New ABG Machine

[BobLoblaw78]

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We have had to switch from Abbot I-stat to another company (Gem?). This has prompted a deluge of values being given/reported, almost 40 values from an ABG!! Maybe it has been too long since I have upgraded my ABG, but I am fine with pH, CO2, O2, HCO3 and saturation. The rest is excess and an unnecessary charge (assuming it does cost more) to the patient unless requested. I have been told that other hospitals standardly obtain Hb, OHb, COHb, MethHb, DeoxyHb on every single ABG. Is this true? A bluff? What is seriously added except cost and Hb? Cooximetry is easily obtained and I'm not ruling those issues out on every patient and ABG. Or do I need to do some more reading? More information is not necessarily bad, but it is bad if it is not necessary. Also, I guess oxygen content is okay but I can figure that out and manage the patient without having it calculated as a value. And I'm not very trusting of the physiologic shunt value (how does it calculate it from only an arterial sample?)

What are your thoughts and normal values that are reported on ABGs at your hospital?

Thanks

 

[deleted87051]

Not a bluff. We’ve been using the Gem for over 10 yrs and we love it. In addition to all the values you listed, we get Na, K+, Ca++, Cl-, and Glu with every blood gas and it takes 1minute. Very useful during massive transfusions, coming off CPB, etc. There’s no added cost to the hospital. I don’t know what the patient gets charged.


This one, right?

GEM Premier 4000 | Instrumentation Laboratory

With its unique GEM PAK, Intelligent Quality Management (iQM), full analyte menu including onboard CO-Oximetry and integrated GEMweb Plus Custom Connectivity software, the GEM Premier 4000 system with Plus technology brings true automation to Acute Care diagnostics.

www.instrumentationlaboratory.com

 

[BobLoblaw78]

Not a bluff. We’ve been using use the Gem for over 10 yrs and we love it. In addition to all the values you listed, we get Na, K+, Ca++, Cl-, and Glu with every blood gas and it takes 1minute. Very useful during massive transfusions, coming off CPB, etc. There’s no added cost to the hospital. I don’t know what the patient gets charged.


This one, right?

GEM Premier 4000 | Instrumentation Laboratory

With its unique GEM PAK, Intelligent Quality Management (iQM), full analyte menu including onboard CO-Oximetry and integrated GEMweb Plus Custom Connectivity software, the GEM Premier 4000 system with Plus technology brings true automation to Acute Care diagnostics.

www.instrumentationlaboratory.com

Not sure, but I will check with our lab dept head. We have not made the full switch so I haven't touched the machine, just the list of reported values and what need and/or want. My first thought was, "I don't need a machine to calculate that for me!" My second thought was, "Crap, I am sounding like an old man."

I was told cooximetry is $300 on top of the ABG which is $300. I'm (they) unsure if that is patient cost or recommended hospital cost (I will assume the latter)

 

[deleted875186]

Our OR ABGs report standard blood gases, electrolytes, glucose, lactate, hemoglobin and hematocrit. I find it incredibly helpful, especially in bigger cases. I think it helps gauge resuscitation much better than blood gas values alone.

 

[Shimmy8]

We need a new system as our I-stats are getting close to replacement and the cartridges have been consistently on back order.

What else are you all using? We don’t want to send to lab, as we do trauma/MTP a fair amount.

 

[Morzh]

Our iStat's provide ABG, Hb, electrolytes, glucose, ionized Cal, and lactate. Agree that having electrolytes, glucose, H/H is very helpful in traumas and major EBL long cases.

However we've had issues with iStat Hb levels being "precise but not accurate", sometimes accurate but other times 2-3 g/dl off from the lab's CBC values. We still use them to trend during a case, but it casts doubt on transfusion threshold decisions. I suspect a calibration issue but our techs have recalibrated them and the problem persists.

Another issue is that a few months ago the FDA rescinded their approval for the iStat lactate cartridges, so for cases where we might like to trend a lactate (liver transplants, etc.) we have been sending those to the main lab with a 45min turnaround time.

 

[drmwvr]

We use the Gem 3500 in our CT/vascular suite...we can turn on and off the values were interested in...They're not practically portable tho which is why we still use the iStat for all other areas.

 

[Fart Daddy Smooth]

However we've had issues with iStat Hb levels being "precise but not accurate", sometimes accurate but other times 2-3 g/dl off from the lab's CBC values. We still use them to trend during a case, but it casts doubt on transfusion threshold decisions. I suspect a calibration issue but our techs have recalibrated them and the problem persists.

Another issue is that a few months ago the FDA rescinded their approval for the iStat lactate cartridges, so for cases where we might like to trend a lactate (liver transplants, etc.) we have been sending those to the main lab with a 45min turnaround time.

We’ve had the same issues with the h/h and the lactate with the istat machine. Only use it for ABGs really