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July 17, 1991, Vol 266, No. 3 >
ARTICLE | July 17, 1991

Bedside Diagnostic Blood Testing: Title and subTitle BreakIts Accuracy, Rapidity, and Utility in Blood Conservation FREE

Michael Salem, MD; Bart Chernow, MD; Robert Burke; JoAnn Stacey, RN; Michele Slogoff; Seema Sood, MD
[+] Author Affiliations

Reprint requests to Sinai Hospital of Baltimore, Department of Medicine, Belvedere Avenue at Greenspring, Baltimore, MD 21215 (Dr Chernow).


JAMA. 1991;266(3):382-389. doi:10.1001/jama.1991.03470030082028
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Published online
Article
References

Objective.  —Bedside diagnostic testing utilizing microchemistry instruments potentially offers physicians the opportunity to evaluate urgent blood test results rapidly and reliably using only drops (250 μL) of whole blood. The use of microchemistry technology may also represent an essential component of a blood conservation program in acutely ill patients. We tested the hypothesis that a microchemistry instrument would have important advantages in the intensive care unit, including rapid turnaround time, decreased iatrogenic blood loss, and the provision of accurate analyte results.

Design.  —One-year prospective, random-sample comparative study.

Setting.  —A tertiary, acute care, 1000-bed university teaching hospital and a 450-bed university-affiliated community hospital.

Patients.  —Blood samples from 850 patients were analyzed.

Results.  —There were strong correlations (for pH, R2 =.97; Pco2, R2 =.97; Po2, R2 =.99; sodium, R2 =.83; potassium, R2 =.94; chloride, R2 =.90; glucose, R2 =.98; and hematocrit, R2 =.92) when paired samples were analyzed simultaneously in the laboratory comparing the microchemistry instrument and currently accepted clinical laboratory instruments. There were significant correlations (for pH, R2 =.91; Pco2, R2 =.94; Po2, R2 =.97; sodium, R2 =.91; potassium, R2 =.86; chloride, R2=.91; ionized calcium, R2 =.82; glucose, R2 =.96; and hematocrit, R2 =.75) but increased variability occurred in some analyte results when samples were first analyzed in the intensive care unit (using the microchemistry instrument) and then transported to the laboratory in the routine fashion for "stat" determinations.

Conclusions.  —The multichannel microchemistry instrument provided accurate analyte determinations when compared with accepted clinical laboratory instruments. Significant savings of time and blood were also realized by the use of a microchemistry instrument in the intensive care unit. Bedside microchemistry may provide clinically important advantages in emergency departments, operating rooms, and neonatal, pediatric, coronary, adult medical and surgical, trauma, and burn intensive care units.(JAMA. 1991;266:382-389)

