Handheld blood analyzers

[kataraang, BSN]

I have absolutely no experience with NICU, but I'm doing my QI project for my BSN on iatrogenic anemia in NICU patients. Reading some articles, I found this device: i-STAT Handheld Blood Analyzer | Abbott Point of Care

1) does your unit use a device like this?

2) for what labs do you use it? (I'm wondering how it could be enough to have just a few drops of blood)

3) how often do NICU patients need blood draws, and what do the doctors do to prevent unnecessary testing?

It seems like a wonderful device, and I wonder why it's not used in the adult setting if they use it in NICU. Adults can get phlebotomy induced anemia too.

Thanks! I'm not taking any data from this, I just want some perspectives from those who currently work in the field.

[jennylee321]

Where I've seen the iStat used it is not used for routine bloods or for minimising blood loss. It is used usually by transport team or when you need an art gas/lactate but don't have enough blood to send to the lab.

[adventure_rn, MSN, NP]

We use iStat. Here's a list of every test that we can run. They make several different cartridges that have different capacities (so if you need a gas you'd pick the gas cartridge, if you need a lactate you'd pick the lactate cartridge). i-STAT® System Test Cartridge Menu

On my unit, the primary function for the device is point of care ABG analysis. The additional lab values can be added on if you're already planning to get a gas, but the iStat isn't used unless a gas is indicated. So for instance, there is a cartridge that runs only electrolytes, but we never use it; however, there's another cartridge that has a gas + electrolytes which we use all of the time. A CG8 panel (our most common cartridge) requires 0.1 mL of blood and runs a gas, a crit/hemaglobin, electrolytes, and blood glucose. It results in two minutes.

I'm guessing they aren't used very often on other units because they're expensive. I'd imagine they're used much more often in ICUs and the ED, where rapid results are crucial. Our POC department told us that the results the same quality as lab-sent samples, but some providers don't feel that way and will occasionally send follow-ups of the same test to the lab to corroborate the iStat results.

I'm sure many NICU nurses don't even realize that these devices are being used on their units if their blood gases are run by RTs. In my first NICU job, all I knew was that the RT ran the 'blood gas machine.' I didn't know how it worked, and I had no idea that it could also analyze crit, lytes, lactate and glucose.

The frequency of labs is entirely dependent on the baby. An unstable intubated baby may get ABGs every few hours, a kid with screwed up electrolytes may get lytes every day, and a chronic former 25-weeker may get a crit, retic and lytes once a week.

[RNtoNNP, BSN, DNP, APRN]

My unit uses a different bedside lab analysis system called epoc (epoc® Blood Analysis System - Alere). It works similarly to the iStat and also requires just 0.1mL of blood. Bedside RNs are taught how to use the epoc and we can test blood gases, electrolytes, glucose, hematocrit, lactate, and creatinine. There is only one card to insert and then you can choose from all of these different test options. Once the card is inserted into the reader, it takes a couple minutes for it to be ready for blood insertion, but once the blood sample is inserted, the results are available in 30 seconds. We use this to run all of our blood gases and we don't send any blood gas samples down to the lab. As adventure_RN said, this is typically used to get additional lab tests if we are already getting a blood gas, but we also will use the epoc just to get electrolytes or a hematocrit on some of our smaller babies just so we don't have to send so much blood down to the lab. I love using this for our micropreemies who are on the vent since there are times that we are getting blood gases every couple hours. Not only does the epoc not require a lot of blood, but also, we get the results very quickly.

I also worked in a pediatric ER for a while and we used the iStat there. The bedside RNs were trained to use these as well as the RTs. We used the iStat for our critically ill or trauma patients and we also used it to get blood gases on our new diabetic patients to determine if they were in DKA. Using the iStat for these types of patients made a huge difference since we could determine how sick these patients were much quicker than if we had to wait for lab to send us the results and we could start treatment quicker.

[KKEGS, MSN, RN]

We use POC devices for blood glucose and blood gases. It really depends on the situation and the provider and how they want to do it but some situations I've seen are, for example, when we have a very unstable baby and we're having to adjust their vent settings a lot we often do a POC blood gas after each change to help the provider choose the next change.

We check blood glucose sometimes every 1 to 2 hours on our hypoglycemic babies.

[meanmaryjean, DNP, RN]

iSTAT is used extensively in the adult world- why did you think it was not?

[NICU Guy, BSN, RN]

The hospital's blood gas lab is in the NICU, so we use the CAP Gas tube (straw) which needs 0.1 mL. Our turn around time is under 5 min. Unless we need a lactic acid, we rarely use ISTAT.

[rnkaytee]

We use it all the time - I wish they had an option to run a bili! We've had it for about 10 years after it was started in the ER/adult ICU.

[adventure_rn, MSN, NP]

We use it all the time - I wish they had an option to run a bili! We've had it for about 10 years after it was started in the ER/adult ICU.

I wrote a post about that topic just a couple of days ago!! The FDA just approved a POC analyzer with a bili cartridge a couple of years ago. It sounds amazing!