poct即时检验专题知识

,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Point-Of-Care Coagulation Testing:What is it?Why do we do it?Where are we going?,John A.Saavedra,International Sales Manager,International Technidyne Corporation(ITC),Edison,New Jersey,USA,What is Point of Care Testing?,According to CAP(College of American Pathologists):,testing performed at the bedside,not in fixed dedicated space,Performed by a large number of different non-laboratory healthcare personnel,Utilizes portable devices or simple reagent kits different from those used in the primary laboratory.,Why Test Coagulation?,Monitor anticoagulation therapy,Heparin and Warfarin are monitored,Both have,highly variable patient dose response,.,A therapeutic dose for patient A,Thrombotic dose for patient B,Hemorrhagic dose for patient C,Determine patients hemostatic status,Why Point-Of-Care Testing?,Prompt Turn Around Time,Improved Clinical Outcome,Reduced Length of Stay,Standardization,Improved,timely patient care,Benefit-Immediate Turn Around,When is Turn Around Important,Operating Room and Cath Lab,ICU/CCU Dose Adjustments,Emergency Room,Immediate Turn Around,Fitch,et.al,J.Clin Monit&Comput.1999.,15,:197-204,Reduced Turn Around Time,Post Surgical Patients,Reduced blood loss,Reduced transfusion requirements,Heparin Drip,Results Obtained Prior to Next Scheduled Test,Fewer,More Rapid Dosage Adjustments,Reduction in Length of Stay,Overall,cost reduction,POC Coagulation Testing Analyzers,HEMOCHRON Response,HEMOCHRON Jr.II/,Signature,ProTime,Medtronic HMS/HemoTec ACT II,Roche CoaguChek/CoaguChek Pro,Bayer RapidPoint,i-STAT,Others,Point of Care Coagulation Testing,Test Menu,ACT,-,multiple activators,Dosing Assays for Open Heart Surgery,Heparin and Protamine,APTT,-,fresh or citrated blood,PT,-,fresh or citrated blood,Fibrinogen,TT,-,thrombin time,Point-Of-Care Coagulation Testing,Clinical Applications,Operating Room,Cardiac Surgery,Interventional Cardiology and Radiology,Critical Care,Satellite Sites,Dialysis,ECMO,Emergency Room,Anticoagulation Clinic,What do we use an ACT for?,Maintain Balance,Bleeding,Thrombosis,Heparin,Rapid Anticoagulant Effect,Individual sensitivities vary significantly,Potency differences,Source:Bovine or Porcine,Lot to Lot variability,Rapidly Reversible with Protamine,Why are there so many different ACTs?,Monitoring Heparin with ACT,Benefits,Industry Standard Since 1970 Hemochron pioneered ACT testing in 1969,Recommended as primary method in AmSECT guidelines(perfusion),Easy to run,Inexpensive,Monitoring Heparin with ACT,Disadvantages,Each system yields somewhat different numbers,High sensitivity to hypothermia and hemodilution(with exceptions),Little correlation to heparin level in pediatric patients,Monitoring during Open Heart Surgery,Data from clinical evaluation,on file,ITC,Monitoring during Open Heart Surgery,Data from clinical evaluation,on file,ITC,Pharmaceutical Intervention,Amicar or Transexamic Acid,No effect on standard celite ACT,Continued debate on efficacy,Multiple reports of reduction in post-operative blood loss and reduced transfusion requirements,Pharmaceutical Intervention,Aprotinin,Significant elevation of celite ACT,Two dosing regimens,Full Hammersmith,2 x 10,6,KIU loading dose;2 x 10,6,KIU pump prime;0.5 x 10,6,KIU/hr infusion,Half Hammersmith,1 x 10,6,KIU loading dose;1 x 10,6,KIU pump prime;0.25 x 10,6,KIU/hr infusion,ACT Monitoring with Aprotinin Treatment,Celite ACT,Not recommended,Still used with target times of 750 seconds,Kaolin ACT,Unaffected by,moderate doses of aprotinin,Used with target times of 480 seconds,ACT+,Unaffected by ALL doses of aprotinin,Used with target times of 400 seconds,ACT Monitoring with Aprotinin Treatment,Data from clinical evaluation,on file,ITC,Other Point-Of-Care Coagulation Testing in the Operating Room,APTT&PT,Pre-and post-procedural screening,Fibrinogen,Pre-and post-procedural screening,Dosing Assays,Individualized heparin and protamine dose,HEMOCHRON HRT/PRT,Hepcon HMS,Managing Heparin and Protamine Dosing,Why is management important?,Traditional dosing regimens recommend fixed drug doses by body weight.For most patients,this regimen provides adequate anticoagulation.,Regimen does not account for patients whose response to heparin is different than the average patient.,Patients differ in their response to heparin;some patients may be resistant or sensitive to heparin,They can represent 20-40%of patient population,Managing Heparin and Protamine Dosing,Heparin Resistance:,Repeated exposure to heparin(from previous procedures)may reduce patients response to the drug,Patient requires a,higher,dose of heparin in order to obtain the same anticoagulant effect,Managing Heparin and Protamine Dosing,Heparin Sensitivity:,Patients response to heparin is greater th