The Joys of Shopping
Change is constant, especially in laboratory medicine. Monoclonal antibody assays changed latex agglutination kits; discrete random-assay analyzers changed batch testing; point of care instruments are refocusing core laboratory testing. These days, leaving the field for more than a few years almost guarantees learning some areas all over again. New technology is one of the more exciting aspects of our field.
Lately I’ve been looking at blood gas analyzers for our lab. Ah, the joys of shopping.
Some instruments, such as the IL GEM4000, bring total automation to the process with a cartridge-based, self-contained reagent system. This low-maintenance technology saves time, but lower volumes will waste reagent.
The Radiometer ABL90 FLEX analyzer is cartridge-based but more portable than the GEM. Similarly, it runs controls automatically. What’s really cool about this level of technology is that it’s portable, with a battery and WiFi. The future of blood gas analysis is leaning toward point of care.
There are practical reasons to embrace point of care blood gas testing: more immediate results, faster treatment, and more space in the core laboratory. Downsides are similar for other point of care testing: less control, more competency, and more time to manage the system.
I’m leaning toward a point of care analyzer also for the sake of cost. Our volumes are low enough to make systems like IL and Radiometer cost prohibitive. Fortunately, there are several good alternatives:
The Abbott iSTAT is a handheld analyzer without reagents. Everything is self-contained in a small one-use cartridge. While it seems to me that this system is showing its age, its proven technology still works well. Labs can have control over cartridge configurations that include chemistry and coagulation testing. The disadvantage for me is that the iSTAT doesn’t have WiFi capability. It needs to be docked to a central workstation.
Alere’s EPOC system is somewhat similar to the iSTAT but adds that WiFi capability that is essential to point of care testing. I don’t have experience with the EPOC, although I’ve seen demos. It looks like a good point of care alternative.
OPTIMedical’s CCA-TS2 analyzer is an interesting point of care alternative. It is cassette-based like the iSTAT and EPOC, and includes a color touch screen with step-by-step instruments and a built-in printer. It strikes me that this system would require the least amount of training.
Choices each have advantages and disadvantages. From a core laboratory standpoint it comes down to the business of cost: reagents and consumables, service, and maintenance time. But considering point of care testing alternatives adds many variables: portability, ease of use, ease of training, connectivity, and other issues. Other departments such as the ED, ICU, NICU, and respiratory therapy should be consulted. Each will have its own needs. From the lab standpoint it’s still mostly a matter of cost. But deciding the biggest bang for that buck is more complicated.
Ah, the joys of shopping.
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