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Advanced Laboratory Operations and Automation > POL and POCT > Flashcards

POL and POCT Flashcards

1
Q

Instruments for large and small hospitals did not meet

A

Physicians’ office requirements based on space and size

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2
Q

Personnel at physicians office is not

A

Always Laboratory specialists

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3
Q

Special Instrumentation–Why It Exists

A
  • Instruments designed for large or small hospital
    laboratories did not meet needs of the physician’s
    office
  • Personnel at physician’s office were not always
    laboratory specialists
  • Government regulations increased
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4
Q

POL- POCT

POC

POL

A
  • Usually performed by non-laboratory personnel
  • POC
    Point-of-Care Instrumentation
  • POL
    Physician’s Office Laboratory
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5
Q

POL-POCT regulatory

A
  • Regulatory
  • International Organization for Standardization (ISO)
  • CLIA ‘88
  • FDA
  • CAP
  • The Joint Commission (formerly JCAHO)
  • COLA
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6
Q

FDA is very regulatory of

A

Blood bank because of the fresh human blood requirement

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7
Q

CLIA is top

A

regulatory agency

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8
Q

What is under CLIA

A

Cola, FDA, and CAP

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9
Q

Cola

A

Inspects physicians office laboratories

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10
Q

CAP does

A

Hospital lab inspections

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11
Q

TJC inspects what type of testing

A

Waived

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12
Q

POL physician office laboratory Instrumentation

A
  • User friendly
  • Provide rapid laboratory test results
  • Provide convenient and effective means of monitoring patient
    disease
  • Increase efficiency and profitability of physician’s office
  • Provide a new market for manufacturers
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13
Q

Physicians office Laboratory Instrumentations

A
  • Many models and designs
  • Hematology
  • Coagulation
  • Chemistry
  • Immunology
  • Microbiology
  • Urinalysis
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14
Q

POLI concerns

A

Office space concerns – size of analyzers
Training of personnel – analyzer ease and simplicity of
operation
Assists POL in regulatory issues and compliance
Interface capabilities

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15
Q

Hematology analyzers

are what type

A

Small cell counters

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16
Q

Hematology analyzers

3 part Diff use

A

Electrical Impedance to size & count
cells

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17
Q

Hematology analyzers require

blank mode features

Interface capabilities with

Store what and what

A

Small cell counters
* 3 Part Diff using Electrical Impedance to size & count
cells
* Minimum training to operate
* Closed mode features – graphic results
* Interface capabilities to LIS or EMR
* Stores QC and patient data with easy retrieval of data

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18
Q

Coagulation analyzers

common tests

A
  • Common tests
  • pt, appt, fibrinogen, bleeding times
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19
Q

Coagulation analyzers

common analyzers

A
  • Common analyzers
  • Fibrometer, MLA, Sysmex
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20
Q

Coagulation analyzers

POC- point of care anaylyzer

A
  • POC – point of care analyzer
  • Coaguchek – PT, INR
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21
Q

Chemistry analyzers- Urinalysis analyzers

A
  • Benchtop vs POC
  • Both:
  • Dipstick
  • Colorimetry
  • Interface – LIS, EMR
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22
Q

VItros Dry-Slide system

A
  • DT-60—limited general chemistries
  • Glucose, BUN, cholesterol, amylase, hemoglobin,
    phosphorus, lactic acid
    DTE—electrolytes
    Na, K, Cl, CO2
    DTSC—enzymes
    LD, AST, ALT, CK, CK-MB, GGT,
    ALP
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23
Q

DT-60- electrolytes ( type of Vitros dry slide system)

A

DTE—electrolytes
Na, K, Cl, CO2

24
Q

DT-60- enzyme ( type of Vitros dry slide system)

A

DTSC—enzymes
LD, AST, ALT, CK, CK-MB, GGT,
ALP

25
Q

Current POCT

Most common POC test is

Most POCT testing is

A
  • Most common POC test is glucose
  • Most POCT testing is classified as waived testing under CLIA
26
Q

Current POCT testing

where is most testing done

Concerns with

Generally more what

A
  • Most testing performed by lab personnel in STAT labs or site labs
  • Concerns with accuracy, quality control, connectivity to LIS
  • Generally, more expensive than tests performed in the laboratory,
    but readily available and quicker turnaround time
27
Q

What Is a waived test

A
  • Under CLIA, tests are categorized by complexity
  • Waived, moderate, high and PPM
  • Waived tests are:
  • Simple to perform
  • Cleared by FDA for home use
  • Negligible likelihood for errors
  • No reasonable risk of harm if performed incorrectly
28
Q

Components of Instrumentation

A
  • Operator interface
  • Bar code reader
  • Sample delivery
  • Reaction cell (strip, flow through, cartridge)
  • Sensor
  • Read-out – instrument, LIS
29
Q

Reaction cell

A
  • Reaction cell (strip, flow through, cartridge)
30
Q

Glucometers

A
  • Good reliability
  • Simple to use – patients often have their own for home use
  • Training by video
  • Critical limits (<40 and >400) usually followed with drawn blood
    sample for testing on chem analyzer for confirmation
31
Q

