I-stat In the ED

HI Elliott, 
We use the Istat in our ED and have been for quite a few years.  They use the EG7 or CG4 and Chem8 combo.  The things to watch out for are the sample types and syringe types that can be used with the CG4 and Chem8.  They have to be heparinized syringes (I think the Chem8 went to non-hep but if one needs the hep then they all need that syringe).  We have a great educator in the ED who we have a very good relationship with.  I think that is one of the biggest pros is to make good relationships with your nursing counterparts.  She's very good at tracking the operators down for their competency and any follow up issues we have with samples.  One more thing to be on the look out for is interosseous samples.  The ED especially has a tendency to try and use it if they can't get blood access.  I'll send you my procedure if that helps and feel free to contact me if I can help answer any questions.

Our ED has been wanting iSTAT capability for years, but we have denied that due to the Main Laboratory being very close to the ED.  Also, there have been issues with labeling/sample quality from the unit.  I would make sure to include both of those aspects in your decision.

Thank you guys so far with all the emails and message.  Its greatly appreciated , more than you know.   I'm sure I'll be back with more  questions, but keep the advices coming.  We have a meeting with the ED next week to discuses plans.  The kicker is that we are going to epic in October and they want to  push buying the interference off until then, but still use the i-stats :-( .  Nope    Thank you all again. 

Hello Elliott,

Don't do it!! It is a lot of work.  Competencies, quality control, quality assessment and maintenance was a lot for me to keep up with.  If ED was the only location that I had to watch it would be a full-time job.  I had over 50 RNs and 10 i-STATs down in ED who were testing troponin (cTnI) and CG4+ (Lactate).  The ED is just down the hall from the laboratory so location of the lab was not an issue.  The Educator, RNs and management all came to an agreement that it was too time consuming to get anything done for the RNs.  After 3 years I finally cut the cord, which a lot of hard work. Nurses need to be nurses and they need to focus on  patients.  The laboratory needs to be the laboratory.

Hi, 
I echo a lot of what Adonica said. You didn't say if you already have iSTAT established at your facility in other areas or not? If this is brand new, there many things to consider. Why do they feel they need to perform that testing in the ED - Is the lab far away? Are they not getting the turn around times they want? 

They will need to understand all the regulatory requirements such as education document collection, training, competency, etc that must be followed. Most time they are not aware of any of this. 

Our ED uses the CG4 and Chem8 combo, along with troponin, glucose and creatinine.  We only use arterial or venous samples drawn in heparin syringes.  We do rely heavily on our educators for training and competencies. I have been filling in quite a bit as we've had a huge influx of new employees. The ED seems to have the most issues with sample quality and the tendency to try and use whatever sample they have struggled to obtain. I do quite a lot of follow up and early competency check ins. 

We have had iSTAT in the ED for almost 20 years now. We have several different size ED's in our system, and the one thing that has worked best is to have limited number of staff trained for testing. Training 150 RN's is NOT the way to go. We also have made a dedicated space for iSTAT and other POC testing to be performed in the ED. It is staffed mostly by EMT's, Phlebs, and NT's.  Competency and communication is much easier to keep up with a staff of 30.  

Thank you guys again for  all the advice and policies you sent me .   I do have another question for the guys that run i-stats?  Do you guys let the ED techs run them?

We are in the process of setting up an ambulatory clinic with the iSTAT. Adonica, do you mind sharing your iSTAT Chem8 procedure and compliance documents with me - blmill7@uky.edu? Thanks!

Kim,
I love the set up in the ED to have a dedicated space for iSTAT and other POC testing!  And yes, training every RN and ER Tech is NOT the way to go, but my opinion did not matter.  They are pushing to do Chem 8 on the iSTAT, along with troponins in the ED.  We use RALS and I know that if an RN is trained and competent to perform troponins, there will be a separate training and competency for Chem 8.  So how would I set up a separate certification in RALS for iSTAT when there is only one application for Device certification?  An RN may be on a yearly competency schedule for troponins and now will have new initial training for Chem 8 which will be on another schedule.  So, how do you manage that??  Can anyone help???