Hi Stephanie, Most would suggest arterial lactate is the better measure. Venous lactate can be dependent on local perfusion to the sampled limb, whereas arterial lactate is analogous to mixed venous oxygen saturation: it's a more appropriate surrogate measure of global perfusion.
Pragmatically, if a venous lactate is normal we can be reassured that arterial lactate will also be normal. If venous is high, however, it's worth checking arterial to rule out regional perfusion abnormalities. Capillary lactate has also been validated... Hope this helps Kind regards Ron Dr Ron Daniels Chair: UK Sepsis Trust CEO: Global Sepsis Alliance Sent on the move from my iPhone, excuse brevity! On 9 Nov 2012, at 16:15, "Shawver, Stephanie" <[email protected]> wrote: > Colleagues, > > Our facility has recently implemented point of care arterial lactate testing > as an extension of point of care ABG’s. However, all of our sepsis protocols > are built around the assessment of venous lactate. We are starting to see > practitioners rely on the arterial lactate rather than the venous lactate and > / or reassess an elevated arterial lactate with a venous lactate or vice > versa. It is a concern of mine that if a practitioner sees a normal arterial > lactate and doesn’t assess the venous lactate as well – it could be missed > that the venous lactate is elevated (as I understand it, in sepsis the venous > lactate will be elevated before the arterial lactate becomes elevated). We > have had a couple cases where the practitioner did not activate the sepsis > protocols based on a normal arterial lactate, only to find out later the > venous lactate was elevated and EGDT was delayed. > > I have looked into the research and cannot find much about the use of > arterial lactates in sepsis & all the SSC / EGDT studies focus on the use of > venous lactate levels. Have any of you ran into this in your sepsis programs > and if so, how did you address it? And if anyone out there can point me to > research about arterial vs. venous lactate in sepsis? Any > thoughts/feedback/suggestions are welcome! Thank you! > > > Stephanie Shawver BSN, RN > SLMV Sepsis and Stroke Coordinator > St. Luke's Magic Valley > 801 Pole Line Road West | Twin Falls, ID 83301 > Office: (208) 814.4030 | Email: [email protected] > Suspect stroke? Think FAST! > Facial droop, Arm drift, Speech impairment, Time is brain - this is an > emergency! > > > > > > mg.slrmc.org made the following annotations > --------------------------------------------------------------------- > "This message is intended for the use of the person or entity to which it is > addressed and may contain information that is confidential or privileged, the > disclosure of which is governed by applicable law. If the reader of this > message > is not the intended recipient, you are hereby notified that any > dissemination, > distribution, or copying of this information is strictly prohibited. If you > have > received this message by error, please notify us immediately and destroy > the related message." > > --------------------------------------------------------------------- > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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