L1: POCT Flashcards
1
Q
Identification
Specimen analysis performed outside of the clinical laboratory setting.
A
POINT OF
CARE TESTING
2
Q
Identification
Where is testing done at with the use of POCT to get immediate results delivered, allowing assessment and management tobe given swiftly?
A
◦ bedside
◦ physician’s office
◦ or any alternative site
3
Q
What is the goal of POCT?
A
To generate results that will not take an hour (pinakadugay is 30 mins)
4
Q
Other terms for POCT
A
o Near patient testing
o Bedside testing
o Remote testing
o Satellite testing
o Physician’s office testing
o Extra-laboratory
o Decentralizeds
o Ancillary
o Alternate site testing (AST)
o Rapid diagnostics
5
Q
Conventional Testing Procedure Process
A
- Patient arrival
- Triage
- Collect sample
- sample processing
- Perform test
- Compile Test results
- Analyze test results
- Patient admitted/discharged
6
Q
POCT Process
A
- Patient Arrival
- Sample collection
- Load sample
- Analyze results
- Patient Admitted/discharged
7
Q
Advantages of POCT
A
- Cheaper and quicker traditional diagnostic methods
- Can be used in resource limited settings.
- Reduced preanalytical and post analytic testing errors
- Small sample volume for a large test menu
- Easy to use and reduces the need for training.
- Rapid data availability
- Reduced patient’s length of stay and waiting times in the hospital.
- Convenience for clinicians
- Ability to test many types of samples
8
Q
Identify what advantage to the use of POCT:
Sometimes, samples are not even prepared before testing. However, results depend on the quality of the sample collected.
A
Reduced preanalytical and post analytic testing errors
9
Q
Identify what advantage to the use of POCT:
It is a disadvantage to the healthcare team that is not part of the medical technologists since they may compromise the accuracy of the results.
A
Easy to use and reduces the need for training.
10
Q
Identify what advantage to the use of POCT:
It ensures the comfort of the patient especially if the patient is not a local resident.
A
Reduced patient’s length of stay and waiting times in
the hospital.
11
Q
Identify what disadvantage to the use of POCT:
POCT does not require quality control and is only calibrated upon using the device.
A
Concerns about inaccuracy, imprecision, and performance
12
Q
Disadvatages of POCT
A
1.Concerns about inaccuracy, imprecision, and performance
2.Bedside laboratory tests performed by poorly trained non-laboratorians
3.Quality of testing is operator-dependent
4.Difficulty in integrating test results with hospital information system (HIS) or laboratory information system (LIS); lack of connectivity
5.Narrower measuring range for some analytes
13
Q
Identify what disadvantage of POCT:
If the user does not know how to use the POCT device, that can also contribute to the results
A
Quality of testing is operator-dependent
14
Q
Identification
Criteria by WHO for the use of POCT devices
A
R = Real-time connectivity
E = Ease of specimen collection
A = affordable
S = sensitive
S = specific
U = user friendly/simple to perform
R = robust and rapid (results available in less than 30 minutes)
E = equipment-free
D = deliverable to those who need the test
15
Q
Identification
Stage in POCT process that occurs before running the POCT on a sample; involves collection, transport, preparation, and loading
A
Pre-analytical stage
16
Q
What stage in POCT process is loading of sample under?
A
Pre-analytical.
loading still part of pre-ana; if wala pa nipress ug button to start the process then still at pre-analytical pa; ex: gibutang ang rack sa machine
17
Q
Identification
Stage in the POCT process where actual testing sequence of a POCT is conducted
A
Analytical stage
18
Q
Identification
Stage in POCT process that begins when testing is complete, and an obtained result is available
A
Post-Analytical stage
19
Q
In what stage in the POCT process are diagnosis, treatment, and prescription of medicine to patient under?
A
Post-analytical
20
Q
Pre-analytical errors in POCT diagnostic testing
A
o Lack of preparation of the patient
o Lack of information about the patient’s condition
o Inappropriate sampling technique
o Wrong or missing additives to blood
o Mishandling and/or mislabeling of patient specimen
o Specimen contamination
o Degradation of specimen due to delays in specimen processing
21
Q
Whose fault is it if pre-analytical errors occur?
