SPECIAL COLLECTIONS AND

POINT-OF-CARE TESTING
 LEARNING OUTCOMES
1. Analyze the purpose behind each special collection procedure, the
steps involved, and special supplies or equipment required;
2. Illustrate the proper patient identification and specimen labeling
procedures required for blood bank tests and types of specimens
typically required;
3. Describe proper donor identification, blood units labeling, and
post collection handling procedures;
4. Discuss the sterile technique in blood culture collection, its
importance, and reasons why physician orders blood cultures;
5. Identify coagulation specimens and their proper collection and
handling;
6. Expound the chain-of-custody procedures and the tests that may
require them;
7. Clarify the timing, role of drug half-life, names, peaks and troughs
of drugs, and therapeutic levels in drug monitoring; and
8. Explain the principle that underlies the point-of-care testing
(POCT).
PRINCIPLE BEHIND SPECIAL COLLECTION
PROCEDURES, SPECIAL SUPPLIES OR EQUIPMENT
Special collection procedures are non-routine
laboratory test that may not only involve additional
preparation and procedure but may require other specimen
such as urine or feces. These can be applied for special
cases such as blood donation.
 Table 8.1 List of Special Collection Procedure

Name of test Purpose Special requirement (if any)

Blood Bank: Blood type Determines the blood type and None
& Screen Rh factor
Blood Bank: Cross- Checks the compatibility of the Patient's serum or plasma and
match test blood between the donor and donor's RBCs
the recipient
Blood Culture Determines the presence of Blood volume should be 20 to
infection, identifies the type 30 mL per culture with a
organism involved and measure minimum of 10 mL per draw for
the extent of infection. patients weighing more than 80
pounds. For infants it should be
only 1 to 4% of the total blood
volume.
Coagulation test Evaluates the blood clotting Microclots are avoided by gently
function inverting anticoagulants tubes
three or four times from
collection.
2-hour Postprandial Screening for diabetes and other Must be obtained 2 hours after
glucose metabolic disorders meal
Glucose Tolerance Test Diagnose problems in 1 hour for gestational diabetes
(GTT) and Oral Glucose carbohydrate metabolism and and 3 hours for other glucose
Tolerance Test (OGTT) checks the ability to metabolize metabolism evaluation.
glucose thru the tolerance level
 Table 8.1 List of Special Collection Procedure
Name of test Purpose Special requirement (if any)
Lactose Tolerance Determine the lack of Same procedure as 2-hour
Test mucosal lactase which is GTT but an equal amount of
responsible for conversion of lactose is substituted for
lactose into glucose. glucose.
Paternity/Parentage Verifies the probability that Follows the chain-of custody
Testing the patient fathered a protocol and specific
particular child. identification procedures.
Therapeutic Drug Tests the drug levels at Collection timing should
Monitoring specific interval to establish include the peak and trough
proper drug dosage and level.
avoid toxicity.
Therapeutic Used as treatment to Involves withdrawal of
Phlebotomy polycythemia and approximately 500 mL as
hemochromatosis part of the treatment.
Toxicology test Checks the presence of Toxins usually exist in very
toxins in the blood, hair, small amounts
urine, and other substances
Trace elements Checks for presence of Measured in small amounts
aluminum, arsenic, copper,
lead, iron, and zinc
 BLOOD BANK SPECIMENS
• The Blood bank specimen is important in determining
which blood product can be safely used for blood
transfusion. Blood banks use a lavender-top or pink-top
Ethylenediaminetetraacetic acid (EDTA) tube or a red-top
non additive glass as an alternative.
• Blood banks follow a strict identification and labeling
procedure to ensure that there are no errors which could
lead to incompatible blood product that can cause fatal
reaction to the recipient of the blood.
The following information must be included:
1.Full name including middle initial
2.Hospital ID Number
3.Social Security Number for outpatients
4.Date of Birth
5.Date & time of collection
6.Initials of the phlebotomist.
Note: Room number and bed number is optional.
