HemoCue Hb 201 Training Session

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HemoCue Hb 201 Training Session
Emma James POCT CoordinatorCentral Site
February 2007Last update Dec 2007
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Point of Care Testing

• POCT is
• Laboratory testing performed in the clinical
  setting by non-laboratory healthcare
  professionals
• Subject to the same level of professional and
  judicial scrutiny as conventional lab testing
• Advantages of POCT
• Fast turnaround time for results
• Improved patient management
• Disadvantages of POCT
• Increased risk of adverse incidents and
  litigation
• 10 significant incidents on Central in 2006 3
  reported to MHRA
• Trust and Operator liable
• Reports from POCTc elsewhere in UK
• unregistered HemoCue in use - optics faulty and
  results 4mg/dL out

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The MHRA

• Only staff whose training and competence has
  been established and recorded should be permitted
  to carry out POCT
• Training should include
• Basic principles of testing
• Demonstration of proper use of system
• Consequences of improper use
• Instruction in sample collection
• Instruction in the importance of complete
  documentation of all results
• Appropriate calibration and QC testing
• Practical experience to satisfy instructor that
  trainee is competent
• Student staff grades are not permitted to perform
  testing independently, whether in the laboratory
  or POCT setting

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So what can go wrong? - and how the risk is
reduced

• Something wrong with the equipment
• Daily check and documentation
• Operator technique
• Training
• Proficiency Testing
• Sample unsuitable for testing on device
• Poor sampling
• Limitations of device
• The POCT Operator takes responsibility for all of
  these.
• Make sure you follow the Standard Operating
  Procedure it is there to protect the patient
  and you!

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Test cuvettes

• Very sensitive to moisture in atmosphere
• Risk of erroneous results
• Now using individually wrapped
• NB these cuvettes are chemically different from
  the old ones
• do not use any old stock
• can distinguish between old and new - no longer
  have wings

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Daily Start-up

• Purpose
• Checks the lamp and light path are working
• When
• Every day before the device is used for patient
  testing
• Meter dropped etc
• How
• Switch meter on
• All the LEDs on the display will light up
• Then the number 101 will appear then Hb
• Pull out cuvette holder
• Data and time displayed at top of screen and hour
  glass symbol at right hand side as self-test
  proceeds
• Once successfully completed Hb replaced by
  three flashing lines appear on the screen and
  cuvette icon appears at top left

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Daily Quality Control Check

• Purpose
• To check and document the meter and cuvettes are
  giving accurate readings
• When
• 2 levels (low and normal) every day before the
  device is used for patient testing
• New batch of cuvettes
• Unexpected patient result
• Meter dropped etc
• Practical Notes
• Quality Control expires 1 month after opening
• Replace shelf life expiry date with new expiry
  date when opening
• Store UNOPENED bottles in fridge and in use
  bottles at room temperature

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Filling the Cuvette with QC

• Drop of QC onto plastic surface (eg Record Book
  cover) and draw into cuvette by capillary action
• Clean any excess from outside cuvette using swab
• Inspect optical eye for smears and bubbles

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Processing the QC test

• If cuvette is underfilled do not refill
• Wait 1 minute for QC to react with chemicals in
  cuvette
• (no wait time with patient samples)
• Load cuvette into meter and rotate the holder
  shut
• Result displayed after approx 15s

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Documenting QC Result

• Quality Control and Patient Record Book
• Required to provide evidence of
• meter checks
• QC results
• Complete audit trail of patient results
• legal document archived for 30 years
• Meter displays result in g/L, record in book in
  g/dL
• Cuvette lot no and expiry date printed on
  individual wrappers
• yyyy-mm-dd format
• Review result check it falls within the
  acceptable range printed on the side of the
  bottle. If not
• repeat test
• check date on QC
• try cleaning optics
• If these actions fail, do not attempt to use
  meter for patient testing, document problem in
  record book and contact 4891

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The puncture site patients gt1year

• Health care professional
• Wash and dry hands and put on gloves
• Patient
• Ensure hands are socially clean
• If hands are cold ask patient to rub hands
  together
• Puncture site
• One of three outer fingers
• Avoid finger pad and nail bed
• Wash with water gauze swab (not alcohol)
• Wipe dry and ensure completely dry before
  proceeding

