ACT testing Implementation

Brochure - i-STAT Core Detail Aid ( 3890.REV3).PDF

My go to for Point of Care ACT is always the i-Stat. 

We use Medtronic, but they are phasing out, so I am currently looking for what we will replace them with. So far, I have only looked at the Werfen Hemochron, and it seems really good. It's fast, handheld/portable, takes a very small sample size, can transmit to LIS... The major cons I'm seeing so far is cost of materials (at least compared to Medtronic) and I keep seeing people have problems with the battery life and needing replacements.

iSTAT 100%.

We recently transitioned from the Hemochron Sig Elites to the GEM 100s and staff seem to like them a lot. They were pretty easy to use. Something that you should consider prior to implementation is where these devices will be placed. The Hemochron has two cuvette types (ACT+ and ACT-LR). We implemented the ACT+ system wide, as that was what was in place historically, however, we are noticing some discrepancies in results on the lower side of the reportable range. We are now going to implement ACT-LR system wide in everywhere but the OR due to the lower doses of heparin given in the cath lab and EP lab. 

The middleware offered by Werfen is also pretty straight forward. The only thing I don't love about it is the fact that the samples do not alert/ hold when it is unable to transmit to the chart, so you just have to go in every day to be sure all results have crossed. Usually, the error is caused by someone scanning the wrong barcode.

We also had to interface the analyzers to Cerner which took a while, so definitely talk to your IT department when you decide which analyzer is best for you! We still have not been able to put the GEMs on WiFi so all machines are hard wired into the network with an ethernet cord when not in use. 

What location is the ACT testing going to be used?  We found in CCL that iSTAT ACT works well, but in the OR with Open Hearts, the Medtronics ACT HMS met their needs.  The Medtronics ACT HMS has a little more support than the Medtronics ACT Plus, which is now history.  Know that the methods are different, where iSTAT is detecting the presence of Thrombin, whereas the Medtronnics HMS is clot detection.  Thanks.

We implemented iSTAT ACTk in the last year, system wide. We transitioned from Medtronic ACT plus, which was sunsetting. For us, it was a no brainer as we already have iSTATs in all areas. Ease of use and sample size are a huge plus. Decreased QC frequency and cost. Increase trust in results - best precision and reproducibility. And if you are going to used in pediatrics, it's the only option right now. 

Thank you everyone.

Emily Allen, how has the implementation of ACT-LR cartridges gone in your Cath and EP labs?  We are struggling with implementation in our Cath lab.  We have done a lot of patient correlations between the Medtronic ACT+ and the GEM Hemochron 100.  We see a lot of Out of Range High Errors on the ACT-LR, but the ACT+ cartridge results are inconsistent and unreliable.  Do you get a lot of Out of Range errors on the low range cartridge, and if so, how do your doctors feel about that?

@ Kristin
We are in the very beginning stages of the ACT-LR transition studies (still doing a 30-day precision study to affirm our IQCP plan). We have not started using this on patients yet, but I will be sure to look out for the out-of-range errors. I have noticed a lot more out of range errors with the QC, so I'm curious as to how it will do with patients.

The LR cuvettes have a different heparin sensitivity curve vs the ACT+ cuvettes, so our vendor stated that results would not correlate to the ACT+. We are planning on doing a normal donor study to determine a new target for puling sheaths. It was then recommended that the medical director and cath lab providers work together to determine new target ranges for certain procedures. We are still trying to come up with the best way to determine these targets. Sorry I couldn't be of more help!

I'm not sure if you have seen this document, but I have attached a helpful flyer for you, and anyone else interested in the difference between ACT+ and ACT-LR.

MSIG0025 ACT+-ACT-LR Tech Bulletin 1215.pdf