Preface

Manual of POCT
(Point of Care Testing) Point of care testing involves the performance of a test in the
immediate vicinity to a patient to provide a rapid result outside
the conventional laboratory environment. Recent advances in
diagnostic technology and the delivery of healthcare services has
resulted in an increase in the demand for and provision of point
of care testing (POCT) in Primary and Community Care
environments. GP surgeries, community pharmacies, community
clinics, health centres, industrial medical centres and
anticoagulation clinics all represent Primary and Community Care
locations. POCT is not a replacement for conventional laboratory
testing but rather a supplement to it. POC test results which are
used for diagnosis or critical patient management decisions, or
DGD. Dharma Santhi
which give unexpected results should be confirmed by hospital
CLINICAL PATHOLOGY DEPARTMENT
FACULTY OF MEDICINE, UDAYANA UNIVERSITY 2016 laboratories to ensure accurate diagnosis and to facilitate correct
patient management decisions

Writter

DGD. Dharma Santhi

 Contents Introduction
There is a need for establishing an evidence-based practice for
Introduction POCT. POCT is an increasingly popular means of delivering
Where it all began ………………………………………. 1 laboratory testing. When used appropriately, POCT can
Definition of POCT ………………………………………. 2 improve patient outcome by providing a faster result and a
Terms of POCT ………………………………………. 3 shorter timeframe to therapeutic intervention. However, when
Classification of POCT ………………………………………. 4 overused or incorrectly performed, POCT presents a patient
The advantages of POCT ………………………………………. 5 risk. POCT may seem deceptively simple, but the test is not
Limitations of POCT ………………………………………. 6
freely interchangeable with traditional core laboratory
Devices available today ………………………………………. 7
instrumentation in all patient-care situations. POCT may seem
Common Locations of POCT ………………………………………. 8
Guidance for selection ………………………………………. 9
inexpensive, but overuse and inappropriate test use leads to
POCT: Blood Glucose ………………………………………. 10 significant increases in cost of care. The value of POCT really
Reference ………………………………………. 33 needs to be demonstrated through well-designed randomized
controlled trials.
Where it all began? An Early Definition of POCT…

 Tests done by non-laboratory staff outside a

recognized diagnostic laboratory

 “…testing that is performed near or at the site of the

patient with the result leading to possible change in the
care of the patient.”

 “… any analytical test performed for a patient by a

healthcare professional outside the conventional
laboratory.”

 A diagnostic test when the result is required within 5 –

10 minutes of specimen collection and appropriate
immediate medical decision is required based on the
result.

“Historically, laboratory testing has been performed in a

central laboratory by laboratorians…. POCT is performed close
to or at the patient's location‐and often by nonlaboratorians.
This is clearly a different model from the historic central
laboratory.”
Terms of POCT Classification of POCT
The Advantages of POCT Limitations of POCT
Devices Available Today Common Locations of Point of Care Testing Devices

 Blood gases and electrolytes analyzers  ntensive/critical care units

 Coagulation
 Operating rooms,
 Blood Chemistries, ex. Glucose, cholesterol, uric acid
Med/Surg units
 Drug abuse
 Pregnancy screening  Emergency departments

 Cardiac markers
 Ambulances, first
 Hemoglobin and Hematocrit responders

 Home care (field

personnel)

 Homes (increasing)
Guidance For POCT Selection Point of Care: Blood Glucose

 High accuracy and precision Glucose became one of the

 Limit of detection clear most frequently measured
 Operation is easy and practical analytes in clinical units,
 Availability of technicians primary care and by patients
 Parts are easy to obtain for monitoring at home,
 Having facilities for after-sales service made possible through the
 If possible, POCT is not dependent on the reagent of the availability of systems based
type/ brand specific (open method) on dry-reagent test strips
with visually read end-points
and/or simple-to-use
reflectance meters and
biosensors.
Point of Care: Blood Glucose
What is Glucose?
 a simple sugar essential for cell respiration
 Also used as a source of energy in cells through aerobic
and anaerobic respiration
 Glucose plays important role in various metabolic
function in the body
So glucose level must be maintained periodically
Point of Care: Blood Glucose
Blood Glucose Monitoring
What is it?
 Blood Glucose Monitoring is a way of checking the
concentration of glucose in the blood using a glucometer.
What is the purpose?
 Provides quick response to tell if the sugar is high or low
indicating a change in diet, exercise or insulin.
Over time, it reveals individual of blood glucose changes
Why monitor blood glucose?
 Reduces risk of developing complications with
diabetes.
 Allows diabetics to see if the insulin and other
medications they are taking are working.
 Gives diabetics an idea as to how exercise and food
affect their blood sugar.
May prevent hypoglycemia or hyperglycemia
Point of Care: Blood Glucose Point of Care: Blood Glucose