A
BOTH patient and medtech; miscommunication in delivering instructions; patient not following fasting by patient but still gikuhaan sa MT
22
Q
Post-analytical errors in POCT Diagnostic testing
A
o Misreporting patient result
o Recording wrong patient test results
o Lost data
o Delayed reporting of critical results
23
Q
Analytical errors in POCT Diagnostic testing
A
- Expired reagent/device
- Expired Kit
- Device not calibrated
- Sudden error of the device (battery dead, etc.)
24
Q
What factors influence the errors and problems in POCT Diagnostic Testing
A
- setting (practice, hospital, etc.) and
- the extent to which the instrument is within a network
25
T or F:
Transport, storage, and centrifugation are irrelevant for POCT.
T
26
What blood composition is needed in POCT if blood is a sample to be used?
Whole blood
## Footnote
Evaluation of the test material is mostly unnecessary, as whole blood is used.
27
What process is of the greatest importance in the pre-analytical process of POCT diagnostic testing?
correct collection of the sample
28
POCT is accomplished using ________ instruments
portable instruments
29
Many point-of-care test systems are in the form of?
- easy-to-use membrane-based test strips,
- often nclosed by a plastic test cassette
## Footnote
Ex: PT kits, HIV kits, Hepa kits
30
What is the purpose of test kits enclosed in cassettes?
- location where specimen is placed; cover loading
- avoid contamination (leads to false positive/neg)
- protects medtech from exposure to reaction happening in the casette
31
Examples of test kits withut cassette?
- urine strips
- glucose strips
32
What is the parameter in Pregnancy testing and what are the samples used?
Parameter: HCG hormone
Sample: Urine, Serum
33
What form and when is Human chorionic gonadotropin detected in pregnant women?
Human chorionic gonadotropin: Beta form
Detected in urine 10 days after conception
34
Compare urine and serum samples in pregnancy testing
Urine
- can be done at home
- prone to false reactions
- qualitative (+/-)
Serum
- in hospital
- more precise
- can be quantified
- gives information of possible miscarriage
35
What are the parameters tested in Urine dipstick analyses?
- Ascorbic acid,
- glucose,
- bilirubin,
- ketone,
- SG (specific gravity)
- blood
- pH,
- protein,
- urobilinogen
- leukocytes,
- nitrite
36
What is the purpose of Microalbumin screening?
To examine urine of the presence of Albumin that may indicate possible kidney damage
## Footnote
Urine may be bubbly
37
What parameters are tested in Infectious agents detection and what samples are required for each?
- Group A Strep (SWAB in tonsils)
- Influenza A + B (SWAB in nasopharynx)
- HIV (plasma, serum, whole blood, Dried blood spot, and oral fluid)
- Chlamydia trachomatis antigen (SERUM)
- MRSA (SWAB nose)
- Helicobacter pylori-specific IgG antibody (SERUM)
38
# Identify
Bacterium that manifests in formation of ulcers as it withstands the acidity in stomach
Helicobacter pylori
39
What does MRSA stands for?
Methicillin-resistant Staphylococcus aureus
40
Normal flora in the anterior nose and skin that may be passed on to other people in instances like touching the nose then touching other people's skin. It is also evident in reusing tourniquet in medical institutions.
MRSA
41
What parameter is tested in Fecal Occult Blood Test (FOBT)?
Hemoglobin
42
What does "Occult" indicate in Fecal Occult Blood Test?
It indicates that there is something hidden in the feces. For patients patients suspected suffering from colon cancer; abrasion in GIT; blood in stool; may or may not seen when you poop.
43
Differentiate Qualitative and Quantitative POCT devices
- Quali can be positive, negative, invalid, reactive, nonreactive
- Quanti measures concentration of analyte
44
# Identify
This is a wide range of devices, including single pad urine test (dipsticks) and test kits
Single-use qualitative strip or cartridge and/or strip devices
45
# Identify
These are generally dried, porous matrices with impregnated carrier elements that interact with the analyte(s) when exposed; chemical reaction usually results in a color change
Dipsticks/Urine strips
46
# Identify
These utilize a layer of supporting materials, such as porous paper of cellulose fiber filters or woven meshes; Example: home pregnancy test
PLACED in PLASTIC CASSETTES
Test kits
47
What type of data is deteccted by Urine strips?
