HemochronPPT英文.pptVIP

Point-Of-Care Coagulation Testing:What is it? Why do we do it?Where are we going? John A. Saavedra 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 patient’s 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? Why are there so many different ACTs? Monitoring Heparin