Point of care testing

• POCT


  point of care testing
• Benefits of POCT


  convenient to patient and short turn around time
• POCT has been made possible by advances in laboratory instrumentation that have led to the development of _____________,_________, &___________testing devices

  small, portable, and often hand held testing devices
• In POCT, aside from being able to operate instrumentation and skills, one should be able to


  carry out the quality control (QC) and maintenance procedures necessary to ensure that results obtained are accurate
• POCT in a clinical setting must meet the requirements of:


  CLIA for testing and OSHA guidelines for specimen handling
• CLIA


  clinical laboratory improvement amendments
• OSHA


  occupational safety and health administration
• Handheld POC analyzers carried between patients in HCI can be fomites for __________

  diseases
• Several manufacturers recommend cleaning handheld POC analyzers with ____________

  10% bleach or 1:10 bleach solution
• Cleaning POC devices reduces cross contamination of various bacteria such as


  clostridium difficile, methicilin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE)
• POC Coagulation tests


  PT & INR, PTT, ACT, and platelet function
• POC coagulation analyzers can be used to monitor patients on ___________________

  warfarin and heparin therapy
• POCT instruments used for coagulation test


  1. coaguChek XS Plus- PT & INR

  2. Cascade POC - ACT, PTT, PT & INR

  3. Hemochron signature elite - ACT

  4. Gem Premier 4000 - ACT, PTT, PT & INR

  5. iSTAT - ACT, PT & INR

  6. VerifyNow - Platelet Function
• ACT


  activated clotting time or activated coagulation time
• this analyzes activity of the intrinsic coagulation factors and used to monitor heparin therapy


  ACT
• it is given to patients intravenously who have blood clots or whose blood is apt to clot easily

  heparin
• Heparin is also given as _______________

  precaution following certain surgeries
• after heparin therapy, patient is placed on ____________ and monitored by

  oral anticoagulant therapy such as warfarin and monitored by PT testing
• It is an example of ACT analyzer

  Hemachron signature elite
• also called as protime test


  prothrombin test (PT)
• It is used to monitor warfarin therapy such as coumadin, provides information on how long it takes for a patient's blood to clot

  PT
• This standardizes the differences found between the reagents in the various manufacturers test and allow results from different laboratories to be compared


  International Normalized Ratio (INR)
• INR formula


  (patient result (PT)/ Mean of reference range)ISI
• Many warfarin or anticoagulation clinics use POC coagulation analyzers tat perform PT and INR test on whole blood from _____________


  fingerstick
• An example of PT/INR analyzer that is frequently used


  CoaguCheck XS Plus
• allows the physician to determine a patient's response to a medication before an open heart surgery or cardiac catheterization

  platelet function
• platelet function analyzers uses

  whole blood samples
• platelet function test can help prevent


  excessive bleeding or blood clot
• Example of Platelet function analyzer

  VerifyNow
• It evaluates platelet plug formation in the capillaries to detect platelet function disorders and capillary integrity problems

  Bleeding Time
• Normal bleeding time


  2-8 minutes
• Duke Method Bleeding Time


  prick finger and every 30 seconds blot it until bleeding stops
• It monitors low dose heparin therapy

  PTT
• Bleeding time surgicutt method


  1. patient identification, proper hand hygiene.

  2. Ask patient if he has taken aspirin/ any salicylate containing within 2 weeks because it can prolong BT which can influence result. Inform patient that although small cut, scarring can occur.

  3. Place arm on steady surface for support.

  4. Site: volar lateral of forearm, 5cm distal to the antecubital area. Shave when necessary and make sure it does not have surface veins, scars, bruises or edema.

  5. A blood pressure cuff is placed around the arm.

  6. Use alcohol to clean the selected area with alcohol. Allow the site to air-dry.

  7. Phlebotomist put on gloves and prepare equipment while waiting for the site to dry.

  8. open the puncture device package and keep blade sterile.

  9. blood pressure should be inflated to 40mmHg

  10. safety clip must be removed quickly and positioned on the forearm.

  11. trigger should be depressed while simultaneously starting the timer, blade will then retract. Remove the device from the arm then discard sharps properly.

  12. filter paper used to blot the blood for 30 sec. wick the blood without touching the wound.

  13. stop the timer when bleeding stops and no longer stain the blotting paper. Test is stopped if bleeding persists beyond 15 minutes

  14. BP cuff is removed, clean arm then bandage. Advise patient to keep the site dry and bandage should be intact for the next 24 hrs.

  15. BT is recorded and rounded to the nearest 30 secs. Normal: 2-8 minutes

  16. follow proper disposal of used and contaminated supplies. Thank the patient before leaving
• These are panel of tests that are often ordered in emergency situations because of the critical balance in which these analytes must be maintained

  Arterial Blood Gases and Electrolytes
• This evaluate respiratory functions and measures the level of oxygen (Oxygen saturation sO2), carbon dioxide (partial pressure pCo2), acid bade (pH) & partial pressure of oxygen (po2) in the patients blood


  ABG
• a scale representing the relative acidity or alkalinity or concentration of hydrogen ions in the solution

  pH or potential hydrogen
• measure of the body's acid base balance and indicates metabolic and respiratory status

  arterial blood pH
• normal range for arterial blood pH


  7.35-7.45
• optimum pH


  7.40