hCG testing in emergency departments

In your emergency departments are nurses performing hCG testing? If yes, what test are you using? How do you handle the limitations of the test with the nursing staff?

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Are you talking blood or urine?

Hi Linda,

Check out the ADEXUSDx hCG Test (https://nowdx.com/adexusdx-hcg-test/).

It is blood based and uses 1 drop of capillary or venous whole blood, plasma, or serum. It is a moderatly complex today (CLIA Waiver pending). No extra equipment needed, stores at room temperature, and detects pregnancy at 10 mIU/mL. My email is morgan.peterson@nowdx.com if you want more information.

We use the Cardinal SP brand urine preg kits performed by nursing. At my previous institution we required a urine specific gravity with every urine preg, and any result below 1.010 had to be canceled and a serum preg sent to lab for a quant. At my current institution I have not implemented that requirement yet and I am not sure if I will be since it is pediatrics, but the majority of our ED pregs have a tandem UA so once I evaluate the data to see how often the SPG is low I may decide to implement that here as well.

We report a SG with all urine hCG in our main lab, but not POC.  I did a study one time at my facility with regard to low SG and had an incidence rate of about 10% for urines with S.G. <1.010.  Given that, I dropped the SG requirement with POC and opted for a disclaimer about 'urines with low SG may not contain representative amounts of hCG.'  If it was an hCG only it seemed too wasteful to report out an entire urine dip just for SG and using a refractometer adds CLIA moderate complexity testing to the mix.  Didn't seem worth it, all those things considered.

 

 

 

This is the Siemens response to using the hCG cassette on the Clinitek Status- They go to <1.003




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Which is sort of interesting, considering the Clinitek STATUS only reports in increments of 0.005, with a lower limit of 1.005!

I also use the cardinal health hcg kit for urine testing only in the ED dept. I instruct them to also dip a urine multistix for the spec grav and it is entered in the EMR with the result and internal control (C line and clear white background). I also have the disclaimer about the low specific gravity. Probably overkill and I haven't had a single JC inspector ever ask me about waived testing during inspections.

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