![]() Analyses were done on the ABL555 blood gas analyzer and the Dade Dimension RxL Max, both located in the central laboratory. Statistical analyses were performed using paired Student’s t test. ResultsĪ total of 200 paired samples were analyzed. The mean ABG potassium value was 3.74 (SD 1.92), and the mean AA potassium value was 3.896 (SD 1.848) (p = 0.2679). Conclusionīased on the above analysis, the authors found no significant difference between the potassium values measured by the blood gas machine and the auto-analyzer. However, the difference between the measured sodium was found to be significant. We therefore conclude that critical decisions can be made by trusting the potassium values obtained from the arterial blood gas analysis. Point-of-care testing enables clinicians to initiate appropriate treatment for emergent conditions, thereby benefitting the patient both clinically and economically. Įlectrolyte values are conventionally measured for all critical patients who present to the emergency department, for patients receiving fluid therapy, and for patients admitted to intensive care units (ICU). Routinely, all electrolytes are measured from serum by the auto-analyzers (AA) available in central laboratories of hospitals however, this is time-consuming. Typically, a turnaround time of about 15 min is noted on average in acute care laboratories of most tertiary care hospitals for the above. Quick decisions that need to be made depending on electrolyte values hence are often made either blindly or are delayed. Point-of-care testing for electrolytes is available from specialized equipment such as the iSTAT or Stat Profile Critical Care Xpress analyzers. ![]() The operational cost of iSTAT and other similar equipment is a major deterrent to their utilization in developing systems of health care. Electrolytes are also measured during arterial blood gas analysis, but are traditionally rarely trusted for clinical decision-making because of the dearth of published research about the same. The arterial blood gas (ABG) machines and AA differ in several aspects as listed in Table 1. The United States Clinical Laboratory Improvement Amendment (US CLIA) 2006 accepts a difference of 0.5 mmol/l in measured potassium, and 4 mmol/l in measured sodium, from the gold standard measure of standard calibration solutions. Previous studies that measured the accuracy of electrolyte values obtained by ABG machines concluded that the results from two different measurement technologies differed significantly for plasma sodium and chloride concentrations. These differences significantly affected the calculated anion gap and strong ion difference values. Others have also found statistically significant differences in measures of pH, potassium, and hematocrit between ABG machines and leading bench-top analyzers. Įxperts have cited theoretical reasons for these differences based on the chemical reactions employed in the AA and the auto-analyzers. ĭilution with heparin raises the volume of the sample, thereby lowering the value of the measured electrolytes on the ABG. All rights reserved.High volume of heparin itself binds the electrolytes, thereby lowering the value of measured electrolytes on the ABG. The iSTAT PT/INR compares well to the MDA II when performed by phlebotomists or nurses.Ĭopyright © 2012 Elsevier B.V. In all discordant cases the differences were minor and would have resulted in either no or minimal change in therapy. Sixty one (61) of 68 patient sample pairs collected by nurses showed acceptable agreement. The criteria for determining clinical equivalence of the iSTAT to the MDA II were (1) same clinical category (subtherapeutic INR3) or (2) paired values within ≤ 0.4 INR.įorty nine of 50 patient sample pairs collected by phlebotomists showed acceptable clinical agreement. ![]() We also obtained 68 near simultaneous capillary/venous test results for assessment of performance by non-laboratory personnel. We obtained simultaneous capillary/venous samples on 20 healthy volunteers for a normal range study and on 50 anticoagulated patients for a clinical evaluation. We report an evaluation of the iSTAT PT/INR with a comparison to the Tcoag MDA II analyzer. However, the performance of some devices has been shown to be suboptimal and there are only limited published data comparing specific devices to various central laboratory coagulation analyzers. ![]() Point-of-care devices for performing a prothrombin time/international normalized ratio (PT/INR) using capillary blood samples are being increasingly used to monitor patients receiving anticoagulation therapy. ![]()
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