What is istat chem 8

iSTAT

Skills Training

St. Luke’s Magic Valley Point of Care

Employee Name / Employee Number: _________________________________________________ Date: ____________________________ Employee’s Work Unit: _____________________________

Instructor’s Name: _________________________________________________________________

Training Points - Critical Skills

Introduction & Demonstration

(√ & Instructor’s Initials)

Employee Performance Observed

(√ & Instructor’s Initials)

Test Purpose: For the bedside testing of troponin, blood gases, electrolytes, glucose, BUN, creatinine, lactate, ionized calcium, hematocrit, clotting times, and INRs. There are two parts to the iSTAT testing – the instrument, or device, and the cartridges.

The Instrument:

1. Keyboard

2. Laser Scanner

3. Cartridge portal

4. Communication portal

5. Battery compartment

6. Docking Station

Internal Quality Control: There is an internal electronic simulator that runs every 8 hours which checks all the instrument electronics. If the instrument fails the internal simulator, it will not allow you to run a test. Please call the POC office and we will troubleshoot.

Cartridges Types:

· Troponin: myocardial injury

· Creatinine: renal function

· Glucose: blood glucose

· G3+: pH, PCO2 and PO2 – blood gases

· CG4+: blood gases and a lactate

· Chem8+ and EC8+: chemistry profiles

· ACT: measures blood clotting time and is useful for patients receiving heparin

· PT/INR: measures blood clotting time and is useful for patients on Coumadin

Cartridge Storage Requirements: The cartridge package indicates the type of cartridge, the tests measured, and the barcode with the lot number and refrigerated expiration date. On the back of the package, the room temperature expiration date is given, which is either 2 weeks or 2 months. Individual cartridges must be warmed for 5 minutes at RT before use; entire boxes for one hour. Once the cartridges are at RT, they cannot go back in the frig. Write the new expiration date on the front of the package. Do not send cartridges in the pneumatic tube system.

External Quality Control: Cartridge QC is done on every new lot, every new shipment, and every 30 days. We place a green dot on the box when it is OK to use. Please verify that the green dot is present on the box before you use any cartridges.

Cartridge Components: Do not touch the top end with the metal sensors or the top with the reagent bladder. Hold the cartridge by the sides and insert into the instrument by holding the thumb well.

Training Points - Critical Skills

Introduction & Demonstration

(√ & Instructor’s Initials)

Employee Performance Observed

(√ & Instructor’s Initials)

Specimen Requirements:

Acceptable specimens vary by test, and include arterial, venous, and capillary:

· Fresh whole blood collected in a plastic tube or syringe without anticoagulant (test immediately for ACT; within 1 minute of collection for all others). Use for CREA, ACT, PT/INR, and Troponin.

· Fresh whole blood collected in a plastic tube or syringe with lithium heparin anticoagulant (Fill tubes to capacity; fill syringes for correct blood-to-heparin ratio). Use for G3+, CG4+,EC8+, Chem 8+, CREA and Troponin. DO NOT place specimens on ice before testing on i-STAT.

· Fingerstick specimens should not be used for Troponin or ACT testing.

· No mint green tube or blood collected in a serum separator tube.

Test Procedure:

1. Turn on the iSTAT. The test menu comes up. Choose iSTAT cartridge.

2. Scan or enter your 6 digit Operator ID.

3. Enter the patient ID (the 9 digit CSN) by either scanning the wristband or entering the information from the wristband. Use nine 9s if the patient is in the ED or the newborn ID before a CSN is generated. Any non-patient testing use 565656565.

4. After the patient ID is entered, scan the cartridge barcode. The “Insert Cartridge” prompt will show and the analyzer will hold here for 15 minutes.

5. Obtain the patient specimen, either by fingerstick, syringe, or blood draw into a tube.

6. Fill the cartridge with patient sample. Fill in a continuous stream, no bubbles, and no clots. Fill to the fill mark without overfilling. Snap the door shut.

7. Insert the cartridge. Do not remove the cartridge until the test is completed. The “Cartridge Locked” prompt will show.

8. STAT NOTES: These are different types of parameters entered by the RT when doing blood gases. You will need to enter that information before the results will show.