PATIENT IDENTIFICATION, TYPES OF SPECIMEN,
LABELING PROCEDURES REQUIRED FOR BLOOD
BANK TESTS

Figure 8.1. Sample Blood Bank Label

✓ Blood banks can use special identification systems such
as ID bracelet (self-carbon adhesive for specimen), Blood
ID band (linear bar-code), and Siemens Patient
Identification check-blood administration.
✓ Screening includes typing the blood for transfusion and
screening for infectious diseases. The blood type (ABO)
and Rh factor (+ or -) are determined.
✓ There are cases when there is a need to conduct a cross-
match test to eliminate blood related compatibility issues
that may arise between the patient and the donor. The
plasma or serum from the patient is mixed the RBC of the
donor to check the compatibility.
✓ Blood donor collection is done mainly for the purposes of
blood transfusion.
✓ Blood donors should be 17 to 66 years of age, with a
minimum weight of 110 lbs. They must have completed
the physical exam and declared their medical history.
✓ The unit of blood can be separated into RBCs, plasma
and platelets but these should still be traceable to the
donor. Under the lookback program, blood recipients
needs be notified when the donor was diagnosed positive
for transmittable disease. The blood components are then
verified and retrieved.
✓ There are also cases when there is an autologous
donation where the patient donates blood for his use
especially for elective surgeries. After securing a written
permission from the physician, blood can be collected
within a minimum of 72 hours from the surgery schedule.
✓ Another special scenario is cell salvaging where the blood
of the patient is salvaged (during surgical procedure),
washed and re-infused after testing for residual free
hemoglobin. The salvaged blood needs to be tested prior
to reinfusion because a high free hemoglobin level means
that too many red cells were destroyed during the
salvage process and reinfusion is not recommended
because it will result to renal dysfunction.
STERILE TECHNIQUE IN BLOOD CULTURE
COLLECTION
✓ A blood culture is a test that checks the blood for
pathogens for patients who have a fever of unknown
origin (FUO).
✓ The test determines the presence of bacteria in the blood
that causes bacteremia or presence of microorganism
and toxins in the blood that causes septicemia.
✓ The physician orders this test only if there is a probability
of bloodstream microorganism invasion.
✓ For optimum results, the collection should have 2-4
blood culture sets placed in special bottles, one aerobic
(with air) and one anaerobic (without air), that were
drawn 30 to 60 minutes apart.
✓ Skin antisepsis is crucial in the blood collection procedure
because it prevents the contamination by microbial flora
in the skin which can be introduced in blood culture
bottles and affect the results.
✓ The sterile technique varies per laboratory but the
following antiseptics can be used to sterilize the site:
betadine swab sticks, chloroprep, PVP ampule,
Frepp/Sepp II, and Benzalkonium chloride. To minimize
the risk, friction rub of the collection sites are performed
for about 30 to 60 seconds using tincture of iodine,
chlorhexidine gluconate, and a povidine/70% ethyl
alcohol combination. Any detected microorganism in the
laboratory should be reported so that the physician could
evaluate if it is clinically significant.
Blood Culture Collection Procedure
1. The patient should be properly identified and the
collection procedure should be explained clearly.
2. Select the venipuncture site and release the tourniquet
within 60 seconds.
3. Assemble the equipment and make sure to follow proper
aseptic technique.
4. Perform the friction rub for about 60 seconds.
5. Wait for 30 seconds to allow the site to dry.
6. Open the culture bottle by removing the flip-off cap
while checking the same for defects. Bottle should draw
at least 8cc and should be in date.
7. Clean the bottle stopper while waiting for the site to
dry.
8. Check the fill lines on the bottle to determine the
minimum and maximum level of the bottle.
9. Tourniquet should be reapplied and perform the
venipuncture. Make sure that the site is not touched.
10. Inoculate the medium.
11.To mix the blood with the medium, invert the bottle a
couple of times.
12.If iodine is used in the arm, the patient's skin should be
cleaned.
13.Observe proper labeling procedures. Make sure to include
information about the site where the blood was collected.
14.Discard used and contaminated materials properly.
15.Courteously thank the patient. Remove the gloves and
decontaminate the hands with hand sanitizer.