Both Qualitative and Quantitative
48
Indicate the time it takes for the result of each parameter to occur in urine strip tests.
Leukocytes
Albumin
Nitrite
Urobilinogen
Protein
pH
Blood
Specific Gravity
Ketone
Ascorbic acid
Bilirubin
Glucose
Leukocyte esterase = 120 s
Albumin = 60 s
Nitrite = 60 s
Urobilinogen = 60 s
Protein = 60 s
pH = 60 s
Blood = 60 s
Specific Gravity = 45 s
Ketone = 40 s
Ascorbic acid = 30 s
Bilirubin = 30 s
Glucose = 30 s
49
What test kit uses antibodies to detect human chorionic gonadotropin (hCG), a hormone that can be detected in the urine?
Pregnancy Test Kits
50
What is the Specimen used and Principle of Pregnancy Test kits?
Specimen: First morning urine
Principle: Lateral flow technology
51
What part of the pregnancy test kit utilizes a combination of antibodies including a monoclonal hCG antibody to detect elevated levels of hCG?
Test line
52
What part of the pregnancy test kit is composed of goat polyclonal antibodies and
colloidal gold particles
Control Line
53
What kit Detects hepatitis
B surface antigen in human serum or plasma?
HBsAg Test Kit
54
What is the sample used and principle applied in HBsAg Test Kits?
Sample: Serum/Plasma
Principle: Sandwich immunoassay
55
What is the sandwich immunoassay principle and in what test kit is it applied?
Sandwich immunoassay principle is the formation of antibody-antigen-antibody complex and is applied in HBsAg Test Kits.
56
Where does the excess reagent go in a test kit with a cassette?
in the WICK
57
What part of a pregnancy test kit is the analyte placed?
Sample pad
58
How does the red line appear in a pregnancy test kit?
The red line indicates the impregnation or formation of antigen-antibody complex which is a sign of positive result in interpretation.
59
Another term for FOBT?
Hema screen
60
# Identify
A lab test used to check stool samples for hidden (occult) blood
Fecal Occult Blood Test
61
What does occult blood indicate in the colon or rectum?
Colon cancer or the presence of polyps
62
T or F:
FOBT can detect the presence or absence of blood and determine what’s causing the bleeding
FALSE:
FOBT Can only detect the presence or absence of blood – it cannot determine what’s causing the bleeding
63
What is applied to the stool sample when placed in the FOBT test device?
2 drops of buffer
64
What antigen and antibody are found in the FOBT test device?
Anti-human hemoglobin antibody
Human Hemoglobin antigen
65
# Identify
They include a meter or monitoring device thereby enabling for the detection and quantification of analytes
Single-use quantitative cartridge and strip test with monitoring devices
## Footnote
Ex: Glucometer
66
# Identify
Done to evaluate warfarin and heparin therapy using coagulation POCT analyzer
Coagulation monitoring
67
What are some common coagulation tests checked in coagulation monitoring?
1. Prothrombin time (PT)
2. International normalized ratio (INR)
3. Activated partial thromboplastin time (APTT or PTT)
4. Activated clotting time (ACT)
5. Platelet function
68
# Identify
A non-instrumented test ordered by the physician to evaluate capillaries for platelet plug formation
Bleeding Time
69
Bleeding time is used for ________ and ________ involving __________
Used for pre-surgical screening and detection of problems involving hemostasis
70
What methods are presently available for Bleeding Time?
▪ Duke method (finger and earlobe)
▪ Ivy method
▪ Copley-Lalitch Immersion Test
▪ Surgicutt method
71
____________ has a prospective influence on patient care than any other laboratory determinants of blood gas
ABG analysis
72
What are the most important factors in the management of critically ill patients?
Tissue oxygenation, ventilation, and acid-base status
73
What parameters are tested by Blood gas analyzer devices?
pH, pO2
and pCO
74
What is the sample used in Blood gas analyzer devices?
Sample is arterial blood placed on ice and held at 0 °C until analysis
75
# Identify
This refers to the concentration of hydrogen ions in a solution
pH
76
# Identify
This is an indicator of how well air is exchanged between the blood and lungs;
pCO2
77
# Identify
This is a measure of the pressure exerted by dissolved CO2 in the blood plasma in proportion to the PO2 in the alveoli
pCO2
78
________ is pressure exerted by dissolved O2 and the ability of the lungs to diffuse oxygen through the alveoli
PO2
79
# Identify:
A cartridge-based analyzer with all the analytical requirements for the performance of a test contained within an individual
cartridge
i-STAT
80
What electrolyte is responsible for transmitting nerve impulses?
