringe and they do the test and hand me the print out. It is a nice way to get labs. Blaz

 

[Noyac]

We have it. No extra license needed. But beware, the values are frequently off.

 

[OB1🤙]

I trust the ABG values generally, but the true hematocrit is always 2-3 points higher than the i-stat value. This has been true in every place I have worked in.

As for licensing. I have no idea. I tell the tech to run an i-stat and they do.

 

[BobBarker]

We run them ourselves at my academic place. Annually, we have to show the i-stat lady that we still know how to do it to keep up our "authorization".

 

[amyl]

Thanks

 

[Noyac]

I trust the ABG values generally, but the true hematocrit is always 2-3 points higher than the i-stat value. This has been true in every place I have worked in.

As for licensing. I have no idea. I tell the tech to run an i-stat and they do.

Exactly. Why is this?
I don't like to use it when I know the value is gonna be low because then I have to explain to whomever that I'm not transfusing based on iSTAT numbers. They always look at me funny then continue in working. They usually transfuse after the case for some stupid reason. It seems like our surgical colleagues don't read the same literature as we do.

 

[amyl]

Is that everyone's experience? Istat runs low on hct by a couple points? You have no idea how arduous a task it is in my hospital to get an abg or h/h stat in the OR so I'm desperate to have this available. My hospital owns one but won't let me use it - citing clia issues - but it's on the waived clia poct list.

 

[IlDestriero]

They just don't want the hassle of doing your annual competencies. Volunteer to do it for them and see if they change their tune. I've had it at every place I've ever worked. If you are doing trauma, transplant, cardiac, that data is absolutely useful. You can run a HemoCue and an Istat and be acting on the result before the techs get a sample to the lab.

 

[IlDestriero]

Maybe start sending stat samples q30 min, for H/H and ABGs in 15 min intervals for every major case until they buy you one.

 

[amyl]

We have one.... Already. They just don't want to let me use it. We are in the process of becoming a level 3 trauma center but we do vascular and thoracic and we do have the sickest pts in the world. Everyone smokes and is morbidly obese, can afford cigarettes but not their medicines, hasn't seen a doctor in years.... Seriously you wouldn't believe what ends up in my OR.
To get an abg the nurse has to call RT to come get the sample from where ever they are on the floor. The nurse then leaves the ors area to hand off the abg to the RT who runs back up to the floor to run the sample. RT runs it. If something is critical they call us but otherwise the nurse has to leave the room to look it up on the computer or call the lab to get the values. The whole thing takes forever!

 

[G0S2]

We go through a brief training seminar and take a test. It's kept in the anesthesia office and when I place an art line I bring the machine and a couple of cartridges with me. Easy to use.

 

[batina17]

We have one, and the lab put up a big stink to try and prevent us from getting it- the problem is all the correlation studies they have to run on it all the time - lots of work for them.

 

[BobBarker]

We have maybe 12 machines for 22 ORs. Our department probably runs at minimum 30 cartridges a day.

 

[Noyac]

We have maybe 12 machines for 22 ORs. Our department probably runs at minimum 30 cartridges a day.

Holy ****. What kind of cases are you doing that need that many tests intra op?

 

[DreamLover]

Does anybody in pp use the I-stat poct abg machine? If so do you have your own clia license? My hospital has one but they don't want anesthesiologists to use it, only perfusionists, who we rarely ever use. They say we can't use it because I would have to go on the pathologists clia license - anybody know anything about all this?

Same for me. Only our perfusionist can run them and are certified. I always ran my own in residency for ABGs and ACTs but not in practice. I asked about it as well and was told it wasn't an option to get certified. Honestly, with the hoops I have to jump through to remain eligible to use the accucheck, I didn't want to force open that can of worms.

 

[cchoukal]

We have one.... Already. They just don't want to let me use it. We are in the process of becoming a level 3 trauma center but we do vascular and thoracic and we do have the sickest pts in the world. Everyone smokes and is morbidly obese, can afford cigarettes but not their medicines, hasn't seen a doctor in years.... Seriously you wouldn't believe what ends up in my OR.
To get an abg the nurse has to call RT to come get the sample from where ever they are on the floor. The nurse then leaves the ors area to hand off the abg to the RT who runs back up to the floor to run the sample. RT runs it. If something is critical they call us but otherwise the nurse has to leave the room to look it up on the computer or call the lab to get the values. The whole thing takes forever!

That sounds nuts. Call me a coward, but I would be very uncomfortable practicing in an environment where I didn't have rapid access to ABGs. In the modern era, one way to move things forward is to mention the words "Quality," "Safety," or "Access." I wonder how hard it would be to come up with a clinical scenario that got dangerous very quickly for lack of timely labs.

 

[Monty Python]

We have one.... Already. They just don't want to let me use it. We are in the process of becoming a level 3 trauma center but we do vascular and thoracic and we do have the sickest pts in the world. Everyone smokes and is morbidly obese, can afford cigarettes but not their medicines, hasn't seen a doctor in years.... Seriously you wouldn't believe what ends up in my OR.
!

Geez, you wouldn't be in New Orleans would you? Sounds like pre-Katrina Charity Hospital, my old stomping grounds.

 

[epidural man]

It seems like our surgical colleagues don't read the same literature as we do.

I am sure they do, but I think their standard is different.

I bet they do it to make the patient feel better. HBG 0f 8 vs HBG of 10 probably feels a lot different.

 

[Noyac]

. Everyone smokes and is morbidly obese, can afford cigarettes but not their medicines, hasn't seen a doctor in years.... Seriously you wouldn't believe what ends up in my OR.

Trust me I know what kind of cases you are describing. I've worked in two areas that are probably as intense as any area in this country. From the gun and knife club, high speed MVAs to the exact same population you describe.
But I don't think an iSTAT is necessary for every case. It is a good tool to give you additional information but we all know the the numbers don't tell you the entire picture. I feel like the current trainees come out wanting to focus on these numbers rather than the case at hand.

 

[sevoflurane]

IDK. I've yet to use an istat in PP outside of the heart room. This includes ruptured AAA's, MVAs, GSWs, etc.
We can get our stat labs back pretty quickly though.

 

[BuzzPhreed]

I've noticed iStat being "off" on the margins. That is when the Hb is below 7.5. In that point in the case you're probably going to give blood anyway. I think it's a useful tool. I understand why labs hate it too.

 

[epidural man]

I really like iStat for lactates. I don't know how inaccurate they are, but they seem to trend correctly.
It is also very useful for potassium and calcium, PaCO2. These are values that really will direct my care.

 

[BobBarker]

Holy ****. What kind of cases are you doing that need that many tests intra op?

We typically have 2-4 crani's, 2 exsanguinating abdominal/thoracic traumas, 1-2 whipples, 1 heart, 1 lung, 1 free flap, and a variety of s/p trauma long term ICU players, gyn/onc disasters, and open long bone fractures.