When to check blood glucose? Glucose in the Blood

 Before meals
assess basal glucose level, particulary in high level
HbA1c
 2 hours after meals
assess peak of glucose level
 Before bed
assess risk of hypoglycemia

* Konsensus Perkeni 2011

** ADA 2013
Point of Care: Blood Glucose Point of Care: Blood Glucose

Glucometer Working principle of glucose meter

 A glucose meter or glucometer, is a medical device used
for measuring the approximate level of glucose in the
blood.
 New models are able to read and calculate the blood
sugar within seconds.
 Some models not only display the glucose reading but
also say it.
Glucose meters are based on electrochemical technology, they
use electrochemical test strips to perform the measurement.
A small drop of the solution to be tested, is placed on a
disposable test strip, that the glucose meter uses for the
glucose measurement.
Methods used in electrochemical measurement of glucose

The two most common methods, used in

electrochemical measurement of glucose are:
 Colorimetric method
 Amperometric method
Point of Care: Blood Glucose
Colorimetric method
 In this method, the typical sensors such as LEDs or photo
sensors form the analog interface. These sensors are
followed by a Transimpedance Amplifier (TIA) for the
glucose concentration measurement in the solution.
 The Colour Reflectance principle is used in this method
to sense the colour intensity in the reaction layer of
the teststrip by the photometry.
 The glucose meter generates a numerical value, that is
a measurement of the glucose concentration present in
the solution.
Point of Care: Blood Glucose
Amperometric method
 In this method, the electrochemical test strip contains a
capillary that is used to draw in the solution placed at one
end of the test strip. The test strip also contains an
enzyme electrode containing a reagent such as Glucose
Oxidase.
 Glucose undergoes a chemical reaction in the presence of
enzymes and electrons produced during the chemical
reaction.
 Glucose Oxidase reacts with the glucose, creates an acid
called Gluconic Acid. The gluconic acid then reacts, with
another chemical (electrons) in the testing strip called
Ferricyanide. The ferricyanide and the gluconic acid, then
combine to create Ferrocyanide.
 These electrons (i.e., the charge passing through the
electrode) are measured and this is proportional to the
concentration of glucose in the solution
Point of Care: Blood Glucose Point of Care: Blood Glucose

How to use glucometer?

Getting Ready
1. Wash your hands with warm water and soap for at least
15 seconds then rinse and towel dry.
2. Get your supplies:
 Your meter
 Test strips
 Lancing device
 Needle, often called a lancet
3. Open the lancing device and put a needle in. Take the
cap off the needle. Do not touch the needle.
4. Put the cover back on the device. Set the spring on the
device so it is ready to be used to stick you.
5. Get a test strip out of the bottle or package. Put the cap
back on the bottle.
6. Put the strip in the meter. This will turn the meter on
7. Match the code on your meter screen with the code for
your test strips.
 The code is printed on the test strip bottle or
package.
  If your meter has the code built into the strips, go to Point of Care: Blood Glucose
the next step.
8. When the test strip symbol flashes on the screen, the
meter is ready for a drop of blood

Checking Your Blood Sugar

1. Pick up the lancing device and put it against the side of
one of your fingers.
2. Push the button on the device to release the needle. You
will feel the needle stick. Set the device down.
3. Squeeze your finger at its base to get a large drop of
blood.
4. Based on the type of test strip you use:
 Touch the end of the test strip to the drop of blood.
 Put the blood drop on the test area of the strip.
5. Be sure that the test area on the strip fills completely
with blood.
6. The meter will time the test and then your blood sugar
number will show on the screen.
7. Write your blood sugar number in your log book or
blood sugar diary.
Point of Care: Blood Glucose Point of Care: Blood Glucose

Cleaning Up the Supplies

1. Remove the test strip and throw it away in your trash.
2. Remove the needle from the device. Throw the needle
into a puncture proof container with a lid such as an old
bleach or detergent bottle.
3. Put your supplies away. Store the needle container
away from children and pets.
4. Wash your hands again with water and soap
Point of Care: Blood Glucose Point of Care: Blood Glucose

Quality Control when? Monitoring Errors Can result from:

 New meter  Improper calibration of glucometer

 New test strips  Lack of glucometer maintenance and cleaning

 Battery failure
 Change of Batteries

 Test strip failure (ex. out of date strips, contaminated

 Test strips left open strips)

 Meter dropped/damaged  Codes on strip container and glucometer don’t match

 Unexpected result  Hands not clean

 Temperature of equipment
Point of Care: Blood Glucose REFERENCES
"Diabetes and Blood Sugar Testing." WebMD Diabetes Center:
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"Blood Glucose Monitoring | The Importance of Self-
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