i-STAT CA++
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I was wondering, for those of you who use i-STAT for ionized calcium testing, what is the acceptability for draw-to-test timing? Does icing the sample elongate this or has no affect and is this documented with Abbott?
Thanks!
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Here's what the iSTAT Procedure manual says:
Precautions: avoid the following circumstances
I had found this under the arterial puncture procedure, but it is also in the venous:
Time to Test "Samples for pH, PCO2, PO2, TCO2 and ionized calcium should be tested within 10 minutes. Other analytes should be tested within 30 min." Lactate, PT/INR, and ACT should be tested immediately.
Sample on Ice "Fill the cartridge before icing the sample for transport. Icing will increase the potassium and will affect oxygen levels in samples collected in plastic syringes".
Our lab did a special study on iCa a few years back and determined that we could safely perform them within 2 hours of collection. This study was only for lab performed iCa, not those actually performed as point of care (not all of our units have or desire the ISTAT). All other requirements stay intact, including room temp and correct volume in the heparin tube. The lab's chief pathologist (Medical Director) signed off on this change.
Our Lab requires iced sample for iCA but since iSTAT is designed to run samples not iced, iCA must be done immediately. I always presumed the no ice issue was due to specified timing of testing and ability to warm the sample to 37 degrees within that time frame. Ivy
I have not ever heard of an icing requirement for iCAL.
In my experience, the largest effect on iCAL values is sample exposure to air. Hence the "full tube" requirement. You will see values change considerably after the tube top is removed and the ambient air causes the pH to rise and the iCAL to fall.