Avox - POC or respiratory?

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Our facility has the director of respiratory handle all things blood gas. Cath lab has mentioned getting an AVOX machine. I am curious on opinions if POCC should oversee or if respiratory should. 

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Our AVOX instruments in cath lab fall under me for POC, but I also over see all blood gas instruments as well. 

Hello, I am out of office and shall return 7/22/2024. If you require immediate assistance, please contact the main lab at 5872 for Southlake and 4247 for Northlake. Thank you.

Monika Bibbs, MHA, H(ASCP)

Lab, Point of Care Coordinator

Southlake Campus

(219) 757-7340

Northlake Campus

(219) 881-5183

mbibbs@methodisthospitals.org
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In my facility the AVOX is POC. Since the device is not being used by the respiratory therapists it falls under POC. Our blood gas analyzers are only ran by respiratory therapists, so they fall under respiratory (which still falls under the lab but at a higher level).

I oversee the Avox in our Cath Lab, but Respiratory oversees their own blood gas (GEM 5000), they have a different CAP # as well.  

That makes sense. Thank you all for your input!

At our facility, we have ABL90's.  POC oversees Cath Lab / EP Lab and respiratory oversees their devices.

AVOX is a pretty crude machine, by current POC standards, in that there are not a whole lot of lock-out options that you can set to ensure compliance when you're not there.  That said, I would say it is better under the auspices of an experienced POCC as opposed to a Respiratory department, where there are other patient-related priorities and distractions.

I have to completely agree with James on his statements and is why other system are moving to more modern systems.

To answer the proposed initial question, the first question must be asked: does the Cath lab/Respiratory have their own licensure to perform co-ox testing?  if not it absolutely falls under the lab licensure and most likely the pathologist that is on the CLIA.   Respiratory staff while typically much better at testing as a whole than other non-laboratorian depts but also don't typically understand or are even aware of all the regulatory requirements needed to be followed to maintain its use. 

Agree with Jeremy above which is why as POCC I even over see the GEM 5000s that the RTs and perfusionists use. 

Can I ask what other systems facilities are moving to instead of the AVOX? Something you would recommend or familiar with?


"Modern systems" What does that mean? Lock out of operators and interfacing? 
 
AVOX serves the patient and the cardiologist in a faster manner from result to reset than other instruments that perform OXYHGB can. While it is a spectrophotometer essentially, it is reliable and cheap by cost per test.  

Also, for us in San Antonio, it was invented here. The inventor used to train my Cath Labs in the late 1990's.

Breana, We use the Nova Prime Plus, similar systems include the Werfen GEM 5000 or the Radiometer ABL systems.  Be fully aware that moving away from the Avox to another system will guarantee resistance out on the floors, see below.  

Deanna, "Modern Systems":  systems designed around todays regulatory requirements with improved safeguards.
Yes, the Avox can do a test in 10 seconds... but thats about all its got going for it besides its historical dominance in the industry.  It was really the only system available for use for a very long time.  Which is why most practitioners nearly all demand it.  "I did my physician internship using it 30 years ago" = "I'm most familiar with it and haven't used anything else or are aware of the benefits of others, andI don't like change"
*IF* you have a small user database, which follows QC requirements "to the Letter" religiously, have few to no sample issues it is possible that the Avox will fill your depts. needs HOWEVER:
More modern systems have more features, safe gaurds and benefits that the avox simple does not have the capability for.  Examples include:
  • QC lockout - if the QC isn't in, it will not provide patient results
  • A bi-directional interface that allows user database to be controlled remotely.  The Avox user database must be managed at each analyzer individually, in larger systems this very quickly becomes impossible.  This means at larger facilities that it must be "open" for use to all... huge regulatory compliance issues.
  • Internal test system checks.  These analyzers will take internal checks within the loading and testing phases to confirm the sample integrity.  We very quickly found that after switching to the newer system that they would occasionally not provide results on NICU babies on high intralipid transfusions (essentially nutrition via IV).  Any Medical Technologist can quickly understand the interference that refractive lipids would have on a spectrophotometer which could/would impact its reading.  The Avox does not detect for this and would simply release a result... accuracy of these results? who can say....  and the Intralipid used to transfuse into NICU babies was developed and *After* the Avox was developed and passed through the FDA.

 Politely stated: Brand loyalty to something because it was locally developed is in my opinion not something that should be considered when patient care is at stake.  The Avox was a good system for.... its... time, which has now passed.  Are you using mainframe chemistry analyzers in your main lab that were developed 40 years ago?  I'd bet my last dollar you are not.


The AVOX is moderately complex. In my experience, respiratory techs often have associates degrees, and thus can't function as technical consultants for competency assessment and other TC duties. We have always had these under the lab's CLIA/CAP, and they are managed by POCT.

Jeremy summed it up well.  There's also another negative with AVOX and that's that it keeps the same patient ID in it unless a new patient ID is entered or it is powered off.  If you have the device interfaced to middleware and LIS (which you can do), that feature can be a nightmare, if the staff isn't consistent about making sure they enter the correct PID.  Yes it is quick and very easy for non-laboratorians to use but it comes at a cost and the company has also made no efforts to bring it into the 21st century.  I wish they would, because it does have its attributes.

Breana - in our system, if AVOX is not being used, then a Radiometer ABL90 (with all parameters but tHb and O2Hb disabled) is what is currently being used.  With thirty-five second throughput per sample, it's not that much longer than AVOX to get a result - with many, many more advantages.

We don't use an interface, a patient ID or an operator ID. Most of the negatives mentioned don't apply to our situation. 

In the place that I work, when cardiologists ask for something by name, they usually get it. It is then up to me to manage it.  

Just another case of POCT being different everywhere, depending on multiple opinions and varying patient population needs...... POCC find different solutions to the same issue. 

This is why we have multiple manufacturers to cover the same test menus.  

Bless his heart...I did appreciate Jeremy's explanation of spectrophotometry......knowledge on a Friday. I will certainly leave him with his last dollar...


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