In the continuous quality journey, Controlling laboratory Errors is an integral part & focusing on analytical, post-analytical process is the first step. Developing a reporting culture followed by thorough analysis and implementation of appropriate corrective, preventive actions is required.
Slides on medical laboratory testing process and pre-analytical factors that might contribute to laboratory errors and sample rejection, and how to prevent it.
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
In the continuous quality journey, Controlling laboratory Errors is an integral part & focusing on analytical, post-analytical process is the first step. Developing a reporting culture followed by thorough analysis and implementation of appropriate corrective, preventive actions is required.
Slides on medical laboratory testing process and pre-analytical factors that might contribute to laboratory errors and sample rejection, and how to prevent it.
Quality in clinical laboratory is a continuous journey of improving processes through team work, innovative solutions, regulatory compliance with final objective to meet the evolving needs of clinicians & patients.
A routine session on quality assurance practice in a medical laboratory to sensitize and provide basics to those interested in working in a medical testing laboratory.
Preanalytical quality control practices in clinical laboratoryDr. Rajesh Bendre
Preanalytical variables contribute maximally to lab errors. However, these variables are most difficult to control as they include human dependency for phlebotomy skills & pretest patient conditioning. Quantifying & monitoring these variables is also more challenging. Use of checklists, continuous training, competency assessments, internal audits & clinician education for appropriate test utilization form some of the tools for improving the preanalytical processes.
Harmonization of Laboratory Indicators, 09 03-2017Ola Elgaddar
Most of Medical labs are having KPIs to monitor their performance and enhance process improvement. This presentation discusses in short the IFCC attempts to reach a consensus and harmonize medical labs quality indicators.
Chemiluminescence Immunoassay (CLIA) using Microplate luminometers provides a sensitive, high throughput, and economical way to quantitatively measure antigen in cell lysates, plasma, urine, saliva, tissue and culture media samples.
Chemiluminescence Immunoassay does not require long incubations and the addition of stopping reagents, as is the case in conventional colorimetric assays such as Enzyme-linked ImmunoSorbent Assays (ELISA).
Among various enzyme assays that employ light-emitting reactions, one of the most successful assays is the enhanced chemiluminescent immunoassay involving a horseradish peroxidase (HRP) labeled antibody or antigen and a mixture of chemiluminescent substrate, hydrogen peroxide, and enhancers.
In recent years, CLIA has become very popular in clinical chemistry and environmental analysis, due to its high sensitivity, wide dynamic range and complete automation. With the development and application of recombinant Ab (rAb) technology, markers and related techniques, solid-phase materials and improvements in automation, integration and miniaturization, CLIA has acquired an entirely new appearance.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
A routine session on quality assurance practice in a medical laboratory to sensitize and provide basics to those interested in working in a medical testing laboratory.
Preanalytical quality control practices in clinical laboratoryDr. Rajesh Bendre
Preanalytical variables contribute maximally to lab errors. However, these variables are most difficult to control as they include human dependency for phlebotomy skills & pretest patient conditioning. Quantifying & monitoring these variables is also more challenging. Use of checklists, continuous training, competency assessments, internal audits & clinician education for appropriate test utilization form some of the tools for improving the preanalytical processes.
Harmonization of Laboratory Indicators, 09 03-2017Ola Elgaddar
Most of Medical labs are having KPIs to monitor their performance and enhance process improvement. This presentation discusses in short the IFCC attempts to reach a consensus and harmonize medical labs quality indicators.
Chemiluminescence Immunoassay (CLIA) using Microplate luminometers provides a sensitive, high throughput, and economical way to quantitatively measure antigen in cell lysates, plasma, urine, saliva, tissue and culture media samples.
Chemiluminescence Immunoassay does not require long incubations and the addition of stopping reagents, as is the case in conventional colorimetric assays such as Enzyme-linked ImmunoSorbent Assays (ELISA).
Among various enzyme assays that employ light-emitting reactions, one of the most successful assays is the enhanced chemiluminescent immunoassay involving a horseradish peroxidase (HRP) labeled antibody or antigen and a mixture of chemiluminescent substrate, hydrogen peroxide, and enhancers.
In recent years, CLIA has become very popular in clinical chemistry and environmental analysis, due to its high sensitivity, wide dynamic range and complete automation. With the development and application of recombinant Ab (rAb) technology, markers and related techniques, solid-phase materials and improvements in automation, integration and miniaturization, CLIA has acquired an entirely new appearance.
QUALITY
Conformance to the requirements of users or customers satisfaction of their needs and expectations.
