I-STAT use for blood gas: respiratory and maybe surgery

McKenna, 

Give me a call if you want to chat. I manage 6 hospitals for the ISTAT RT areas and have used most of the other gas products on the market. 
Deanna Bogner 210-297-9657

Our Resp. Ther. depts. use the i-STAT for the ICUs. Although, we had some bias issues with the Hct. Our Anesth. providers prefer the GEM5000s for ease of use and consistent results in all the ORs and the PACUs/Pre-opPost-ops. For us, they are the most maintenance free and perform QC/Quality checks between every sample.

I have used I-stat exclusively for ABG in all areas of the hospital for many years.  Once they are setup initially we have had very few issues with them.  Our RTs like the portability.  They don't have to drag a cart with a table top model with them when doing a gas.  I-stat has good expiration dates and cartridges are easy to handle.  I like the I-stat in surgery for the option of different cartridges.  CG8+ or ACT covers just about everything surgery needs.  Be sure to use CPB mode for open heart it does make a difference with the H&H.  

Hi, May I ask why your OR wants to switch from ABL 90's to i-stat or Rapidpoints?  Our Cardiac Perfusionists are using the Rapidpoint 500 and we piloted the ABL 90's. Still haven't' made a decision on whether or not to switch.  
Thanks,
Nancy

Nancy,

The only reason the OR is switching is so it can be using the same instruments as the laboratory. 
Right now, if you count the iSTATS, we have 3 different blood gas platforms. .
The ABL90s have been wonderful, we’re just trying to all use the same instruments 

We have long used the iSTATs throughout out entire system - RT is the main operator in the ICUs. I rarely hear a complaint. The wireless works great so they are really portable. 
We also use the iSTATs in the general ORs and Cath lab. Up until this year, the OR team had to do some cases at our adjoining adult hospital so they needed a very portable option. Our CVOR has long used ABLs. I do personally think that an ABL or GEM is very well suited for the ORs but you have to have the test volume to make it worth while. 

We use i-STAT's in both our Open Heart and Main OR's, Pre/Post surgery area, all Intensive Care units and a couple of inpatient units.  In the Intensive Care units the testing is performed by Respiratory, all other locations the testing is done by the RN's.  We have ABL90's in the Main Lab, ETR Lab and the NICU Lab.

Our respiratory team uses iSTATs and Rapid Point. Our iSTATs are used in the OR, ICU, NICU, Cath Lab, and PACU/PreOp, typically if the sample volume is low or there's insufficient time to get the sample to a RapidPoint. Our comparison studies over the last 2 years have shown very little deviation in terms of results between the two platforms. 
For what it's worth, we are considering switching entirely to iSTAT. 

Nicholas ,  interested in how you approved the iStat for use in your neonatal intensive care unit?.  We switched from i stat to EPOC in 2021 when istat lost FDA approval for capillary specimens.  I was told they did not intend to seek approval for capillary specimens.  Has this changed?

Thanks

Diana, we also brought on the EPOC for around 11 months until FDA approved iSTAT cartridges for capillary use. 
Not sure if it was a specific cartridge that iSTAT was not seeking approval for.

We use EC8+, CG8+, and G3+ (soon to be CG4+ since G3+ is no longer EUA'd) on our NICU iSTATs. 
Our current sore spot is CHEM8+ since they are venous or arterial only. We don't run many in NICU, the only advantage is creat and direct TCO2.

It was my understanding that the CG4 is only approved for venous and arterial. I see they do still have the IFU for the white CG4, which is approved for capillary but I thought they didn't sell the white CG4's anymore.

I previously used a blood gas analyzer with a conductivity based Hct and a calculated Hgb method (the old ABL80, but iSTAT is also conductivity-based) and thought it was a very bad fit.  Lots of discrepancies in values as compared to direct-measured H/H - so much so that they pretty much stopped relying on it.  I chalked it up to the various fluid/infusion manipulations that are common to the OR setting that makes those patients particularly vulnerable to the discrepancies (because my q6-month comparisons were always fine).  As soon as the ABL90 became available, with a direct-measured tHb, I have seen far fewer instances of discrepancy.

We have used the i-STAT for the floors, ICUs , EDs and Peds units for about 10+ years and in the past year experienced "real" Hct issues (unacceptable + bias compared to CORE Lab) to the point that we had to add Hemocues and block the reporting of i-STAT Hcts. We are an academic medical system with multiple hospitals, free-standing EDs, Off-site surgical facilities, etc. This is something to be mindful of when you get complaints about i-STAT Hct issues. And now the G3+s have not been FDA approved since COVID emergency use and we have to seek an alternate cartridge. We have lost our credibility with Abbott.

A little late on the reply, but the CG4+ white cartridges are available and in our inventory right now. 
They do have a different order number, so be mindful if you plan to bring on the CG4+ to replace the G3+.

For iStat capillary testing in NICU, it's possible to run it as a moderately complex modified test. You can use all the data you have and Abbott's validation data for your records, you just classify it as modified since there is no FDA approval (yet). The same goes for any samples collected in non-heparinized syringes (we limit that to only CVOR since they run CG4, Chem 8 and ACT testing during open hearts).
We use the iStat platform across the facility. NICU, ICU, OR, CVOR, Cath Lab and we keep our Radiology as moderate complexity for CT and MRI since we can't guarantee they won't collect a sample with a syringe. Only complaints we get are usually operator error related. Always in units where test volumes are low. We've always run CG4 and Chem 8 cartridges so we haven't had to onboard anything new or switch a cartridge.