Pros & Cons of ACT Testing Platforms

We had the Hemochron Jr. Sig Elites for years.  There were definitely some clunky processes.  The newer models have wireless connectivity, which makes a big difference.  The Hemochrons use clot based methodology so results can be affected more by platelet counts, Hct, etc. and while it is measuring clot formation, there is still some end-point extrapolation.  We found that results would vary quite a bit, even when testing the same sample side by side on two hemochrons simultaneously.  Staff had come to expect that they would need to go grab another instrument and run another sample.  We transitioned to the iSTAT ACTk which measures the ACT by detecting the reappearance of thrombin.  It is less affected by low platelet counts, hct, etc.  It is also much more precise.  However cutoffs had to be adjusted because therapeutic levels of heparin would be reached at lower ACTk thresholds than what had previously been used with the Hemochrons. We have perfusionists, cath lab nurses, Anesthesia Techs, interventional radiology nurses, and unit nurses (pulling sheaths) performing the testing.  We have IQCPs.

Our largest struggle has been developing new therapeutic ranges when transitioning from Medtronic to i-STAT ACTk. 

Abbott has an IQCP aide on their website which I found very helpful in drafting ours.

772336-00A.pdf

We have the Hemochron GEM100 for ACTs.  One of the challenges is that the operations of testing and QC is very technique dependent.  It takes a lot of repetitions to get used to testing because it is time sensitive.  This leads to somewhat of incosistent QC results which is why we have not implemented IQCP.  We also had abnormal results stemming from incorrect collection procedures but this problem will exist whether it is Hemochron or the iSTAT.  

Kenji 

We prefer the Hemochron whether it be Signature elite or gems.  I stay we found problems going missing and updates.  Cath lab techs, nurses, anesthesia techs, percussionist and lab techs all run our devices.  Never had issues with qc.  Gem 100 are nice being wireless.

hi Edith, 
Could you please share the new therapeutic ranges when transitioning from Medtronic to i-STAT ACT-k in CVOR? Thank you.