CLS 301 - POCT

Point of Care Testing

tests designed to be used at or near where the patient is located

Why is there a push for POCT?

faster diagnostics, decreased turnaround times (TATs), optimal care, and solution to rising healthcare costs, lab staff shortages, aging and at-risk populations

Technological Advancements of POCT

easy to operate, small counter-top/hand-held, battery operated, waived testing, whole blood methodologies, molecular assays

Where is POCT uses?

hospital bedside, emergency department testing, operating room testing, home testing, physician’s office, accident scene, disaster response, epidemics/pandemics

Glucose monitoring

most used POCT, for diabetes management

Glucometers

Glucocard: Vital - requires 0.5 ul of blood, results in 7 sec, mg/dL, stores results, time, and date

Hemoglobin A1C (venipuncture)

DCA Vantage Analyzer - collection in EDTA, heparin, fluoride/oxalate, or citrate and 1 ul is transferred to glass capillary specific tubeHe

Hemoglobin A1C (capillary)

DCA Vantage Analyzer - collect 1 up in glass capillary specific tube - analysis must occur w/in 5 min (uses monoclonal antibody agglutination reaction for test methodology)

Cholesterol Screening

Accutrend Plus - meter and strip technology - uses whole blood (venipuncture collection in heparin coated tube and transferred 15-50 ul into glass capillary specific tube - capillary collection is 15-50 ul directly into strip) - results in 3 min

Oximetry

Radiometer ABL 90 Flex - collected in lyophilized heparin tube

ctHb

total hemoglobin concentration - transfers O2 to the tissues, indicator of anemia

sO2

oxygen saturation

Blood Gases

Radiometer ABL 90 Flex - collected in lyophilized heparin tube - pH, pCO2, pO2 (pO2 and pCO2 indicated heart and lung disorders)

pH

acidity - respiratory and renal issues

pCO2

carbon dioxide tension

pO2

oxygen tension

Electrolytes

Radiometer ABL 90 Flex - collected in lyophilized heparin tube, cK+, cNa+,cCa2+, cCl-

Hyperkalemia

high potassium concentration h

Hypokalemia

low potassium concentration

Hypernatremia

high sodium concentration

hyponatremia

low sodium concentration

hypercalcemia

high calcium concentration

hypocalcemia

low calcium concentration

hyperchloremia

high chlorine concentration - with hyperkalemia can cause sever kidney problems/failure - with hypokalemia can cause diarrhea, fluid leakage from pancreas, and urinary tract problems

hypokalemia

low chloride concentration - usually happens with hyponatremia

Metabolites

Radiometer ABL 90 Flex - cGlu (D-glucose concentration) used for diabetes monitoring - cLac (lactate concentration) used to monitor immune response to infections

Coagulation Testing

hemochron signature elite - PT (measures extrinsic pathway), APTT (measures intrinsic pathway), Fibrinogen (coagulation factor I), Thrombin time (how long it takes fibrinogen to turn into fibrin), Activated Coagulation Time (ACT - monitoring high doses of unfractionated heparin therapy)

Bilirubin

Bilicheck - measures concentration of bilirubin in newborns - high levels can cause jaundice - noninvasive (uses light and no needles/blood draw)

Treatment of jaundice

low to mild with exposure to light near a window, high levels require phototherapy (blue light for 1-2 days)

Cobas Liat

SARs-CoV-2/ Influenza A/B - tests for diagnoses from nasopharyngeal swab and running RT-PCR test

Advantages of POCT

rapid results = immediate medical need, faster diagnosis, targeted treatment, decrease TAT can shorten length of stay, battery operated and small, whole blood methodologies (small amount of blood), wireless input to patient medical record, user friendly/CLIA waived

Disadvantages of POCT

small sample size = tissue fluid might interfere/dilute/cause clotting, cost analysis, quality management, safety, data management

Testing in California

POCT can only be performed by licensed personnel, within scope of practice