Bedside diagnostic blood testing. Its accuracy, rapidity, and utility in blood conservation.

OBJECTIVE --Bedside diagnostic testing utilizing microchemistry instruments potentially offers physicians the opportunity to evaluate urgent blood test results rapidly and reliably using only drops (250 microL) of whole blood. The use of microchemistry technology may also represent an essential component of a blood conservation program in acutely ill patients. We tested the hypothesis that a microchemistry instrument would have important advantages in the intensive care unit, including rapid turnaround time, decreased iatrogenic blood loss, and the provision of accurate analyte results. DESIGN --One-year prospective, random-sample comparative study. SETTING --A tertiary, acute care, 1000-bed university teaching hospital and a 450-bed university-affiliated community hospital. PATIENTS --Blood samples from 850 patients were analyzed. RESULTS --There were strong correlations (for pH, R2 = .97; PCO2, R2 = .97; PO2, R2 = .99; sodium, R2 = .83; potassium, R2 = .94; chloride, R2 = .90; glucose, R2 = .98; and hematocrit, R2 = .92) when paired samples were analyzed simultaneously in the laboratory comparing the microchemistry instrument and currently accepted clinical laboratory instruments. There were significant correlations (for pH, R2 = .91; PCO2, R2 = .94; PO2, R2 = .97; sodium, R2 = .91; potassium, R2 = .86; chloride, R2 = .91; ionized calcium, R2 = .82; glucose, R2 = .96; and hematocrit, R2 = .75) but increased variability occurred in some analyte results when samples were first analyzed in the intensive care unit (using the microchemistry instrument) and then transported to the laboratory in the routine fashion for "stat" determinations. CONCLUSIONS --The multichannel microchemistry instrument provided accurate analyte determinations when compared with accepted clinical laboratory instruments. Significant savings of time and blood were also realized by the use of a microchemistry instrument in the intensive care unit. Bedside microchemistry may provide clinically important advantages in emergency departments, operating rooms, and neonatal, pediatric, coronary, adult medical and surgical, trauma, and burn intensive care units.

[1]  R. Swaminathan,et al.  Errors due to heparin in the estimation of plasma sodium and potassium concentrations , 2004, Intensive Care Medicine.

[2]  M F Burritt,et al.  Current analytical approaches to measuring blood analytes. , 1990, Clinical chemistry.

[3]  M Fleisher,et al.  Strategies of organization and service for the critical-care laboratory. , 1990, Clinical chemistry.

[4]  M. Meyerhoff.  New in vitro analytical approaches for clinical chemistry measurements in critical care. , 1990, Clinical chemistry.

[5]  M. Meyerhoff,et al.  Current and Future Directions in the Technology Relating to Bedside Testing of Critically III Patients , 1990 .

[6]  B. Chernow.  The bedside laboratory. A critical step forward in ICU care. , 1990, Chest.

[7]  G. Zaloga.  Evaluation of bedside testing options for the critical care unit. , 1990, Chest.

[8]  The evolving regulatory environment and bedside metabolic monitoring of the acute care patient. , 1990, Chest.

[9]  B. Statland,et al.  Evaluating STAT testing alternatives by calculating annual laboratory costs. , 1990, Chest.

[10]  M. Visser,et al.  Bedside blood gas and electrolyte monitoring in critically ill patients. , 1989, Critical care medicine.

[11]  M. Fleisher,et al.  Two whole-blood multi-analyte analyzers evaluated. , 1989, Clinical chemistry.

[12]  R. Oye,et al.  Evaluation of stat and routine turnaround times as a component of laboratory quality. , 1989, American journal of clinical pathology.

[13]  G. Bashein,et al.  Evaluation of a blood gas and chemistry monitor for use during surgery. , 1989, Anesthesiology.

[14]  T. Hill,et al.  RAPID BEDSIDE ANALYSIS OF ARTERIAL BLOOD GASES AND ELECTROLYTES IMPROVES PATIENT CARE DURING AND AFTER CARDIAC SURGERY , 1988 .

