Point of Care Testing

(POCT)
DGD. DHARMA SANTHI
CLINICAL PATHOLOGY DEPARTMENT
FACULTY OF MEDICINE, UDAYANA UNIVERSITY
2018

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Where it all began?
“Historically, laboratory testing has been
performed in a central laboratory by
laboratorians…. POCT is performed close to or at
the patient's location‐and often by
nonlaboratorians. This is clearly a different model
from the historic central laboratory.”
[Thomas Dilts, BD Lab Notes]

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An Early Definition of POCT…

 Tests done by non-laboratory staff outside a

recognized diagnostic laboratory

 “…testing that is performed near or at the site of

the patient with the result leading to possible
change in the care of the patient.”

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 “… any analytical test performed for a patient by
a healthcare professional outside the conventional
laboratory.”

 A diagnostic test when the result is required

within 5 – 10 minutes of specimen collection and
appropriate immediate medical decision is
required based on the result.

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Terms of POCT

Near Patient Testing

Bedside Testing

POCT Decentralized Testing

Patient-focused Testing

Waived Testing
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Classification of POCT
Non instrumental System
1  Sistem disposibel (sekali pakai)
 Reagen test strip (satu/multi analit)

Small analyzer
2  Dapat digenggam,
 Contoh: Blood glucose meter.

Desktop analyzer
3  Ukuran lebih besar
 Digunakan untuk laboratorium klinik
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The Advantages of POCT
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3 Shorter TAT

2 Smaller sample size

3 Automatic

4 Minimal maintenance

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3 Automatic calibration

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Limitation of POCT
1
3 Recording patient identity -
2 Recording result manual/ -

3 Interface HIS or LIS -

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 Point of Care Testing

 Point of Care Testing (point of care testing)

Devices Available Today
 Blood gases and electrolytes analyzers
 Coagulation
 Blood Chemistries, ex. Glucose, cholesterol, uric acid
 Drug abuse
 Pregnancy screening
 Cardiac markers
 Hemoglobin and Hematocrit

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 Point of Care Testing

Common Locations of Point of

Care Testing Devices
Intensive/critical care units
Operating rooms, Med/Surg
units
Emergency departments
Ambulances, first responders
Home care (field personnel)
Homes (increasing)

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 Point of Care Testing

Guidance For POCT Selection

High accuracy and precision
Limit of detection clear
Operation is easy and practical
Availability of technicians
Parts are easy to obtain
Having facilities for after-sales service
If possible, POCT is not dependent on the reagent
of the type/ brand specific (open method)

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 Point of Care: Blood Glucose
Glucose became one of the Glukosa
120
most frequently measured 100 koagulasi
analytes in clinical units, primary
80 gas/elektrolit
care and by patients for
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monitoring at home, made Chemistry

possible through the availability 40 Hematologi

of systems based on dry-reagent 20
Urine
test strips with visually read end- chemistry
0
points and/or simple-to-use Cardiac marke

reflectance meters and

biosensors.

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 Point of Care: Blood Glucose

What is Glucose:
 a simple sugar essential for cell respiration
 Point of Care: Blood Glucose

 Also used as a source of energy in cells

through aerobic and anaerobic respiration
 Glucose plays important role in various
metabolic function in the body.
So glucose level must be maintained periodically
 Point of Care: Blood Glucose

Blood Glucose Monitoring

What is it?
 Blood Glucose Monitoring is a way of checking the
concentration of glucose in the blood using a
glucometer.
What is the purpose?
 Provides quick response to tell if the sugar is high or
low indicating a change in diet, exercise or insulin.
 Over time, it reveals individual of blood glucose
changes.
 Point of Care: Blood Glucose

Why monitor blood glucose?

 Reduces risk of developing complications with
diabetes.
 Allows diabetics to see if the insulin and other
medications they are taking are working.
 Gives diabetics an idea as to how exercise and
food affect their blood sugar.
 May prevent hypoglycemia or hyperglycemia
 Point of Care: Blood Glucose

When to check blood glucose?

 Before meals
assess basal glucose level, particulary in
high level HbA1c
 2 hours after meals
assess peak of glucose level
 Before bed
assess risk of hypoglycemia
 Point of Care: Blood Glucose

Glucose in the Blood

Glucose Test Person without diabetes
Fasting testing < 100 mg/ dL*
Pre - meal 70-130 mg/dL**
Post – meal <140 mg/dL* or
< 180 mg/dL**
* Konsensus Perkeni 2011
** ADA 2013
 Point of Care: Blood Glucose

Glucometer
 A glucose meter or glucometer, is a medical
device used for measuring the approximate
level of glucose in the blood.
 New models are able to read and calculate the
blood sugar within seconds.
 Some models not only display the glucose
reading but also say it.
Point of Care: Blood Glucose
 Point of Care: Blood Glucose
Working principle of glucose meter

Glucose meters are based on electrochemical

technology, they use electrochemical test strips to
perform the measurement.
A small drop of the solution to be tested, is placed
on a disposable test strip, that the glucose meter
uses for the glucose measurement.

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 Point of Care: Blood Glucose

Methods used in electrochemical measurement of

glucose

The two most common methods, used in

electrochemical measurement of glucose are:
 Colorimetric method
 Amperometric method

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 Point of Care: Blood Glucose

Colorimetric method
 In this method, the typical sensors such as LEDs or photo sensors
form the analog interface. These sensors are followed by a
Transimpedance Amplifier (TIA) for the
glucose concentration measurement in the solution.

 The Colour Reflectance principle is used in this method to sense the

colour intensity in the reaction layer of the teststrip by the
photometry.