REFERENCES

1 +
Chernow B.  The bedside laboratory: a critical step forward in ICU care. Chest . 1990;;97:183S-184S.
2 +
Zaloga GP.  Evaluation of bedside testing options for the critical care unit. Chest . 1990;;97:185S-190S.
3 +
Misiano DR, Meyerhoff ME, Collison ME.  Current and future directions in the technology relating to the bedside testing of critically ill patients. Chest . 1990;;97:204S-214S.
4 +
Bashein G, Greydanus WK, Kenny MA.  Evaluation of a blood gas and chemistry monitor for use during surgery. Anesthesiology . 1989;;70:123-127.
5 +
Smoller BR, Kruskall MS.  Phlebotomy for diagnostic laboratory tests in adults. N Engl J Med . 1986;;314:1233-1235.
6 +
Conrad PD, Sparks JW, Osberg I, Abrams L, Hay WE.  Clinical application of a new glucose analyzer in the neonatal intensive care unit. J Pediatr . 1989;;114:281-287.
7 +
Belsey R, Morrison JI, Whitlow KL, Baer DM, Nelson S, Hardwick DF.  Managing bedside glucose testing in the hospital. JAMA . 1987;;258:1634-1638.
8 +
Zaloga GP, Hill TR, Strickland RA, et al.  Bedside blood gas and electrolyte monitoring in critically ill patients. Crit Care Med . 1989;;17:920-925.
9 +
Fleisher M, Gladstone M, Crystal D, Schwartz MK.  Two whole-blood multi-analyte analyzers evaluated. Clin Chem . 1989;;35:1532-1535.
10 +
Mikkelsen DJ, James KR, Dohrman DH.  Experience with laboratory instrumentation placed in critical care situations over a seven year period. N Z Med J . 1987;;100:686-688.
11 +
Belsey R, Baer D, Sewell D.  Laboratory test analysis near the patient. JAMA . 1986;;255:775-786.
12 +
Oesch U, Ammann D, Simon W.  Ion-selective electrodes for clinical use. Clin Chem . 1986;; 32:1448-1459.
13 +
Bland JM, Altman DG.  Statistical methods for assessing agreement between two methods of clinical measurement. Lancet . 1986;;2:307-310.
14 +
Moran RF, Misiano DR.  Multichannel analysis of electrolytes, blood gases, and related analytes.  In: Burritt MF, Moran RF, eds. Methodology and Clinical Applications of Fiberoptic Sensors . Rochester, Minn: American Association of Clinical Chemistry; 1990;;11:191-219.
15 +
Fleisher M, Schwartz MK.  Strategies of organization and service for the critical-care laboratory. Clin Chem . 1990;;36:1557-1561.
16 +
Hilborne LH, Oye RK, McArdle JE, Repinski JA, Rodgerson DO.  Evaluation of stat and routine turnaround times as a component of laboratory quality. Am J Clin Pathol . 1989;;91:331-335.
17 +
Cembrowski GS, Steindel SJ. Emergency Department Turnaround Time Data Analysis and Critique . Northfield, Ill: College of American Pathologists, Q-Probes. 1991;;90-13A:1-15.
18 +
Strickland RA, Hill TR, Zaloga GP.  Rapid bedside analysis of arterial blood gases and electrolytes improves patient care during and after cardiac surgery. Anesthesiology . 1988;;69:A257.
19 +
Riley JB, Burgess BM, Smith CA, Crowley JC, Soronen SW.  In vitro measurement of the accuracy of a new patient side blood gas, pH, hematocrit and electrolyte monitor. J Extra Corpor Technol . 1987;;19:322-329.
20 +
Severinghaus JW.  Measurements of blood gases. Ann N Y Acad Sci . 1969;;148:115-132.
21 +
Hutchinson AS, Ralston SH, Dryburgh FJ, Small M, Fogelman I.  Too much heparin: source of error in blood gas analysis. BMJ . 1983;;287:1131-1132.
22 +
Eichhorn J, Moran RF, Cormier AD. Blood Gas Pre-Analytical Considerations . Villanova, Pa: National Committee for Clinical Laboratory Standards; 1989;. Document C-27T.
23 +
