Subtherapeutic ACT values after standard heparin dosing

We have had this issue since mid-December. It is not on every patient, but we are seeing it happen on more patients than not across our system. We are working with Abbott as well and we have heard the same information as Lisa. We started doing anti-Xa studies this week to help get more information as to whether it is the cartridges or the heparin. It seems like it is a problem with the ACT-K cartridges. Is anyone seeing this issue with the ACT-C cartridges? When we meet with Abbott on Tuesday, I didn't get a straight answer as to whether it was the Kaolin or Celite or both. 

I have had 2 events since late November where the ACT-c did not increase after multiple doses of Heparin.  What do you tell your Cath Lab/ OR staff to do as ACT by iSTAT is the only ACT available here?  What is the recommended time between Heparin dose and drawing the ACT sample? Thank you

Hi all!  Same issues over here.  I've opened 13 incidents with Abbott very recently for lots 436R252770181 (Cartridge ACT-K)  and 436R253191181 (Cartridge ACT-K).  We are using heparin lot G1050143 by Sagent and CT02512A by Sandoz.  Very sporadic issue for us as well.  I am leaning more towards an uptick in patients who have underlying issues, as it doesn't make sense to me that the ACT lots are performing sometimes, but not all the time, and all quality tests are passing without bias or trend.  All information submitted to Abbott last week, so hopefully that will add fuel to the overall investigation.

Has anyone gotten any updates from Abbott or found a brand of heparin that is working well?  Tiffany are you still getting good results with
 the Sandoz 5000 USP/mL?  I also have a case in with Abbott, our cath lab is at their wits end!  Is anyone using the Hemochron signature with same issues?  Alot of questions for a Friday!!!

Has the issue resolved for anyone on this post? We have weekly Abbott calls, but Abbott has not identified root cause. We sent Heparin to Prompt Praxis Laboratories LLC for testing. All lots tested were WNL for potency. We sent vials of Heparin to Abbott also for their own testing. Has anyone switched to another cartridge/testing platform?

Last year, I experienced this for the first time in the 12 years I have been in POC.  We use the Sig Elite Hemochron ACT-LR.  The OR RN requested a different lot of cuvette, we didn't have a different lot available (We are a small hospital and I don't typically have much overlap in lots).  When I asked what the issue was she told me they had administered X rounds of heparin and had not reach the desired 250 sec clot time.  (I say X rounds because things are fuzzy).  I told her that it's got to be something to do with the patient/sample.  QC was well within range. However I did give them another Hemochron when they asked.  Same result.  It was then I learned a new word - Infiltrated (maybe everyone here already knows this).  The anesthetist could not see the lines because of the drape and as such did not notice that the heparin was not going in the vein. 

With all the evidence you have gathered, I am sure this is not what you are experiencing.  This was just a learning opportunity for me and one I now include in all my training.

We are having the same issue at our organization in our OR as they use the istat ACTK, but have heard nothing from our Cath Lab (they use the GEM100).  It is kind of coincidental also that we are having issues getting cartridges in right now (usually never have an issue).  As soon as we get cartridges in we are going to perform a heparin sensitivity curve.  So frustrating.

Hello,
We are currently running ACT on istat ACT-k cartiridges.
We are having the same issue. It is very intermittent.
We just had 2 cases reported to Abbott for investigation.
The pharmacy is also involved and (as I was told) gives the best product, but it doesn't help.
Our perfusion team believes that switching to ACT-c can fix this issue.
Did anyone try it?
How many hospitals use iSTAT ACT-C cartridges?
Thank you.