Open Heart Surgery

For our open heart cases, we use i-STATs (CG8 and ACT) and TEG 6s.  

If you are going to get a TEG, get the TEG 6s rather than the TEG 5000.  The 6s is a lot easier to use for the nurses and doesn't require precise pipetting.

Also, we have wireless i-STATs in CVOR so the results will cross in real time rather than having to go redock the analyzer for results to download.

Hope this helps and Good Luck!!

We have iSTATs everywhere, including Cath Lab, but not in the CVOR. I don't know the origin of that decision. Perfusion uses Radiometer ABL90s for open hearts instead. We also use ACT (Medtronic ACTPlus), but no TEG at this time. 

We have GEM5000's for blood gases, and Medtronic HR ACTs for Adult Open Heart, although we are looking to switch to the Hemochrons for ACT. In Pediatric Open Heart, we have the GEMS, the Medtronic ACTs, the Medtronic HMS and the Rotem.  I would highly recommend you do not go with Rotem, but get the Teg 6's instead.  Our Peds perfusionists are not happy with the Rotems, and we used to have the TEG 5000's which they much preferred. 

In Open Hearts we have:
- Blood gas - we just switched from GEM 5000s to ABL90s (not a huge difference, but better pricing).  familiarize yourself with temp corrected blood gas, they might ask for that.
- ACT - we have Medtronic ACT Plus in both the OR and in the CVICU where the patient recovers after open heart.  Familiarize yourself with the HMS Plus too, they might ask for that instead - it will give them a heparin dose response, which helps them give a heparin dose that's specific to that patient (everyone metabolizes heparin differently), an HR-ACT, and measure actual circulating heparin, which helps them give a specific protamine dose.  The HMS Plus is more expensive.
- TEG - we have TEG 5000s in the lab right now (runners take the sample from OR to lab), but we just submitted a request to upgrade to TEG 6S and we'll be putting 1 or 2 of those in the OR.

Speaking very generally, in any operative setting, I would avoid devices that use a conductivity-based hematocrit/total hemoglobin determination, in favor of analyzers that measure these parameters directly, like ABL90.

Our Perfusionist perform our POC testing in OHS we use the EPOC for blood gases and the Hemochron Elite for ACT+'s .  

In our CVOR our perfusionist use Istat (mostly EG7), Sig Elite ACT+ and TEGs.

We have ABL90s in our CVOR and Cathlab.  They use them for everything gases and sats.  They love them because they are fast (36 seconds to results, 1 minute to the next sample), for peds they want the measured FO2Hb.  We used to have TEGs in CVOR, what a nightmare, they hated having to run QC.  So we moved them to the lab, they run them in hematology now.  For ACT we have Medtronics HMS+ in CVOR and Hemochron Sig Elite in Cathlab.

Thank you for everyone's input!! I appreciate it!

We use i-STAT for Cath Lab and CVOR.  They run ACT and CG8+ simultaneously. In an open-heart situation, they keep 2 i-STATs in the room. We also use wireless so that they do not have to download during the case.  All CRNAs and perfusionists have access to the i-STATs.  This seems to be a good practice giving them both answers from the same sample bedside.

We use iStat in both CVOR and Cath Lab. CVOR runs CG4, Chem 8 and ACTk. Cath lab has all 3 options as well, but they primarily use ACTk cartridges. Cath Lab had some complaints that the iStat was slower than the Hemochon Sig Elite we used to use, but it's easier to keep the same platform hospital wide with just iStat. The results download wirelessly  in all locations. CVOR runs 3 iStats at the same time with the same sample. Cath lab tends to just use one, but they have 2 available if they choose. ICU uses 2 iStats to recover heart patients. They all seem to prefer the immediate bedside answers over a standalone instrument that isn't portable.