[15]  P. Lawler,et al.  How much blood for a blood gas? , 1988, Anaesthesia.

[16]  J. Davies.  Misuse of adhesive tape , 1988, Anaesthesia.

[17]  A. Nanji,et al.  Desktop analysers: quality of results obtained by medical office personnel. , 1988, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[18]  R. Bone,et al.  Noninvasive respiratory care unit. A cost effective solution for the future. , 1988, Chest.

[19]  I. Gunn,et al.  EVALUATION OF A BEDSIDE ANALYSER , 1988, The Lancet.

[20]  Mikkelsen Dj,et al.  Experience with laboratory instrumentation placed in critical care situations over a seven year period. , 1987 .

[21]  J I Morrison,et al.  Managing bedside glucose testing in the hospital. , 1987, JAMA.

[22]  R. Belsey,et al.  Evaluation of a laboratory system intended for use in physicians' offices. II. Reliability of results produced by health care workers without formal or professional laboratory training. , 1987, JAMA.

[23]  L. Nelson,et al.  Titrating positive end‐expiratory pressure therapy in patients with early, moderate arterial hypoxemia , 1987, Critical care medicine.

[24]  J. Crowley,et al.  In Vitro Measurement of the Accuracy of a New Patient Side Blood Gas, pH, Hematocrit and Electrolyte Monitor , 1987, The Journal of ExtraCorporeal Technology.

[25]  W. Simon,et al.  Ion-selective membrane electrodes for clinical use. , 1986, Clinical chemistry.

[26]  B. Smoller,et al.  Phlebotomy for diagnostic laboratory tests in adults. Pattern of use and effect on transfusion requirements. , 1986, The New England journal of medicine.

[27]  D. Sewell,et al.  Laboratory test analysis near the patient. Opportunities for improved clinical diagnosis and management. , 1986, JAMA.

[28]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[29]  R. C. Dennis,et al.  Effect of sample dilutions on arterial blood gas determinations. , 1985, Critical care medicine.

[30]  B. Shapiro,et al.  Acute care/blood gas laboratories: Profile of current operations , 1984, Critical care medicine.

[31]  O. Siggaard‐Andersen,et al.  Determination of sodium and potassium with ion-selective electrodes. , 1984, Clinical chemistry.

[32]  A. Hutchison,et al.  Too much heparin: possible source of error in blood gas analysis. , 1983, British medical journal.

[33]  J. Marini,et al.  Variability of arterial blood gas values in stable patients in the ICU. , 1983, Chest.

[34]  F. Hashimoto.  Bleeding less for diagnostics. , 1982, JAMA.

[35]  J. M. Ramos,et al.  Blood gas analysis: effect of air bubbles in syringe and delay in estimation. , 1982, British medical journal.

[36]  S. Michaels,et al.  The stat laboratory: facilitating blood gas and biochemical measurements for the critically ill and injured. , 1981, American journal of clinical pathology.

[37]  R. Sciacca,et al.  Air bubbles and temperature effect on blood gas analysis. , 1980, Journal of clinical pathology.

[38]  J. Ladenson.  Direct potentiometric measurement of sodium and potassium in whole blood. , 1977, Clinical chemistry.

[39]  Miller Es.  Letter: Blood lost because of phlebotomy. , 1975 .

[40]  M. Schwartz,et al.  Interferences in diagnostic biochemical procedures. , 1973, Advances in clinical chemistry.

[41]  J. Severinghaus.  MEASUREMENTS OF BLOOD GASES: Po2 AND Pco2 * , 1968, Annals of the New York Academy of Sciences.

[42]  V. Devita,et al.  Pseudohyperkalemia due to release of potassium from white blood cells during clotting. , 1966, The New England journal of medicine.

[43]  R. Ingram,et al.  Pseudohyperkalemia with thrombocytosis. , 1962, The New England journal of medicine.

[44]  B. Scribner,et al.  Improved method for the bedside determination of bicarbonate in serum. , 1954, Journal of the American Medical Association.