POCT AND TROUBLESHOOTING

• Point-of-Care Testing (POCT)


  Also known as alternate site testing (AST), involves collecting blood and conducting laboratory tests at or near the patient's bedside
• Benefits of POCT


  • Offers convenience, quick turnaround for results, and enables prompt medical attention
• Compliance


  Must follow Clinical Laboratory Improvement Amendments (CLIA) and Occupational Safety and Health Administration (OSHA) guidelines
• Disinfection in POCT


  Use 10% bleach, prepared and mixed daily
• Quality-Control (QC) Logs in POCT


  Record control results for consistency
• Specimen Handling in POCT


  Follow OSHA guidelines for specimen collection and disposal
• Coagulation Monitoring by POCT


  Monitor warfarin and heparin therapy in patients with clotting disorders
• Common Coagulation Tests in POCT

  • Activated Partial Thromboplastin Time (APTT/PTT)
  • Prothrombin Time (PT) and International Normalized Ratio (INR)
  • Activated Clotting Time (ACT)
  • Platelet Function
• Instruments for Coagulation Monitoring in POCT


  • CoaguChek XS Plus
  • i-STAT
  • Verify Now
• Bleeding Time (BT) Test


  1. Measures the time required for blood to stop flowing from a standardized puncture

  2. Equipment Needed: Blood pressure cuff, Sterile automated incision device (e.g., Surgicutt), Stopwatch, Alcohol, cotton balls, and micropore
• Sources of Error in Bleeding Time Test


  • Aspirin intake, incorrect pressure, or improper timing
• Arterial Blood Gases (ABGs)


  Key Parameters: pH, Partial Pressure of CO2 (pCO2), Partial Pressure of O2 (pO2), Oxygen Saturation (sO2)
• Purpose of ABGs


  Used in critical care settings to monitor metabolic and respiratory states
• Common Electrolytes Measured in POCT

  • Sodium (Na+)
  • Potassium (K+)
  • Ionized Calcium (iCa2+)
  • Chloride (Cl-)
  • Bicarbonate (HCO3-)
• Electrolytes


  Maintain osmotic pressure, acid-base balance, muscle function, nerve conduction, cardiac output, blood clotting, and cellular integrity
• Examples of Multiple-Test-Panel Instruments in POCT


  • ABL80 Flex
  • i-STAT
  • GEM Premier
  • NOVA Stat Profile Analyzer
• 1. Reactive Protein (CRP) Measurement


  Indicates systemic inflammation, used as a marker for inflammatory response
• Lipid Testing in POCT


  Measures cholesterol, triglycerides, LDL, and HDL levels
• Other Tests Performed by POCT


  • Cardiac Troponin T and I Testing
  • Glucose Testing
• Cardiac Troponin T and I Testing


  Detects proteins specific to heart muscle, aiding in diagnosing heart attacks
• Glucose Testing


  Used to monitor glucose levels in diabetic patients, conducted through skin puncture, applying blood to a test strip/microcuvette
• Troubleshooting Failed Venipuncture


  1. Needle Position: Slowly advance the needle, disengage the tube and redirect, gently push the needle forward, pull the needle back slightly, withdraw the needle until blood flow is established, remove the tube and advance the needle slowly

  2. Collapsed Vein: Retighten the tourniquet, apply pressure to the vein above the needle, use a smaller-volume tube, choose a new site

  3. Tube Position and Vacuum: Ensure the tube is correctly seated, use a new tube if the vacuum is lost
• Post-Phlebotomy Procedures


  1. Disassembly of Needle from Syringe: Use a one-hand scoop technique or a removal device, discard the needle immediately in a sharps container

  2. Safe Waste and Sharps Disposal: Use puncture-resistant, leak-proof containers, dispose of biomedical waste according to regulatory guidelines

  3. Blood Spillage Management: Wear gloves and protective clothing, clean up with paper towels and disinfect with a bleach solution, discard gloves and wash hands thoroughly
• Infection Prevention and Control in POCT


  • Use clean tourniquets and puncture-proof sharps containers, transport blood samples in closed systems to prevent contamination, store specimens in a cool, secure area
• Best Practices in POCT

  • Follow strict safety protocols to avoid needle-stick injuries and blood contamination, use properly labeled blood sample containers with a tracking system to ensure samples are handled correctly
• The needle was likely only partially in the vein, causing the tube to lose vacuum
• The hissing sound and the stoppage of blood flow indicate that the vacuum was lost
• Corrective Measures


  Position the needle correctly in the vein, ensuring no part of it is outside the skin, replace the current tube with a new one to re-establish blood flow
• If there's any sign of a hematoma or patient discomfort, discontinue the draw and choose a new site to ensure patient safety