Total Quality Management
A management approach that focuses on processes and their improvement.
Are laboratory tests always needed frequency and causes of laboratory overu...Hossamaldin Alzawawi
This article is discussing the importance of monitoring clinical laboratory resource utilization and how the team has implemented a monitor system to assess clinical laboratory resource overuse.
Pathology Optimisation in Chronic Blood Disease MonitoringAndrew O'Hara
Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Dehradun ❤CALL Girls 8901183002 ❤ℂall Girls IN Dehradun ESCORT SERVICE❤
POCT (Challenges in laboratory medicine)
1. Point of Care Testing
(Challenge in Laboratory Medicine)
Dr.NashwaElsayedClinical Pathologist, CPHQ , CPOCT (AACC)
Laboratory & Blood Bank Quality Manager
Hospital Accreditations Manager
KFH-Medina, SA
2. Worldwide,
One of The Fastest Growing Aspects of Clinical
Laboratory Medicine is POCT.
It Is Growing At Higher Rate Than Conventional
Laboratory Testing
❖ Increasing at Least 10-12% Per Year Overall. Up to 30% Per Year in
some Testing areas.
❖ In Contrast, Central Laboratory Testing has Grown about 6-7%
Annually.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
3. POCT ??
Point Of Care Testing
Tests Performed Outside the Clinical
Laboratories, Designed to be Used Near
the Patient & Do not Require Permanent
Dedicated Space.
(College of American Pathologist)
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
4. Who Performs The POC Tests ?
➢Nurses
➢Physicians
➢Medics
➢Technicians (Outside Laboratories)
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
7. ✓ CBAHI
✓ JCI
✓ CAP
✓ CLIA
✓ ISO
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Regulatory & Accreditation Bodies
8. POCT Standard (LB.28)
LB.28 The laboratory develops a comprehensive system for Point-of
Care-Testing (POCT).
LB.28.1 The laboratory implements policies & procedures to address the following:
LB.28.1.1 Clear definition of POCT.
LB.28.1.2 Assignment of the responsibility of managing the POCT to the laboratory.
LB.28.1.3 Guidelines describing the process of acquiring POCT devices/methods.
LB.28.1.4 Training and competency testing requirements.
LB.28.1.5 Maintenance, quality control, and quality management of the POCT
devices/methods.
LB.28.2 The laboratory assigned a qualified individual as POCT coordinator.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
9. POCT Standards (AOP.5.1.1)
AOP.5.1.1 A Qualified Individual is Responsible for the Oversight &
Supervision of the Point-of-Care Testing Program. 𝖯
Measurable Elements of AOP.5.1.1
1. The person responsible for managing the laboratory services, or a designee, provides
oversight and supervision of the POCT program.
2. Staff performing point-of-care testing have the required qualifications and training and are
competent to perform POCT.
3. The POCT program includes a defined process for reporting abnormal test results,
including reporting of critical results.
4. The POCT program includes quality control performance, documentation, and evaluation.
5. The POCT program is monitored and evaluated and included in quality improvement
activities.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
10. POCT Checklist
• POCT has a Separate Checklist that includes:
1. Oversight and Governance,
2. Document Control,
3. Process Improvement,
4. Equipment,
5. Purchasing and Inventory,
6. Quality Assurance,
7. Personnel Policies and Training,
8. Pre-Analytical Processes and Analytical Processes.
9. Latest Addition of IQCP wherever Applicable.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
11. CLIA Certifications
• Certificate of Waiver.
• Certificate for Provider Performed Microscopy (PPM)
Procedures.
• Certificate of Registration and Certificate of Compliance.
• Certificate of Accreditation
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
12. ISO 22870 Certificate
• ISO 15189 Applies to Medical Laboratories.
• ISO 22870 Applies Specifically to POCT.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
13. POCT Successful Program
• Implementation of a Successful POC test Can be
a Complex Process that Requires Special Skills.
• POCCs should have a Basic Understanding of
the Related Sections in the Main Laboratory
from which the Method or analyzer be Derived.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
15. Management Responsibility
This Is A Great Challenge
For Laboratories
As
The Testing Performed Out of their Hands,
But still the Lab is Accountable for Ensuring Compliance
with Laboratory Accreditation Standards.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
16. POCT is performed by Clinical Staff rather
than Laboratory Trained Individuals which
can lead to errors resulting from a lack of
understanding of the importance of Quality
Control And Quality Assurance Practices.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
17. Challenges Associated with POCT
• Documentation of POCT orders,
• Charting of POCT results
• Training and certification of individuals performing
POCT.
