From Meg Hardin. George, The surgical services in our hospital are requesting that we look into purchasing the Thromboelastograph (TEG) or Rotational Thromboelastometry System (ROTEM) in order to decrease blood utilization. TEG representatives tell surgical services that they can receive results with in 2 minutes of the blood being placed on the analyzer. I know nothing (except what I read) about these analyzers and was wondering if any of your readers who use TEG or ROTEM could give me some information? I thank everyone in advance for their time with this question.
Hi, Meg, I hope we get some good responses. I have no experience with the ROTEM, though many Fritsma Factor participants use them. The TEG has been around since 1948, is a point of care analyzer that provides clotting results within two minutes of initiation as claimed, though the complete TEG tracing may require as much as 30 minutes, the trailing portion illustrating fibrinolysis. Most TEGs and ROTEMs are managed by operating room personnel and interpreted by anesthetists and anesthesiologists as a means for monitoring anticoagulant therapy, fibrinolysis, and for detecting disseminated intravascular coagulation.
An article, Gorlinger K, Fries D, Dirkmann D, et al. Reduction of FFP requirements by perioperative POC coagulation management with early calculated goal-directed therapy. Transfus Med Hemother 2012; 29: 104–13. illustrates how TEG may be used prior to surgery and in response to trauma to reduce therapeutic red blood cell and plasma volumes.
The issue of pneumatic tube delivery was addressed in severa
The issue of pneumatic tube delivery was addressed in several recent papers:
Amann G, et al. Effect of acceleration forces during transport through a pneumatic tube system on ROTEM® analysis. Clin Chem Lab Med. 2012;50:133542. http://www.ncbi.nlm.nih.gov/pubmed/22868797
Martin J, et al. Alterations in rotation thromboelastometry (ROTEM®) parameters: point-of-care testing vs analysis after pneumatic tube system transport. Br J Anaesth. 2012;109:5405. http://bja.oxfordjournals.org/content/109/4/540.full.pdf+html
We are in the process of purchasing the ROTEM for use in the
We are in the process of purchasing the ROTEM for use in the ER and cardiac surgery. The intention is to use the pneumatic tube system and have the test performed in the lab. I am concerned about activating platelets using the pneumatic tube. Does anyone use this process? Also, in regards to platelet activation, we use siliconized glass tubes for our platelet function studies because with time platelets clump and the count decreases over 50% when the plastic tubes are used. Which blue-top tube is used?
we have 6 TEGS. Two are located in our special coag lab and
we have 6 TEGS. Two are located in our special coag lab and service our Berlin Heart Program and Riley Childrens’ Hospital. the other four are at our Methodist Blood Bank and currently are only being used by trauma and CV. but I think there are plans to expand that. Two minutes is a bit optomistic, I agree.
JoeLamb and All,
Joe, I would love to speak with you. My
JoeLamb and All,
Joe, I would love to speak with you. My email is [email protected]. Thank you to all that responded to my question about TEG and ROTEM, I look forward to more input and please feel free to contact me at the above email address. Merry Christmas and Happy Holidays to all.
Meg
Very good slide psesentation from Ann Tobin, Ph.D.,Technical
Very good slide psesentation from Ann Tobin, Ph.D.,Technical Director, Advanced Coagulation and Core Lab, Pathology Consultants of South Broward/Memorial Healthcare System
http://www.aacc.org/members/divisions/cpoct/poc_forum/Documents/AnnTobin_ViscoelasticCoagulation.pdf
Hi. Meg, two minutes are too optimistic… please check this
Hi. Meg, two minutes are too optimistic… please check this paper with particular attention on the prices per test and QA:
HEAD-TO-HEAD
The TEG vs the ROTEM thromboelastography ?
thromboelastometry systems
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2008.05752.x/pdf
I have two TEGs. Meg, call me. I’d be happy to talk to you
I have two TEGs. Meg, call me. I’d be happy to talk to you.