epocal/iSTAT usage and protocols

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Hello,
 
I’m reaching out to gather insights on how you utilize Epocal/iSTAT devices, particularly for POC testing in the NICU, PICU, and Pediatric units.
 
We’ve recently received requests from PICU providers to use Epocal during codes and challenging draws/access for our CRRT patients. Currently, our NICU RTs perform Epoc testing exclusively in the NICU and during NICU transports. However, they’re now facing increasing pressure from PICU providers to expand their role.
 
Could you share:
 
1.       Who performs POC testing on these units?
2.      Do you have any protocols or guidelines in place regarding patient populations, frequency, or indications for use?
3.      How are testing staff notified when POC testing is needed—do providers use order sets or another method?
 
We are open to expanding this testing, but need some boundaries around this testing so that it doesn’t get out of hand.
 
 
Thanks,
Brian

4 Replies

It is just like any other Moderate complexity testing. The most important thing to consider after you have done the validation, correlation and training is WHO will do the moderate complexity competency documentation. After CLIA change that took effect after Dec 28th, 2024, none of the RN, RT will qualify to do the competency documentation because their education will not meet the requirements for them to be qualified a Lab Technical supervisor because they lack the number of science required. Review the CLIA changes that took effect after Dec 28th, 2024.

Sincerely,
Alma
“Far and away the best prize that life offers is the CHANCE to work hard at work worth doing” – Theodore Roosevelt

Alma Calzado-Knudson, MBA, CLS, MT (ASCPi & AMT)
Manager, Lab Quality and Point of Care Testing
Student Education Coordinator
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• alma.calzadoknudson@enloe.org
“Together you and I will Each Accomplish More as we WORK towards achieving a common goal – Patient Safety and Satisfaction”

To answer your questions:
1.       Who performs POC testing on these units? 
The nurse intensivists are the only ones who do the neonatal epoc testing in the nursery. However, we have also trained our ED epoc operators to do  neonate testing- but it has to be collected by a nurse or doctor from our family birth unit.
2.      Do you have any protocols or guidelines in place regarding patient populations, frequency, or indications for use? The capillary sample testing is only for neonates <30 days of age. Frequency and indications for use is up to the care providers.
3.      How are testing staff notified when POC testing is needed—do providers use order sets or another method? 
The orders are unsolicited, and the test profile is 'activated' when a valid account is scanned into the patient ID field and a sample type is chosen. Our intensivists are called to the unit when they are needed and they carry an epoc and cards at all times.

Thank you both for your input. 

I answered your questions below based on what we do at our organization. I do want to note that Abbott just had K and iCA pulled for capillary testing on their cartridges due to an FDA update. Something to keep in mind if that is the path you decide to go.

1. Our Respiratory Therapists perform all i-STAT testing in the inpatient units. The nursing staff draws the samples, but the RT's perform the testing.
2. We have an i-STAT usage policy that outlines when they can be used. This was created to help limit overuse. Unfortunately, some providers still overuse the i-STAT.
3. The orders are unsolicited and flow through our middleware when a valid patient ID is scanned. The RTs know the testing is needed when a communication order is placed in Epic by the procivider.

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Brian Wittkop
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