 The glucose meter generates a numerical value, that is

a measurement of the glucose concentration present in the
solution.
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 Point of Care: Blood Glucose

Amperometric method

 In this method, the electrochemical test strip contains a

capillary that is used to draw in the solution placed at
one end of the test strip. The test strip also contains an
enzyme electrode containing a reagent such as Glucose
Oxidase.

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 Point of Care: Blood Glucose

 Glucose undergoes a chemical reaction in the presence

of enzymes and electrons produced during the chemical
reaction.
 Glucose Oxidase reacts with the glucose, creates an acid
called Gluconic Acid. The gluconic acid then reacts, with
another chemical (electrons) in the testing strip called
Ferricyanide. The ferricyanide and the gluconic acid,
then combine to create Ferrocyanide.
 These electrons (i.e., the charge passing through the
electrode) are measured and this is proportional to the
concentration of glucose in the solution.
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Point of Care: Blood Glucose

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 Point of Care: Blood Glucose

How to use glucometer?

Getting Ready
1. Wash your hands with warm water and soap for at
least 15 seconds then rinse and towel dry.
2. Get your supplies:
Your meter
Test strips
Lancing device
Needle, often called a lancet

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 Point of Care: Blood Glucose

3. Open the lancing device and put a needle in. Take

the cap off the needle. Do not touch the needle.
4. Put the cover back on the device. Set the spring
on the device so it is ready to be used to stick you.
5. Get a test strip out of the bottle or package. Put
the cap back on the bottle.
6. Put the strip in the meter. This will turn the meter
on.

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 Point of Care: Blood Glucose
7. Match the code on your meter screen with the
code for your test strips.
• The code is printed on the test strip bottle or
package.
• If your meter has the code built into the strips,
go to the next step.
8. When the test strip symbol flashes on the screen,
the meter is ready for a drop of blood.

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 Point of Care: Blood Glucose

Checking Your Blood Sugar

1. Pick up the lancing device and put it against the side of
one of your fingers.
2. Push the button on the device to release the needle.
You will feel the needle stick. Set the device down.
3. Squeeze your finger at its base to get a large drop of
blood.
4. Based on the type of test strip you use:
Touch the end of the test strip to the drop of blood.
Put the blood drop on the test area of the strip.

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 Point of Care: Blood Glucose

5. Be sure that the test area on the strip fills completely

with blood.
6. The meter will time the test and then your blood sugar
number will show on the screen.
7. Write your blood sugar number in your log book or
blood sugar diary.

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Point of Care: Blood Glucose

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Point of Care: Blood Glucose

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 Point of Care: Blood Glucose

Cleaning Up the Supplies

1. Remove the test strip and throw it away in your trash.
2. Remove the needle from the device. Throw the needle
into a puncture proof container with a lid such as an
old bleach or detergent bottle.
3. Put your supplies away. Store the needle container
away from children and pets.
4. Wash your hands again with water and soap.

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 Point of Care: Blood Glucose

Quality Control when?

 New meter
 New test strips
 Change of Batteries
 Test strips left open
 Meter dropped/damaged
 Unexpected result
 Point of Care: Blood Glucose
Monitoring Errors Can result from:
 Improper calibration of glucometer
 Lack of glucometer maintenance and cleaning
 Battery failure
 Test strip failure (ex. out of date strips,
contaminated strips)
 Codes on strip container and glucometer don’t
match
 Hands not clean
 Temperature of equipment
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 Point of Care: Blood Glucose

Care of the Blood Glucometer

 Handle with care!
 Do NOT expose to excessive heat, humidity,
cold, dust, or dirt
 Clean as directed by manufacturer
 Store the glucometer and supplies in the case
provided by the manufacturer

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 Conclucions

 POCT can provide “bedside” results to the

patients and their physicians

 Although POCT can be perceived as easy, it is

not necessarily simple

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 Point of Care: Blood Glucose
REFERENCES
"Diabetes and Blood Sugar Testing." WebMD Diabetes Center: Types, Causes,
Symptoms, Tests, and Treatments. Web. 14 Mar. 2018.
<http://diabetes.webmd.com/guide/how-test-blood-glucose>.
"Blood Glucose Monitoring." Wikipedia. Web. 14 Mar. 2018.
http://en.wikipedia.org/wiki/Blood_glucose_monitoring
"Blood Glucose Monitoring | The Importance of Self-Monitoring Your Blood
Sugar." Diabetes Care, Information & Support | Changing Life With Diabetes.
Web. 14 Mar. 2018. <http://www.changingdiabetes-
us.com/ManagingDiabetes/Monitoring/>.
"Latest Developments in Insulin Delivery Technology." Lifeclinic: Blood Pressure
Monitors and Personal Health Management. Web. 14 Mar. 2018.
<http://www.lifeclinic.com/focus/diabetes/advances.asp>.
"Sensors for Medicine and Science Is Woking on Flourescent Trechnology for the
Measurement of Blood Glucose." DiabetesNet.com. Web. 14 Mar. 2018.
<http://www.diabetesnet.com/diabetes_technology/sms.php>.
"Children with DIABETES - Personal Lasette." Children with DIABETES Online
Community. Web. 14 Mar. 2018.
<http://www.childrenwithdiabetes.com/d_06_2ab.htm>.
 Point of Care: Blood Glucose
Using a Glucose Meter.mp4
 Point of Care: Blood Glucose

Conclusion:
 POCT is a diagnostic test when the result is
required within 5 – 10 minutes of specimen
collection and appropriate immediate medical
decision is required based on the result
 Guidance for POCT selection

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Thank You
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