Point Of Care Test

A Point-Of-Care (POCT) test is defined as a medical analysis performed near the patient or in the place where health care is provided. The driving concept of the POCT is to perform the test in the most comfortable and immediate way. POCT tests are carried out using transportable, portable and palm-sized instruments.

POCT devices can find applications in many situations: in homes, on an outpatient level, in emergency departments, in containment departments for infectious diseases, in ambulances, in military centers, on cruise ships, in areas where an accident happened or even in the space shuttle.

Furthermore, these devices can be used by many people, including laboratory technicians, first aid doctors, radiologists, nurses or other health professionals. POCTs for self-monitoring can also be used directly by the patient (for example, for devices for controlling blood glucose in diabetic patients)

When a handheld device is not available, small-sized bench analyzers or even fixed equipment can be used. The objective remains that of, collecting the sample and obtaining results in a very short period of time and in the immediacy of the area or clinic where the patient is located. In this way the treatment plan and the first care can be provided quickly and with the necessary corrections based on laboratory data, before the patient is transferred to a specialist department or another more suitable hospital.

TYPES OF POCT

The various types of POCT include: blood glucose testing, determination of blood gas analysis, determination of electrolytes, blood coagulation tests (PT / INR), rapid diagnosis of heart markers, screening for drug abuse, routine testing of urine, tests of pregnancy, determination of fecal occult blood (FOB), determination of hemoglobin, cholesterol screening, screening test for foodborne pathogens, test for infectious diseases.

TECHNOLOGY

Many POCT test systems are made of plastic and are based on test strips (dry chemistry). This traditional approach is the one that most glucose meters or instruments for pharmacy self-diagnostics rely on. Recently it is possible to perform a self-diagnosis on diagnostic rheumatology indices such as: C-reactive protein (PCR), anti-Streptolysin O (ASO), rheumatoid factor (RF). These tests require only a drop of sample such as whole blood, urine or saliva, and can be performed and interpreted by any doctor or pharmacist within minutes.

TESTS AVAILABLE IN VARIOUS SETTINGS

Primary care

• Glucose, HbA1c (glycosylated hemoglobin), Microalbuminuria find applications in fields such as diabetology.
• Lipid Profile (Total Cholesterol, HDL, LDL, Triglycerides) of interest, among other things, for nutrition specialists to monitor the progress of the diet followed by the patient.
• CRP (C-Reactive Protein), a marker in acute inflammation states, very interesting in Pediatrics to define whether a disease has bacterial or viral origin for antibiotic therapy.
• Urine analysis.
• Indices of coagulation, interesting among other things in dental surgeries to verify the coagulation times of the patient’s blood before any surgical intervention, even of the minimally invasive type.
• Beta-hemolytic streptococcus infections of group A (from pharyngeal swab) interesting for the pediatrician and group B beta-hemolytic streptococcus (from Vaginal Swab) interesting for the gynecologist before birth.

Emergency room

• Electrolytes, Arterial blood gas analysis and Lactate determination
• Glucose, Creatinine, Amylase
• Screening of Drugs (Opiates, THC, Benzodiazepines, Ecstasy, Barbiturates)
• Cardiac markers (TroponinaI, Myoglobin, CK-MB)
• Coagulation markers
• Electrolytes, calcium and magnesium, arterial blood gas with lactates
• Glucose, Osmolality, Creatinine
•  Hemoglobin
• Prothrombin time (PT) and INR

ADVANTAGES OF THIS TECHNOLOGY

When used properly, POCT devices can be very efficient and improve the clinical care provided to the patient. POCTs have established themselves all over the world and play a vital role in organizing public health services. There are some scientific works and monographs that emphasize that POCT should be considered a normal standard of care.

In the domestic environment, for self-control, they allow more assiduous monitoring of patients and therefore better management of the disease. For example, some studies have shown that the availability of POCT devices for monitoring patients on anticoagulant therapy with warfarin has decreased the incidence of therapy related complications.

POCT devices are crucial in emergency conditions and in operating rooms. For example, people with suspected strokes can benefit from the use of a POCT device for the measurement of PT / INR and the evaluation of coagulation abilities, before the administration of the therapy. They can also be used in operating theaters during heart surgery or organ transplant operations.

The main advantages are obtained when the results of a POCT device are immediately exported to an electronic medical record. In this way the data obtained can be instantly shared with all the members of the medical team thanks to the software interface, thus reducing the so-called turn around time (TAT), that is the journey time of a request necessary to obtain the result or response of the report. According to some studies, a reduction in morbidity and mortality was found using goal-directed therapy, GDT (early therapy aimed at achieving the goal) techniques used in combination with POCT and the electronic medical record. POCTs have potential operational advantages: triage and decision-making would be faster; the operating times would be reduced; reduction of post-operative care time; reduction of time spent in the emergency room; reduction in the number of outpatient visits; reduction of hospitalizations.

DISADVANTAGES

Although most POCT devices are designed to be easy to use and with little margin for error, they are not completely error-free. People, both patients and healthcare professionals, who use these devices must be properly instructed in their use. Some POCT tests, such as those used to choose the variation of the therapeutic dosage of drugs, can have serious consequences if not used correctly.

For example, POCT devices for measuring blood glucose or HbA1c are developed only for diabetes monitoring and should not be used for diagnosis or screening.

This element has been included in Diagnostics at your fingertips, Specialized and tagged Blood coagulation, CRP, Drugs, Electrolytes, Blood gas analysis, Blood glucose testing, Point-Of-Care (POCT), C-reactive protein, PT / INR, test of pregnancy, Urine.