Sodium
81
What electrolyte helps in nerve conduction and muscle function and regulates acid-base balance and osmotic pressure?
Potassium
82
What electrolyte maintains the integrity of the cells by helping in balancing osmotic pressure and acid-base and water balance of the body?
Chloride
83
What electrolyte helps transport CO2 from the lungs resulting in the reduction of hydrogen ions and increase in blood pH?
Bicarbonate ion
84
What electrolye helps in muscular function cardiac function, blood clotting, nerve transmission function of the body?
Ionized calcium
85
List all Non-Invasive POCT
1. Pulse oximetry
2. Transcutaneous measurement of bilirubin
3. Non-invasive hemoglobin monitors
4. GlucoWatch Biographer
86
What non-invasive POCT is used for For monitoring patient’s oxygen saturation?
Pulse oximetry
87
What are the most common used sites for apllication of pulse oximetry?
fingernail and toenail beds
88
What is the principle used in Pulse oximetry?
Principle is based on the red and infrared light absorption characteristics of oxygenated and deoxygenated hemoglobin
89
# Identify
This meter measures the yellowness of the
subcutaneous tissue by measuring the difference in the optical density of two wavelengths through the skin
Transcutaneous measurement of bilirubin
90
Where are Transcutaneous measurement of bilirubin taken?
either on the baby’s forehead or sternum
91
# Identify
This is a pulse co-oximeter that uses multi-wavelength sensor for spot check and continuous measurement
Non-invasive hemoglobin monitors
92
How do Non-invasive hemoglobin monitors function?
The technology emits multiple wavelengths of light and then calculates the hemoglobin concentration based on the adsorption of light in the blood
93
# Identify
This is a device that extracts glucose through intact skin via reverse iontophoresis where it is detected by an amperometric biosensor
GlucoWatch Biographer
94
How long and how often can GlucoWatch Biographer provide glucose readings?
Can provide glucose readings every 20 mins for 12 hours
95
# Identify
Test that gauge the effectiveness of the
thrombolytic therapy being administered to patients who have suffered from heart attacks
Cardiac Troponin T and Troponin I
96
What POCT measures the alanine transferase (ALT) of patients under lipid-lowering medication
Lipid Testing
97
What test differentiates chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF)?
B-Type Natriuretic Peptide (BNP)
98
What test detects and evaluates infection, tissue injury, and other inflammation disorders?
C-Reactive Protein (CRP)
99
# Identify
Diagnostic tool for
diabetes therapy monitoring
Glycosylated hemoglobin
100
What test measures the volume of the red blood cells?
Hematocrit
101
What test checks the hemoglobin level to manage patients suffering from anemia?
Hemoglobin
102
# Identify
This test evaluates the severity of lactic acid
disorder and stress response of the patient
Lactate
103
What test checks contact with allergens and
determines if the body has developed antibodies?
Skin test
104
# Identify
This test detects the presence of group A streptococci
Strep testing
105
What is the clinical significance of coagulation monitoring?
To monitor Coagulation disorders; even without wounds they have abnormal clot inside the body
- clot can break off and lead to strokes (ex: in brain; or in lungs: pulmonary embolism - difficulty breathing)
106
Patients with abnormal formation of clot drink medications called ___________?
blood thinners
107
If Coagulation monitoring is done traditionally, in what section in the laboratory is it performed?
Hematology Section
108
The sample collected in coagulation monitoring is placed in what tube? What coagulant does it use?
Light Blue top tube with 3.2% sodium citrate coagulant
109
Aside from the blue top tube, which tube also uses sodium citrate as a coagulant and in what percentage?
Black top tube with 3.8% sodium citrate
110
The color of collection tubes depend on?
the type of coagulant used
111
# Identify
This test determines the time it takes for the bleeding of the patient to stop from a small incision
Bleeding Time
112
What is the purpose of bleeding time test?
- requested by Doctors before surgery/operation to know if needed magpastandby ug blood bank during the operation
113
What is the normal value for bleeding time?