16.Transport the specimen promptly to the laboratory for
analysis and processing.
Media Inoculation Methods

There are three ways to inoculate the medium:

(1) directly into the bottle (during collection),
(2) collected in a syringe (after collection), and
(3) through an intermediate collection tube (in the
laboratory).
 In direct inoculation, a
butterfly and specially
designed holder is used. The
holder is connected to the
Luer connector of the
butterfly collection set. The
aerobic vial is filled first and
each container is mixed after
removal from the holder. The
needle is removed after
completing the collection
and the safety device is
activated as pressure is
applied over the site.
✓ When using the syringe method, blood is transferred to
the culture bottles after completing the draw using a
safety transfer device which is activated as soon as the
needle is removed from the site. Attach the safety
transfer device to the syringe. Push the bottle into the
device until it reaches the stopper. The blood will be
drawn from the syringe filling the vacuum in the
container. The bottle should be placed in a solid surface
or in a rack.
✓ Intermediate Collection Tube is
performed in the laboratory rather
than the patient's bedside.
Although this is not recommended
because the sodium polyaethol
sulfonate (SFS) in collection tubes
increase concentration when
added to the blood culture bottles.
Moreover, the transfer of blood
increases the risk of contamination
and exposure of laboratory staff.
However, if it could not be
avoided, the yellow-top SFS tube
is acceptable for collection
purposes.
COAGULATION SPECIMEN AND ITS PROPER
COLLECTION AND HANDLING
✓ A physician requests coagulation tests to assess the blood
clotting functions especially if the patient has an
unexplained bleeding.
✓ This test could be prothrombin time (PT), activated
partial thromboplastin time (aPTT), and thrombin time
(TT) which is a close approximation of the hemostatic
system.
✓ The integrity of the blood specimen during collection and
transportation has a direct effect on the test result, thus,
special care should be taken to ensure that it is done
properly.
✓ If only the coagulation specimen is drawn, draw a "clear"
tube with 1-2 mL which is discarded prior to collection.
The blood specimen is then collected using a light blue
top with 3.2% citrate tube with the correct (9:1) blood to
coagulant ratio.
✓ To ensure proper mixing, invert the tubes gently 3 to 4 times
immediately after collection.
✓ Coagulation sample is collected second when an evacuated tube
system is used.
✓ For draws using indwelling catheter, the line should be flushed with 5
mL of saline. The 5 mL which is equivalent to six dead space volumes
of catheter is discarded.
✓ The concentration of the sodium citrate should be adjusted for
patients with above 55% hematocrit values.
✓ The collected specimen should be transported to the laboratory
immediately. Should the specimen be unable to reach the laboratory
within four hours, it should be centrifuged and the plasma frozen.
2-hour Postprandrial Glucose (2-hour PP)
This blood test is done to check if the patient is suffering from
diabetes and other metabolic problems. The 2-hour PP test is also used
to monitor insulin therapy. The principles of 2-hour PP specimen
collection are:
1. A high-carbohydrate diet was introduced 2 to 3 days prior to the test.
2. The patient should fast at least 10 hours prior to the test.
3. Fasting glucose specimen maybe be collected before the start of the
procedure.
4. A special breakfast containing an equivalent of 100g glucose or a
glucose beverage will be given on the day of the test.
5. Blood glucose specimen will then be collected 2 hours after the meal.
Glucose Tolerance Test
✓ A patient who could be suffering from carbohydrate metabolism
problems is subjected to the glucose tolerance test (GTT) which is
also called oral glucose tolerance test (OGTT) to evaluate the ability
of the body to metabolize glucose by measuring the tolerance level
to high glucose level.
✓ Insulin response to a measured dose of glucose is recorded by
specimen collection at given intervals.
✓ The GTT length is 1 hour for gestational diabetes while it is 3 hours
for other evaluations.
✓ The method of collection should also be consistent be it venipuncture
or skin puncture.
