Melissa, Same issue here:
We have - Arterial Istat >1.25 Venous Istat >1.7 Serum sample >2.5 I posed this question to Dr. Levy and Christa Shore at one of our SCCM live collaborative sessions to see if we should just go by what is above the high end limit for that method. I was told that per SCCM guidelines any lactic acid >2.0 is considered severe sepsis, so we are just standardizing our protocols to address for >2.0. I am still working with our lab dept to see about having >2.0 a critical value regardless of method. Laurie Laurie A. Hiebert, BSN, RN System Sepsis Program Coordinator-ED/Inpatient Critical Care Performance Improvement Florida Hospital System Office: 407-303-2800 ext 110-1572 Cell: 407-312-4294 Fax: 407-303-2865 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Keck, Melissa R Sent: Thursday, September 24, 2015 8:18 AM To: '[email protected]' <[email protected]> Subject: [Sepsis Groups] Lactate level/Critical value Hi, Our organization is assessing the critical call-back level of lactate to clinicians from the lab. Currently, our call-back level is 4 mmol/L which places an individual in septic shock within the sepsis continuum. In order to identify patients earlier, i.e., those who will require bundle implementation with severe sepsis (lactate >/= 2), we have requested the that critical value call-back level be changed to 2 mmol/L. However, there is debate surrounding this secondary to concerns on whether or not the sample is arterial or venous -- depending on the source of the sample, there are different ranges of normal. I haven't been able to find anything in the CMS Core Measure Specs Manual that addresses whether or not the sample is arterial or venous when identifying septic patients with elevated lactate levels as a marker for organ dysfunction. A few questions: Specifically, are there any organizations that have a lactate of 2 mmol/L prompting a call from the lab for a critical value, and/or what is your critical call-back level for lactate? Does anyone have any specific literature and/or pointed direction that you are willing to share with regards to this topic? Any help would be appreciated here. Thanks so much in advance, Melissa Keck, RN, MSN/MSBA Sepsis Coordinator Quality Management Beaumont Hospital - Dearborn Oakwood Campus 18101 Oakwood Blvd. Dearborn, MI 48124 Office: 313.593.7103 Fax: 313.982.5671 Internal Page: #2513 External Page: 313-503-2068 x2513 [email protected]<mailto:[email protected]> [cid:[email protected]] This message (including any attachments) is intended only for the use of the individual or entity to which it is addressed and may contain information that is non-public, proprietary, privileged, confidential, and exempt from disclosure under applicable law or may constitute as attorney work product. If you are not the intended recipient, you are hereby notified that any use, dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, notify us immediately by telephone and (i) destroy this message if a facsimile or (ii) delete this message immediately if this is an electronic communication. Thank you.
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