POCT即时检验

1、point-of-carecoagulationtesting:whatisit?whydowedoit?wherearewegoing?,johna.saavedra,internationalsalesmanagerinternationaltechnidynecorporation(itc)edison,newjersey,usa,whatispointofcaretesting?,accordingtocap(collegeofamericanpathologists):testingperformedatthebedsidenotinfixeddedicatedspaceperfor

2、medbyalargenumberofdifferentnon-laboratoryhealthcarepersonnelutilizesportabledevicesorsimplereagentkitsdifferentfromthoseusedintheprimarylaboratory.,whytestcoagulation?,monitoranticoagulationtherapyheparinandwarfarinaremonitoredbothhavehighlyvariablepatientdoseresponse.atherapeuticdoseforpatientathr

3、omboticdoseforpatientbhemorrhagicdoseforpatientcdeterminepatientshemostaticstatus,whypoint-of-caretesting?,promptturnaroundtimeimprovedclinicaloutcomereducedlengthofstaystandardizationimproved,timelypatientcare,benefit-immediateturnaround,whenisturnaroundimportantoperatingroomandcathlabicu/ccudosead

4、justmentsemergencyroom,immediateturnaround,fitch,et.al,j.clinmonit2x106kiupumpprime;0.5x106kiu/hrinfusionhalfhammersmith1x106kiuloadingdose;1x106kiupumpprime;0.25x106kiu/hrinfusion,actmonitoringwithaprotinintreatment,celiteactnotrecommendedstillusedwithtargettimesof750secondskaolinactunaffectedbymod

5、eratedosesofaprotininusedwithtargettimesof480secondsact+unaffectedbyalldosesofaprotininusedwithtargettimesof400seconds,actmonitoringwithaprotinintreatment,datafromclinicalevaluation,onfile,itc,otherpoint-of-carecoagulationtestingintheoperatingroom,apttsomepatientsmayberesistantorsensitivetoheparinth

6、eycanrepresent20-40%ofpatientpopulation,managingheparinandprotaminedosing,heparinresistance:repeatedexposuretoheparin(frompreviousprocedures)mayreducepatientsresponsetothedrugpatientrequiresahigherdoseofheparininordertoobtainthesameanticoagulanteffect,managingheparinandprotaminedosing,heparinsensiti

7、vity:patientsresponsetoheparinisgreaterthantheaveragepatientofthesameheight,weightandgender.patientrequiresalowerheparindosetoobtainthesameanticoagulanteffect.,managingheparinandprotaminedosing,benefits:individualizesheparindoseforsensitiveandresistantpatientsreducesuseofbloodproductsneededforpost-o

8、perativetransfusionsjobesdr,etal.1995.increasedaccuracyandprecisionofheparinandprotaminedosingreducesbloodlossandtransfusionrequirementsinpatientsundergoingprimarycardiacoperations.jthoraccardiovascsurg110:36-45,managingheparinandprotaminedosing,benefits:reducespotentialforprotaminedosesideeffectspr

9、otaminereducedbyaverageof30%zuckerml.,etal.1997.utilityofinvitroheparinandprotaminetitrationfordosingduringcardiopulmonarybypasssurgery.jextra-corptech.29:176-180.costsavingsjobesd,etal.1996.costeffectivemanagementofheparin/protamineincpbypass:analysisbytypeofsurgery.anesthes85:3a,otherpoint-of-care

10、coagulationtestingintheoperatingroom,heparinneutralizationverificationensurecompleteremovalofcirculatingheparinapttpda-o-actbasedtt/hntt-thrombintimebased,clinicalstudies,reducedbloodloss/transfusionuseofhrtandprt(rxdxsystem)jobes,d.et.al.,1995.j.thorac.cardiovasc.surg.reducedcostresultingfrompocass

11、aysrxdxcombinedwithtt/hnttjobes,d.et.al.,1996.amsocanesthmtg.,clinicalstudies,reducedcomplicationratestt/hnttre-explorationforbleedingreducedfrom2.5%to1.1%re-explorationforcoagulopathyreducedfrom1.0%to0.0%jobes,et.al.1997,nacbpresentation,phila,pa.,point-of-carecoagulationtesting,clinicalapplication

12、soperatingroomcardiacsurgeryinterventionalcardiologyandradiologycriticalcaresatellitesitesdialysisecmoemergencyroomanticoagulationclinic,criticalcare,actdeterminewhentopullthefemoralsheathhighactvaluesindicatethepresenceofheparin.prematuresheathpullcanleadtobleedingcomplications.delayedremovalcaninc

13、reasetimeinboththeccuandhospitaltargetactsetateachsitevariesfrom150secto250secondmonitorheparintherapytargettimesdeterminedbyeachfacilitytargetsusuallysetas1.5-2xbaselineactvalues(180-240seconds).,criticalcare,apttlaboratoryorpointofcarehighapttvaluesindicatethepresenceofheparinorunderlyingcoagulopa

14、thydeterminewhentopullthefemoralsheathtargettimesdeterminedbyeachfacility.monitorheparintherapytargettimesdeterminedbyeachfacilitytargetsaresetas1.5-2xbaseline50-80secondsmonitorduringheparin/coumadincross-over,heparinversuswarfarin,whatdothetestresultsmean?,ptlaboratoryorpointofcaremonitorwarfarint

15、herapymonitorheparin/warfarincrossovertargettimesaresetbyinternationalnormalizedratio(inr)isi=internationalsensitivityindexinrtargetrangesarespecifiedbypatientpopulationsprophylactictherapyfordvt:inr=2.0-3.0artificialheartvalve:inr=3.0-4.0,willresultsmatchthelab?,probablynotbuttheywillcorrelate,why?

16、,pointofcarewholebloodnoaddedanticoagulantnodilutionnopreanalyticaldelay,standardlaboratoryplateletpoorplasmasodiumcitrateanticoagulant1:9dilutionvariablepreanalyticaldelay,correlationswithdifferentsystems,signatureinrvslab,point-of-carecoagulationtesting,clinicalapplicationsoperatingroomcardiacsurg

17、eryinterventionalcardiologyandradiologycriticalcaresatellitesitesdialysisecmoemergencyroomanticoagulationclinic,dialysis/ecmo,actusedtomonitorheparinusep214glassactivatedacttubeoract-lrcuvettetargetsgenerally180-220secondsbettercontrolofanticoagulationleadstoincreaseddialyzerreusepotentialforlongter

18、mcostsavingsnocompromiseindialysisefficacy(kt/v)ouseph,r.et.al.amjkidneydis35:89-94;2000,emergencyroom,act;aptt;pt;fibrinogenimmediateidentificationofcoagulopathiesoptimizationofcriticaldecisionpathwaysactallowsearlydetectionoftraumaticcoagulopathyallowsearlytreatmentdecisionsaidsdamagecontroldecisi

19、onsaucar,j.et.al.1998swsurgeonscongressoptimizestaffingduringoffhours,anticoagulationclinics,resultsavailablewhilepatientispresentimprovedanticoagulationmanagementimprovedstandardofcarestaffefficiencyimmediateretesting(ifneeded)fingersticksamplingsamesystemforclinicandhomeboundpatientsstandardizedisi(testsystemspe