I-Stat or other testing options for Anesthesia Department

We use the i-STAT in our OR.  The i-STAT cartridge is the CG8 (includes gluc, lytes, H/H, ionized Ca, and blood gases).  It is non-waived, but they love it.  We have not had any problems with it.

Thanks Shonda!  I have a few questions about these cartridges and the i-STAT. if you wouldn't mind providing me with a little more information.  My email is aholland@catawbavalleymc.org

Anesthesia and Perfusion have been using the i-STAT in our OR setting since 1994.  We use the CG8+, G, ACT Celite (peripheral vascular cases) and ACT Kaolin (open heart cases).  POC conducts all of the training.  Our Chief Perfusionist and one of the CRNAs do all of the staff competencies. The Perfusionists and Anesthesia Techs run the simulator q 8 hours.  Each department manages their own inventory of cartridges.  We have refrigerators in our hospital storeroom from which the cartridges are distributed to the various departments by our storeroom staff. Monthly liquid QC on the cartridges is a centralized process as well.  

We also use the CG8 for the anesthesia staff.  We've had no issues except with the ionized calcium debacle at the beginning of 2022.  The staff love it and the RT storage temp is for 2 months!

Thanks everyone for all your input!   So the CG8 cartridges are non-waived, moderate complexity?  What is the sample type, just whole blood?  Sorry for all the questions!  I am unfamiliar with the i-STAT as our hospital has never used them and want to be sure I can relay all of the necessary information as far as what is needed for implementation and ongoing monitoring.  Is the simulator required to be run every 8 hours for all testing on the i-STAT or just when doing coagulation testing?  If moderately complex, do you all have an iQCP used to allow lower frequency of controls?  Does POC handle new lots validations, instrument correlations, linearities, cal ver or do you have the departments run these?  Of course I am assuming all of these items are required since the test is non-waived?  If anyone would prefer to respond privately my email is aholland@catawbavalleymc.org  
Again, thanks for all the responses!

Hi Ashlee,
  I'll chime in with a few suggestions.  First, you won't find a waived platform that will include chemistries, H/H and blood gas, it just doesn't exist.  Second, although we did not have iSTAT in our facility in an intraoperative/anesthesia setting, we did have a device that also uses a conductivity-based hematocrit method, like iSTAT does.  What complicates the anesthesia setting is often the frequent infusion of plasma supplements/additives that can make conductivity-based assessments unreliable.  We had too much discrepancy between these readings and actual measured H/H samples obtained in the lab.  We opted for Radiometer ABL90s, which give an actual measured (not calculated) hemoglobin.  No issues, no effect from plasma infusions. Other win is no IQCP required, because the q8H internal QC follows the same path as a patient sample.  Attaching a link here to an article about conductivity-based hematocrits.  Intravenous fluids cause systemic bias in a conductivity-based point-of-care hematocrit meter - PubMed (nih.gov)

We use the i-STAT CG8 in our OR/Anesth area--the docs seem to like it, but we have suppressed the calculated hgb and only allow them to have the measured pH, PCO2, PO2, Na, K, iCa Gluc and HCT. I don't think there is a waived platform that can provide the tests you are looking for. 

As far as benchtop POC analyzers go, we have some other hospitals in our delivery network that use the GEM 5000's and really like them-- from what I hear they are expensive, but less maintenance than an ABL. 

We looked at Siemens epoc a couple years ago when the FDA pulled a bunch of Abbotts cartridges. It was a similar option to the iSTAT, but the design of the cards meant less storage issues. The cards are kept at room temp--unlike the iSTAT cartridges which are refrigerated (once brought to RT the CG8 is good for 2 months). This certainly would have reduced the POC oversite over the supplies which would have been a plus.

Has anyone switched from Hemochron ACT+ to the Istat ACT's?
If so- do you find the Istat has better reproducibility?