Shah Trushil, Narasimhan Madhusudhanan, Rathinam Mary Latha, Relle Karen, Kim Melanie, Muthukumar Tharani, Tharpe William, Bartolome Sonja, Mahimainathan Lenin, Muthukumar Alagarraju
Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
William P. Clements Jr. University Hospital (CUH), University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
J Clin Med. 2021 Apr 15;10(8):1689. doi: 10.3390/jcm10081689.
An accurate creatinine (Cr) estimate is pivotal for the assessment of renal function. Both patient- and practice-spawned factors palliate the test accuracy of serum creatinine (sCr) and can erratically represent actual kidney function. This study evaluated the caregivers' awareness of enzymatic serum creatinine (E-sCr) assay interfering in dopamine/dobutamine (DD)-infused patient samples and the frequency of such interference in a critical care setting. We conducted an sCr awareness survey among UT Southwestern physicians, nurses, and pharmacists. We then performed a cross-sectional E-sCr comparison against the kinetic Jaffe method using the DD-infused patient samples collected from central venous catheters (CVC), peripherally inserted central catheter (PICC) lines, and the peripheral vein (PV). We retrospectively compared the longitudinal E-sCr results of the CVC/PICC draws with the corresponding blood urea nitrogen (BUN) levels. The survey results show a significant lack of awareness among caregivers about the negative interference of DD infusions on E-sCr. Cross-sectional E-sCr assessment relative to the Jaffe method displayed a negative interference in 12% of CVC/PICC line samples (7/57 DD-infused patients) compared to none in the PV draws. A longitudinal assessment of E-sCr, BUN, and potassium (K) levels from CVC/PICC line samples further confirmed a spurious decrease for E-sCr in about 12/50 (24%) patients who did not show a concurrent BUN or K decrease. The results suggest that a direct PV sampling accompanied by clinical laboratory-directed proactive discussion/activities can foster awareness among caregivers and eschew the false E-sCr estimates in DD-infused patients.
准确估算肌酐（Cr）对于评估肾功能至关重要。患者自身因素和医疗实践中产生的因素都会影响血清肌酐（sCr）检测的准确性，可能无法准确反映实际肾功能。本研究评估了护理人员对酶法血清肌酐（E-sCr）检测在多巴胺/多巴酚丁胺（DD）输注患者样本中干扰情况的认识，以及在重症监护环境中这种干扰的发生频率。我们对德克萨斯大学西南医学中心的医生、护士和药剂师进行了sCr认识情况调查。然后，我们使用从中心静脉导管（CVC）、外周静脉中心导管（PICC）和外周静脉（PV）采集的DD输注患者样本，将E-sCr与动力学Jaffe法进行了横断面比较。我们回顾性比较了CVC/PICC采集样本的纵向E-sCr结果与相应的血尿素氮（BUN）水平。调查结果显示，护理人员对DD输注对E-sCr的负面干扰认识严重不足。与Jaffe法相比，横断面E-sCr评估显示，12%的CVC/PICC样本（7/57例DD输注患者）存在负面干扰，而PV采集样本中未出现这种情况。对CVC/PICC样本的E-sCr、BUN和钾（K）水平进行纵向评估进一步证实，在约12/50（24%）未同时出现BUN或K降低的患者中，E-sCr出现了假性降低。结果表明，直接从PV采样并结合临床实验室主导的主动讨论/活动，可以提高护理人员的认识，避免在DD输注患者中出现错误的E-sCr估算。
