POC tests in Neonatal ICU
We recently moved our Women's and Children's Services to a new tower as part of our main hospital. It had previously been it's own hospital with inhouse lab services. Now that we are are one big happy family the main lab does not get NICU specimens turned around as quickly and they seem to have more specimen rejections. They now want CBC, bilirubin, and Basic metabolic done on the unit. Asides from making a satellite lab, what are others doing in NICU?
My questions to those of you with NICU's
--What if any POC testing are you doing in NICU (we currently only do CBG and pH)
--Who is performing the testing
--What options allow heel stick (iSTAT chem 8 does not allow capillary)
--Any other advice you have for what is working at your location
Thanks
Kim Ballister
| Topic | Replies | Likes | Views | Participants | Last Reply |
|---|---|---|---|---|---|
| iSTAT in NICU -chem 8, CG4 | 6 | 0 | 263 | ||
| Rotem Sigma Validation Help | 1 | 0 | 106 | ||
| Hemochron Sig Elite use outside of manufacturer temperature range | 2 | 0 | 175 |
Hello Kim,
We use Radiometer 800 currently in our NICU and they run ABG/CBG, Na, K, CL, iCa, tBil, Crea, lac, and H/H.
Respiratory Therapy or nursing staff are trained and run the samples under their log in information.
Other than the maintenance, it works really well for them. I have been considering switching to an ABL90 so that it takes less sample and less time and space, but it would also mean that they loose tBil I believe.
We use RP500 for gases plus lytes and whole blood glucose. Respiratory techs run blood gas samples on the unit or send to main lab (as backup). RNs run the whole blood glucose.
This might sound funny. Has there been group involvement on why lab hasn't met turn around time needs. Could adjustments be made to do so? I would expect the hospital would like to save all of the $$$ involved with another lab set up, maintaining and accreditation.. Have there been investigations on why there are so many redraws? What gives?
Good luck!
We use i-STAT CG8 and creatinine (rarely used). We used to use the CHEM8 before the Abbott debacle, so I'm interested to hear about any potential replacement options. The RNs and RTs do the testing.
Kim- thank you for bringing this topic. our new Women & Children services also asking for more tests/ devices to perform themselves cause we currently have only glucometers.
Colleen - do you mind if you can share how to validate or establish the iSTAT CG8'S reportable/ reference / critical range for NEONATAL? I have several iSTAT validated for CG8 on adults, but i'm struggle with BABIES since it's difficult to get the samples.
I appreciate all thoughts & advice.
thanks
Erika
i think there has been so much change in the last 6 months, the WCC tower just opened the end of February and then COVID hit and the lab has been in a tail spin ever since. I have spoken to the lab manager and they are looking at TAT's and ways to improve this area. I think the main problem is that NICU is not always #1 now that they are on the main campus where every unit thinks they need to be #1 priority. I always like to see how others are handling the same situation, I really have no desire to implement any POC testing in the NICU but I like to be prepared with pros/cons of any ideas that come up in lab/NICU meetings. They already have a radiometer on the unit, so I don't need blood gas testing, we are heavy iSTAT users in our system so we can easily implement if we wanted, just looking at what others are doing! Thank you all for the ideas!!
Hi Jill,
ABL90 has TBil but it does not have Creatinine. The RT's like it a lot so far. They had a problem with capillary samples at first but it was more of operator error.
Kim N.- most of the implementation predates me, so I am not sure how the validations were done. Our system also recently moved to standardize reference ranges, so we match the main lab wherever possible. Sorry I can't be more help!
hi Colleen,
thank you for replying...yes! i'm stucked with this step since asking for 20 NICU samples is a pain for them & i'm pretty sure it's gonna be more than 20 though....i'll continue to search for help & advice.
have a nice day, All.
Kim N.,
The validation process requires the following:
1. Accuracy
2. Precision
3. Reportable Range
4. Reference Range Verification
Are you referring to #1 above? Most people use correlation samples to prove accuracy. As long as you can prove its accuracy, it does not matter what you use. You can use calibrators, controls, adult samples, verification materials, proficiency testing materials, and etc.
Hi Kim,
We do BG (mostly capillary and lines) EG7 on the Istat, Nova glucose, gastric pH, Gastric and Stool occult bloods. The testing is performed by the nurses on the unit. They send very few blood gases to the lab, they are all done on the Istat but they do send other tests and so far (knock on wood) they haven't complained.
Following -
We went live with Nova glucose in the beginning of March days before the shut down.
Hello,
We had transitioned over to the Nova last September, but discontinued their use in the NICU because we were experiencing issues with correlation and we had a dramatic increase in the amount of (unnecessary) interventions do to falsely decreased values.
Those of you using the Nova in the NICU, have you experienced any issues?
Bridget,
We also experienced an increase in low glucoses in the NICU with the Nova meter after our switch in October. Email me and I can explain what we did.
rmakiya@chw.org
Bridget and Reine,
We went live with our Nova meters in October 2019. Recently, we are getting more instances where babies are lower on the Nova than what the serum glucose gets on our Architect and are unnecessarily admitted into the NICU for low blood sugar treatment. I would love to hear what you did/are doing to investigate this.
Thanks, Ashlee
afells@stlukeshealth.org
Bridget and Reine,
We went live with Nova about a month ago. I would be very interested to know what you are doing regarding this issue.
Thank you, Ashley
kliles@colquittregional.com