Laboratory point-of-care monitoring in the operating room

Rhee, Amanda J.; Kahn, Ronald A.

doi:10.1097/aco.0b013e32834015bd

Cited by 20 publications

(19 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Point-of-care testing has been shown to decrease the turnaround time of such tests, which can potentially improve patient care and decrease costs (Kost, 1995). There are a few good reviews for POC testing in the operating room (Rhee and Kahn, 2010, Salem et al, 1991). Here we briefly describe the use of diagnostic tests for coagulation monitoring and hemoglobin monitoring in the perioperative setting.…”

Section: Operating Roommentioning

confidence: 99%

Point-of-care diagnostics for niche applications

Cummins

Ligler

Walker

2016

Biotechnology Advances

View full text Add to dashboard Cite

Point-of-care or point-of-use diagnostics are analytical devices that provide clinically relevant information without the need for a core clinical laboratory. In this review we define point-of-care diagnostics as portable versions of assays performed in a traditional clinical chemistry laboratory. This review discusses five areas relevant to human and animal health where increased attention could produce significant impact: veterinary medicine, space travel, sports medicine, emergency medicine, and operating room efficiency. For each of these areas, clinical need, available commercial products, and ongoing research into new devices are highlighted.

show abstract

Section: Operating Roommentioning

confidence: 99%

Point-of-care diagnostics for niche applications

Cummins

Ligler

Walker

2016

Biotechnology Advances

View full text Add to dashboard Cite

show abstract

“…The major challenges are cost reduction combined with continued improvement of accuracy and precision. Less often considered, but equally important, challenges include the need to improve data management, quality control, and training of laboratory personnel 41 . Finally, POCT will be a valuable adjunct for the evaluation 42,43 and implementation of emerging pharmacologic alternatives 44,45 to allogeneic blood in the field of patient blood management.…”

Section: Resultsmentioning

confidence: 99%

Use of point‐of‐care testing for plasma therapy

Goodnough

Hill

2012

Transfusion

View full text Add to dashboard Cite

Use of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a tool for decisions for transfusions of blood components. Clinical settings such as liver transplantation, cardiothoracic surgery, and trauma are particularly in need of such diagnostic tests because of the complex coagulopathies that can develop in these settings of substantial hemorrhage and need for blood component support. Successful implementation of POCT requires collaboration between surgery, anesthesia, critical care, and the laboratory to ensure proper quality control of equipment, operator training and competency, medical records test results, billing procedures, and consensus-derived transfusion algorithms for cost-effective, targeted blood component transfusion support. In this review we summarize clinical evidence for the effectiveness of POCT, along with some future directions for this strategy.U se of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a decision-guiding tool for blood component therapy, particularly in patients with substantial hemorrhage or complex coagulopathy. Thromboelastography (TEG) was first developed in 1948 and is a global assay of coagulation that uses whole blood to produce a tracing that records kinetic changes in clot formation. This tracing allows the rapid assessment of coagulation and fibrinolysis that is dependent on the interaction of the coagulation factors, platelets (PLTs), and fibrinogen.1 It has been tested and is now widely used in various clinical scenarios such as cardiac surgery, 2 hepatic transplantation, 3 and major trauma (with concomitant massive transfusion therapy) 4 to monitor and guide blood component therapy. Newer POCT technologies have also become available that provide rapid hemostasis results with whole blood. The accuracy and reliability of the POCT for prothrombin time (PT), activated partial thromboplastin time (aPTT), and PLT assays have been demonstrated. 5,6 POCT systems are being developed to impact use of blood component therapy utilizing two variables: timely availability of assay results and their link to algorithms for result-based use of blood component therapy. 2,7,8 This review will summarize the use of these strategies as currently applied, along with potential future applications. COAGULOPATHY IN SURGICAL SETTINGSThe complex coagulopathy in patients undergoing liver transplant, along with the role of point-of-care monitoring in this setting, have been well established 3 and will therefore not be discussed further in this review. Cardiopulmonary bypassExposure of blood to an extracorporeal circuit results in abnormalities of the hemostatic system, which can lead to excessive bleeding; 9 the type of cardiac procedure and the duration of cardiopulmonary bypass (CPB) influence the risk for development of coagulopathic bleeding, 10 and the volumes of cardiac surgery procedures along with substantial number of blood components transfused in these patients, have made this clinical setting an impo...

show abstract

“…Point-of-care testing devices were first used in the operating room in the 1980s. 2 Though they are increasingly common, arguments against their routine use are continually raised because of concerns about inaccuracy, 19 increased cost, 19 and the possible increase in the frequency of unnecessary testing. 19,20 Nevertheless, POCT technology has been refined such that the results of most near-patient tests have been found to be acceptable approximations of their central laboratory equivalents-particularly when frontline staff are sufficiently trained.…”

Section: Discussionmentioning

confidence: 99%

“…Given this, POCT is of particular relevance to the anesthesiologist and is rapidly becoming a standard of care. 2,3 Nevertheless, because of its cost and the lack of evidence supporting advantages over central laboratory testing, POCT is not available in all perioperative environments.…”

Section: Introductionmentioning

confidence: 99%

Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system

Spence

Troncone

Long

et al. 2017

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Intraoperative testing is common and more likely in patients undergoing high-risk surgical procedures. In a central laboratory system, there is substantial time from ordering the tests to receiving the results. The clinical impact of this delay is unknown. Further evaluation is required regarding the relationship between the time required for intraoperative test results and perioperative outcomes.

show abstract

Laboratory point-of-care monitoring in the operating room

Cited by 20 publications

References 65 publications

Point-of-care diagnostics for niche applications

Point-of-care diagnostics for niche applications

Use of point‐of‐care testing for plasma therapy

Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system

Contact Info

Product

Resources

About