| Abstract | OBJECTIVE: To evaluate the bias, precision, and blood loss characteristics of an ex vivo
in-line point-of-care testing blood gas and electrolyte monitor designed for use in critically ill
newborn infants. STUDY DESIGN: Study participants included consecutive neonates with
an umbilical artery catheter (UAC) in use for clinical laboratory testing. The in-line monitor
(VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medical, San Diego, CA)
was directly connected to the participant's UAC and the monitor's determinations of pH,
PCO(2), PO(2), sodium, potassium, and hematocrit (Hct) were compared with those
simultaneously drawn and measured with a standard bench top laboratory instrument
(Radiometer 625 ABL; Radiometer America, Inc, Westlake, OH). The bias (the mean
difference from the reference method) and precision (1 standard deviation of the mean
difference) performance criteria of the in-line monitor were derived using standard
laboratory procedures. RESULTS: Sixteen neonates monitored for a total of 37 days had a
total of 229 paired blood samples available for comparison by the 2 methods. Bias and
precision performance characteristics of the in-line monitor were similar to reports of other
point-of-care devices (ie, pH: -.003 +/-.024; PCO(2):.35 +/- 2.84 mm Hg; PO(2):.39 +/-
7.30 mm Hg; sodium:.52 +/- 2.34 mmol/L; potassium:.17 +/-.18 mmol/L; and Hct:.61 +/-
2.80%). The range of values observed for each parameter included much of the range
anticipated among critically ill neonates (ie, pH: 7.15-7.65; PCO(2): 25-75 mm Hg; PO(2):
25-275 mm Hg; sodium: 127-150 mmol/L; potassium: 2.6-5.5 mmol/L; and Hct: 32%-60%).
Mean blood loss (+/- standard deviation) per sample with the in-line monitor was
approximately one-tenth that of the reference method: 24 +/- 7 microL versus 250 microL,
respectively. There was no evidence of hemolysis and no patient related safety issues were
identified with use of the in-line monitor. CONCLUSIONS: Repeated laboratory testing of
critically ill neonates using an ex vivo in-line monitor designed for use in neonates provides
reliable laboratory results. The blood loss and hemolysis data obtained suggests that this
monitoring device offers potential for reducing neonatal blood loss-and possibly transfusion
needs-during the first weeks of life. Before this promising technology can be routinely
recommended for care of critically ill neonates, greater practical experience in a variety of
clinical settings is needed. |