Point of Care Patient Testing

Question: Discuss about thePoint of Care Patient Testing. Answer: Introduction The main purpose of the report is to provide information on the examination of point of care devices (POCT) used in troponin and creatinine testing among the patients with the aim of giving recommendation for the best devices to use in troponin and creatinine test. Mainly the report makes an assessment of the devices used for the test of creatinine and troponin and recommends for the best device with respect to the analytical, pre-analytical and post-analytical consideration. Troponin Test: The troponin test measures the level of troponin T or troponin I protein present in the blood (1). These protein are mainly released when the muscles of the heart are damaged which occurs normally at the tie of heart attack. The more damaged is caused in the heart the greater is the amount of the release of troponin T and I in the blood (3). Troponin test is mainly done to check that whether a heart attack has occurred or not. Some devices used for the Troponin test are i-Stat Troponin I, Triage troponin I, PATHFAST troponin I, AQT90 Flex troponin I and AQT90 Flex troponin T. Creatinine Test The creatinine blood test is a test used to measure the level of creatinine present in the blood. Creatinine is one type of waste product which is formed when there is a breaking down of creatine (2). The doctors determines that how an individual persons kidney is working by the creatinine level present in the individuals blood. Creatinine is a substances that is normally eliminated by the kidney from the body (4). So increase in the blood creatinine level denotes the condition of the blood. Some of the devices that are used for creatinine test are i-STAT, ABL 800 Flex, Reflotron, Dri-Chem 4000, StatSensor and Piccolo. Pre-Analytical Considerations Protocol for Preparation of Patient The practitioner of POCT must get introduce themselves to the patient. The details of the test should be explained to the patient by the POCT practitioners and consent of the patient should be taken. The equipment like bio-hazards and sharps container, cotton wool balls, alcohol swabs and automated skin devise adhesive bandage required for the collection of the blood should be prepared by the POCT practitioner. The area from where the blood sample is to be collected must be cleaned with antiseptic before collection of the blood to kill the germs present there and to avoid their infection. Protocol for Collection of Blood Sample The POCT technician should follow the protocol of collection of blood sample. According to this protocol the needle should be inserted into the patients vein very carefully. Safety of Patient and Management of Risk The expected risk with the patients are excessive bleeding, puncturing of several points if locating a vein proves to be difficult, patient fainting of becoming lightheaded and hematoma. Training of Practitioners and Respective on-going Competency Assessment POCT Practitioners Training The POCT practitioners should be efficiently trained on various aspects like maintenance of equipment, Quality Control, analysis and interpretation of the test results and handling the patients. Analytical Considerations Type and frequency of quality control tests A quality control test of the devices should always be performed so that the accuracy and precision of the Troponin and Creatinine test devices can be ensured. Maintenance of device and performance records To ensure continuous functionalities of the devices, they should be maintained efficiently according to the instructions of the manufacturers. Post-analytical considerations Recording and reporting of test results The test results of every patient should be recorded manually and electronically. Post implementation follow-up and confirmation of performance requirements On the basis of the results of the test appropriate medical attention should be provided to the patients with high level of blood troponin and creatinine. Reference: Apple FS, Collinson PO, IFCC Task Force on Clinical Applications of Cardiac Biomarkers. Analytical characteristics of high-sensitivity cardiac troponin assays. Clinical chemistry. 2012 Jan 1;58(1):54-61. Grossi EN, Hogan JA, Flynn M. The utilization of urine processing for the advancement of life support technologies. 44th International Conference on Environmental Systems. Killingsworth CR, Melnick SB, Litovsky SH, Ideker RE, Walcott GP. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter defibrillator in Swine. Pacing and Clinical Electrophysiology. 2013 Oct 1;36(10):1265-72. Nguyen MT, Fong J, Ullah S, Lovell A, Thompson CH. Estimating glomerular filtration rate in obese subjects. Obesity research clinical practice. 2015 Apr 30;9(2):152-7.