Lab Values in the ICU

[Santiago Pinon III]

Has anyone worked in an ICU and uses istat blood analyzers on the regular? Or anything similar to that? Like a portable quick blood analyzer for patients that need frequent lab values?

[meanmaryjean, DNP, RN]

We use iSTAT, I'm not sure how many other approved devices exist, iSTAT is the only POC tester I've heard of that can do a variety of labs. Results take less than a few minutes. If you get your labs results from central lab typically in 30 minutes then that's not too bad, we get some results from central lab in 30 minutes, but typically it's closer to an hour or more. Outside of the designated patients we can use it for, we can use it only if there's a clear benefit in terms of outcomes, the first sodium check after initiating treatment for hyponatremia for instance.

There are some silly hoops to jump through, the College of Pathologists which is involved in accrediting labs, doesn't seem to like that staff nurses are intruding into their territory and have come up with some odd requirements. We all had to submit copies of our high school diplomas (they wouldn't accept a college degree as proof we graduated from high school) to get signed off on iSTATS because the College of Pathologists required this specifically.

Abbott Point of Care | i-STAT System & Piccolo Xpress

They had a problem with me 'cause my high school transcripts were in cuneiform.

[hawaiicarl, BSN, RN]

We use Istats in our ICU, mostly on our post-op open hearts, although they are faster they are way less accurate. We use them as an initial value for replacements, then confirm when the labs show up 30 minutes later. Competency requirements are the same as glucometers, annual written, and practical test to maintain proficiency per JHACO.

Cheers

[bgxyrnf, MSN, RN]

We use Istats in our ICU, mostly on our post-op open hearts, although they are faster they are way less accurate.

We use an iStat in one of my EDs. We don't use them in the ICUs to which I float at my other job.

I'm curious about the source of your "way less accurate" statement. I've heard some other folks express this statement but I haven't seen this backed up. From what I've seen, the values come out pretty close between the two.

Our primary use in the ED is:

2nd troponins (10m v 1h)

Lactate (2m v 1h)

H&H

Creatinine for stat CTcon

Double check potassium (oh, a student drew that specimen that your clinic doc says came back w/ a

K=6.8?)

Codes

[Wuzzie]

We use Istats in our ICU, mostly on our post-op open hearts, although they are faster they are way less accurate. We use them as an initial value for replacements, then confirm when the labs show up 30 minutes later. Competency requirements are the same as glucometers, annual written, and practical test to maintain proficiency per JHACO.

Cheers

I'd like to know where you got your information that they are "way less accurate" too. Federal standards for these things are rather tight.

[Rocknurse, MSN, APRN, NP]

Yes we used them in the open hear CICU that I worked in. We would use them frequently every day for the post ops and anyone we were concerned about. We would do them immediately post op, at 4 hours and then pre and post extubation. We'd use them when we weaned people off the vents and during codes too but if things were going bad we'd also send a back up to the lab to check accuracy. I just finished a clinical rotation for NP school in another ICU that didn't have them and it was kind of ridiculous how they would wean patients blindly or not do gases for days on end. Felt like the dark ages. Every unit should have one.