TEG testing

[adiescast]

There was a short thread about this several years ago. I am curious as to who is using this test and whether it actually does reduce blood component usage. Our cardiac surgeons are asking about implementing it. It was pitched to them as a point of care test, but I don't know if that is the best choice for location of test performance.

If you use it, who performs the test? Does it reduce component usage?

Thanks ahead of time for your response!

[Malcolm Needs ☆]

I must admit, as a pure (well, maybe a little sullied) blood group serologist, I have little or no knowledge of this, but there is a chapter (chapter 15) in A Manual for Blood Conservation" edited by Dafydd Thomas, John Thompson and Biddy Ridler, tfm Publishing Limited, 1st edition, 2005 (ISBN 1 903378 24 9) that talks about this, if that is any help.

:confused::confused:

[Lcsmrz]

Perfusionists love the TEG analyzer and swear by its clinical utility in transfusion decision-making. I would read their literature to see what information they're getting.

[donde]

Our facility received a pitch for this testing also. After a thorough evaluation of current blood usage, costs associated with the TEG system, etc., the physician-based team recognized that our Cardiac department wasn't really overusing blood. Our pathologists reviewed indications/usage and didn't really see where there was much room for improvement. That being said, the real interest in TEG came from our Trauma surgeons. However, they were drawn in by the earliest reading time quoted from the test system and said if they had to wait until the run was complete for the most accurate result, it may not help them either. Lab was insistent the instrument not be based in the OR/ER because of the potential for basing transfusion decisions before the test had completed its entire cycle. I do not have access to the complete detail on this study, so I hope this short synopsis helps.

[Karen Olsen]

We have been using the TEG at our facility for probably 10 years now. It has dramatically reduced the blood product usage on open heart cases. It is operated by a perfusionist in the OR. We have always wanted to duplicate the instrument in the Lab but that has not happened yet. Other surgical areas have studied the usefulness of this instument in their areas but it has not really taken off very well into any area other than OHS. (Mostly because they are unscheduled and the Perfusionist needs to be there to run the instrument)

Matter of fact we had a really bad week in June a few years ago with tons of product going out. We couldn't figure out what was going on. Then later found out that the TEG had been out of service that week. (The lab is the last to know!) I swear by the TEG. We did many studies on the usefulness of the TEG back in 2001-2002. That was when we were trying to get a second unit in. The studies looked great but the second unit never has appeared! Some of the key points to it are that the physician has to trust the person reading the results! And then also the person interpreting the results needs to be well trained! The interpretation tells you exactly what products to give the patient or if there is still a bleeder that needs to be repaired. Personal opinion - for the patient's sake I think this instument is awesome!

[tbostock]

Saw a pretty thorough demo of it a couple years ago. It does take some training to be able to interpret the results correctly. And I did get the salesperson to admit that most sites start out with it in the ED or OR, but then it becomes relocated to the Lab. As Karen states above, a perfusionist would be the perfect one to deal with it if it is a point of care instrument. Otherwise, you need someone trained in its use...I also remember that you had to test the sample quickly after collection, so if it is located in the Lab, there needs to be a mechanism for quick transport.

Used as designed, I do believe it would save on blood products, but more importantly, I think you get a better idea of which blood products are needed first (platelets, plasma, etc). So many patients on Plavix and Coumadin nowadays...

[kate murphy]

We use TEG here, but in the lab, not point of care. It appears that it does reduce PLT usage. It has no bearing on other products.

Personally, I think that advances in surgical technique (use of robotics) has much more of an impact.

Though - price of a surgical robot + training = $1M

Price of TEG = $20K

[ybunch]

We use TEG. Recently we had software problems that came from our system. CT surgeons wanted it fixed. So, evidently, they think it is valuable. We use it with in combination with a other systems. Our transfusion use is down, but it has to be a comibination of strategies. I know Englewood uses it and they have low transfusion rates with the lowest mortality rate in New Jersey.

[BenchTech]

The place that I am at has been using TEG testing for quite awhile (6yrs-8yrs) and although I have not worked there that long they rave about the reduction in the usage of plts, cryo, and FFP. The perfusionists were in charge of the TEGs and the lab has recently got two additional machines as back up for the OR and for outpatient testing. They do TEGs on all OR cardiac cases and in certain other instances. Having run the machines, they are really cool and provide a ton of information once you learn how to interpret the graphs. They also use TEGs to determine if the bleeding post-OP is just from the procedure or if they are leaking and need to go back in to the OR.

[bbbiker]

We have been using the TEG at our facility for probably 10 years now. It has dramatically reduced the blood product usage on open heart cases. It is operated by a perfusionist in the OR. We have always wanted to duplicate the instrument in the Lab but that has not happened yet. Other surgical areas have studied the usefulness of this instument in their areas but it has not really taken off very well into any area other than OHS. (Mostly because they are unscheduled and the Perfusionist needs to be there to run the instrument)

Matter of fact we had a really bad week in June a few years ago with tons of product going out. We couldn't figure out what was going on. Then later found out that the TEG had been out of service that week. (The lab is the last to know!) I swear by the TEG. We did many studies on the usefulness of the TEG back in 2001-2002. That was when we were trying to get a second unit in. The studies looked great but the second unit never has appeared! Some of the key points to it are that the physician has to trust the person reading the results! And then also the person interpreting the results needs to be well trained! The interpretation tells you exactly what products to give the patient or if there is still a bleeder that needs to be repaired. Personal opinion - for the patient's sake I think this instument is awesome!

We are also looking at using the TEG for CV surgery, and trauma. Is one instrument enough? We were told for platelet mapping you need 2 analyzers (4 channels). At your institution do they do platelet mapping (pre-op to look for platelet inhibition) in addition to the rapid TEG (intra and post-op)?