i-STAT Training

Brooke Army Medical Center

Anesthesia Research Laboratory
Dr. Rajni C.Patel; Medical Director
 What Is i-STAT?
 Hand-held unit which allows point-of-care testing with
small aliquots of blood
 Current configurations
– EG7+ Blood gases plus Na/K, iCA, Hct
– G Glucose
 Future configurations?
– “super” EG7+ includes glucose
– Coags PT, PTT, ACT
 Sample Collection
 Have all materials, ID patient
 Prepare phlebotomy site
 May be drawn into heparinzed or non-heparinzed syringe
– “Norm” is non-heparinzed
– Non-heparinzed must be run within two minutes of being drawn
 Sample Handling
 Mix specimen gently
 Invert and remove air bubbles
– Using 4x4 is helpful
 Cartridge Expiration and
Warm-Up
 “Stamped” expiration date refers to properly stored,
refrigerated cartridges only
 Cartridges must be at room temperature prior to use
– Warm-up time is 4 hours
– Boxes are labeled with a time stating when they are “eligible”
 When a box is removed from the refrigerator, the
cartridges are “good” for two weeks
– The “room temp” expiration date is labeled on each box at this
time
 Cartridge Handling
 Handle the cartridge like a CD--by the edges
 Fill to “fill mark”
– Avoid bubbles
– Avoid overfilling/underfilling
 Close snap by pressing the rounded edge of the closure
– Avoid exerting pressure directly on the closure
– Improper snap closure can cause overfill errors or “Unable to
Position Sample” error
 When test procedure is completed, dispose of material in
the red sharps/biohazard containers
 Cartridge Filling

Fill to this mark

Grasp Here

Do not push here!!

 Data Entry--ID Numbers
 First prompt is for Operator ID Number
– Use last 4 of your SSN
– Must be input twice for verification
– Must be exactly 4 digits
 Next prompt is for Patient ID Number
– Use FMP-SSN (11 digits) without hyphen
– Must be repeated for verification
– If no test or Simulation has preceeded this test and the prior test on
the same patient, the DIS button will recall the patient number for
you
– The ID number must be exactly 11 digits!
 Data Entry--”Page”
 In some instances, you may wish to enter extra information
 The unit is programmed to automatically bring you to the
screen where you input:
– Patient Temperature
– FIO2
– Miscellaneous Numbers (e.g. TV, RR, ET-CO2)
– Sample type (e.g. ART, VEN, CAP, CORD, MXVN, CPB)
 Sample type is only critical when using CPB
– All patients undergoing CPB should use this once they go on pump
for a full two hours after they are off pump
– This affects hematocrit calculations
Has Your Data Been Entered?
 Result Reporting
 Since the caregiver is performing the test, reporting the
results is non-applicable
 Results must be recorded on the anesthesia record
– Acceptable to only record results you are interested in
– Record time of test along with results
– “In order to minimize transcription errors, a second individual will
participate in the transcription process”
 Potential integration with AIMS in the future
– Will eliminate your need to record the data manually
 Stored Results
 The MENU soft key allows you to access stored results
– 1 Status
– 2 Stored Results
 Hit “2” to access Stored Results
– 1 Display a Result
– 2 Print a Result
– 3 Transmit All
 Display a Result allows you to access one of the 50 results
currently stored in the unit
Transmitting to Central Station
 If the unit is in the IR cradle at the CDS, Transmit All will
transmit results to the Central Data Station
– The unit is able to determine what has been and what has not been
transmitted, so duplication is impossible
 Central Data Station
– Users don’t need to use this on a routine basis
– If “off-line” and you need it, click on the i-STAT Central Data
Station icon in Windows
 Quality Control
 Electronic Simulators
– Internal simulators are run by the machines software
– External simulators are available for failures, and also for some
programming features that the average user does not need to know
– If the display says SIM, the machine will run an electronic
simulator first as you plug in your sample
 Simulator Failure
– Attempt simulator with an external module
– If this fails, repeat with the external module
– If this fails, don’t use unit and report this to anesthesia technicians
 Quality Controls
 Liquid Controls are performed by perfusionists weekly
 Units may be pulled from service if our controls are not
currently within well-defined limits
 Battery Changing
 Unit uses two lithium batteries
– They are not standard 9 volt batteries!!!
 If the BAT message appears on the screen, notify the
anesthesia technicians
– When BAT message first appears, there is enough power left to
run approximately 50 more cartridges
 Date and Time
 Should be maintained by the anesthesia technicians
 If unit is wrong, it can be changed by:
– Pressing MENU soft key
– Pressing 1 (Status)
– Pressing the CLKSET soft key
– This allows you to edit the clock--hit enter to save
– * key exits the Status screen
 Please be extra aware of the time around the time changes
each spring and fall; if you see it is wrong, change it or
have one of the anesthesia technicians change it
 Portable Printers
 The i-STAT units can print to one of two printers
– The HR i-STAT is set-up to print on the high-speed Seiko printer
– The other i-STATs are set up to print on the small HP printer
 The HR i-STAT will not print on the HP printer
 The other i-STATs will not print on the Seiko
 Changing printer paper/batteries is the responsibility of the
anesthesia technicians
 Analyzer Cleaning
 Wipe with moist towel/alcohol wipe to keep blood, dirt,
etc. off unit
– Don’t soak in water, Cidex, soap, etc.
 Troubleshooting
 BAT, SIM, and LCK messages
– BAT Battery running low
– SIM Electronic simulator overdue
– LCK Cartridge/simulator is engaged, don’t remove
 Error Messages
– Numbered error messages are frequently used
– The code for these numbers is found in the i-STAT manual under
“Technical Bulletins”
 Other Messages
 ***
– Signals from a particular sensor are uncharacteristic
 Compromised sensor or an interferent in the sample
– Also may appear for any test that depends on another test which
itself is flagged with stars
– Sample should be rerun with another cartridge
– If *** reappears, run the test via an alternate method (respiratory
therapy, main lab)
 Other Messages
 < (less than)
– Result falls below the displayed concentration value which represents
the low end of the reportable range of the test (e.g. for glucose, 20
mg/dL)
 > (greater than)
– Result falls above the displayed concentration value which represents
the high end of the reportable range of the test
 <>
– Indicates that the calculations for the test are dependent upon another
test which has been flagged “<“ or “>“
 e.g. calculations for potassium and hematocrit are dependent on sodium
value--if sodium is flagged, this will display for these tests
 Critical Values
 Most laboratories define “critical values”
– This result is then immediately relayed to the personnel in charge
of the patient
 However, since each provider performs the test while
caring for the patient directly, no critical values have been
defined, instead leaving this decision up to each individual
 When All Else Fails...
 Use alternate means to obtain labs
– Respiratory for blood gases, hematocrits, sodium, potassium
– Main lab for CBCs, chemistry