GTT Procedure
Before the procedure the patient must eat balanced meal
containing approximately 150 grams of carbohydrates for 3 days and
must fast for 12 to 16 hours before the scheduled test. Drinking water is
allowed to avoid dehydration and because urine specimen is also
collected as part of the test. The steps in the GTT procedure are as
follows:
1. Begin with the normal identification protocol. Explain the procedure
and advise the patient that only water is allowed during the whole test
period.
2. The fasting specimen is drawn and the glucose level is checked and
should NOT be over 200 mg/dL for the test to proceed.
3. The patient should collect a fasting urine specimen if ordered.
4. The patient is given the glucose beverage dose. Adult dose is 75g while
children are given 1g per kilogram of weight. For gestational diabetes the
dose should be between 50 to 75g.
5. The beverage should be ingested within 5 minutes.
6. Record the time when the drink was finished then start timing the test which
is collected within 30 minutes, 1 hour, 2 hours and so forth.
7. A copy of the collection time is provided to the patient.
8. If applicable the collection time for other specimen such as urine should
coincide with the computed collection time.
9. The exact time collected and the time interval should be written in the label
along with patient identification information.
10. Transport the specimen immediately or within 2 hours for accurate results.
Lactose Tolerance Test

A lactose tolerance test measures the ability of the

body to process lactose and determines if the patient lacks
mucosal lactase, which is an enzyme that converts lactose
into glucose or galactose. Gastrointestinal distress and
diarrhea follows after ingestion of milk or food containing
lactose for those who lack the lactase enzyme.
The principles for the lactose tolerance testing include:
1. It is recommended that a 2-hour GTT test be administered at least a day
before the lactose tolerance test.
2. Equal amount of lactose is substituted to glucose but the test will be
performed following the manner of GTT.
3. Glucose specimen is drawn at the same time as the previous GTT procedure.
4. The GTT curve and the glucose curve will be similar if the patient has mucosal
lactase.
5. If the patient is lactose intolerant, the result will yield a "flat" curve where
glucose levels just slightly rise over the fasting level.
6. Patients with slow gastric emptying, Crohn's disease and cystic fibrosis could
show false-positive results.
Paternity/Parentage Testing
✓ Parentage testing or paternity testing is performed to exclude the
possibility of paternity of a particular child.
✓ Before the advent of DNA parenting testing, testing for parentage
involves ABO and Rh typing, and basic red cell antigen testing.
Should the result does not exclude alleged parent further test is
performed which include extended red cell antigens, red cell
enzymes, serum proteins testing, white cell enzymes, white cells
antigen, and human leukocyte antigen (HLA).
✓ DNA paternity testing is the most advanced technology to date.
✓ The test uses the genetic fingerprinting or DNA profiling to establish
parentage by providing genetic proof.
✓ Polymerase chain reaction (PCR) and restriction fragment length
polymorphism (RFLP) are two other methods used today although
the older techniques still exist.
The principles of DNA paternity testing are:
1. All involved parties need to submit a government issued photo
identification along with the completed Chain of Custody form. The
photos of all tested parties are also taken.
2. The Buccal samples as collected by using a swab that was rubbed
inside the cheek and the loose cheek cells adhere to the swab.
3. Sealed and tamper-evident package are used to hold the specimen
during transportation to the laboratory.
4. The test results are ready after 48 hours which are usually sent via
mail.
TIMING, ROLE OF DRUG HALF-LIFE, NAMES OF DRUGS, ITS
PEAK, TROUGH, AND THERAPEUTIC LEVELS IN DRUG
MONITORING

Therapeutic Drug Monitoring

✓ The Therapeutic drug monitoring (TDM) measures drug levels at
designated intervals so that the appropriate dosage can be
established and maintained for the patient thus avoiding toxicity.
✓ TDM begins with prescription of the initial dosage appropriate for the
patient's clinical condition. The amount in the bloodstream is
expected to rise, eventually reach peak (maximum) which screens
drug toxicity, and gradually fall to a trough or minimum level which
ensures that the levels within therapeutic range.
✓ The timing of collection is important for aminoglycoside drugs
(amikacin, gentamicin, and tobramycin) which have short half-lives
but it is not critical for phenobarbital and digoxin.
