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Rarely Ordered But Critical Tests

Published July 23, 2014 6:05 AM by Scott Warner

The bread and butter of labs are those tests ordered on most patients: chemistry panels, blood counts, urinalysis and culture, and to an extent coagulation and blood bank. These are often ordered serially on patients admitted to your hospital, creating a cumulative report of laboratory values. As professionals we tend to be most productive and competent performing these tests, or at least operating the instruments that produce them.

But it is those rarely ordered but critical tests that can drive new technology and make us valuable to clinicians. Not just anyone can run them.

For example, in Maine many people use wood heat or are shut in for much of the winter. Carbon monoxide poisoning is a seasonal risk. These patients arrive at our ED, and it would be good if a physician could have a carboxyhemoglobin level STAT. Instead we offer this test as a sendout to our referral lab. It’s rarely ordered, instrumentation is costly, the docs don’t complain about not having it except (naturally) when they really need it, and when the weather warms it falls off the radar. It’s a good example of test that when the doc needs a result, he or she needs it now and not in two to four hours.

These rare but critical tests present unique challenges. They are expensive to keep in house, sometimes difficult to verify and control, more likely to have expired materials, and are harder for techs to remember how to do. Since they can be ordered in an urgent context, the latter is a real problem. It isn’t a problem to put a STAT chemistry panel on a busy instrument designed to prioritize STATs, but cerebrospinal fluid testing, for example, is always disruptive -- ask any night tech!

“Rare but critical” is the reason laboratories need highly trained professionals. Running routine specimens through analyzers isn’t worry-free, but variables are limited and repetition ensures a degree of competency. But a rarely ordered test ordered on a critical patient is already a problem.

We’re looking at the Avoximeter to resolve our carboxyhemoglogin issue. Is anyone using this?

NEXT: How Many Tests?


Our lab has had the Avoximeter for eight years and still going strong.

We mainly use it for methemoglobins and CO's esp during the winter.

We love it.

Sonia August 5, 2014 1:37 PM
Harlingen TX

Thanks for the input!

Scott Warner August 3, 2014 1:03 PM

Hi Scott,

We have had our Avoximeter for two years now and like Sue find it very easy to use and reliable.  I would highly recommend it.

Lisa Hanks, , Director Laboratory Salem Township Hospital August 1, 2014 9:11 AM
Salem IL

Scott, we use an Avoximeter in our lab as a part of our backup to our blood gas analyzer and in our Cath lab for O2 saturation. We have found it reliable and very easy to operate. And a plus, it isn't very big and requires very little maintanance.

Sue Ross, , Lab Director Mid Coast Hospital August 1, 2014 8:01 AM
Brunswick ME

We have avoximeters at our two campus labs and yes the volume is low but we consider it a critical test.

Carol DiMeo July 31, 2014 9:01 PM


We are also a Critical Access Hospital. I purchased a Rad-57c Pluse CO-oximeter from Masino Co, Irvine CA afew years ago for are ED to monitor CO. I do not recall the exact  price but not unreasonable.


Gene Maronde, , lab manager LCMC July 31, 2014 5:43 PM
Winslow AZ

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About this Blog

    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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