9. Once the test is completed, pull out the cartridge and discard it. Turn off the instrument and dock the device.

10. The instrument must be cleaned after each patient testing. Clean with ammonia or alcohol based wipes. Bleach wipes must only be used for C. diff patients.

Interpret Test Results:

< or > means that the result is outside the measurement range of the instrument. Redraw the sample and send it to the laboratory for testing.

*** means there is either a cartridge error or there is an interfering substance in the patient’s blood. The test must be repeated on a new sample.

Call all critical results!

I have read, observed, and been trained on the preceding skills sets.

Employee’s Signature and Date

iSTAT

Training Quiz

St. Luke’s Magic Valley Point of Care

Employee Name / Employee Number: _______________________________________________ Date: ___________________________Location: ______________________________________

1. The actual testing takes place in the test cartridge and not in the device.

a. True

b. False

2. What type of battery does the iSTAT use?

a. AAA

b. AA

c. 9 volt

d. D

3. How often is the iSTAT analyzer checked with the internal electronic simulator?

a. Every 60 minutes

b. Every 2 hours

c. Every 8 hours

d. Every 24 hours

4. Cartridges can be stored at room temperature for either 3 weeks or 3 months, depending on the type of cartridge.

a. True

b. False

5. Cartridges cannot be returned to the refrigerator once they have been out at room temperature.

a. True

b. False

6. The green dot on the cartridge box indicates that external QC has been performed and the cartridges are OK to use.

a. True

b. False

7. Fingerstick specimens are not acceptable for troponins testing.

a. True

b. False

8. Which is true regarding patient identification?

a. The patient information should be scanned or manually entered from the wristband

b. Nine 9s should be used as patient ID in the ED before the CSN is generated

c. The month, date, and military time of an infant’s birth plus a “0” can be used before the CSN is generated for an infant.

d. All of the above

9. Which is true regarding cartridge usage?

a. Individualized cartridges must be at room temperature for 5 minutes prior to use

b. Air bubbles trapped in the sample well will affect testing

c. Samples should be dispensed slowly and steadily until it reaches the fill mark

d. All of the above

10. Cartridges must not be removed when the “cartridge locked” prompt is on – only when the test is completed.

a. True

b. False

11. What is the purpose of the internal and external electronic simulators?

a. Stimulates blood flow

b. Checks the batteries

c. Determines if the analyzer is working properly

d. Recharges the 9-volt batteries

12. A result that is flagged with a < or > means that:

a. The cartridge is defective

b. The test result is outside the cartridge’s measurement range

c. The analyzer needs to be checked with the external electronic simulator

d. The battery is running low

13. A result with *** means that:

a. The cartridge is defective

b. The cartridge must not be removed

c. The analyzer needs to be checked with the internal electronic simulator

d. The individual sensor for that test has been compromised. The patient will need to be redrawn and the test repeated.

iSTAT Critical Skills Review

Competency Assessment

St. Luke’s Magic Valley Point of Care

Employee Name / Employee Number: _________________________________________________ Date: _________________________________ Location: __________________________________

Review of Critical Skills

Test Purpose: For the bedside testing of troponin, blood gases, electrolytes, glucose, BUN, creatinine, lactate, ionized calcium, hematocrit, clotting times, and INRs. There are two parts to the iSTAT testing – the instrument, or device, and the cartridges.

The Instrument:

7. Keyboard

8. Laser Scanner

9. Cartridge portal

10. Communication portal

11. Battery compartment

12. Docking Station

Internal Quality Control: There is an internal electronic simulator that runs every 8 hours which checks all the instrument electronics. If the instrument fails the internal simulator, it will not allow you to run a test. Please call the POC office and we will troubleshoot.

Cartridges Types:

· Troponin: myocardial injury

· Creatinine: renal function

· Glucose: blood glucose

· G3+: pH, PCO2 and PO2 – blood gases

· CG4+: blood gases and a lactate

· Chem8+ and EC8+: chemistry profiles

· ACT: measures blood clotting time and is useful for patients receiving heparin

· PT/INR: measures blood clotting time and is useful for patients on Coumadin

Cartridge Storage Requirements: The cartridge package indicates the type of cartridge, the tests measured, and the barcode with the lot number and refrigerated expiration date. On the back of the package, the room temperature expiration date is given, which is either 2 weeks or 2 months. Individual cartridges must be warmed for 5 minutes at RT before use; entire boxes for one hour. Once the cartridges are at RT, they cannot go back in the frig. Write the new expiration date on the front of the package. Do not send cartridges in the pneumatic tube system.