✓ Appropriate concentrations should be given to optimize the clinical
outcomes while considering the drug dosage, history of dosage
given, the recorded response of the patient and desired outcome.
Therapeutic Phlebotomy
✓ Therapeutic phlebotomy is performed by drawing a large volume of
blood from the patient about 500 mL as part of the treatment
procedure for polycythemia and hemochromatosis.
✓ Polycythemia is the overproduction of red blood cells which is
harmful to the patient. A hematocrit test is used to check the RBC
level and removal of blood is done when level exceeds a certain level
with the goal of returning the levels to normal range.
✓ Hemochromatosis is characterized by excess iron deposits in the
tissues which could be due to problems with iron metabolism as a
result of multiple blood transfusions or excessive intake of iron.
CHAIN OF CUSTODY PROCEDURES IN DRUG TESTING

Toxicology Specimens
A phlebotomist plays a role in both clinical toxicology (detection
of toxins and treatment) and forensic toxicology (legal consequences of
toxin exposure) because toxicology test involves collection of blood, hair,
urine and other substances from the body for the purpose of determining
the presence of toxins which could be in very small amounts.
Forensics Specimens
✓ Toxicology specimen are ordered by the law enforcement department
for legal or forensic purposes.
✓ The most common specimen are breath and blood for alcohol.
✓ Others request urine for drug screening, blood specimen for drugs
and DNA analysis.
✓ For forensic specimen, there is a need to track the specimen from the
time of collection until the time that the results are released using a
special protocol called chain of custody.
✓ Important information about the collection of the specimen is
recorded in this form which includes type of specimen, the
phlebotomist who made the collection, the technician who processed
the specimen, details of the collection (time, date and place) and the
signature of specimen owner. The collection and packaging is done in
the presence of a witness which is usually a law enforcer and the
person responsible in collecting the specimen for legal reasons could
be summoned to appear before the court as witness.
Figure 8.4 Drug Testing Consent Form
Department of Health
Figure 8.5 Custody or Control Form
Department of Health
Blood Alcohol (Ethanol) Specimens
✓ Blood alcohol (ethanol [ETOH]) tests are usually ordered for
purposes related to treatment but could also be for industrial or job-
related purposes such as insurance claims or programs and
employee drug screening.
✓ The law enforcement department orders blood alcohol concentration
(BAC) for individuals involved in traffic related accidents.
✓ The ETOH test for treatment purposes do not require the chain of
custody to be accomplished but the results of such tests can become
evidence in court. However, BAC for industrial and legal samples
should follow the chain-of-custody protocol.
✓ The ETOH specimen collection uses aqueous povidone-iodine and
aqueous benzalkonium chloride (BZK).
✓ Avoid using isopropyl alcohol and tincture of iodine as antiseptic
because these might affect the results.
✓ Use gray-top sodium fluoride glass tubes for specimen collection.
These tubes could be with anticoagulant but it depends on the need
of the required specimen for a specific test.
✓ The tubes are filled until the vacuum is exhausted. The tube stopper
should remain in place at all times because alcohol could evaporate.
Drug Screening
✓ Companies, healthcare organizations and sports associations subject
their potential employee to drug screening as part of their pre-
employment requirement.
✓ The company or organization could also run a random screening
without prior notice.
✓ The specimen used is urine instead of blood. The chain of custody
protocol is strictly implemented since legal implications are involved.
Patient preparation requirements
1. The purpose and procedure should be explained to the patient.
2. The patient should be advised about his legal rights.
3. There should be a witness present when the form is signed.
Specimen collection requirements
1. A special area should be designated for the purpose of urine
collection.
2. During the collection, a proctor is present to ensure that the
specimen came from the correct person.
3. Split sample may be used for parallel testing.
4. Proper labeling should be followed to establish a chain of custody.
5. Protect the specimen from tampering. After collection it should be
sealed in a lock container and sent to the laboratory immediately.
Documentation should be handled carefully.
