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Oral
Clinically Significant Error In ICU Glucometer Testing From Hematocrit Effect Can Be Easily Corrected
By: Mann, E., Pidcoke, H., Wade, C., Salinas, J., Michalek, J., Holcomb, J., Wolf, S., Us Army Institute Of Surgical Research, Fort Sam Houston, TX
For further information, please contact: Elizabeth.Mann@amedd.army.mil
Purpose: Hematocrit effect, the influence of non-optimal hematocrit on the accuracy of glucose analyzers, poses a patient safety risk when tight glucose control is desired. We investigated glucometer error in our ICU and developed a reliable method for correction of hematocrit effect.
Background/Significance: Recent major clinical trials by Van den Berghe et al (2001) and Hebert et al (1999) have changed practice in the ICU. The combination of tight glucose management and restrictive blood transfusion policies has brought about a situation not anticipated when the widespread use of point-of-care glucose testing became the standard of care. Utilizing devices in the intensive care unit that were originally intended for home use by hyperglycemic diabetics with normal hematocrits has proved problematic.
Methods: 211 paired blood samples were prospectively collected and simultaneously tested with bedside glucometers (LifeScan SureStepFlexx™, Lifescan Inc, Milpitas, Ca) and laboratory serum analyzers. Serum versus glucometer results were plotted and regression analysis used to develop a mathematical correction factor subsequently validated with an additional 527 prospectively collected samples time-matched with grey top (sodium fluoride) lab specimens. Results: Glucometers over-estimated blood glucose levels by 30% (STDEV 14%); the average hematocrit for the patients analyzed was 23% (STDEV 5%). The corrected glucometer values for the validation samples were on average within 2% (STDEV 6.5%) of reported lab values. The average hematocrit in validation samples was 23% (STDEV 5%). This correction factor is now applied to all bedside glucose values for patients with a hematocrit less than 35%. Our nurses titrate insulin infusions based on the corrected glucose value.
Conclusions: There is a reliable and efficient method for accurately correcting for the hematocrit effect experienced with the LifeScan SureStepFlexx™ glucose analyzer
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