Topic: blood gasses point of care devices
Pages: 3, Double spaced
Order type: Lab Report
Language: English (U.K.)
Health Sciences research continue to experience significant progress in terms of technology. Some of these technologies have made the diagnosis of different diseases faster and easier. Point of care test (POCT) devices have reduced the turnaround time for diagnosis and currently, results can be delivered in just a few minutes while providing accurate results (6). Thus stimulating medical interventions. POCT are those tests that are performed at the point where the patient is for example on bed. The tests do not require moving the patient to laboratory. Most of the test performed by POCT are routine tests. This laboratory report is aimed at comparing the point of care test (POCT) devices designed by different manufacturers for the diagnosis of blood gases electrolytes and metabolites. Blood gas tests are typically performed on patients who have been ventilated such as in the critical care unit, pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and intensive care unit. Most of the therapeutic interventions used in the treatment of some life-threatening conditions depend to a large extent on the knowledge of the parameters of blood (3) The partial pressure of gases are the relative pressure exerted by these gases when they exist as a mixture. Partial pressure is an important factor in the measurement of blood gases since most of the devices for the measurement of partial pressures estimate the amount of gas by detecting the pressure exerted by particular gasses. For instance, PO2, PCO2 and PHCO3 are detected by blood gas analyzers and in turn used to estimate the amount of each gas present in that sample (8).
Blood Gas Tests Summary
A blood gas is an important indicator of patient ventilation. It is also important in the treatment of emergency patients. Patients experiencing hypoxemia require to be supported with oxygen; it is, therefore, critical for doctors and nurses to perform blood gas analysis of such patients in order to understand if there is need to support the patient on gas (1). Pulse oximetry and capnometry are non-invasive efficient tools for blood gas analysis used to measure oxygen levels in the blood for critically ill patients. The properties of oximetry have been discussed below.
i. Type of gas tested: Oxygen and carbon dioxide
ii. Sample type: the sample type for this test is whole blood drown from patient vein and used to measure the amount of oxygen and carbon dioxide.
iii. Sample collection: collection of blood sample from patients involve using sterilized syringe and needle to draw venous blood.
iv. Size: the device is hand-held. The small size of the device makes it more convenient for use in emergency room.(2).
v. Accuracy: the device has very high accuracy with very high detection capacity that depends on fluorescence
vi. Price: the price of oximetry if affordable
vii. Time to get result: the device has very short turnaround time (10 minutes)
The analysis of different Blood Gas analysis test based on various factors has been provided in the linked excel file. The point of care testing devices has been compared based on various selection criteria such as manufacture and technology, precision, accuracy, price, time to get the results and size.
Oximeter device is developed by Japan-based companies. This device can use whole blood, plasma, or serum as samples for analysis. These sample forms are readily available at point of care. The sample volume for this device is 100 μL which can easily be attained. The device also has a shorter turnaround time for the results to be displayed (10 minutes) (3). This device is Portable and can easily be moved from place to place making it highly adaptable for use in emergency room. The system used by this device has opened up opportunities for emergency care before hospitalization of a patient.
i-STAT, on the other hand, is manufactured by USA based company. This device requires whole blood sample which is readily available at the point of care (4). Sample required by ABL 800 Flex requires the highest amount of sample which is 250μl while Nova Star sensor requires the least amount, 1.2μl (5). Capnometer is manufactured by a USA based company. This device employs the side stream technology to analyze samples. The device requires whole blood samples making it easier to use in terms of obtaining samples. It is also FDA approved. The detection technique for the device is fluorescence which is more accurate and reduces the incidence of false negative and false positive (6). Considering the principle of operation, Triage cardiac panel employs chromatography, i-STAT uses ELISA, Oximeter uses absorbance while Capnometer uses sidestream technology. (7). The justification excel table that critically compares devices against selection criteria has been embedded in the link below: Justification table.xlsx
All the devices compared in this report use whole blood sample for analysis of Blood Gas apart from i-STAT which uses blood sample without string in heparin. The storage of samples in tubes containing either heparin or EDTA helps to prevent coagulation of the blood sample. On the other hand, the operation principle for the devices differ significantly. For example, Triage cardiac panel uses chromatography, i-STAT uses ELISA, Oximeter uses absorbance while Capnometer uses sidestream technology. Based on the comparisons of different blood gas analyzers, i-STAT is the best device for running point of care tests for Blood gases. The selection of this device is based on factors such as its small size. The device is hand-held; small in size. The accuracy level of the device is also high as it uses high detection level ALP technique. The device is affordable in terms of price. Additionally, the device has a short turn-around time of 10 minutes. Considering these criteria, these i-STAT has been selected as the best device (5). We therefore recommend the use of i-STAT as the best device for blood gas analysis at the point of care.