Trace Elements
✓ Trace elements tests for presence of aluminum, arsenic, copper, lead,
iron, and zinc.
✓ They are collected in small amounts and must use special element-
free tubes colored royal blue, since traces of these elements in the
glass, plastic or stopper could trickle into the specimen will affect the
accuracy of the result.
✓ The type of additive, if any, is indicated in the label. (red - no
additive, lavender - EDTA, and green-heparin). To avoid
contamination, change the transfer device before filing the tube.
PRINCIPLE OF THE DIFFERENT POINT-OF-CARE TESTING
(POCT)
✓ The Point-of-Care Testing (POCT) is any analytical test that is done
outside the centralized laboratory and near the site where the patient
receives treatment.
✓ POCT has been called by different names, such as alternate site
testing (AST), bedside, near-patient testing, remote testing, satellite
testing, and rapid diagnostics.
✓ The testing ranges from a simple procedure as a dipstick, glucometer
which is handheld, and up to automated molecular test using
analyzers and imaging systems that are portable. These tests are not
only convenient, but it also shortens the turnaround time (TAT).
Quality and Safety in POCT
✓ Quality Control (QC) and maintenance procedures should be followed
during the conduct of POCT to maintain the accuracy of the results.
✓ The processes should yield results that are no different if the test has
been performed in the centralized or main laboratory which poses a
challenge to the phlebotomist.
✓ However, waived test are becoming more prevalent and these test
does not need to be of the same level as non-waived test.
✓ For this reason, Quality Control procedures are in place for strict
compliance.
Quality and Safety in POCT
✓ In the effort to continuously improve the healthcare service provided
to the patients, manufacturers have enhanced their instruments to
include electronic Quality Controls (EQCs) which can detect specimen
related problems.
✓ Internal checks are also in place to check the functionality status of
the instrument. These enhancements have greatly helped ease the
regulatory requirements for POCT.
✓ For non-instrumented tests, daily external liquid QC checks make
sure that there is adherence to use of required techniques and the
generated results are accurate.
Quality and Safety in POCT

✓ Another challenge is that POC instruments, such a handheld

analyzers, may help in the transmission of infection in the facility.
✓ Several manufacturers recommended disinfecting the instrument using
10% bleach to reduce the risk of cross contamination between
patients.
Coagulation Monitoring by POCT
✓ Warfarin and heparin therapy can be evaluated using a Coagulation POCT
analyzer.
✓ The common coagulation tests checked are Prothrombin time (PT) &
international normalized ratio (INR), Activated partial thromboplastin time
(APTT or PTT), Activated clotting time (ACT), and Platelet function.
✓ Listed are the available POCT instruments available:
• Cascade POC —ACT, APTT, PT/INR
• CoaguChek XS Plus —PT/INR
• GEM Premier 4000 —ACT, APTT, PT/INR
• i-STAT —ACT, PT/INR
• Verify Now —platelet function
Bleeding Time
✓ Bleeding time (BT) test is a non-instrumented test ordered by the
physician to evaluate the capillaries for platelet plug formation which
is indicative of disorder in the platelet function or problems in
capillary integrity.
✓ This test is also used for pre-surgical screening and detection of
problems involving hemostasis. Although platelet function assays
(coagulation test) has been mostly ordered in place of BT, it is still
requested in some occasion.
✓ Execution of the proper technique is important to get an accurate
result.
The following steps in BT should be followed:
1. The patient should be identified properly. Proper hand hygiene should
be followed.
2. Ask the patient if he has taken aspirin or any salicylate-containing
drug within a period of the past two weeks because it can prolong
bleeding time which will influence the result. Inform the patient that
although the incision is small, scarring could still occur.
3. Place the arm on a steady surface for support.
4. The site should be in the volar lateral of the forearm and 5 cm distal
to the antecubital area. Shave the area when necessary and make
sure that the area does not have surface veins, scars, bruises or
edema.
5. A blood pressure cuff is placed around the arm.
6. Use alcohol to clean the selected area with alcohol. Allow the site to
air-dry.
5. A blood pressure cuff is placed around the arm.
6. Use alcohol to clean the selected area with alcohol. Allow the site to
air-dry.
