automation and poct

7/31/2019 Automation and POCT

1/27

PRINCIPLES OF CLINICAL

CHEMISTRY AUTOMATION


2/27

AUTOMATION IN CLINICAL

CHEMISTRY

The modern clinical chemistrylaboratory uses a high degree ofautomation.

Many steps in the analytic process thatwere previously performed manuallycan now be performed automatically.

This Permits the operator to focus ontasks that cannot be readilyautomated and increasing bothefficiency and capacity.


3/27

AUTOMATION IN CLINICAL

CHEMISTRY

The analytic process can be divided intothree major phases preanalytic,analytic, and postanalyticcorresponding

to sample processing, chemical analysis,and data management, respectively.

Substantial improvements have occurredin all three areas during the past decade.

The analytic phase is the mostautomated, and more research anddevelopment efforts are focusing onincreasing automation of the preanalytic

and postanalytic processes.


4/27

WHY AUTOMATION?

Increase the number of tests by oneperson in a given period of time

Minimize the variations in results from

one person to anotherMinimize errors found in manual

analyses equipment variations pipettes

Use less sample and reagent for eachtest


5/27

TYPES OF ANALYZERS

Continuous FlowTubing flow of reagents and patients

samples

Centrifugal AnalyzersCentrifuge force to mix sample and

reagents

DiscreteSeparate testing cuvets for each test and

sample

Random and/or irregular access


6/27

CONTINUOUS FLOW

This first AutoAnalyzer (AA) was acontinuous-flow, single-channel,sequential batch analyzer capable of

providing a single test result onapproximately 40 samples per hour.

Analyzers with multiple channels (fordifferent tests), working synchronously

to produce 6 or 12 test resultssimultaneously at the rate of 360 or720 tests per hour.


7/27

In continuous flow analyzers,samples were aspirated into tubing

to introduce samples into a sample

holder,bring in reagent,

create a chemical reaction,

and then pump the chromagensolution into a flow-through cuvettefor spectrophotometric analysis.

CONTINUOUS FLOW


8/27

CONTINUOUS FLOW

The major drawbacks that contributed to theeventual demise of traditional continuous-flowanalyzers in the marketplace were significant

carry-over problems and wasteful use ofcontinuousl flowin rea ents.


9/27

CONTINUOUS FLOW

Continuous flow is also used in somespectrophotometric instruments inwhich the chemical reaction occurs in

one reaction channel and then isrinsed out and reused for the nextsample, which may be an entirelydifferent chemical reaction.

CENTRIFUGAL


10/27

CENTRIFUGAL

ANALYZERS

Discrete aliquots of specimens and reagentsare piptted into discrete chambers in a rotor

The specimens are subsequently analyzed inparallel by spinning the rotor and using theresultant centrifugal force to simultaneouslytransfer and mix aliquots of specimens andreagents into radially located cuvets.

The rotary motion is then used to move the

cuvets through the optical path of an opticalsystem


11/27

DISCRETE ANALYZERS

Discrete analysis is the separation ofeach sample and accompanyingreagents in a separate container.

Discrete analyzers have the capabilityof running multiple tests on onesample at a time or multiple samplesone test at a time.

They are the most popular andversatile analyzers and have almostcompletely replaced continuous-flow

and centrifugal analyzers.


12/27

DISCRETE ANALYZERS

Sample reactions are kept discretethrough the use of separate reactioncuvettes, cells, slides, or wells that are

disposed of following chemicalanalysis.

This keeps sample and reactioncarryover to a minimum but increases

the cost per test due to disposableproducts.


13/27


14/27

HITACHI 902 ANALYZER


15/27

WITH AUTOMATION THERE IS

STILL SOME VERY BASIC STEPS

Specimen preparation and IdentificationLabeling still critical

Programming of instrument

Laboratory personnel must perform andobserve:

Quality AssuranceQuality Control


16/27

TOTAL LABORATORY AUTOMATION


17/27


18/27

SELECTION PROCESS

What is your labs workload like?Discrete or large batch testing?

Single instrument or multiples?

Storage of reagentsNeed refrigeration or freezing?

expense

Kept at room temperature untilreconstituted


19/27

http://www.youtube.com/watch?v=iqSpmwiNTHo

http://www.youtube.com/watch?v=FyLOTBicYbk
http://www.youtube.com/watch?v=iqSpmwiNTHohttp://www.youtube.com/watch?v=FyLOTBicYbkhttp://www.youtube.com/watch?v=FyLOTBicYbkhttp://www.youtube.com/watch?v=iqSpmwiNTHo


20/27

POINT OF CARE

TESTING


21/27

DEFINITION

Point-of-care testing (POCT) has beendefined by the College of AmericanPathologists (CAP) as those analytical

patient-testing activities providedwithin the institution, but performedoutside the physical facilities of theclinical laboratories.


22/27


23/27

PLACE OF ANALYSIS

Physicians offices

Operating rooms

Emergency rooms

Intensive Care Units Home health care

Patient performed


24/27

PERSONNEL ISSUES

Most often performed by non-laboratorians

Physicians

Nurses or nurses aides

Respiratory technicians Not specifically trained in the requirements for

accurate testing and interpretation


25/27

LABORATORY SUPPORT

Laboratory still responsible forresults

Therefore responsible for trainingand management of POCTprograms

Laboratory must build a structure

to support and facilitate POCT


26/27

SUPPORT STAFF

Director - PhD, MD or laboratoryscientist or pathologist

POC Coordinator laboratory scientist

with high level technical &interpersonal skills

POC Trainers designated person(s)for problem solving etc.


27/27

COMMON APPLICATIONS

Glucose Testing

Chemistries

Electrolytes

Blood gases Hematology

Coagulation ACT

Hematocrit

automation and poct

Documents