We have been conforming every positive dipstick result for bilirubin with the ictotest forever. The ictotest is sometimes difficult to read and we're not sure which one to go with. Is it a requirement by Jacho? Is it still needed?

It is no longer a TJC requirement to confirm all positives--just change you P&P to show if you are confirming any positives. If not, there should be info available as to the limitations of the "screening" test.

We have been using Roche strips and analyzer for some time, and there is nothing in the manufacturer's instruction that would make us want to use an Ictotest as a confirmatory.

Years ago we used a Bayer strip/analyzer that gave false positives for bilirubin depending on the color of the urine (the Roche strips have a color compensation pad). We used Ictotests for confirmation then.

I would agree that if your manufacturer does not recommend confirmatory testing you do not need to do it.

A confirmation test on a positive bilirubin by dip stick method is highly recommended because as few as 1 out of 4 or 5 is only true positive. By the way, Ictotest has not been available for almost a year and won't be available, if at all,  until sometime in  2014. A replacement test called ICTOCHECK is now available from Biorex Labs. This test uses a disc instead of a tablet.

For details of confirmation test, see Dr. Robert Novak's write up in "CAP Today" under urine bilirubin.

 

Excerpt from  -  Arch Pathol Lab Med—Vol 137, August 2013   -  available online

 

Currently there is no guideline on whether confirmatory testing needs to be done for urine ketones or bilirubin.  The Clinical and Laboratory Standards Institute has stated that ‘‘many of the historical confirmatory chemical urinalysis tests such as the sulfosalicylic acid

(SSA) test for protein, the tablet test for ketones, and the tablet test for bilirubin may not be relevant to current laboratory practice.’’ 2

 

The College of American Pathologists does not require these confirmations and suggests that users follow the manufacturer’s recommendations.

 

In summary, using the same or a similar qualitative methodology to confirm another qualitative method duplicates work, increases costs, and may provide misleading information.  Thus, such confirmatory tests should be discontinued. Confirmatory and complementary tests such as serum bilirubin and ketones (in particular bhydroxybutyrate) should be ordered when clinically warranted.

 

 

Our laboratory has discontinued all confirmatory testing.

Bayer has stopped manufacturing Acetest tablets for Ketones. For those institutions such as smaller hospitals and labs which still use it, a substitute tablet test is now available. The test tablets are called K-CHECK and are made by Biorex Labs.

We stopped using it in the last century, along with all the other "confirmatory" urinalysis tests.  In the case of the ictotest tablets, the chemistry methodology is the same as the strip, if I am not mistaken.

 

Scott