Avox1000E Correlations & Reference Ranges

My first question would be why is the Cath Lab reporting Total HGB? I have lots of AVOX/GEM and mine do not use THGB.

We do not even do surveys on THGB.

We will still do THGB correlations....not because we are reporting it, but because that is one of the first places you may see a drop/change in the light source when you compare it to the initial install numbers.  We found one gEM that needed to be sent for service in this manner.

They use the total hemoglobin for calculations for output. 

Hi Kathleen we do use the THb in our Cath Lab ( AVOX 1000e) as well and we use the reference range that we got during initial validation and we do a 6 months correlation to check if our ranges are still valid/within range of the initial validation.

We also do CAP surveys 3x a year for our AVOX.

We do CAP Quality Cross Checks on our AVOX as well as 6-month patient sample comparisons to other mod-complex tHb methods.

As you know, you cannot "turn off" the tHb value on the AVOX display.  In my opinion it is better to include the test as a reported parameter for your lab/CLIA# because there is always the potential that they can use the value clinically, because they can always see it.  It is also useful as it may be the first indicator that there is a problem with the sample (dilution, etc.).  Since you are using it specifically for clinical calculations, you should definitely be including it as a reported test, with all that goes along with that.

Good point there is "no turn off" on tHb so you don't know if they are using it or not...

Speaking of using the tHb to detect sample collection errors - has anyone had success with improving the rate of errors in the Cath Lab setting?  Physicians draw the samples and don't want to bleed the patient dry (I see their point), but diluted samples will not give accurate O2 Sat or tHb results.  I would like to hear success stories or how a particular style of coaching or monitoring was well received by the POC staff.

Vicky McArdle

Pathology Lab Coordinator, Baylor St. Luke's Medical Center

I monitor discordant results and pass along to the dept manager, but of course this is all in retrospect as they have already responded clinically by the time I see it.  I teach about it when training (for example - caution them that if the AVOX gives the message "is this liquid QC" during patient testing that it's a red flag the sample is diluted out) so at least the quality of the tHb result is on their radar.  I don't know that there is much else you can do other than educate and continue to report suspected examples of bad samples back to the department.  Even harder to impress physicians with technical advice, as they tend to "see the result they want to see."