Moran RF, Misiano DR.  Effects of storage temperature on whole blood potassium measurements.  In: Burritt MF, Moran RF, eds. Methodology and Clinical Applications of Electrochemical and Fiberoptic Sensors . Rochester, Minn: American Association of Clinical Chemistry; 1990;;11:231-238.
24 +
Bronson WE, DeVita VT, Carbone PP, Cotlove E.  Pseudohyperkalemia due to release of potassium from white blood cells during clotting. N Engl J Med . 1966;;274:369-375.
25 +
Ingram RH, Seki M.  Pseudohyperkalemia with thrombocytosis. N Engl J Med . 1962;;267:894-900.
26 +
Thorson SH, Marini JJ, Pierson DJ, Hudson LD.  Variability of arterial blood gas values in stable patients in the ICU. Crit Care Med . 1988;;15:14-18.
27 +
Madiedo G, Sciacca R, Hause L.  Air bubbles and temperature effect on blood gas analysis. J Clin Pathol . 1980;;33:864-867.
28 +
Biswak CK, Ramos JM, Agroyannis B, Kerr DNS.  Blood gas analysis: effect of air bubbles in syringe and delay in estimation. BMJ . 1982;; 284:923-927.
29 +
Schwartz MK.  Interferences in diagnostic biochemical procedures. Adv Clin Chem . 1976;;16:1-46.
30 +
Shek CC, Swaminathan R.  Errors due to heparin in the estimation of plasma sodium and potassium concentrations. Intensive Care Med . 1985;; 11:309-311.
31 +
Burritt MF.  Current analytical approaches to measuring blood analytes. Clin Chem . 1990;;36:1562-1566.
32 +
Bauer DM, Belsey RE.  The evolving regulatory environment and bedside metabolic monitoring of the acute care patient. Chest . 1990;;97:191S-197S.
33 +
Statland BE, Brzys K.  Evaluating STAT testing alternatives by calculating annual laboratory costs. Chest . 1990;;97:198S-203S.
34 +
Hall JR, Shapiro BA.  Acute care/blood gas laboratories. Crit Care Med . 1984;;12:530-533.
35 +
Belsey R, Vandenbark M, Goitein RK, Baer DM.  Evaluation of a laboratory system intended for use in physicians' offices. JAMA . 1987;;258:357-361.
36 +
Faye S, Gunn I.  Evaluation of a bedside analyser. Lancet . 1988;;2:59.
37 +
Nanji AA, Poon R, Hinberg I.  Desktop analysers: quality of results obtained by medical office personnel. Can Med Assoc J . 1988;;138:517-520.
38 +
Weil MH, Michael S, Puri VK, Carlson RW.  The stat laboratory: facilitating blood gas and biochemical measurements for the critically ill and injured. Am J Clin Pathol . 1981;;76:34-42.
39 +
Scribner BH.  Bedside determination of chloride. Mayo Clin Proc . 1950;;9:209-218.
40 +
Scribner BH, Caillouette JC.  Improved method for the bedside determination of bicarbonate in serum. JAMA . 1954;;155:644-647.
41 +
Myerhoff ME.  New in vitro analytical approaches for clinical chemistry measurements in critical care. Clin Chem . 1990;;36B:1567-1572.
42 +
Fogh-Anderson N, Wimberely PD, Thode J, Siggaard-Andersen O.  Determination of sodium and potassium with ion-selective electrodes. Clin Chem . 1984;;30:433-436.
43 +
Ladenson JH.  Direct potentiometric measurement of sodium and potassium in whole blood. Clin Chem . 1977;;23:1912-1916.
44 +
Miller ES.  Blood lost because of phlebotomy. N Engl J Med . 1975;;292:319.
45 +
Eyster F, Bernene J.  Nosocomial anemia. JAMA . 1973;;223:73-75.
46 +
Hashimoto F.  Bleeding less for diagnostics. JAMA . 1982;;248:171.
47 +
Bhaskaran NC, Lawler PG.  How much blood for a blood gas. Anaesthesia . 1988;;43:811-812.
48 +
Dennis RC, Yeston NS, Statland B.  Effect of sample dilutions on arterial blood gas determinations. Crit Care Med . 1985;;13:1067-1068.
49 +
Bone RC, Balk RA.  Noninvasive respiratory care unit. Chest . 1988;;93:390-394.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Chernow B.  The bedside laboratory: a critical step forward in ICU care. Chest . 1990;;97:183S-184S.
