ACT result complaints - looking for advice!

I am following as I had a similar compliant last week from a Cardiac Cath Lab provider as well. 

Hello! Our facility had similar complaint for the Werfen ACT+. After some investigation we determined that the amount of heparin our Cath Lab was giving did not fall under the intended range of the ACT+ (ratio of 1.0-6.0 units/mL). We were informed of the ACT-low range (ACT-LR) that has a higher sensitivity for smaller heparin doses (0-2.5 units/mL). I was looking through the ListServ for ACT complaints in the past, and historically there have been cases of people having lot to lot issues with Heparin Manufacturers.

As far as I know, the iSTAT ACTc/ACtk will work with all heparin doses. Good luck!

Have you and the Dr tried looking into the posibility that the patient is heparin resistant? See attached doc.

Heparin-resistance.pdf

We had this issue last week as well.  I sent the information about the amount of heparin being given may not have fallen under the intended range of the ACT+.  Also the patient could have been heparin resistant or the heparin could have been bad.  Funny we all had issues last week.

Same issue here....Cath Lab has been seeing this since June. We've ruled out temperature, heparin lots (they've even had pharmacy order heparin from a new vendor), cuvette handling, etc. We had our Werfen Applications Consultant on site to observe technique and workflow, and while he found some minor issues, nothing was glaring. He too recommended using the ACT-LR cartridges, but we have been using ACT+ for years with no issues. Interesting to find out it is a bigger issue than we may all have thought! I will reach back out to our Applications Consultant with this for his feedback. 

I am circling back to this discussion. I use the ACT-celite cartridges on the i-STAT and I have one proficiency sample that was unacceptable a few months ago and we usually do not have any problems with this test. The reason I am concerned is that my Cath Lab was also questioning some patient results back around the same time. Do you think this is more of a Heparin issue or more of an iSTAT issue. Also should I be using the ACT-kaolin cartridges, these seem to be more popular but I am not sure what the difference is between the two? Thanks 

We are still on Medtronic ACT Plus as we have not completed the correlations to transition to iSTAT ACT-k. Our cardiologists have been complaining about having to give more heparin than they usually do to get the ACT they want. We have looked at this from every angle possible and have tried heparin from a different manufacturer. There was no noticeable difference. We have not had any QC or PT issues - we are right on the mean with different lot numbers of cartridges and QC. I personally think it may be a current heparin issue but I would think that the different manufacturer product would have shown that. 
Myself and an iSTAT applications manager have walked through their process with them in depth and provided feedback for best practices. Oh the things you discover when you spend more time with them... The timing of their post-heparin dose ACT was all over the place. Anywhere from 25 minutes to almost an hour. So we're trying to get them to clean that up and test at specific times but that's easier said than done. 
At this point, we're just trying to get switched over to iSTAT ASAP because the providers "like those results better". 

Even when you switch, I guarantee Cath Lab will question results at some point. I double down on Heparin resistance investigation and offer my correlation studies whenever this happens. It comes up every year, it seems like. When they get unexpected results, for some reason the simple analyzer is always to blame instead of the patient's complicated hemostasis status with anti-coagulants and other meds on board.  

Especially in house patients receiving heparin therapy; they can end up deficient in ATIII and then heparin can't do its job properly.

Ken, I'm definitely going to study up on heparin resistance so I'm ready for next time! We just went live with iSTAT ACTk in Cath Lab and perfusion this week. The study itself really went so well and we got good correlation stats. We ended up slightly adjusting target values for CVOR as perfusion seemed to really understand that this was not apples to apples. Cath Lab I am just so frustrated with. They are just chasing a number and I could not get them to see the big picture.