Whole Blood Pregnancy and Lactates in the Emergency Departments

We use the i-STAT for both the Lactate and Whole Blood Pregnancy.  For the pregnancy we only allow the Qualitative result flow to the chart. It is expensive way to perform pregnancy.

In our hospital, Lactate is used as a sepsis marker, so the i-STAT gives them a rapid result. 

Cathy

We have a Rapid ComboKit Test that allows testing for serum and urine.  It's made by Cardinal Health.  My previous job uses iStat ( quant hcg) and Clinitek (qual hcg) in the ED.  

We only do urine pregnancy at point of care (the Clinitek in the ED). We also use the ISTAT CG4+ cartridge for lactate testing.

Our respiratory coworkers run lactates in the ED on the GEM 5000.  
We used to have ISTAT BHCG in ED, but encountered too many false positives.  When sent to Main Lab, they would be negative.  Because we couldn't narrow down the exact reason for each patient we saw this on, in addition to the decrease in patient satisfaction that the result would say pregnant but they were not, we decided to discontinue the use.  We now only use Clinitek Status for urine and all blood Preg's go to the Main Lab.

We only perform urine pregnancy tests on the StanBio QuPID (CLIA waived version) and staff manually report the results into the EMR - performed by our ED techs and RNs. We have the ABL Radiometer 90 Flex Plus in the ED which runs blood gases, lytes, HH, carboxy, and lactates - performed by our ED phlebotomists. 

We use the Clinitest on the Clinitek.  It works well for us, if the staff use the correct patient ID, test is resulted in 4 mins. or less, and crosses to the HIS immediately.  We use the i-STAT for blood gases so the Respiratory Therapists run a CG4 cartridge which provides a Lactate.  We suppress the Lactate if the doc doesn't want one.

we use the Siemens Clinitek Status for pregnancy, and NOVA Biomedical meter for lactate.  The ED is happy .

Thank you so much for these responses. This information will be VERY helpful as we move forward with testing evaluations.

For those who are doing lactate and blood gas testing on the iSTAT in the ED, I’m interested to know your workflow and how you manage your non-waived competency.

Our ED is pushing us to have the CG4+ and Chem8+ on the iSTAT. We have a blood gas lab in the basement beneath the ED, but the ED isn't happy with the TAT, so they are pushing for the iSTAT.

However, we’re looking at 100+ users, so it could be a nightmare to keep track of their training and competency (we have a small team of POC coordinators), especially considering all the pre-analytical errors that can happen with the iSTAT.

You can also send me an email at khanh.nguyen@bmc.org 

Thanks in advance!