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Point of care testing

Point of care testing (POCT) refers to medical testing performed at or near the site of patient care, providing rapid results and improved health outcomes. This lecture discusses the advantages and disadvantages of POCT, as well as the characteristics and types of POCT devices. It also highlights the use of POCT in primary care, secondary and tertiary care, and the availability of POCT devices in hospitals and community settings. Additionally, it covers the importance of POCT in cardiac markers and glucose monitoring programs, while addressing their limitations.

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Point of care testing

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  1. Point of care testing Lecture 6

  2. Definition • Medical testing at or near the site of patient care. • It is a mode of analysis which is performed at the site where the health care is provided close to the patient. • Bed side, near patient, physician’s office, extra laboratory, off site, unit used testing.

  3. Advantages • Reduced turnaround time (TAT). • Improved health outcomes. • Rapid data availability. • Self contained and user friendly instruments. • Small sample volume for large test menu. • Ability to test many types of samples.

  4. Disadvantages • Bedside tests performed by poorly trained non-laboratorian. • Cost of POCT compared with traditional laboratory testing. • Quality of testing is operator dependent. • Narrower measuring range for some of the analytes.

  5. Characteristics of POCT devices • First result in minutes or less. • Portable instruments with consumable reagent cartridges. • A one or two step operating protocol. • The capability of performing direct specimen analysis on whole blood and urine. • Simple procedure that do not require laboratory trained operator.

  6. Characteristics of POCT devices • Built in/ integrated calibration and quality control. • Results provided as hard copy, stored and available for transmission. • Low instrument cost. • Built in regulatory record keeping. • Temperature storage for reagents.

  7. Point of care testing might be employed Primary care • Home • Community pharmacist • Health centers (general practice) • Workplace clinic • Physician’s office • Paramedical support vehicle (ambulance, helicopter, air craft )

  8. Secondary and tertiary care • Emergency room • Admission unit • Operating room • Intensive care unit • Wards • Outpatient clinics

  9. Types of devices used for POCT • Single use qualitative or semi-quantitative cartridge strip test • Single use quantitative cartridge/ strip test with a reader device • Multiple use quantitative cartridge/bench top devices

  10. Single use qualitative or semi-quantitative cartridge strip test • Urine chemistry • Blood chemistry • Infectious disease agents • Cardiac markers • hCG

  11. Single use quantitative cartridge/ strip test with a reader device • Glucose • Blood chemistry • Coagulation • Cardiac markers • Drugs • CRP • Allergy • Fertility testing • pH • HbA1c • Blood gases • Electrolytes

  12. Multiple use quantitative cartridge/bench top devices • pH • Blood gases • Electrolytes • Metabolites • Complete blood count • Bilirubin • Cardiac marker • CRP

  13. POCT devices available in the hospitals • Blood gases, electrolytes, lactate • Cardiac biomarkers, renal markers, Bilirubin • Cholesterol, triglyceride and HDL • Intra-operative PTH measurement • Blood glucose (includes self-testing devices) • Alcohol and toxicology (paracetamol, drugs of abuse) • Urinalysis(with or without a reader)

  14. POCT devices available in the hospitals • Haemoglobin A1c • Albumin • Anticoagulant therapy monitoring (includes self-testing devices) • Detection of pregnancy and ovulation (includes self-testing devices) • Infections(Chlamydia, HIV) • Stool occult blood

  15. POCT devices available in community setting • Blood glucose (includes self-testing devices) • Urinalysis(with or without a reader) • Cholesterol, triglyceride and HDL • Anticoagulant therapy monitoring (includes self-testing devices) • Detection of pregnancy and ovulation (includes self-testing devices)

  16. Cardiac markers • The American Heart Association has recommended a turnaround time for cardiac markers of 60 minutes. • Tests of POCT should be compatible to the results of the central laboratory. • Improved diagnosis • Shortened emergency department length of stay • Decreasing patient time in the emergency department by 45 minutes.

  17. Glucose monitoring programme • First glucometer was introduced by “Bayer” in 1969. • Old standard is the laboratory based test. • Glucometer give the rapid and relatively precise glucose estimation on whole blood at the patients bedside. • Frequent blood glucose monitoring allows better glycemic control in hospital as well as at home. • Reduced morbidity and mortality associated with glycemic control.

  18. limitations • POCT glucose is slightly higher than venous blood. • This difference is significant in case of postprandial specimen. • Other interferences include hematocrit, po2, temperature and humidity. • Use of POCT not recommended in shock, dibetic coma and dehydartion.

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