• Pre-analytical factors Associated Errors.
• Quality Assurance.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
18. Challenges in Critical Care
POC Blood Gas Testing
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
19. • “Blood gas and pH analysis has more immediacy and potential
impact on patient care than any other laboratory determination.”
• ”In blood gas and pH analysis an incorrect result can often be
worse for the patient than no result at all”
• ”Arterial blood is one of the most sensitive of the specimens sent
to the clinical laboratory for analysis”
“National Committee for Clinical Laboratory Standards
(NCCLS)”
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Pre-Analytical Error
20. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Pre-Analytical Error
• Pre Analytical Errors Represents 68% Of Total
Errors In Laboratory Medicine.
• 75% Of Error In Blood Gases Analysis Occur
From Pre Analytical Factors.
68%13%
19%
Pre-analytical
Analytical
Post analytical
21. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Pre-Analytical Error
Impact on the patient?
• Inappropriate or Delayed Treatment
• Increased Length of Hospital Stay
• Increased Morbidity & Mortality
• Pain – sticks hurt!
22. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Pre-Analytical Error
• Awareness is Important.
Reduced Error Improved Care
Better Patient
Outcome
25. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Ordering
1. Name of Patient
2. MRN
3. Age
4. Sex
5. Operator ID
6. Date & time of sample Collection
27. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Identification
1. Label Immediately After Sampling:
2. Avoid Mix-up of Samples
3. Avoid Missing Samples
4. Avoid Poor Data
28. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Collection
The ideal collection device for arterial blood
sampling is:
✓ Plastic Syringe
✓ Self-filling Disposable
✓ a 1-, 3-, or 5-mL
✓ Prefilled With Appropriate Type Of Lyophilized
Lithium Heparin.
29. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Other Collection Devices
1. Syringes, not dedicated for blood gas analysis:
(insulin syringe, etc). Not to be used. High risk of
hemolysis and gas exchange.
2. Vacutainer to be avoided, due to the negative
pressure on pCO2 and pO2.
30. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Collection by Capillary Tubes
When circumstances do not allow true arterial
sampling, capillary blood sampling may be selected as
an alternative method
31. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Collection by Capillary Tubes
Correlation
pH and pCO2,
Good Correlation is demonstrated between a capillary (arterialized)
blood sample and the equivalent arterial one
pO2
the Correlation Is Poor (due to the variable percent of venous
component in the sample)
K
Significant Differences are caused in the process of “arterialization”
or hemolysis.
32. Brachial Artery
at the Elbow
Femoral Artery at the
Inguinal Ligament
Capillary at the Heel
Capillary at the Ear Lobe
Radial Artery
at the Wrist
Mixed Venous Blood
At the pulmonary artery
Collected with catheter
Capillary at the Fingers
Puncture Sites
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
33. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Sample Handling
➢ Whole blood samples must be mixed thoroughly
(particularly for Hb & Hct accuracy).
➢ Recommendation:
✓ 30 second minimum (or longer)
✓ Mix immediately & remix prior to analysis
✓ Mix in two planes (rock & roll)
✓ Be gentle (prevent hemolysis, very important for K)
34. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Sample Handling
➢ Expel Air Immediately & Completely
➢ Measure < 30 Minutes - Room Temperature*
➢ Measure 30-60 Minutes - Ice/Water Slurry*
*CLSI document H11-A4, Vol 24 No 28. Procedures for the Collection of Arterial Blood Specimens.
35. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Iced Vs Non-iced
➢ Ice slurry (metabolic inhibition)
• Helps preserve pH, pCO2, pO2, glucose & lactate
• pO2 might increase in plastic syringes
• May increase K+, decrease Na+
➢ Non-iced
• Must analyze quickly
• No change in K+
• Glucose 0.5 mmol/L Hr
• Lactate 0.5 mmol/L/Hr
36. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Handling of Capillary Sample
Puncture Site should be:
➢ Pre-warmed up to (42 C), increases flow up to 7X
➢ Free-flowing sample
“milking” introduces venous blood and interstitial fluid
➢ Completely filled, air free tubes, with sealed ends
➢ Should be analyzed within 10 minutes, with plastic caps.
37. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Handling of Capillary Sample
1. Remove the first blood drop before sampling
2. Cap and roll tube immediately
3. Using the small magnet, move the metallic
flea in the capillary at least 5 times forward
and back before analyzing the sample. This
make the blood homogeneous and reduce the
risk of micro clottings
38. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Handling of Capillary Sample
• Move the metal wire flea from end to end
• Analyze as soon as possible (max delay 10 mins)
39. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Sample Transport
Effect of Time on Blood Gas Sample
↓ pO2 Oxygen will still be consumed
↑ pCO2 Carbon dioxide will still be produced
↓ pH Primarily due to the change in pCO2 and glycolysis
↑ cCa2+ Change in pH will influence the binding of Ca2+ to protein
↓ cGlu since glucose will be metabolized
↑ cLac due to glycolysis
Continued cellular metabolism in sample
40. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Pneumatic Tube Transport (PT)
➢ pH and pCO2 not affected by PT, regardless of use of
Pressure sealed/non-sealed containers
➢ pO2 significantly altered in non-sealed containers.
➢ pO2 No Alteration if sent in pressure sealed containers.
POC Blood Gas Is A Huge
Advantage In This Respect
41. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Venous Admixture
➢ The addition of 10% of venous blood to an arterial
sample can produce > 25% drop in Po2
➢ Increased Probability On Femoral Artery Punctures
Suspect Venous Contamination If Condition &
ABG Results Do Not Correspond With Patient
Clinical Picture
42. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Hemolysis
➢ Hemolysis causes the release of intracellular
components from destroyed erythrocytes into
extracellular fluid.
43. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Hemolysis
The following actions might cause hemolysis:
➢Vigorous mixing
➢Blood collection: pressure increase through a narrow
diameter syringe or when path is blocked by clots
➢Squeezing the skin during capillary blood sampling
➢Storage directly in ice
➢Transport on pneumatic tube system
44. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Quality of ABG Analyzer
Testing performed by Non-
laboratory Professionals
❖Not familiar with testing process
❖No time allocated for testing
❖Primary responsibility is patient care
❖No time for quality control
❖No understanding of QC
❖Not familiar with QC interpretation
Quality is a Concern at POCT!
45. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Quality of ABG Analyzer
The technology for ABG measurements is based on the
use of electrodes. Their performance is slightly changing
during its life,
To Verify That The Response Of The System Is Within
Acceptable Range A Calibration Have To Be
Performed.
46. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
Quality of ABG Analyzer
So, Every time a new blood sample is introduced on the
analyzer;
The Risk To Report Not Reliable Result Increases, For This
Sample And For The Subsequent, Specially If There Is A
Poor Pre-analytic Phase.
47. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
The solution about Quality
Analyzing on the BG analyzer a solution with known concentration
and comparing the result with the values given by the instrument is
the common way to find errors in the system.
If the QC is outside of the expected range, then the instrument alerts
the operator to take the corrective action, in the most advanced
analyzer the parameter that failed is automatically disabled.
More often the QC’s are analyzed “less” probability to report
wrong results.
49. • Failures detected
• Automatic QC control
• Auto QC requires active
operator supervision
• Auto QC requires instrument
corrective actions
• Temporary failures might not
be detected:
• Air contamination
• Electrodes drift
• Clots and micro clots
• Interferences
Blood Gas QC
50. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
iQM:
Intelligent Quality Management
What does iQM do?
It runs Automatically Real Time Quality Control for all the system:
✓ Automatically Detects Issues in the system
✓ Automatically Performs Corrective Actions
✓ Automatically Documents The Failure & Corrective Actions taken
51. Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
How iQM Enhances
Patient Care Safety?
Start of Shift
(8-hour QC)
Start of Shift
(8-hour QC)
Measurement problem occurs
Measurement problem detectedQuestionable test results
Reliable test resultsTraditional or
Automatic QC
Ongoing, Continuous QC testing
Measurement problem detected
Reliable test results
Measurement problem occurs
52. A New QC Paradigm
Intelligent Quality Management (iQM) is used as the quality control and
assessment system for the GEM Premier 4000 system. iQM is an active
quality process control program designed to provide continuous
monitoring of the analytical process with real-time, automatic error
detection, automatic correction of the system and automatic
documentation of all corrective actions, replacing the use of traditional
external quality controls.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
53. What does iQM for POCT operators?
Real Time Manufacturer guaranteed
quality without: “?”
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
57. iQM Validation Dr. Westgard
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
58. iQM Validation Dr. Westgard
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)
59. POCT is a Lean Process
Testing on-site Requires Fewer Steps than
Transporting a Specimen to a Core Laboratory
that Improve Patient Outcome or Workflow
by having Immediately Available Results.
Point-of-Care-Testing can have
a Positive Impact on Operational Efficiency
and Patient Care.
Dr. Nashwa Elsayed
POCT(Challenge inLaboratoryMedicine)