2 +
Zaloga GP.  Evaluation of bedside testing options for the critical care unit. Chest . 1990;;97:185S-190S.
3 +
Misiano DR, Meyerhoff ME, Collison ME.  Current and future directions in the technology relating to the bedside testing of critically ill patients. Chest . 1990;;97:204S-214S.
4 +
Bashein G, Greydanus WK, Kenny MA.  Evaluation of a blood gas and chemistry monitor for use during surgery. Anesthesiology . 1989;;70:123-127.
5 +
Smoller BR, Kruskall MS.  Phlebotomy for diagnostic laboratory tests in adults. N Engl J Med . 1986;;314:1233-1235.
6 +
Conrad PD, Sparks JW, Osberg I, Abrams L, Hay WE.  Clinical application of a new glucose analyzer in the neonatal intensive care unit. J Pediatr . 1989;;114:281-287.
7 +
Belsey R, Morrison JI, Whitlow KL, Baer DM, Nelson S, Hardwick DF.  Managing bedside glucose testing in the hospital. JAMA . 1987;;258:1634-1638.
8 +
Zaloga GP, Hill TR, Strickland RA, et al.  Bedside blood gas and electrolyte monitoring in critically ill patients. Crit Care Med . 1989;;17:920-925.
9 +
Fleisher M, Gladstone M, Crystal D, Schwartz MK.  Two whole-blood multi-analyte analyzers evaluated. Clin Chem . 1989;;35:1532-1535.
10 +
Mikkelsen DJ, James KR, Dohrman DH.  Experience with laboratory instrumentation placed in critical care situations over a seven year period. N Z Med J . 1987;;100:686-688.
11 +
Belsey R, Baer D, Sewell D.  Laboratory test analysis near the patient. JAMA . 1986;;255:775-786.
12 +
Oesch U, Ammann D, Simon W.  Ion-selective electrodes for clinical use. Clin Chem . 1986;; 32:1448-1459.
13 +
Bland JM, Altman DG.  Statistical methods for assessing agreement between two methods of clinical measurement. Lancet . 1986;;2:307-310.
14 +
Moran RF, Misiano DR.  Multichannel analysis of electrolytes, blood gases, and related analytes.  In: Burritt MF, Moran RF, eds. Methodology and Clinical Applications of Fiberoptic Sensors . Rochester, Minn: American Association of Clinical Chemistry; 1990;;11:191-219.
15 +
Fleisher M, Schwartz MK.  Strategies of organization and service for the critical-care laboratory. Clin Chem . 1990;;36:1557-1561.
16 +
Hilborne LH, Oye RK, McArdle JE, Repinski JA, Rodgerson DO.  Evaluation of stat and routine turnaround times as a component of laboratory quality. Am J Clin Pathol . 1989;;91:331-335.
17 +
Cembrowski GS, Steindel SJ. Emergency Department Turnaround Time Data Analysis and Critique . Northfield, Ill: College of American Pathologists, Q-Probes. 1991;;90-13A:1-15.
18 +
Strickland RA, Hill TR, Zaloga GP.  Rapid bedside analysis of arterial blood gases and electrolytes improves patient care during and after cardiac surgery. Anesthesiology . 1988;;69:A257.
19 +
Riley JB, Burgess BM, Smith CA, Crowley JC, Soronen SW.  In vitro measurement of the accuracy of a new patient side blood gas, pH, hematocrit and electrolyte monitor. J Extra Corpor Technol . 1987;;19:322-329.
20 +
Severinghaus JW.  Measurements of blood gases. Ann N Y Acad Sci . 1969;;148:115-132.
21 +
Hutchinson AS, Ralston SH, Dryburgh FJ, Small M, Fogelman I.  Too much heparin: source of error in blood gas analysis. BMJ . 1983;;287:1131-1132.
22 +
Eichhorn J, Moran RF, Cormier AD. Blood Gas Pre-Analytical Considerations . Villanova, Pa: National Committee for Clinical Laboratory Standards; 1989;. Document C-27T.
23 +