2-4 minutes
114
# Identify
This method of bleeding time test is peformed in the earlobe or finger
Duke Method
115
What are the steps in performing bleeding time test through Duke Method?
- make sure no hair mutouch sa skin/area
- not at the sight where earing is (if earlobe)
- disinfect the site; wait for it to dry
- get lancet, ready timer and filter paper
- squeeze earlobe; pinch
- do quick firm stab; entire lancet gets in
- start timer after puncture
- use filter paper to blot the blood every 30
seconds (only ball of blood; should not
touch the skin cause mashorten ang
blotting time)
- make sure to blot in different areas in the
filter paper
116
What is the normal value for bleeding time through Duke Method?
2-4 minutes
117
What materials/tools do you need to perform bleeding time test through Ivy bleeding time method?
- BP apparatus
- timer
- lancet
- filter paper
118
What are the steps in performing the Ivy bleeding time test?
- disinfect the site of incision
(below antecubital crease)
- apply the BP Apparatus
- maintain the pressure to
40 mmHg
- grab lancet and puncture
3 areas with 1.5 cm distance
from each other
- start timer right after the
first puncture
- get filter paper and blot the
blood every 30 seconds
- start blotting with the first
puncture until it stops bleeding
before proceeding to the next
one
- TIME IS CONTINUOUS
119
In the Ivy bleeding time test, how much pressure should be maintained?
40mmHg
120
# identify
This method of bleeding time test punctures the area below the antecubital crease into 3 separate punctures with 1.5 cm distance from each other.
Ivy bleeding time test
121
How should the lancet be punctured in the Duke method bleeding time test?
quick firm stab: entire lancet gets in
122
How many seconds should you blot the ball of blood in the bleeding time test?
30 s
123
How should you blot the blood in the Ivy bleeding time test?
start blotting with the first puncture until it stops bleeding before proceeding to the next one (STILL 30s)
124
How is the bleeding time result acquired in Ivy bleeding time test and what is the normal value?
Total bleeding time is divided by 3
Normal value: 2-4 minutes
125
What are the materials used in Copley Lalitch Immersion test method of bleeding time?
- beaker w/ NSS (normal saline solution prewarmed in water bath at 37 degrees Celsius: normal body temp)
- timer
- lancet
126
What is the normal value of bleeding time in the Copley LALITCH IMMERSION TEST
4-10 minutes
127
What are the steps in performing Copley LALITCH IMMERSION TEST?
- prep prewarmed NSS
- disinfect skin/finger
- puncture and start the timer
- immerse finger in the beaker with NSS: make sure there is distance between the tip of punctured finger and the bottom of the beaker to avoid covering the puncture; you need to see the flow of blood!
128
This is the most standardized method of bleeding time test. Identify and state why it is so.
Surgicutt Method
: incision made by device has specific dimension which is 5mm long x 1mm deep
129
What bleeding time methods use the BP apparatus and at what pressure?
- Ivy bleeding time
- Surgicutt method
40mmHg
130
What is the site of incision for the surgicutt method of bleeding time test?
below the antecubital crease
131
What is the disadvantage of the surgicutt method of bleeding time test?
forms keloid scar
132
When do you stop the timer in surgicutt method of bleeding time test and what is the normal value?
stop time when blood doesn't blot anymore
Normal Value: 7-15 minutes
133
In the blood gas analyzer, the sample is placed in what tube?
placed in tube with anticoagulant heparin: green stopper blood collection tube: heparinized sample
134
Why is the arterial blood sample in the Bloood gas analyzer placed on ice until analysis?
- transported in ice bucket in order to maintain parameters esp. oxygen since cold temp:
(1) DECREASES CELLULAR METABOLISM
(2) DECREASES CONSUMPTION OF OXYGEN
135
Any deviation in blood pH can result to what?
Acidosis or Alkalosis
136
# Identify
This type of blood gas analyzere has a cartridge where the heparinized sample is loaded.
EPOC Critical Care Blood Gas Analyzer
137
What blood gas analyzer also checks for the electrolytes?
OPTI Critical Care Analyzer
138
What comprehensive POCT device has a cartridge and utilizes one sample to perform many test?
i-STAT
139
Why is i-STAT considered a comprehensive POCT device?
it performs many parameters
for testing
140
What is the function of the bicarbonate ion?
