POCT in Critical Care Units
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Happy Friday!
I recently received an inquiry from our PICU manager about the use of point of care testing in PEDS/PICU/NICU areas. Her question was is point of care testing the standard practice for these critical care units in hospitals?
It would be greatly appreciated if you wouldn't mind sharing what point of care testing your PEDS/PICU/NICU units does, and what testing is sent down to the lab.
Courtney Matz MLS (ASCP) CM
Point-of-Care Coordinator
Clinical Laboratory
Loyola University Medical Center
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Hi Courtney!
At Children's Hospital Colorado every unit is Ped's :) We have the following:
Med/Surg units - POC Glucometer, pH paper for NG tubes
PICU - iSTAT's for all Blood Gas, Lactate and ACT testing, POC Glucometer
NICU- We are a Level 4 (highest acuity NICU) - iSTAT's for all Blood Gas, Lactate and ACT, POC Glucometer
Let me know if you need to know about any other areas such as ER, OR, Cath, etc.
I forgot to mention the iSTAT cartridge types we use in the ICU's are CG8+, CG4+ and ACT - so we run more than just gases in our ICU's, we also do electrolytes and H/H as needed, and they can recheck glucose on the iSTAT if needed.
We also have CICU doing all of the same as NICU and PICU. We do a lot of ECMO's here, so we have a separate ECMO team with their own iSTAT's, otherwise the majority of blood gases are performed by our RT's.
Very few blood gases are sent to the lab - about 95% of the blood gases are performed bedside on the iSTAT here at Children's.
For our hospitals with higher acuity, they all have blood gas capability for NICU/PICU. One hospital uses i-STAT (G3+, CHEM8), another has a Pulmonary lab with Radiometer instruments, and the third has RapidPoint 500 in NICU and PICU. Hospital 2 also has an ECMO team that will bring a GEM4000 to the ECMO site for the duration, as well as ACT. Hospital 3 also has an ECMO team, and has recently asked for Epoc due to the RapidPoint being too far away and sometimes in use when they need it. My personal belief is that NICU needs to have access to fast results for blood gas and metabolites, and only POCT can give them the TAT they need. In addition, the POC devices can use less specimen, helping out with iatrogenic blood loss.
I would, however, be delighted if we could have less platforms!
Hi Courtney,
At St. Christopher's Hospital for Children we do Glucose POC and Gastric pH for NG tube placement. We have blood gas instruments in the units, but only Respiratory runs them. We do have an iStat in the CCU but it is only used for CT patients when they first come out of surgery.
Our ECMO team has Hemochrons for running ACT, but they are only brought to the floor if there is an ECMO patient.
We are all Peds and we have the following. They use the iSTATs as needed - we have not transitioned to running all gases on the floor. Wish we would but there's been a lot of push back here on that. Would love to hear how others have transitioned to that! Also, we only do VBG/ABG on the iSTATs. No capillary.
Med/Surg units - glucometer
PICU - iSTATs(G3,CG4,CG8,Chem8, Trop I), glucometers and Hemocue(we shut the H/H off on the iSTAT years ago)
NICU- iSTATs(G3,CG4,CG8,Chem8), glucometers and Hemocue
CVICU - iSTATs(G3,CG4,CG8,Chem8, Trop I, INR for Coumadin monitoring on VAD patients), glucometers and Hemocue
We do ECMO in all these locations - we had Medtronic ACT for that.