Blood gas analysis technology continues to shorten the length of time between testing and results, thanks to improved technology and a focus on point-of-care devices.

 

Image of blood gas test.

January 2014’s Market Analysis discusses blood gas analyzers, including product trends and new developments, the movement toward point-of-care blood gas testing, recommendations for RTs using these devices, and some of the latest blood gas analyzers on the market.

RT Magazine spoke with executives from two leading product manufacturers, including:

RT: As technology and sensors have improved over the last 5 years, in general, what features and advantages do today’s blood gas analyzers have over previous generations?

Alan Beder (Radiometer America): Radiometer analyzers automate many functions with the goal of streamlining and reducing errors throughout the entire analytical process. Starting in the preanalytical phase using the safePICO sampler, Radiometer analyzers can automatically identify, mix, and aspirate arterial blood gas samples, reducing user variability and the possibility of error.

In addition to automation, Radiometer has dramatically shortened turnaround time with the ABL90 FLEX analyzer through use of a unique sensor array featuring a uniquely efficient sample path. The compact POC analyzer delivered results on 16 parameters in just 35 seconds.

Bruce Lewis (Alere): Similar to other technologies, blood gas analyzers continue to progress toward a smaller platform with key features such as fully wireless communications and patient-side or bedside utilization characteristics. Having a system that can be used in any part of the patient care continuum, including the lab, ED, OR, all of the ICUs, step-down units, telemetry, transport, and the physician office market, is critical for continuity of care. Having a product that provides critical results in less than 3 minutes with minimal process steps maximizes outcomes and minimizes potential medical errors.

RT: What impact have point-of-care devices had on the market? What advantages do these analyzers offer to respiratory therapists?

Beder: It has caused many managers to reevaluate how they deliver their blood service. As hospitals are challenged to meet the requirements of the Affordable Care Act, they are discovering a hybrid model using a combination of benchtop and compact analyzers can result in greater workflow efficiency and cost savings.

Lewis: Having results in three minutes instantaneously transmitted into EMR and the LIS (laboratory information system) will robustly improve the clinical, operational, and financial outcome of the institution. All of this can be completed without ever leaving the patient’s side. The epoc test card does not require refrigeration and all of the analytes are on one card. The test card has been designed to be cost-effective and safe, as the bar coding is on the card and not the packaging. The system provides a “high tech and high touch” solution.

RT: Tell us about your company’s most recent products, why they are innovative, and how they are meeting the needs of RTs.

Beder: ABL80 FLEX OSM is Radiometer’s multitest, standalone CO-oximetry analyzer for the point of care. It provides high-quality CO-OX measurements in a compact platform with automatic quality control, full data integration, and a standby mode to help reduce consumable costs. The analyzer’s small footprint, connectivity, and no need for sample prep make it ideal for the cardiac cath lab.

ABL90 FLEX was introduced in 2010 and offers ease of use, portability, fast turnaround (16 parameters in 35 seconds), small sample size (65 microliters), and high throughput at 44 samples per hour. The analyzer’s small size, intuitive operation, and fast turnaround make it ideal for use even in high-volume applications such as busy EDs and ICUs.

All Radiometer ABL analyzers may be configured as a 1st Automatic system. 1st Automatic is Radiometer’s solution for automating and simplifying blood sampling and data capture, from test order to reported results. 1st Automatic combines analyzers, samplers, and data management to ensure the right result for the right patient at the right time, while improving operator safety and sample integrity.

Lewis: We manufacture epoc, which stands for Enterprise Point of Care. The word “enterprise” captures the broad utility of the product. Currently, we have the following analytes available in the marketplace including the measured parameters pH, pCO2, pO2, Na+, K+, Ca++, Glu, Hct, Lac, and recently 510(k)-cleared creatinine and chloride.

The calculated values include cHCO3-, cTCO2, BE (ecf), BE(b), cSO2, cHgb, and recently 510(k)-cleared eGFR, eGFR-a, AGap, and AGapK. The user interface includes several screens and applications specifically designed with the RT in mind.

RT: As blood gas analyzers have become more sophisticated, how has your company responded to clinicians’ needs and made them easier to use?

Beder: As noted earlier, automation of many analyzer features makes the operation of Radiometer analyzers more intuitive for the respiratory practitioner and other caregivers. Automated sample handling features reduce user variability and associated errors and inaccuracies. Automatic quality control ensures regulatory compliance when the analyzer is used outside the respiratory department or lab.

Lewis: With critical results, time is of the essence. Alere’s epoc Blood Analysis System has been simplified to report results in less than 3 minutes. This includes the time taken to order a test to results reported. This new generation of blood gas analyzer demands that the system characteristics be easy to use.

RT: What are the most important things RTs should be aware of when collecting samples for today’s devices? Are there any precautions RTs should take in order to get the best results?

Beder: Accuracy depends not just on the analyzer, but on the steps taken in the preanalytical phase. Before the sample is analyzed, the RT needs to ensure the sample is properly mixed, that there are no clots or air bubbles compromising the specimen, and that the sample has been properly identified to the patient.

A syringe such as Radiometer’s safePICO incorporates electrolyte-balanced dry heparin to eliminate clots, an integrated mixing ball to ensure a homogenous sample, and a vented tip cap to expel air bubbles. Each sampler is pre-bar-coded and can be registered automatically at the bedside.

Radiometer’s products—sampling devices, analyzers, IT—are designed to work as a system that supports the entire analytical process. When used with Radiometer analyzers, safePICO’s integrated mixing ball is activated on the analyzer (ABL800 and ABL90 models) to automatically mix the sample.

Also of concern to the RT is the risk of needlestick injury and blood exposure. A syringe with an onboard safety device can help to prevent needlesticks. Radiometer’s safePICO incorporates a safety sheath that cannot be removed. Single-handed operation reduces the possibility of needlesticks. The previously mentioned vented tip cap creates a closed system to minimize the risk of blood exposure.

Lewis: As with any system, please refer to the hospital/institution policies and procedures for specimen collecting.

RT: What about future trends/products in blood gas analysis that will be coming out in the next 5 years? What improvements do you believe they may have over the current generation?

Beder: The realities of a changing healthcare landscape will drive hospitals to automate their service to review the entire analytical process to gain greater efficiency and improve patient care.

Lewis: We anticipate the addition of blood urea nitrogen (BUN) and a measured TCO2. RT


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