- concentration is directly proportional to the concentration of CO2 because it helps transport CO2
- so, decrease number of Bicarbonate ion means decreased number of transported CO2
141
# List
Steps in handling POCT devices and connecting with the LIS/HIS
STEP 1
Insert two or three drops of blood into the cartridge.
STEP 2
Close the cartridge and insert into the i-STAT handheld.
STEP 3
View the results on the handheld screen within minutes.
STEP 4
Upload information automatically into the LIS/HIS.
142
# List
Steps in i-STAT System Integration with LIS/EMR
STEP 1
i-STAT result wirelessly transferred to i-STAT downloader to POC Data Manager
STEP 2
LIS
STEP 3
EMR
143
What is the disadvantage of using i-STAT system integrated with LIS/EMR?
without wifi: Doctor will not be able to access the result
144
What type of POCT does not require incision on patient or collection of sample?
Non-invasive POCT
145
Oxygenated and deoxygenated hemoglobin absorb infrared light at different wavelengths. Identify the wavelengths for each.
- Oxygenated hemoglobin: 940 nm
- Deoxygenated hemoglobin: 660 nm
146
What principle does the Transcutaneous measurement of bilirubin use?
Optical Spectroscopy - the more unconjugated bilirubin present in baby's body; the more light will be absorbed by the analyte
147
The Optical Spectroscopy is affected by 3 factors which are?
1. Gestational Age
2. body weight
3. Skin color
- brown or with color at birth
- sometimes dli maklaro but taas ang uncon. bilirubin sa newborn babies
148
The Transcutaneous measurement of bilirubin is only intended for?
Babies
149
What type of bilirubin is detected by the Transcutaneous measurement of bilirubin?
Unconjugated bilirubin
150
Conjugated vs. Unconjugated bilirubin
- Conjugated: not yellowish ang skin
- Unconjugated: increase concentration during childbirth; yellowish
151
What type of Hepatitis is curable? Where is this usually acquired from?
Hepa A: acquired from contaminated food and water
(ex: tagay and sharing of glass)
152
What principle is applied in Non-invasive hemoglobin monitors?
same as pulse oximeter: Principle is based on the red and infrared light absorption
characteristics of oxygenated and deoxygenated hemoglobin
153
Why is hemoglobin monitored?
Possible case of Anemia
oxygen has a high affinity to hemoglobin - low hemoglobin; low O2 macarry
154
How does the GlucoWatch Biographer determine the glucose levels?
- determines glucose without blood sample through its photosensor when it comes in contact with the skin
155
What are the cardiac markers in our body?
Troponin T, I, and C
156
In what section in the laboratory is Cardiac Troponin T and I performed?
Clinical Chemistry section
157
What are cardiac markers?
markers that increase when person experiences myocardial infarction
158
Cardiac marker tests are used to gauge the effectiveness of thrombolytic therapy where the patient takes a medication called?
Thrombolytic (lyses thrombus)
159
What parameters are included in the lipid testing?
TAG, LDL, HDL, Cholesterol
160
What is the relationship between the concentration of cholesterol and ALT enzyme and why does this relationship exist?
direct/directly proportional
- ALT enzyme is made by liver and it is a marker of liver damage; people with high conc of cholesterol could have liver dmg because the liver cannot break down cholesterol
161
What is the level of BNP concentration in COPD and CHF respectively?
COPD = lower compared to CHF
CHF = higher BNP levels
162
In what section in the laboratory is the C-Reactive Protein Test done?
Clincal Chemistry Section
163
C-Reactive Protein (CRP) is a NON-SPECIFIC test which means?
It is NOT a diagnostic test to determine inflammation
- if high: there is inflammation, BUT will not tell which specific organ/tissue has inflammation/damage
- to confirm just do DIAGNOSTIC tests because CRP is just a SCREENING test
164
Glycosylated hemoglobin is also called?
HbA1c
165
# Identify
This test measures the glucose levels in a span of 3 months. Thus, it is more accurate and specific
Glycosylated hemoglobin
166
When is skin test done?
- if there are allergies,
- before vaccination,
- before dental operations
167
What does Group A streptococci cause?
Pharyngitis or strepthroat
168
If a person has no tonsil, in which area should the medical worker take a swab for Strep testing?
uvula