7. The phlebotomist should put on gloves & prepare equipment to be
used while waiting for the site to dry.
8. Open the puncture device package and keep blade sterile.
9. The blood pressure cuff should be inflated to 40 mm Hg.
10.The safety clip must be removed quickly and positioned on the
forearm
11.The trigger should be depressed while simultaneously starting the
timer. The blade will then retract. Remove the device from the arm
and discard sharps properly.
12. A filter paper should be used to blot the blood flow for 30 seconds.
Wick the blood without touching the wound.
13. Stop the timer when bleeding stops and no longer stains the filter
paper. The test is stopped if bleeding persists beyond 15 minutes.
14. The blood pressure cuff is removed. Clean the arm and bandage the
arm. Advise the patient to keep the site dry and bandage should be
intact for the next 24 hours.
15. The bleeding time is recorded and rounded to the nearest 30
seconds. Normal results are between 2 to 8 minutes.
16. Follow proper disposal of used & contaminated supplies. Thank
patient before you leave.
Arterial Blood Gases and Electrolytes
✓ Many healthcare institutions have supported the use of POCT for
arterial blood gases (ABGs) and electrolytes in selected settings such
as the emergency department, pulmonary unit and neonatal
intensive care unit.
✓ It has been said that these panels of test are more expensive than
traditional pre-analytic and analytic procedures performed in a typical
laboratory.
✓ It has greatly improved the turnaround time for the of test for
patients in emergency situations which in turn reduces the time of
waiting for the physician's medical diagnosis and prescription.
Arterial Blood Gases
✓ The arterial blood gas (ABG) test measures the level of oxygen,
carbon dioxide and acid-base (pH) in the patient's blood which gives
the physician an idea about the status of the function of your lungs,
heart and kidneys.
✓ ABGs measured by POCT methods include potential hydrogen (pH),
partial pressure of carbon dioxide (PCO2), partial pressure of oxygen
(PO2), and oxygen saturation (SO2).
✓ pH refers to the concentration of hydrogen ions in a solution. The
arterial pH test checks the balance of the acid-base level which
shows the metabolic and respiratory status of the patient.
✓ Normal range is from 7.35 to 7.45 only.
✓ The PCO2 is an indicator on how well air is exchanged between the
blood and lungs. The test shows the measure of pressure exerted by
dissolved CO2 in the blood plasma in proportion to the PO2 in the
alveoli.
✓ Hypoventilation is when the PCO2 level increased to an abnormal
level while hyperventilation is when it decreases.
✓ PO2 is representative of the pressure exerted by the dissolved O2 and
the ability of the lungs to diffuse oxygen through the alveoli which is
usually used to measure the effectiveness of an oxygen therapy.
✓ SO2 is used to evaluate the oxygenation status of the patient. It
measures the percentage of the binding sites of the hemoglobin that
is occupied by oxygen in the blood. A normal person exhibits 98%
oxygen saturation.
Electrolytes
✓ The electrolytes in the body mainly aid in moving nutrients in the
body and removes wastes in the cells of the body.
✓ The POCT uses electrolyte panels to determine the blood level of
sodium (Na+), potassium (K+), chloride (Cl-), bicarbonate ion
(HCO3), and ionized calcium (iCa2+).
✓ Sodium helps keep the normal balance of fluids in the body and also
plays a role in transmitting nerve impulses. An elevated level of
sodium is called Hypernatremia while reduced level is known as
hyponatremia.
Electrolytes
✓ Potassium is an electrolyte that helps in nerve conduction and muscle
function. It also regulates the acid-base balance and keeps the blood
pressure in check. We call increased blood potassium hyperkalemia
while the decreased level is called hypokalemia.
✓ Chloride maintains the integrity of the cells by helping in keeping the
balance in osmotic pressure as well as the acid-base and water
balance of the body.
✓ Bicarbonate ion helps transport carbon dioxide to the lungs and it
also helps with the regulation of blood pH.
✓ The removal of CO2 from the lungs results in the reduction of H+ ion
and increase in blood pH.