EPOC-EPOCAL

A
  • Smart card technology
  • Blood gas, electrolyte and metabolite panel
    consisting of the following:
  • measured analytes: pH, pCO2, pO2, Na+, K+,
    Ca++, Glu, Lac, Hct
  • calculated values: cTCO2, cHCO3-, BE(ecf),
    BE(b), cSO2, cHgb
32
Q

EPOC- EPOCAL measured analytes

A

measured analytes: pH, pCO2, pO2, Na+, K+,
Ca++, Glu, Lac, Hct

33
Q

Epoc® - Epocal

calculated values

A
  • calculated values: cTCO2, cHCO3-, BE(ecf),
    BE(b), cSO2, cHgb
34
Q

I-STAT Abbott

Hand-held what

Multi- what

Self what

A
  • Hand-held, microprocessor controlled
  • Multi-analyte disposable cartridge
  • Self-calibrated
35
Q

I-STAT-abbott

what specimen

Test menu includes

blank turn around time

A
  • Whole blood, 65 μL
  • Test Menu includes Na, K, Cl, glucose,
    urea, blood gases, ionized Ca,
    Hematocrit, hemoglobin
  • 90 sec. Turn-around time
36
Q

Lab-on-a-chip

A
  • “Lab-on-a-chip” (nanotechnology) technology will expand
    POCT to include biotechnology, oncology, molecular, and
    virology (just to name a few!)
  • Faster analysis with reduced cost and size….portability and
    disposability
  • Goal is to make state-of-the-art technologies accessible for a
    wider population…delivering faster and lower-cost disease
    diagnosis, prognosis, and screening
37
Q

A lab on a chip

water fab

Cartridge assembly

A
  • Fabrication of silicon-based circuits with biologically reactive electro-sensors

Precision fluidics and self-calibration in a tiny package

Fast
Accurate
Reliable
Disposable

38
Q

POCT policies and procedures

A
  • Method validation
  • Patient preparation
  • Specimen collection and preservation
  • Instrument calibration
  • Quality control
  • Equipment maintenance
  • Test performance
  • Result reporting (interface)
39
Q

Daily QC

A

Temp monitoring
QU performance ( hi and low controls)
Cleaning/ Disinfection

40
Q

Weekly QC

A

Reagent inventory and recording

41
Q

Monthly QC requirements

A

POCT compliance checks ( all instruments)
QA reports generated

42
Q

Biannual QC requirements

A

Calibrations ( send out)

43
Q

POCT records

A
  • Time and date of test
  • Patient results
  • Operator
  • QC
  • Maintenance
  • Training and competency testing
  • Dates of use
  • Policies and procedures
44
Q

Supplies for glucometers

A

control solution
OneTouch lancing device
Onetouch ultra blue tests strips
Onetouch ultra meter

45
Q

Glucometer instructions

A

Insert tests strip

Make sure the bars are facing you

46
Q

Controls for glucometers

A
  • Important to test low/high controls daily (per shift?)
  • Record results
  • Log book
  • Docking station
  • Abnormal results
47
Q

Sample collection

A

Wash hands thoroughly and wear gloves

Always observe universal precautions

48
Q

Capillary sample collection from finger

A

Wash hands and wear gloves

Identify appropriate puncture site- middle or ring finger preferred
Prick on side of finger but not into nail

49
Q

Capillary sample collection from finger

Have the patient hold hand in a

A

Downward position to allow gravity to help increase blood flow to the capillary bed of the hand

50
Q

Capillary sample collection from finger

Avoid

A

Thumb( calloused)
Index finger ( sensitive)
Fifth finger ( Insufficient tissue depth)

51
Q

Capillary puncture finger

procedure

A
  1. Grasp the finger to be used
  2. Cleanse the site according to site policy:
  3. soap and water
  4. alcohol (circular motion)
  5. Allow the site to air dry completely to provide effective
    disinfection and to prevent hemolysis of specimen if
    using alcohol
  6. Grasp and steady the patient’s finger slightly below the
    first knuckle
52
Q

Lacing and sampling from your fingertip

A

Puncture your finger

Hold the lancing device firmly against the side of your finger

Pressure the button

Remove the lancing device from your finger

53
Q

Applying blood

A
  • Squeeze and release the finger to initiate blood flow
  • Avoid “milking” which may cause hemolysis or tissue-fluid contamination
  • Wipe away first drop of blood with a clean gauze
  • Again, squeeze the finger until a large drop of blood forms
    on the puncture
  • Place next drop of blood on sample strip
54
Q

Applying blood and reading results

A

Keep your finger straight

Move the meter and test strip toward the blood drop

55
Q

Applying blood do not

A

DO not Apply blood on the top of the test strip

Do not hold the meter and test strip underneath the blood drop ( this can damage the meter).

56
Q

Results of applying blood

A
  • After blood is collected, wipe the site dry and apply direct pressure
    with gauze until bleeding has stopped
  • Bandage if appropriate
  • Read and record test results – patient chart
  • Record QC and patient results – log book

Advanced Laboratory Operations and Automation (17 decks)

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