Intra osseous blood sample on the ISTAT
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I am reaching out to any of you out there that handle pediatric traumas. My hospital just recently opened a trauma unit in the emergency department. The trauma docs want to run intra osseous "blood" (it's actually bone marrow) in critical situations where they cannot obtain venous samples. Accepted ISTAT sources include only arterial, venous and capillary. Are any of your hospitals running IO samples and if so, how did you complete the needed workup prior to beginning what would be a high complexity test?
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IO samples are different from venous blood. If they are using EZIO, the vendor has a white paper which states how the samples differ from venous blood. The biggest Chemistry differences are NA and K.
Hematology is where it is really scary...the IO blood looks like leukemia since it comes from the bone marrow.
The nurses have been taught that IO blood goes only to the lab marked as such. I think that the pathologist has had discussions with the ER docs about IO blood and lab testing. Hemo occasionally stops one that a CBC is ordered upon. We do not receive IO blood very often-but we are not a trauma hosptial. They mainly use it for quick fluid interventions when an IV is tough to start.
We have had this issue before, typically they put OTHR in as a sample type and we catch it that way but not always. We tell them it is not allowed for the same reasons as Deanna stated; it's not the same as circulating blood, especially for blood gases. ivy
Just throwing this out there (because I have no knowledge of what pediatric trauma is like)...I can understand why venous access could be compromised in a trauma situation, but isn't arterial an option? Can't you, in any situation, obtain arterial blood? Just thinking about what might be the easiest path for all involved.
The way I understand it, IO is quicker than arterial. My management has reached out to several pediatric hospitals and so far the answer is NO to IO, but only a few heard from. The trauma docs have received word (from other trauma docs) from one or 2 that say that they perform IO samples but I have to wonder if POC/lab is actually aware of it.
Interesting, Debra. I'd bet you're right; the docs may be performing this on IO but lab is not aware. C/W the prevalent attitude of "I'll decide whether it's right or not" that most physicians espouse, lol.
The only way that I found out about this is because I sit in ER comps and was stationed beside the EZIO rep over the course of about 3 years.
From our hospital, and we are not a trauma, it is a tool for the ER people that is in their arsenal to deliver needed fluids and drugs quickly. Consquently, it may not be used often. One of my 5 adult side ER areas reports using it about 2 a month.
But...the nurse I talked to pointed out that the ER does not have to use EZIO very often because EMS has used it to start access. When I asked if the ER then sent the blood from EMS to the lab....the answer was "Maybe....sometimes...."
My guess is that the lab is not as aware as they need to be.