Thank you for some interesting ideas
We have had an 80% failure rate recently of cartiridges.
There is upto a 20% cartridge ejection usually within 48 hours
We have had a few erroneous results esp a low glucose and a high potassium which didn't correlate with the sample when checked in the lab
Hopefully the new cartidges will be significantly better
Peter Galloway
Yorkhill Children's Hospital
Glasgow
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Janice Still
Sent: 15 July 2009 20:56
To: [log in to unmask]
Subject: Re: Blood gases on IL 4000
Pauline, I have not experienced any of the problems you mention, either in SCBU or Delivery suite with my 4000s.I would suggest that the problem lies with poor sample collection and handling.There is not an analyser on the market that can give accurate, reliable results with a partially clotted sample. Certainly the prolonged "fixing" would indicate that there is something nasty lodged under an electrode. The analyser will continue to attempt to recalibrate and compensate for drift, but if it is irreparable then evantually it will abandon further attempts and place the electrode into "disabled" mode. Extended and frequent fixing due to repeated clots will use up the solutions A and B at a fast rate, and if the drift is so far out the analyser then assumes that it is the solution that is the problem and will eject the cartridge to fail safe.
If a cartride has to be replaced, as you know the unused part is refunded if the cart data is downloaded and returned to the company. This can be done at the same time as a new cartridge is warming up, so there is no increase in downtime.I do not find this process, which takes a total of about an hour including warm up and running CVP, is a problem at all every three weeks.
Have a good look at what your doctors are actually doing. I found that some will insist on using Vaseline, and shove a great dollop on the baby's heel. This can then be introduced into the sample path if they are not careful to place the "clean" end in the port. This can either block the sample path immediately or build up until it does so. I have taken a lot of time to persuade the doctors that either they do not need it at all, or to use a VERY thin smear if they insist on it.
Again, user error and poor sampling is the likely cause for the bad results. Surely in vitro haemolysis would have given an elevated potassium? The undetectable of "incalulable" flags on glucose and lactate together with the "inappropriate" pO2 and pH would strongly indicate a clot and certainly not be acted upon. The analyser screen would have shown all these in red as an indicator to the user that they were unreliable or grossly outside range, in either case, they should be repeated.Do you know from the logs if it was the same user? Might be worth checking.
CVP failures can be largely avoided by placing the analyser into one or more 2pt cals before running the performance verifiers.Giving the analyser a little more time like this to stabilise the electrodes is often very helpful.
As you say it is impossible to install the cartridge incorrectly, but I do wonder if you have some local factor causing a problem. It is important that the air vents are clear, and I have occasionally found that someone has placed boxes of gloves or similar obstructing the vents and then the analyser has trouble keeping the sample path at 37C.
I am more than happy with my 4000s but what users can do to any poor unsuspecting piece of kit is nobody's business. I for one have no desire to return to fishing about in pump tubes with a bit of nylon filament to get clots out, or the business of changing pump tubing and electrode maintenance and then fiddling about for hours trying to get the cal right.If all I need to do is pop another cartridge in and then walk away for another three weeks, then that is fine with me!
Best wishes
Jan
Mrs. J. Still,
POCT Manager,
Biochemistry Dept,
Watford General Hospital. 01923-217998.
The views expressed in this message are personal and do not reflect West Herts NHS Hospitals Trust policy.
--- On Wed, 15/7/09, Angel, Pauline <[log in to unmask]> wrote:
> From: Angel, Pauline <[log in to unmask]>
> Subject: Blood gases on IL 4000
> To: [log in to unmask]
> Date: Wednesday, 15 July, 2009, 10:53 AM
>
>
>
>
>
> Good Morning to you
> all,
>
> Another query to my
> colleagues on the mailbase please regarding our IL GEM
> 4000's;-
>
> Firstly, we are
> still having problems with cartridge failures on our 4000
> analysers. Ours seem to be a mixture of initial
> CVP failures or a
> parameter "fixing" which never resolves
> (resulting in a crtridge having to be
> replaced), or various solution A//B errors. We have
> been told that no
> other sites have this many problems. I wondered if
> this were true,
> particularly as factors such as CVP failures could only be
> due to us installing
> the cartridge in correctly, which is actually difficult to
> do wrong. This
> means there is a consdierable down time when these
> analysers need to have their
> cartridge replaced, the data copied, and be
> re-calibrated.
>
> Secondly, we have
> recently had an issue on SCBU where some completely
> erroneous results were
> obtained on 3 separate occasions, but when the internal
> data for the analyser
> was reviewed, nothing was amiss, according to IL. I
> have wondered whether
> this might be due to the thick film technology that I
> understand is used on
> these sensors, and may be due to the presence of free
> haemoglobin?
> This could have arisen as a result of haemolysis while
> taking
> these (capillary) samples, but the if this was the
> case, I still am
> extremely concerned that result such as undetectable
> glucose, lactate, and
> inappropriate pO2 and pH levels could be reported and
> potentially acted
> upon.
>
> If any of you have
> any experiences or could pass this e-mail on to colleagues
> who may be involved,
> I would be most grateful.
>
> Many
> Thanks
> Pauline
>
>
> Pauline Angel
> Principal
> Biochemist
> Chemical Pathology
> Department
> Barnet & Chase Farm
> Hospitals NHS Trust
> Barnet Site
> Wellhouse
> Lane
> Barnet
> Herts
> EN5 3DJ
>
> Tel: 020 8216
> 4338
> e-mail: [log in to unmask]
>
>
>
>
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