1. Prause G, Ratzenhofer-Komenda B, Offner A, Lauda P, Voit H, Pojer H. Prehospital point of care testing of blood gases and electrolytes—an evaluation of IRMA. Critical Care. 1997;1(2):79.
2. Qureshi A, Gurbuz Y, Niazi JH. Biosensors for cardiac biomarkers detection: A review. Sensors and Actuators B: Chemical. 2012;171:62-76.
3. Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Medical Devices (Auckland, NZ). 2014;7:231.
4. Vashist SK, Luppa PB, Yeo LY, Ozcan A, Luong JH. Emerging technologies for next-generation point-of-care testing. Trends in biotechnology. 2015;33(11):692-705.
5. Pollock NR, Rolland JP, Kumar S, Beattie PD, Jain S, Noubary F, et al. A paper-based multiplexed transaminase test for low-cost, point-of-care liver function testing. Science translational medicine. 2012;4(152):152ra29-ra29.
6. Skurup A, Kristensen T, Wennecke G. New creatinine sensor for point-of-care testing of creatinine meets the National Kidney Disease Education Program guidelines. Clinical chemistry and laboratory medicine. 2008;46(1):3-8.
7. Chan CPY, Mak WC, Cheung KY, Sin KK, Yu CM, Rainer TH, et al. Evidence-based point-of-care diagnostics: current status and emerging technologies. Annual review of analytical chemistry. 2013;6:191-211.
8. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Archives of surgery. 1991 Aug 1;126(8):997-1001.
With significant advancement in health science related research, a number of technological devices are being developed, which have the health care diagnosis easier and faster. Point of care devices are becoming very useful in rapid diagnosis, as the tests are done in easy processes within very short time and the devices gives accurate results, thereby stimulating the medical interventions (5). In this assignment, the focus is to compare the point of care devices (PCOT) developed for easy diagnosis of creatinine and troponin.
Creatinine is a pivotal biomarker and it has a very important contribution in the diagnosis of kidney disease, because, due to malfunctioning of kidney, the filtration is impaired and the level of creatinine in blood increases (4). In this assignment, four point of care devices have been compared, these are i-STAT, ABL 800 Flex, Reflotron and Nova Starsensor.
i-STAT and Nova Starsensor, both are developed by USA based companies and requires whole blood as a sample, which is more available. However, ABL 800 Flex and Reflotron include whole blood, plasma or serum as sample (9). Therefore, the last two devices are more diverse, considering the sample type. In case of sample volume, ABL 800 Flex requires the highest amount, 250μl and Nova Starsensor requires the least amount, 1.2μl (6). Nova Starsensor also shows the best characteristics, based on time of sample analysis; it requires only 30 seconds showing the result. All the devices have approval from FDA. Two USA based devices are lightweight, compared to other two devices. All the devices follow enzymatic method of sample measurement. The range of detection is higher in ABL 800 Flex (10-2000 µmol/L). Except Reflotron, all three devices use Amperometric biosensor, as a method of principle; it has high sensitivity compared to Dye Reflectance. Nova Starsensor has the least weight within these four (400 gram), making it the best choice for the patient to carry the device anywhere (8). Therefore, based on the above criteria, usability and availability of sample, the Nova Starsensor is recommended as the best point of care device for creatinine test.