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Safe-T-Pro Plus in detail
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Using the lancet Step 1 remove the sterility
cap

• Hold the device and twist off the sterility cap
  by twisting it either in direction.
• Throw the sterility cap away
• Select the depth setting
• Depth adjuster is preset to medium

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Using the lancet Step 3 selecting the depth

• Shallow setting 1.3mm
• 1 on Softclix pen 1.1mm
• Most patients for blood glucose
• Medium setting 1.8mm
• 2 on Softclix pen 1.8mm
• Patients with thick skin
• Deep setting 2.3mm
• 3 on Softclix pen 2.3
• Other POCT devices e.g. coag, Hb
• Never use deep on children
• lt 1year

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Using the lancet Step 3 perform the
finger-stick

• Hold the lancet firmly against the side of finger
• Press the purple button to fire the needle
• Wait a few seconds for the puncture site to open
• wipe away the first 3 drops as this will
  contain tissue fluid
• If necessary, milk the finger starting at the
  base working towards the top

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Capillary sampling

• Collect second drop of blood into cuvette
• Discard the used lancet in a Sharps Bin

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Arterial venous samples

• Use solid form anticoagulants eg EDTA/heparin
  sample tubes
• Ensure art lines etc have been flushed to avoid
  dilution effect or contaminants
• Invert 10 times before dispensing sample onto
  plastic film
• Fill cuvette using capillary action

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Patient Testing

• Inspect optical eye for smears and bubbles
• If cuvette is underfilled do not refill
• Analyse immediately
• Result displayed after 15s in g/L
• Document the result in g/dL (divide by 10)
• Discard cuvette as clinical waste

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Reviewing the result

• Ensure patient has had a recent lab FBC to
  exclude non-Hb pathology e.g. thrombocytopaenia
• Single drop sampling less accurate
• Blood cannot be issued on basis of HemoCue result
  alone
• inappropriate transfusion in EOU
• Lab will start X-match send FBC to prevent delay
  in issuing
• Active bleeding blood will issued as normal
  without FBCs
• If unexpected review possible causes of
  inaccurate measurement
• Repeat and send sample to lab
• Common causes of erroneous results
• eg cuvette storage, tissue fluid, delayed
  analysis, regional oedema
• If in doubt send a sample to the lab!!

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Daily Cleaning

• Switch off
• Rotate cuvette to load position
• Release catch by pressing pen into recess
• Pull holder all way round and then remove
  completely
• Clean holder daily with detergent wipe, (and then
  alcohol wipe if blood stained)
• Completely air dry (overnight)
• Wipe exterior of meter with detergent wipe, (and
  then alcohol if blood stained)

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Advanced cleaning

• Excessive blood spill blocking light path
• Erroneous QC/patient results
• Spatulas from HemoCue
• Repeat with new spatulas until no blood staining

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Health Safety

• Wear gloves
• Dispose used lancets cuvettes in Sharps Bin
• Cuvettes QC material contain toxins
• Not a problem in normal working practice
• Refer to CoSHH Assessment for inhalation, skin
  contact, eye contact or ingestion

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Proficiency Testing (External Quality Assessment)

• Clinical Governance
• CMMC Policy that operators participate in the
  scheme
• independently documents the ongoing proficiency
  of operator
• Compares performance of meter with labs and
  clinical areas nationally
• 1-3 samples distributed by the NEQAS monthly
• Operators analyse 1 sample each so 1-3 people in
  month 1
• Participation is rotated so different operators
  analyse in month 2
• Each operator must participate at least 1-2
  results a year

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Standard operating procedure

• In line with MHRA guidelines on POCT there must
  be an SOP in place wherever POCT is performed
• The SOP is the on-site reference manual which
  incorporates the manufacturers instructions and
  Trust Policies and procedures
• Failure to adhere to the most current
  instructions could result in you as an individual
  being liable for any error in testing
• All operators must be able to access SOP so they
  can refer to this info error codes are given in
  the Manufacturers Guide

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Accessing the SOP
From homepage, scroll down to Browse and
select Departments
From Departments select Point of Care Testing
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POCT Homepage
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Auditing

• Meter reliability
• Workload (record results)
• Cleanliness
• Documentation
• Stock control
• IQC results
• EQA/PT results
• Auditors Internal POC and CPA