✓ When there is a decrease in H+ ions and increase in blood pH or
hypoventilation, that patient might suffer from acidosis. When the
condition is reversed or there is hyperventilation, the condition could
lead to alkalosis. Ionized calcium comprise about 45% of the blood
calcium and they help in the muscular function, cardiac function,
blood clotting, and nerve transmission function of the body.
Electrolytes
✓ Bicarbonate ion helps transport carbon dioxide to the lungs and it
also helps with the regulation of blood pH.
✓ The removal of CO2 from the lungs results in the reduction of H+ ion
and increase in blood pH.
✓ Hypoventilation results in higher concentration of CO2 and the
development of more H+ ions and leads to acidosis.
✓ Hyperventilation reduces concentrations of CO2 and leads to
alkalosis.
✓ Ionized calcium comprise about 45% of the blood calcium and they
help in the muscular function, cardiac function, blood clotting, and
nerve transmission function of the body.
MULTIPLE- TEST PANEL MONITORING BY POCT
✓ Composed of small, portable testing devices that measure analytes
such as sodium, potassium, chloride, and bicarbonate ion as well as
blood gas values for potential hydrogen, partial pressure of carbon
dioxide, partial pressure of oxygen, oxygen saturation, BUN, glucose,
hemoglobin, hematocrit, ACT, lactate and troponin.
✓ These instruments play and important role in emergency conditions
because of the short turnaround of the test results.
✓ Some of the instruments include:
Name of the instruments Analytes/ Blood Gas Values that are Tested
GEM Premier Lactate, potassium, BUN and Creatinine
i-STAT BUN, glucose, Hbg, Hct, and ACT values
Avoximeter Thb, SO2, O2Ct, COHb, MetHb, %O2Hb
ABL80 Flex pH, PCO2, PO2, cNa, Cca2+, cCl-, cK+, Hct, cGlu
Other Tests PERFORMED BY POCT
✓ Pregnancy Testing
✓ Could be detected as early as 10 days from conception by
checking the presence of B-subunit of human chorionic
gonadotrophin (hCG) in the urine or serum. The steps are as
follows:
1. Implement the proper patient identification.
2. Write the patient ID information in the specimen cup.
3. Explain the collection procedure to the patient prior to the collection of
the urine specimen.
4. Place the test device on a flat surface after removing it from the safety
pouch.
5. Using the dropper supplied in the pouch, place about 3 drops in the
sample well.
6. Wait for the reaction time for about 3 minutes. Likewise, set the timer to
the time stated by the manufacturer when a negative test must be read.
7. Read the result from the cassette’s window when the timer goes off.
• Cardiac Troponin T (TnT) and Troponin I (TnI) guage the effectiveness
of the thrombolytic therapy being administered to the patients who
have suffered from heart attacks.
• Lipid Testing measures the alanine transferase (ALT) of patients under
lipid-lowering medication.
• B-Type Natriuretic Peptide (BNP) differentiates chronic obstructive
pulmonary disease (COPD) and congestive Heart failure (CHF).
• C-Reactive Protein (CRP)- detects and evaluates infection, tissue
injury, and other inflammation disorders.
• Glucose monitors glucose level of patients with diabetes mellitus.
• Glycosylated Hemoglobin is a diagnostic tool for diabetes therapy
monitoring.
• Hematocrit measures the volume of the red blood cells.
• Hemoglobin checks the hemoglobin level to manage patients suffering
from anemia.
• Lactate evaluates the severity of the lactic acid disorder and the stress
response of the patient.
• Occult Blood (Guaiac) detects gastrointestinal (GIT) bleeding.
• Pregnancy Test detects the presence of human chorionic gonadotropin
(hCG)
• Skin Test checks contact allergens and determines if the body has
developed antibodies. Skin tests could be tuberculin test (TB),
Aspergillus, coccidiomycosis (cocci), histoplasmosis (histo).
• Strep testing detects the presence of group A streptococci.
• Urinalysis involves physical, chemical, and microscopic analysis of the
urine specimen.