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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
Current POCT Most common POC test is Most POCT testing is
* Most common POC test is glucose * Most POCT testing is classified as waived testing under CLIA
26
Current POCT testing where is most testing done Concerns with Generally more what
* 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
What Is a waived test
* 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
Components of Instrumentation
* Operator interface * Bar code reader * Sample delivery * Reaction cell (strip, flow through, cartridge) * Sensor * Read-out – instrument, LIS
29
Reaction cell
* Reaction cell (strip, flow through, cartridge)
30
Glucometers
* 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
EPOC-EPOCAL
* 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
EPOC- EPOCAL measured analytes
measured analytes: pH, pCO2, pO2, Na+, K+, Ca++, Glu, Lac, Hct
33
Epoc® - Epocal calculated values
* calculated values: cTCO2, cHCO3-, BE(ecf), BE(b), cSO2, cHgb
34
I-STAT Abbott Hand-held what Multi- what Self what
* Hand-held, microprocessor controlled * Multi-analyte disposable cartridge * Self-calibrated
35
I-STAT-abbott what specimen Test menu includes blank turn around time
* Whole blood, 65 μL * Test Menu includes Na, K, Cl, glucose, urea, blood gases, ionized Ca, Hematocrit, hemoglobin * 90 sec. Turn-around time
36
Lab-on-a-chip
* “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
A lab on a chip water fab Cartridge assembly
- Fabrication of silicon-based circuits with biologically reactive electro-sensors Precision fluidics and self-calibration in a tiny package Fast Accurate Reliable Disposable
38
POCT policies and procedures
* Method validation * Patient preparation * Specimen collection and preservation * Instrument calibration * Quality control * Equipment maintenance * Test performance * Result reporting (interface)
39
Daily QC
Temp monitoring QU performance ( hi and low controls) Cleaning/ Disinfection
40
Weekly QC
Reagent inventory and recording
41
Monthly QC requirements
POCT compliance checks ( all instruments) QA reports generated
42
Biannual QC requirements
Calibrations ( send out)
43
POCT records
* Time and date of test * Patient results * Operator * QC * Maintenance * Training and competency testing * Dates of use * Policies and procedures
44
Supplies for glucometers
control solution OneTouch lancing device Onetouch ultra blue tests strips Onetouch ultra meter
45
Glucometer instructions
Insert tests strip Make sure the bars are facing you
46
Controls for glucometers
* Important to test low/high controls daily (per shift?) * Record results * Log book * Docking station * Abnormal results
47
Sample collection
Wash hands thoroughly and wear gloves Always observe universal precautions
48
Capillary sample collection from finger
Wash hands and wear gloves Identify appropriate puncture site- middle or ring finger preferred Prick on side of finger but not into nail
49
Capillary sample collection from finger Have the patient hold hand in a
Downward position to allow gravity to help increase blood flow to the capillary bed of the hand
50
Capillary sample collection from finger Avoid
Thumb( calloused) Index finger ( sensitive) Fifth finger ( Insufficient tissue depth)
51
Capillary puncture finger procedure
1. Grasp the finger to be used 2. Cleanse the site according to site policy: 1. soap and water 2. alcohol (circular motion) 3. Allow the site to air dry completely to provide effective disinfection and to prevent hemolysis of specimen if using alcohol 4. Grasp and steady the patient’s finger slightly below the first knuckle
52
Lacing and sampling from your fingertip
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
Applying blood
* 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
Applying blood and reading results
Keep your finger straight Move the meter and test strip toward the blood drop
55
Applying blood do not
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
Results of applying blood
* 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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