epoc device challenges?

The new smartphone NXS version of the Epocs... software updates and functionality issues after they have been uploaded.

Jeremy, can you expand on that? We have the NXS version and I haven't noticed any issues. Perhaps I have not had it long enough to have many updates yet!

Epocs require a software update every ~6 months, which essentially constitutes their Cal/ver modifications, the ISTATs have the same thing.  Last November  when this 6-month software update was uploaded into our system, it prompted the NXS to also require an Android software updated.  This essentially broke some of the configurational settings of the NXS's and while they did upload test results (we could still test with them) we had problems with printing results, defining how many digits the patient ID was, the Patient ID (meter populates patients name and DOB) on meter, and other issues. 

We are also using Siemen's Pocellerator middleware and have been strongly encouraged by Siemens to stop using it as this was the primary source of the issue.  We have not been able to start the project to remove Pocellerator from our interface data flow yet.  It's on the list of projects to be completed once funding and time for the project is obtained.
We have both the Motorola and NXS versions of the Epoc.

We have looked at these several times over the years because of the positive benefits that Alma lists above.  The sticking point has been that there is a large learning curve for its use.  I have heard that the delivery of the sample is very technique driven and there has been an increase in wasted cartridges because of it.  One of our hospitals uses i-STAT a lot for babies, so to waste that precious tiny sample was a deterrent.   But the limitations of capillary samples on i-STAT makes me to think that we might be exploring EPOC again. 

I've now got years of experience with both iSTAT and Epocs. 
The Epocs are less technique driven than the iSTATs in obtaining accurate results.  By default, the iSTAT sample is exposed to air while the Epoc sample is not.  The newer NXS Epoc hosts (looks like a smartphone) are more user intuitive than the older Motorola Host version (which you can no-longer obtain).
The lack of a refrigeration requirement for the Epoc cartridges is very appreciated by the staff not having to re-date the expiration date on them anymore.

@Mary - you are correct that there's a learning curve when it comes to sample delivery. However, the benefit of the EPOC versus the iSTAT for NICU patients is that the calibration takes place at the beginning, PRIOR to sample injection. As a result, if the card calibration fails, you'll know it before you inject your precious baby blood sample. This is the primary reason why our NICU RT team chose the EPOC over the iSTAT when we trialed them both years ago.

I do not have any iStat experience to date but we have been using the epoc for over 10 years. We do use the epoc with the EDM (their data management system) in conjunction with Telcor. Room temperature storage of the epoc cartridges and QC must be stored refrigerated but is good for one week at room temp. An IQCP is required. The manufacturer IFU states that QC needs to be ran at new lot and new shipment with any valid reader. We did have a long process, years of data to prove acceptable risk and now follow the manufacturer IFU for QC performance. Injection error is a quality indicator that we monitor but I am hearing the iStat has a similar injection issue for new users. Cost is a reason as well. It was our experience that the epoc was a lesser cost for the testing system and supplies. I am sure this could vary by institution. I did not experience the same EDM configuration issues spoken above by other contributors. One other point: I also like that there is one card and you can select by data management what is allowed to be tested or allow your users to select from predetermined options. This creates a way to maximize testing or minimize based on unit or device.

Hi,
Does everyone using the EPOC run capillary blood gasses? in the manual within the AMR chart it has a disclaimer at the bottom that says capillary blood gases are not reliable and there are no reference ranges for capillary blood gases? We are looking to move to EPOC as well but hesitant due to this. 
thanks  

Dawn,  by their very nature, capillary blood draws expose the sample to air.  These samples would not be a good source for gas testing.  No testing system would be able to address this.  The users should be made aware of this issue.

The Epoc and other BG analyzers perform other tests as well that would not be impacted by this issue.

@Dawn - our NICU RT team has been running capillary blood gases on the EPOC for years, and we've never heard any complaints from them. There's definitely a learning curve with filling the capillary tubes, but our people are pros now. :) The disclaimer at the bottom of the AMR chart (screenshot below for anyone else who might be interested) refers to capillary gases in general and doesn't appear to be specific to the EPOC. So I'd imagine the same considerations would be applicable regardless of which test system is used. Good luck!

@ Dawn- We only use capillary samples on neonates <30 days of age. Outside of that category, the choices are venous or arterial, either a direct line draw or collected in a Lithium heparin vacutainer. People seem to really like the EPOCs, for the most part. I think the biggest complaint is the 3-minute card  calibration feels like an eternity. There is definitely a learning curve for sample delivery, but most people catch on pretty quickly. Other popular features are the RT storage for the cards, the easy-to-use NXS host and on-board critical reporting, which helps keep us compliant for that documentation. I have suggested to our Siemens rep that they should consider developing more than one type of card to increase their test menu offerings. A card that includes Troponin would be a great addition.
The portability is a plus, too. Our intensivists carry one around in a backpack with no complications.

For the EPOC users above - are any of your areas performing cord gases on the EPOC?

no, we do not.