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
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Bridget and Reine - I'd also like to hear about your experience and solutions.
Danyel.olson@childrensmn.org
Thanks
Wow, I thought we were the only ones that had this problem. We went live with Nova meters at the end of October, 2019 and started getting complaints in November. We were told by Nova that these were possibly flow errors and babies that had poor perfusion, etc. By January, we decided to run our own study. Lab phlebotomists collect a number of capillary blood gases every morning to be run on our ABL835s. They routinely collect 2 capillary tubes but use only 1 of them on the analyzer. We came in at the times that the bulk of the CBGs were collected and ran the Nova meter as soon as possible after the blood was run through the ABL. We found a substantial negative bias with capillary samples. It wasn't just on the low end, it was at every point (our slope was 1.0). When brought to Nova's attention, it was pointed out that there is a way in RALS to change the intercept to raise the glucose results across the board. We changed the intercept and reran a correlation study. We have not had any complaints since.
Does that intercept change only apply to capillary samples? What about art and ven? Does anyone know if this is an option within Telcor?
We opted to use Nova Net. Does anyone know if this is an option?
We use Telcor as well. Would love to know if that change would work in Telcor.
I called NOVA about glucose results on neonates being low. OB would redraw and get a higher result, sometimes 15 points higher. I was told the baby was upset after the first draw and released glucose into its bloodstream as part of the fight or flight response.
I see in NOVANET there is an offset screen that can be used. I have never used it, really I never thought about it. I believe this will make the adjustment we are looking for.
Reine - I think we are headed in that direction. ( I also started another post NOVA and NICU). I have been looking at changing the intercept (we have RALS). A formal study is scheduled for 4 days after the Sept. holiday. I hope I get a good number of samples. I will shoot you and e-mail.
There is a place in NovaNet under instrument set up for offsets.
Hi,
I’m not familiar with Telcor but I’m pretty sure there is a spot for it. The change is sent to all the meters. The IMG picture shows where on the meter the
change is shown. Our slope is 0 and Intercept was changed from 0 to 12. We ran 2 studies one with just capillary samples (from the CBGs) and venous/arterial samples. The capillary samples (maybe because they were all NICU babies) showed a bigger bias than
the venous/arterial samples. But the venous/arterial samples also showed a negative bias, just not to the extent as the capillary samples. After we changed the intercept, we reran the correlation studies to see if it fixed the problem. We have not had any
complaints from NICU since we made the change in March.
Reine
Children's Wisconsin
Point of Care Team Lead
Phone: 414-266-6624
Fax: 414-266-3518
Email: rmakiya@chw.org
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Hi,
I am sure there is somewhere in NovaNet to change the offset. The IMG shows where on the meter the offset is in the meter (we changed our offset from 0 to
12). We did get help from Nova to determine what our offset to be changed to. We sent them our data from all our correlation studies.
Reine
Children's Wisconsin
Point of Care Team Lead
Phone: 414-266-6624
Fax: 414-266-3518
Email: rmakiya@chw.org
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I realize I am throwing another variable into the mix, but it might be helpful.
I did not buy into the troubleshooting that Nova provided. As I starting digging into the data, I realized that all the main lab results that didn't match the Nova meter were above the threshold of hemolysis on our main lab instrument (Vitros). The higher the hemolysis index, the higher the discrepancy. ALL of the values that "matched" within tEA (12.5% or 12.5mg/dL) were those under the hemolysis limit of the Vitros. Typically, you won't see glucose listed among analytes affected by hemolysis, however, the data is compelling. When you consider the collection method and volume of the peditube, it makes sense.
Our solution was to add a G cartridge to the iSTAT already in that area for the sole use of confirming Nova glucoses under 40 mg/dL (AAP recommendations, not ours).
I will also say, however, that we first explored all the most common causes for discrepancy such as collection (perfusion, alcohol contamination, testing first drop, etc) and the testing algorithm after birth (timing of testing as relates to time of birth and feeding) to make sure we were not missing significant issues. If you suspect any preanalytic issues, you would want to address those, of course, before moving forward with any other changes so as not to compound the issue.
Best of luck!
Mary
For those that entered an offset....If this was done in NovaNet-did you have to make a new facility so that the offset does not affect all monitor glucose results? If so, how do you ensure that a glucose meter that has the offset is not used on an adult? Thanks, Liz
We went LIVE with Nova at the end of February and although we do not have a NICU unit, I also noticed we had critically low glucoses followed by normal results from a lab draw. When I followed up with NOVA in May, they told me it was due to incorrect technique. I find this post very interesting.
Will you have to do a correlation with every lot number of test trips to see what the offset should be?
Donna McCalla, CLS ASCP
Point of Care Testing Coordinator
Lankenau Medical Center and Riddle Hospital
Main Line Health Hospitals
100 E Lancaster Ave
Wynnewood, PA 19096
LMC Phone: 484-476-3499
RH Phone: 484-227-3505
Pager: 5366
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We did have Nova send us a case of a different lot number to rule out test strip error. But we got the same negative bias on the other lot number too.