Critical Results for Blood Gases in the NICU

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Good morning,
 Does anyone have critical ranges for blood gases and chemistry tests established for a NICU?
The platform that we used is the Abbott I STAT.

Thanks

10 Replies

We use the same critical ranges across all departments, except for hematology/oncology. We do not have separate ranges for NICU. 
 | Analyte | Critical Range
| Sodium | <124 or >156 mEq/L
| Potassium | <2.5 or >6.5 mEq/L
| Ionized Calcium | <1.5 mEq/L
| pH | <7.2 or  >7.6
| pCO2 | <15 or >70 mmHg
| pO2 (arterial) | <40 mmHg
| HCO3 | <10 or >40 mEq/L
| Glucose | <50 or >300 mg/dL
| Lactate | >45 mg/dL
| Total CO2 | <10 or >40 mEq/L
| Hematocrit | <21 or >65 %
| Hemoglobin | <7 g/dL

Similar to  Danyel, we use the same critical ranges across all depts.
| Analyte  | Reference Range  | Critical Range           | Analytical Measurement Range (AMR)  | Unit
| pH           | 7.350 - 7.450          | <7.20 or >7.60 (art)  | 6.500 – 8.000  | 
| pCO2       | 35.0 - 45.0 (art)
                   41.0 - 51.0 (ven)        | <20 or >70 (art)         | 10 – 160  | mmHg

| pO2          | 83 - 108                  | <40 (art)                     | 5.0 – 620  | mmHg
| Sodium     | 135 -145                  | <125 or >155              | 80 – 180  | mmol/L
| Potassium  | 3.5 - 5.1                 | <3.0 or >6.0                | 1.0 – 15.0  | mmol/L
| Chloride      | 98 -110                                                       |   | 50 – 150        | mmol/L
| iCa               | 1.12 – 1.32  |                                                | 0.20 – 2.69  | mmol/L
| HCT              | 41 - 53   (male)
                        36 - 46 (female)    | <20.0 or >60.0          | 12% - 70  | %PCV

| HGB             | 13.5 - 17.5  (male)
                       12.0 - 16.0  (female)  | <7.0 or >20.0           | 5.0 – 25.0  | g/dL

| Glucose        | 65 - 95                   | <40 or >500             | 15 – 500  | mg/dL
| Lactate         | 0.5 - 1.6 (art)
                        0.5 - 2.2 (ven)            | >3.9                        | 0.3 – 20.0  | mmol/L

| Creat              | 0.7 - 1.5  |                                                   | 0.2 – 12 Epoc
                                                                                             0.2 - 10 Prime  | mg/dL

| BUN                | 7 - 23                       | >90                          | 3 – 90  | mg/dL
| iMg                  | 0.55 - 0.73  |                                              | 0.1 – 1.5  | mmol/L
| SO2%              | 95 - 98 (art)      
                         20 - 95  (ven)  |                                             | 30 – 100  | %

| MetHb
(Methemoglobin)  | 0.0 - 3.0                 | >3.0                        | 0.3 – 60  | %
| O2Hb
(Oxyhemoglobin)  | 94 - 97                   | <83.9                       | 20 – 100  | %
| COHb
(Carboxyhemoglobin)  | 0.0 - 4.0         | >10                           | 0.3 – 60  | %

*sorry for mess, the spreadsheet failed to paste into the form.

Danyel and Jeremy - are these ranges across all age groups?

Yes, we have a few critical ranges specifically for babies - defined as 0-30 days old or NICU.  Our NICU babies, especially the micro-premies, will be here longer than 30 days and the neonatologists wanted the ranges to stay newborn-specific.

HBG - <8.5 or >22 g/dL
HCT - >65%
Glucose - <40 or >250 mg/dL
Potassium - <3.0 or >6.9 mmol/L (critical low is same as adult)
Sodium - <126 or > 160 mmol/L (critical high is same as adult)

No, we do have age dependent reference ranges as well.  The data that I attempted to add was already a big enough mess.

All,
  What did you do to keep istat in your neonatal units after they lost FDA approval for 
capillary collections?  We switched to EPOC but I am continually getting pushback from staff noting that many hospitals continued with iSTAT.

 
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We use the EPOC and just had these approved for our  neonates.

When the blue iSTAT cartridges lost FDA approval we switched to the other cartridge types that still had FDA approval.  When the blue cartridges regained FDA approval, we brought some of them back in but instructed the staff that they could NOT run Capillary tests on them.  We also used Abbott's "iSTAT DE/ Customization" interface which allowed us to define and control the AMR ranges on the different cartridge types to keep that straight.  I'm sure you are also aware that what the blue cartridges regained FDA approval... it was with different AMR ranges than originally.
 
 We have since moved away from iSTAT ABG testing and are now using Epoc and Prime Plus.
 
Push back that other facilities are doing X thing.  My thoughts are this:  "I do not care, I really don’t.  Are they doing it correctly? Are they in or out of compliance?  Perhaps they have the infrastructure that allows them to in the way they are using it but our system setup and patient type doesn’t allow for it.  We are going to do it correctly and within regulatory compliance rules of our area for the best patient care here at our facility.”

Sorry, this is a sore spot for me and I have had this conversation with Sales Reps and staff many times.

Diana - We have always carried multiple cartridge types, so we were able to transition to one that was not affected by the recall. We also only allow capillary samples on the iSTAT at our off-site NICU in the suburbs. We have never allowed capillary use on our main campuses. Those samples are still drawn by phlebotomy and run in the main lab. There's good and bad to that but it works for us. 

Our NICU used the EG7 predominately even before the FDA issue, so it didn't affect them as much.  They do collect capillary samples on some of the babies and the docs know the sample is compromised but the are OK with that.   If they have a line then that's what's used but otherwise it's a cap sample.  We have had on occasion, some rogue CG4 cartridges that have capillary as the sample type but they get stopped in our QML.  We then send an email to the operator explaining those results will not get posted to EPIC and the reason why.

This is great information to have moving forward with all inquiries as to how some still use the istat within their areas and why we moved based on our needed testing from our neonatology group.    Thank you !

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