Troponin is a significant biomarker, which helps in diagnosis of heart attack, because, during myocardial infarction, the damaged heart muscle induces the release of this biomarker in blood, thereby elevating its level in blood. As heart attack needs immediate diagnosis, several point of care devices are used for easy and faster diagnosis, within which four devices, Triage Cardiac Panel Troponin I, i-STAT cardiac troponin I, PATHFAST troponin I and RAMP troponin I has been compared in this assignment (1).
Within the above four devices, all devices required whole blood sample, but instead of i-STAT cardiac troponin I, other devices requires heparinized or EDTA whole blood, therefore, the sample cannot be tested directly, through these devices, however, a patient undergoing a heart attack needs immediate diagnosis, thus, i-STAT cardiac troponin I would be a good choice (7). On the other hand, compared to the Triage cardiac panel troponin I, other three devices can be used in room temperature. However, the i-STAT device has the lowest weight and required the lowest volume of sample (16 μL), compared to the other three devices. The analysis time is also minimum for this device (10 minutes), within these four devices; thus, it is more user-friendly, compared to others (2). In Triage cardiac panel troponin I and RAMP troponin I, chromatography is used as the principle of method, whereas, i-STAT uses ELISA and PATHFAST troponin I uses magnetic beads. ELISA is the most relevant, hazard free and fast technique within the above three principles. Thus, based on the above comparison, i-STAT cardiac troponin I is recommended as the best point of care device for troponin test (3).
1. Bingisser R, Cairns C, Christ M, Hausfater P, Lindahl B, Mair J, Panteghini M, Price C, Venge P. Cardiac troponin: a critical review of the case for point-of-care testing in the ED. The American journal of emergency medicine. 2012 Oct 31;30(8):1639-49.
2. Chan CP, Mak WC, Cheung KY, Sin KK, Yu CM, Rainer TH, Renneberg R. Evidence-based point-of-care diagnostics: current status and emerging technologies. Annual review of analytical chemistry. 2013 Jun 12;6:191-211.
3. Diercks DB, Peacock WF, Hollander JE, Singer AJ, Birkhahn R, Shapiro N, Glynn T, Nowack R, Safdar B, Miller CD, Lewandrowski E. Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. American heart journal. 2012 Jan 31;163(1):74-80.
4. Lee-Lewandrowski E, Chang C, Gregory K, Lewandrowski K. Evaluation of rapid point-of-care creatinine testing in the radiology service of a large academic medical center: impact on clinical operations and patient disposition. Clinica Chimica Acta. 2012 Jan 18;413(1):88-92.
5. Pecoraro V, Germagnoli L, Banfi G. Point-of-care testing: where is the evidence? A systematic survey. Clinical chemistry and laboratory medicine. 2014 Mar 1;52(3):313-24.
6. Pollock NR, Rolland JP, Kumar S, Beattie PD, Jain S, Noubary F, Wong VL, Pohlmann RA, Ryan US, Whitesides GM. A paper-based multiplexed transaminase test for low-cost, point-of-care liver function testing. Science translational medicine. 2012 Sep 19;4(152):152ra129-.
7. Qureshi A, Gurbuz Y, Niazi JH. Biosensors for cardiac biomarkers detection: A review. Sensors and Actuators B: Chemical. 2012 Sep 30;171:62-76.
8. Skurup A, Kristensen T, Wennecke G. New creatinine sensor for point-of-care testing of creatinine meets the National Kidney Disease Education Program guidelines. Clinical chemistry and laboratory medicine. 2008 Jan 1;46(1):3-8.
9. Vashist SK, Luppa PB, Yeo LY, Ozcan A, Luong JH. Emerging technologies for next-generation point-of-care testing. Trends in biotechnology. 2015 Nov 30;33(11):692-705.
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