Recommended change to clinical application
Pleural fluids must not be processed through any arterial blood gas device. The clinical benefit of the result does not appear to warrant the risk to service continuity in the current COVID 19 event.
This will have no impact on clinical decision making nor patient care. This is an important infection control measure.
- Pleural fluid pH will not be available at all.
- Pleural fluid LDH and protein analysis will only be available if sent in a serum gel tube for analysis on the main laboratory analyser.
Any other body fluid analysis concerns should be discussed with your local NSWHP Point of care coordinator or Lab Manager.
Frequently asked questions
Can blood gas analysers be used for pleural fluid testing?
No. NSW Health Pathology understands that some Radiometer blood gas analysers have been used for pleural fluid testing.
The NSWHP Clinical Chemistry Clinical Stream has considered the implications of this in the current context and advised that this should cease immediately.
Due to safety concerns, pleural fluids must not be processed through any blood gas device. NSW Health Pathology will work with Radiometer to make sure this functionality is switched off. Pleural fluid LDH and protein analysis will be available if presented to the laboratory for analysis in a serum gel tube.
How will blood gas analysers be safely maintained?
Advice on Personal Protective Equipment (PPE)
PPE for device maintenance is indicated in the PoCT Operating Folder (green folder) and must be used by NSWHP staff when they are performing service maintenance. Gown, gloves and mask/face shield are the minimum requirement. This may be supplemented in line with local health district protocols for the area in which the device is located.
Check with department/ward staff before entering areas where PoCT equipment is sited to understand if there are any other requirements.
There is a Health Education and Training Institute (HETI) online course to assist staff with infection control precautions: Infection Prevention-Enhanced precautions for pandemic flu: 289888589. The Clinical Excellence Commission (CEC) also provides advice in PPE guidelines the Application of PPE in Response to COVID-19 Pandemic.
Advice for self-cleaning analysers
Some of the larger blood gas analysers like Radiometer models and Werfen GEMs have internal selfcleaning programs. The programmed cleaning cycles must be changed to be a minimum of twice per week.
Advice for external cleaning
Use 70% alcohol to clean the outside of the analyser and its immediate environment, taking care with external probes. Bleach solutions are not recommended for cleaning some PoCT devices. Please refer to the cleaning instructions for individual devices, located in the PoCT Operating Folder (lime green folder). Device ‘declotting’ procotols remain unchanged.
What are we doing to secure reagent supply?
NSW Health Pathology is working hard to ensure the ongoing supply of reagents. We are in regular contact with our vendor partners and NSW Health.
There are stock contingencies in place at a government level in addition to those with each manufacturer. Stock use is tracked weekly and checked against projected usage and delivery times to ensure a reliable supply chain.
We have purchased i-STAT Alinity devices as contingency for expanded BGA requirements across NSW, should this be required. Extra ABL90s and GEM5000 devices have also been purchased and allocated where required to further guard against the anticipated impact on clinical services.
How can hospitals request new devices?
The same process for requesting PoCT applies but will be treated as a priority. Hospital PoCT coordinators for the hospital will lead the rapid processing of applications. Contact details for PoCT teams can be found on the Point of Care Testing site on the NSW Health Pathology website. An interactive map shows the areas and hospitals assigned to each PoCT coordinator.
Who do I contact for more
Contact details for PoCT teams can be found on the Point of Care Testing site on the NSW Health Pathology website.