Deidra Huckabee MSN, RN, CCRN. Research Question Medical ICU staff inquired about the accuracy of...
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Transcript of Deidra Huckabee MSN, RN, CCRN. Research Question Medical ICU staff inquired about the accuracy of...
Deidra Huckabee MSN, RN, CCRN
Research QuestionMedical ICU staff inquired about the
accuracy of utilizing the bedside Point of Care Testing (POCT) analyzer and standard laboratory analysis of samples transported via Pneumatic tube system
Rationale
POCT assessment of arterial blood gases is an increasingly common method of measurement for guiding ventilator management in ICU’s.
RationaleThe team observed discrepancies in
PaO2 values between our POCT analyzer (the i-Stat) and blood gas specimens transported to our laboratory via the pneumatic tube system (PTS).
RationaleThe purpose of this study was to
determine accuracy of PaO2 values obtained via:
POCT analyzerPTS systemHand delivery to the laboratory
MethodsThe project took place in the
Medical ICU in 2 stages
Stage 1 12 patient blood gases were analyzed
per bedside i-Stat and by a blood specimen to be tested in the lab.
MethodsStage 1 12 patient blood gases were analyzed per
bedside i-Stat and by a blood specimen to be tested in the lab.
After evaluation 8 of the 12 specimens has PaO2 difference great than 10mmHg
This was considered clinically significant and moved the analysis into the next stage
MethodStage 2
18 samples were drawn from different patients with three different types of testing:
Bedside i-StatSending blood gas to the labWalking blood gas to the lab
Results
The results were obtained via a two-sided, dependent paired t-test
The largest variation in PaO2 results was found between samples sent via PTS versus POCT and specimens walked to the laboratory.
ResultsThe mean difference between POCT
analysis and samples sent via PTS was 18.4 mm Hg (95% Cl 9.4-27.4mmHg)
The mean difference between walked samples and PTS samples was 9.7 mmHg ( 95% Cl 5.9-13.5 mmHg)
ResultsThe results were obtained via a two-sided,
dependent paired t-test
The specimens that were tested at the bedside using an i-Stat monitor and the specimen walked to the lab had similar PaO2 results.
The specimen sent through PTS has consistent higher PaO2 results than the other 2 methods
Conclusion
Arterial blood gas samples sent via PTS have more PaO2 variability in PaO2 results than samples tested using POCT or walked to the lab.
Why?May be due to air bubbles which are
mixed in the sample when transported via PTS
This theory is also supported by the observation of consistently lower PaO2 values obtained via POCT which might avoid the introduction of microscopic air resulting from transport
Change in Practice
MUHA now has a policy in place for all ICU’s to tube blood gas testing via POCT or walk them to the lab to obtain the most accurate results.