External Quality Control: Cartridge QC is done on every new lot, every new shipment, and every 30 days. We place a green dot on the box when it is OK to use. Please verify that the green dot is present on the box before you use any cartridges.

Cartridge Components: Do not touch the top end with the metal sensors or the top with the reagent bladder. Hold the cartridge by the sides and insert into the instrument by holding the thumb well.

Specimen Requirements:

· Fingerstick: draw up into capillary tube except for PT/INR, where the cassette must be filled directly from the finger. Troponins CANNOT be done from a fingerstick

· Blood from a syringe: must be added to test cartridge within one minute

· Whole blood: venous or arterial whole blood collected in an EDTA or heparin tube. No mint green tube or blood collected in a serum separator tube. Can be from a short or long draw tube as long as it is filled properly. Mix tube well, pop the cap, and use a pipette.

Review of Critical Skills

Test Procedure:

11. Turn on the iSTAT. The test menu comes up. Choose iSTAT cartridge.

12. Put in your 4 digit Operator ID.

13. Enter the patient ID by either scanning the wristband or entering the information from the wristband. Use eleven 9s if the patient is in the ED or the newborn ID before an MF is generated. Any non-patient testing use 565656565656.

14. After the patient ID is entered, scan the cartridge barcode. The “Insert Cartridge” prompt will show and the analyzer will hold here for 15 minutes.

15. Obtain the patient specimen, either by fingerstick, syringe, or blood draw into a tube.

16. Fill the cartridge with patient sample. Fill in a continuous stream, no bubbles, and no clots. Fill to the fill mark without overfilling.

17. Insert the cartridge. Do not remove the cartridge until the test is completed. The “Cartridge Locked” prompt will show.

18. STAT NOTES: These are different types of parameters entered by the RT when doing blood gases. You will need to enter that information before the results will show.

19. Once the test is completed, pull out the cartridge and discard it. Turn off the instrument and dock the device.

20. The instrument must be cleaned after each patient testing. Clean with ammonia or alcohol based wipes. Bleach wipes must only be used for C. diff patients.

Interpret Test Results:

< or > means that the result is outside the measurement range of the instrument. A lab draw is required.

*** means there is either a cartridge error or there is an interfering substance in the patient’s blood. The test must be repeated if that test result is needed. Other analytes with a result are OK.

Call all critical results!

I have reviewed the above critical skills for iSTAT usage for part of my competency evaluation.

Employee’s Signature and Date

iSTAT

Competency Assessment – Non Waived

St. Luke’s Magic Valley Point of Care

Employee Name / Employee Number___________________________________ Date: ___________________ Location: _________________ Employee Signature: ______________________________________________

Competency Evaluation Objectives:

· Review of iSTAT Critical Skills

· Completion of the six CAP competency assessment elements

Department Technical Evaluator : Observe the following key functions being performed by the employee. Check boxes and initial when the observed tasks are performed correctly and accurately according to the written procedure.

Direct Observation of Test Performance (DO)

· Properly identifies patient

· Properly obtains patient specimen

· Correctly fills test cartridge

Observe Performance of Instrument Maintenance and Function Checks (PM)

· Cleans the instrument after each use

Point of Care Coordinator : Assess the following key functions being performed by the employee. Check boxes and initial when competency of each has been properly assessed.

Monitor the Recording and Reporting of Test Results (RR)

· POC review of critical results reporting

Review Intermediate Test Results, Worksheets, QC, and PM Records (MTR)

· POC review of test results

Department Staff Educator or Technical Evaluator : Document the following key functions completed by the employee. Check boxes and initial after each element has been completed.

Test Performance of Proficiency Testing or Blind Samples (TP)

· CAP Survey / Unknowns completed

Problem Solving / Critical Thinking (PS)

· Sum Total Module Completed

Any recommendations for retraining please list on the back.

I attest that this employee was observed or documented as to performing the tasks identified for iSTAT testing according to the standard operating procedure (s).

Technical Evaluator: _____________________________________________ Date: ___________________

Point of Care Coordinator: _________________________________________ Date: ___________________

Staff Educator: __________________________________________________ Date: