Sousan Bagherpoor is a Senior Medical Laboratory Technologist (MLT) and works in the Point-of-Care (POCT) area of the Laboratory Medicine Program (LMP). Sousan is part of the laboratory team that manages and oversees all point-of-care testing devices at UHN that are used at or near a patient’s bedside, in order to measure glucose, blood gases, electrolytes and other analytes for patient care.
LMP is not only responsible for monitoring all these existing bedside testing devices, but part of Sousan’s position includes rolling out additional/new tests that can be performed at the patient’s bedside. When a laboratory test is performed at the bedside, rather than sent to the core lab for processing, the clinician gets the result sooner and can make care decisions sooner, rather than waiting for a result from the main laboratory.
Recently Sousan and her team worked with members of the Medical Surgical intensive care unit (MSICU) team to roll out whole blood Lactate. Using the new Siemens Rapidpoint 500 (RP500) blood gas systems, the team was able to evaluate/validate this assay on the POCT blood gas analyzers. This would mean that clinicians would have these results immediately along with their regular blood gas/electrolyte/metabolite test results.
We spoke with Sousan about the blood lactate test, the RP500 and what’s next for point-of-care.
Why do we need to know a patient’s lactate levels?
Lactate levels are ordered to determine if a patient has lactic acidosis or a high level of lactate in their blood. It’s important to know a patient’s lactate level because lactic acidosis is commonly caused by an inadequate amount of oxygen in the cells and tissue. This is very important for our ICU patients who are very ill. Lactate is also used as an early marker of sepsis. If a patient is suspected of having sepsis, a very serious issue for ICU patients, and their lactate level is above normal range, treatment can be initiated right away.
What is a “whole blood lactate” test?
The lactate test on a RP500 is a simple amperometric measurement using a lactate sensor on the blood gas analyzers using a blood gas collected sample.
What is the benefit of doing this test through point-of-care?
One of the biggest advantages of using a POCT device, such as the RP500, is saving the amount of patient blood needed for obtaining these results. The patients in the MSICU are very sick, so we always want to keep the number of times and the amount of blood drawn on a patient to a minimum. Using a POCT instrument means that one less sample needs to be drawn and sent to the Core Lab because lactate is an additional test result available when a blood gas/electrolyte/metabolite sample is drawn in the ICU. Now, clinicians don’t have to draw a separate blood sample, which saves money on processing, but most importantly saves the amount of the patient’s blood being drawn.
Another savings is that turnaround time is essentially immediate. The clinicians know the result immediately and are not waiting for a result. The sooner we can get an accurate laboratory result into the hands of the clinicians, the better!
Tell us about the point-of-care device – what is a RP500?
The RP500 is an upgraded version of the previous analyzer being used for POCT blood gas/electrolyte/metabolite analysis in the ICU’s. We had the opportunity to upgrade the device and add the test into the menu on these new instruments.
What did you do to add the test?
We went through several rounds of evaluating and testing before we were ready to complete the roll-out. There were several different groups involved: the LMP POCT Team and the LIS Team, our vendor Siemens, the MSICU staff; everyone worked together and collaborated to get the project going.
For example, we worked very closely with the nurses and Respiratory Therapists in the MSICU where, for validating purposes, we would ask them to send the regular plasma lactate blood tube (like they would usually do) and a blood gas syringe to the core lab, then we would simultaneously test them on Core Lab main Chemistry analyzer for lactate and on the POCT blood gas instrument.
What were some of the challenges?
One of the biggest challenges was waiting for a lactate test to be regularly ordered for clinical care before we could do any validations. While it is ordered regularly, there is some waiting involved until we could get the number of samples needed to perform the necessary validations. We were heavily dependent on effective collaboration and cooperation with the MSICU staff, so having them on board really made the process a lot better. Most of the issues were resolved before we went live with the test and the final implementation went very smoothly. We really learned a lot working together and it was really great to be part of such strong collaborations.
Now that the POCT Lactate test is available in the MSICU and operating rooms at TGH, we will be rolling out whole blood lactate to the other areas of the hospital using the POCT blood gas analyzers. We expect to see it available in CVICU and the TW Blood Gas Lab shortly. The turnaround on the project will be much shorter now that we have some great learnings already. We look forward to working with these others units and having whole blood lactate POCT testing available in those areas soon.