Moran RF, Misiano DR.  Effects of storage temperature on whole blood potassium measurements.  In: Burritt MF, Moran RF, eds. Methodology and Clinical Applications of Electrochemical and Fiberoptic Sensors . Rochester, Minn: American Association of Clinical Chemistry; 1990;;11:231-238.
24 +
Bronson WE, DeVita VT, Carbone PP, Cotlove E.  Pseudohyperkalemia due to release of potassium from white blood cells during clotting. N Engl J Med . 1966;;274:369-375.
25 +
Ingram RH, Seki M.  Pseudohyperkalemia with thrombocytosis. N Engl J Med . 1962;;267:894-900.
26 +
Thorson SH, Marini JJ, Pierson DJ, Hudson LD.  Variability of arterial blood gas values in stable patients in the ICU. Crit Care Med . 1988;;15:14-18.
27 +
Madiedo G, Sciacca R, Hause L.  Air bubbles and temperature effect on blood gas analysis. J Clin Pathol . 1980;;33:864-867.
28 +
Biswak CK, Ramos JM, Agroyannis B, Kerr DNS.  Blood gas analysis: effect of air bubbles in syringe and delay in estimation. BMJ . 1982;; 284:923-927.
29 +
Schwartz MK.  Interferences in diagnostic biochemical procedures. Adv Clin Chem . 1976;;16:1-46.
30 +
Shek CC, Swaminathan R.  Errors due to heparin in the estimation of plasma sodium and potassium concentrations. Intensive Care Med . 1985;; 11:309-311.
31 +
Burritt MF.  Current analytical approaches to measuring blood analytes. Clin Chem . 1990;;36:1562-1566.
32 +
Bauer DM, Belsey RE.  The evolving regulatory environment and bedside metabolic monitoring of the acute care patient. Chest . 1990;;97:191S-197S.
33 +
Statland BE, Brzys K.  Evaluating STAT testing alternatives by calculating annual laboratory costs. Chest . 1990;;97:198S-203S.
34 +
Hall JR, Shapiro BA.  Acute care/blood gas laboratories. Crit Care Med . 1984;;12:530-533.
35 +
Belsey R, Vandenbark M, Goitein RK, Baer DM.  Evaluation of a laboratory system intended for use in physicians' offices. JAMA . 1987;;258:357-361.
36 +
Faye S, Gunn I.  Evaluation of a bedside analyser. Lancet . 1988;;2:59.
37 +
Nanji AA, Poon R, Hinberg I.  Desktop analysers: quality of results obtained by medical office personnel. Can Med Assoc J . 1988;;138:517-520.
38 +
Weil MH, Michael S, Puri VK, Carlson RW.  The stat laboratory: facilitating blood gas and biochemical measurements for the critically ill and injured. Am J Clin Pathol . 1981;;76:34-42.
39 +
Scribner BH.  Bedside determination of chloride. Mayo Clin Proc . 1950;;9:209-218.
40 +
Scribner BH, Caillouette JC.  Improved method for the bedside determination of bicarbonate in serum. JAMA . 1954;;155:644-647.
41 +
Myerhoff ME.  New in vitro analytical approaches for clinical chemistry measurements in critical care. Clin Chem . 1990;;36B:1567-1572.
42 +
Fogh-Anderson N, Wimberely PD, Thode J, Siggaard-Andersen O.  Determination of sodium and potassium with ion-selective electrodes. Clin Chem . 1984;;30:433-436.
43 +
Ladenson JH.  Direct potentiometric measurement of sodium and potassium in whole blood. Clin Chem . 1977;;23:1912-1916.
44 +
Miller ES.  Blood lost because of phlebotomy. N Engl J Med . 1975;;292:319.
45 +
Eyster F, Bernene J.  Nosocomial anemia. JAMA . 1973;;223:73-75.
46 +
Hashimoto F.  Bleeding less for diagnostics. JAMA . 1982;;248:171.
47 +
Bhaskaran NC, Lawler PG.  How much blood for a blood gas. Anaesthesia . 1988;;43:811-812.
48 +
Dennis RC, Yeston NS, Statland B.  Effect of sample dilutions on arterial blood gas determinations. Crit Care Med . 1985;;13:1067-1068.
49 +
Bone RC, Balk RA.  Noninvasive respiratory care unit. Chest . 1988;;93:390-394.

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