Hello,
Regarding regional perfusion abnormalities, I have one small point in disagreement to Ron’s but I still don’t offer any better solution for routine sampling however. Although the arterial blood sampled taken from the arm is a well mixed sample, it’s dependent upon the venous return from that same arm (circulation) as to its relevance with current condition. If the venous return blood is backed up in the arm then so too will be the arteries that supply them. So that any lactate measurement (arterial, venous or capillary) from a hand or arm that’s not in current circulation is old news (forgive the pun). As for clearing an arterial line with a syringe to pull down new ‘fresh’ blood from the heart for sampling, that won’t work either. Arteries are simple supply pipes under consistent pressure regardless of their location or size. A pressure drop in one (clearing blood draw with a syringe) is replaced by blood in the surrounding arteries and not straight lined from the heart. Essentially you’d have to clear (circulate) all the current blood in the arm before you’d get a current sample. >From a physics perspective, the only reliable site that will provide a mixed >and undisputed current (circulating) blood sample would be from the SVC via a >central line. Best, Matt Reavill Plainfield, Illinois From: [email protected] [mailto:[email protected]] On Behalf Of Ron Daniels Sent: Tuesday, November 13, 2012 2:53 AM To: Shawver, Stephanie Cc: [email protected] Subject: Re: [Sepsis Groups] Venous vs. Arterial Lactate 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: <mailto:[email protected]> [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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