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Platelet Function Testing in the OR

From Jim Turner: Hey Mr Fritsma! Great site and I really like the longer hair! I now work for TriMedX. I am one of their clinical engineers here in Birmingham at St Vincent’s Medical Center. I (and others) are having a problem with this platelet activity instrument called the VerifyNow. The heaters on these things go out constantly and then it takes the company up to 3 months to repair them and get them back to us. The company does not offer repair training and does not sell us parts. Do you know of another system or methodology that offers surgery units these results with more reliable equipment? I did offer the good ole bleeding time test as an alternative which was not received well. (LOL).

Hi, Jim, it is great to “hear” from you, and thanks for the compliment on my hair! It has been this way for a while, but I decided I should face reality and post a new picture when we enhanced the web site! By the way, although I’m sponsored by Precision BioLogic Inc in Dartmouth, near Halifax, I’m still living and working in Birmingham, Alabama, where the temperature today is colder than Nova Scotia!

On to your question. I’m surprised you are having this problem with the Accumetrics VerifyNow instrument, I’d not previously heard of any instability with their heating device. I presume you have the instruments on surge protectors or uninterruptible power supplies; nevertheless, I wonder if there are local power surge or slump problems. I guess that if there were, you’d be having similar problems with other instruments. Accumetrics was recently purchased by International Technidyne Corporation (ITC) and the new company is renamed Accriva, however their location and services are the same, so the merger should not be affecting their service. Perhaps someone from Accriva will see this post and get in touch with us.

Meanwhile, there is currently no other POC instrument available to check on low platelet response to aspirin, clopidogrel, or glycoprotein inhibitor therapy. One day soon, perhaps, Roche will start a US launch of the Multiplate, manufactured in Germany and currently sold in Europe, but it is currently unavailable. As an alternative, your central laboratory can offer platelet aggregometry, but that doesn’t help of course when anesthesiologists require instant feedback. An alternative instrument used in many operating rooms is the Thromboelastograph (TEG) or its competitor, the ROTEM rotational thromboelastometry instrument, both of which provide a global coagulation pattern that reflects platelet function. They require a little more training than the Accumetrics instrument, but also provide information on the effects of heparin and fibrinolytic therapy. Chances are, your anesthesiologists are familiar with them. I hope this helps, and best wishes to you and your family!

Comments (6)
Antiplatelet Therapy
Mar 3, 2015 10:03am

Interesting conversation
Interesting conversation. We started performing the VerifyNow PRUTest in January and have not had any problems with overheating. Before we went live with the testing the company came in and did an upgrade since our instruments were older and hadn’t been in use for quite some time. We have had occasional error codes but since we ask for 2–3 tubes per patient the repeat usually works fine. We had been performing the TEG platelet mapping prior to this but have stopped offering the ADP mapping due to inconsistent results. We also perform an ADP aggregation with most of our VerfyNow tests since we saw a lot of patient variability when we did the validation. We feel this gives them more information to work with. The only drawback is that we can only offer the aggregation during the day shift hours.

Feb 23, 2015 4:02pm

I would like to add that we
I would like to add that we did the things suggested by Dave, with no luck. The filter wasn’t dirty and the fan was actually moving. We met all the criterion suggested by Accriva for troubleshooting. Still, no luck with the error going away.

Feb 23, 2015 12:12pm

Jim, Ali, Janine, and Dave, I
Jim, Ali, Janine, and Dave, I’ve sent an email to the Accumetrics service department and am awaiting a response. I’d like them to have the opportunity to defend their equipment!

Feb 23, 2015 10:34am

Concerning the heating
Concerning the heating problem with the Accumetrics system I have a suggestion. Make sure the filter fan is clean and totally unobstructed. I experienced issues with this problem that are exactly what you describe. On another note Roche has no current plans to upgrade their efforts to market Multiplate for clinical use in the United States. This is very sad!

Feb 23, 2015 8:49am

We have been having the exact
We have been having the exact same issues. We have had 6 different instruments since we started performing this test at the end of 2011. I’ve not had very much success working with the technical line; asked the same questions every time. We also started experiencing more errors before the instrument died this time. I asked if there was a relationship between the errors and the instrument going down, but received no answers. We would love help with this issues, as our doctors really want the testing.

Feb 19, 2015 11:29am

Hi, I would like to add more
From Ali Sadeghi-Khomami, PhD: Hi, I would like to add more to your platelet function testing shopping list for further consideration: PAP-8E (Bio/Data Corporation), PFA-100 (Siemens), PlateletWorks (Helena Laboratories), AggreGuide (AggreDYNE). No comments on their performance or FDA clearance status.
Hello, Ali, and I’d also add the Chrono-Log Model 700 whole blood and optical lumiaggregometer. Geo.

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