RT had an opportunity to discuss the latest trends in blood gas analyzers with Alan Beder, Manager of Scientific Affairs, Radiometer America Inc, Westlake, Ohio; Howard Deahr, Vice President of Worldwide Marketing for Nova Biomedical Corp, Waltham, Mass; and Britteny Garner, product manager for OPTI Medical Systems Inc, Roswell, Ga.

RT: As computer chips and algorithms have improved over the last 5 years, in general, what features and advantages do today’s blood gas analyzers have over previous generations?

Garner: Improvements in computer technology have led to some exciting improvements in blood gas analyzers in recent years. Blood gas analyzers are smaller and faster than ever with more powerful data-management capabilities. Advancements in algorithms have led to greater accuracy, smaller sample sizes, and faster measurement times. Our OPTI R analyzer returns measurement results in less than 1 minute. When you add it up, all of these improvements have revolutionized point of care testing.

Deahr: Nova blood gas analyzers have taken advantage of computer chips, algorithms, and advanced biosensor technology in several ways. Computerization has been used to automate many tasks that have been performed manually in the past. For example, computerized automation of quality control has eliminated one of the most time-consuming tasks of operating blood gas analyzers—performing and documenting daily quality control. Computerized self-calibrating, self-monitoring, and even self-correction of each analysis and calibration have led to simple, one-button, walk-away automation.

Computerization has also allowed Nova to incorporate additional functions into our blood gas analyzer—such as comprehensive data management and automated maintenance functions. Computer automation, algorithms, and advanced biosensor technology are combined to integrate more tests (as many as 20) into a single, compact analyzer and to reduce analysis time, sample volume, and operating cost.

RT: As blood-gas analyzers are becoming more sophisticated, are they also becoming more complicated to use—especially for RTs performing point-of-care testing—or has ease-of-use also improved with the technology?

Garner: Ease-of-use has definitely improved with technology. In fact, much of what makes newer analyzers more sophisticated are the improvements to ease-of-use over older analyzers. I’ve noticed strong trends toward simpler user interfaces, customizable software, and reduced maintenance on blood gas analyzers. For instance, fourth generation OPTI blood gas analyzers have a touch screen interface that displays easy to follow picture-based instructions that actually reduce training time. Our OPTI CCA-TS requires no daily maintenance, has no standby costs, and has an average time to first service of about 10 years.

Beder: The technological sophistication of the analyzer has actually made ease-of-use improvements possible. Advanced technology has produced simplified user interfaces, automatic quality control, and automated data entry capabilities, to name a few. So, the net effect of technology on ease-of-use has been positive.

Deahr: By automating manual functions like quality control, calibration, and maintenance, Nova blood gas analyzers are easier to use, faster, and more reliable for RTs than ever before. Increased sophistication of these analyzers saves both time and labor, and allows respiratory therapists to spend more time with their patients.

RT: Tell us about your company’s most recent products and why they are innovative for the needs of RTs.

Garner: OPTI Medical’s new OPTI R compact bench-top blood gas analyzer uses our optical fluorescence technology in a reusable sensor cassette that directly measures blood gas, electrolytes, total hemoglobin, and oxygen saturation. The OPTI R has reuseable optical sensors rather than expensive electrodes that require maintenance. The OPTI R comes with a fluid pack with three levels of integrated controls and waste containment. Our software enables users to program the controls to run automatically, which saves lots of time and extra work. Plus the OPTI R is always calibrated so they can put their samples in right away and have the results in 60 seconds.

Beder: Over the past several years, Radiometer has focused on integrating our instruments, samplers, and information technology in a way that reduces the steps in the analytical process, improves patient and operator safety, and minimizes errors.

Deahr: Nova’s most recent product introduction is our Stat Profile Critical Care Xpress (CCX) analyzer that offers up to 20 measured tests, including blood gases, chemistry, electrolytes, hematocrit and hemoglobin, and co-oximetry in a single, compact instrument. CCX expands the role of respiratory therapists as part of the patient care team. Therapists are now able to provide point of care blood gases plus essential electrolytes, chemistry, and hematology results from a single blood sample, with one-button operation, in less than 2 minutes.

RT: What are the most important things RTs should be aware of when collecting samples for today’s machines?

Beder: As much as 60% of all errors in blood gas testing occur in the preanalytical phase, that is, the phase involved with sample collection and preparation. Preanalytical errors, including improper sample draw and mixing, incorrect sample identification, and the presence of air bubbles and clots in the sample, can all lead to an incorrect result. (Radiometer offers a free information booklet called “Avoiding Preanalytical Errors in Blood Gas Testing.” Readers can request it through our Web site, www.radiometeramerica.com, or by calling (800) 871-8900, ext 333.)

Garner: Today’s machines are less sensitive to sample handling. The OPTI family of analyzers has heated measurement chambers so iced samples are not a problem. Because of our automated aspiration and bubble detection, sample introduction is not user technique dependent. Our optical fluorescence technology has also reduced the effects of common interfering substances on test results.

Deahr: Along with expanded test menus, today’s blood gas analyzers are able to accommodate sample sizes as small as 50 mL. With these smaller sample sizes, it becomes more important that samples are heparinized and mixed properly. Sample mixing is important to assure homogeneity of the sample. For samples from arterial lines, the line must be cleared properly to prevent sample dilution or contamination.

RT: Are there any precautions RTs should take in order to get the best results?

Deahr: Proper sample collection, handling, and mixing are important with any blood gas analyzer. For example, glucose results can be affected if the sample is not analyzed within 15 minutes; hematocrit results can be affected if the sample is not mixed properly; blood gases can be affected if air is not expelled from the syringe. Several references are available regarding proper sample handling for blood gases, including Blood Gases and Electrolytes by John Toffaletti, PhD, AACC Press.

RT: What about future trends/products in blood gas analysis that will be coming out in the next generation, or even in the next 5 years? How are they going to be improved over the current generation?

Garner: With the ever rising cost of health care, there is great emphasis to reduce costs, especially cost per sample and labor costs. For instance, analyzers will be available with larger test panels, which will reduce the number of analyzers hospitals need to maintain. OPTI Medical is currently working on expanding our test panel. Quality compliance is also a common concern, and I think we will see more analyzers with sophisticated automatic quality monitoring in the future. Data management and wireless connectivity will be of increasing importance in choosing a blood gas analyzer in the next few years as well.

Editor’s Note
Read about some of the problems RTs might encounter during blood-gas analysis here.

Deahr: Among the future trends in blood gas analysis are expanded test menus, further automation, and reduced labor requirements. Over the long term, we foresee the advent of continuous and less invasive technology.

Beder: In some ways, the future is already here. We see an expansion of the trends already under way, with improvements in IT integration and automation capabilities. In the future, standardized interfaces will enable a more seamless connection between analyzers and the HIS/LIS. Automated sample handling at the point of care will serve to reduce preanalytical errors at the bedside. And the trend toward including additional parameters with blood gas will continue, resulting in a complete acute care profile in a single instrument.

Tor Valenza is a staff writer for RT. For further information contact [email protected].