iSTAT ACT issues

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Starting a new thread to bring it back to the top of conversation.

We are still experiencing random issues with iSTAT ACT's not being at therapeutic levels after dosing of heparin, causing lots of issues with our physicians. iSTAT cannot give any information other that they will put out a letter of their findings "sometime"??  We are very frustrated with the situation, ACT cartridges are now on back order, control is hard to get--just wondering if the letter will say they are no longer going to produce ACT cartridges and leave us all in a panic or the "we could not find anything wrong after investigation" letter.
We have been a long-time customer of iSTAT but have mostly just been disappointed with them since Jan 2020 when they had their massive recall with FDA and then suddenly a few weeks later when Covid hit, they were fine.  I feel like we are getting some sort of communication from them every 4-6 months about a recall of cartridges, discontinuing a cartridge, changed the room temp on EG7 for a while, changing acceptable sample types, the list goes on.

Has anyone found a solution or what the problem is/was?  Are you still having issues?  What are your solutions?  Bringing in a new instrument is no quick and easy task as you all know.  Just feeling frustrated :(

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The problem is not the istat cartridges but the heparin itself.  There is a known quality issue with the liquid heparin.  That is why a bunch of blood gas syringes were recalled as well.  Now the issue with the shortage of cartridges we were told by our rep today that things are turning around and they are shipping a decent amount to us soon (not our full order still but a good amount). 

Came here to say the same as Andrea. A lot of conversation being had among cardiac RN forums regarding issues with the drug itself. It may be worth reaching out to your pharmacy team to see if they can provide additional information you can share with the cardiac team to assure them it's not the instrument, but the drug. 

I reached out to CAP a couple of years ago for clarification on POC.08600 and POC.08300 standards.  They confirmed that iSTAT does not require a 6m CalVer but that the 6m AMR verification is still required.  We utilize Cal Ver and other materials, such as Eurotrol LVM and Hyperbaric/Hypoxic CueSee for the AMR verifications.  CAP also confirmed that since iSTAT cartridges qualify as single-use devices under POC.08600 we can perform AMR verification on a sampling of devices.  We complete AMR ver on 25% of all devices every 6m so all are completed for every inspection cycle.

I agree also Kim! This issue comes up now and then for us as well. We have also submitted data to Abbott in the past. We use ISTAT ACT for our ACT testing, except in Perfusion where they use a Medtronic. Those are going to be phased out though. Providers have repeatedly asked for the Hemochron Sig Elite instead of ISTAT, as they do not agree with the ACT results.  We are moving to Siemens epoc from ISTAT blood gas testing due to the FDA issues with capillary.  ISTAT's best test is Creatinine, so we would likely stick with it for that test since it is waived.

@Kristine Zinn above - I am curious about CAP's response about AMR for ACT.  I perform the AMR for new devices validation, but never afterwards. In regulation POC.08450 it says:  The AMR does not apply to clot-based coagulation tests. 

We also use Hemochron Sig for our perfusion group, everyone else uses iSTAT. The hemochron and iSTAT are not interchangeable results, you need to establish new targets--they are different methodologies, and have to 2 different types of cartridges based on heparin dosing. This is the reason we can't just quickly switch to hemochron.

Can anyone share information that they have on heparin being the culprit? I can't find any recalls; our pharmacy group is aware but say they have tested the concentrations of our heparin and they are good. I have noticed the patients that we have gotten documentation on have all used Meitheal brand.  Curious to any documentation or if it's just complaints filed without any answers.









So Sorry Miranda! I meant to post that in another iSTAT thread.  The perils of multitasking!  No, we do not do AMR verification q 6m, only on new and replacement analyzers.

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Kim Ballister
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