Reliability of Point-of-Care Capillary Blood Glucose Measurements in the Critical Value Range

2014 ◽  
Vol 138 (7) ◽  
pp. 962-966 ◽  
Author(s):  
Ron B. Schifman ◽  
Tan T. Nguyen ◽  
Susan T. Page
Keyword(s):  
Point Of Care ◽  
Venous Blood ◽  
Capillary Blood ◽  
Convenience Sample ◽  
Critical Range ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Value Range ◽  
Blood Specimens ◽  
One Year

Context.—Point-of-care glucose (POCG) testing on capillary blood specimens is central to maintaining glycemic control in patients with diabetes. Although there are known performance issues with POCG methods, especially for maintaining tight glucose control, there is little information about the accuracy of results in the critical ranges that may involve life-threatening conditions. Objectives.—To evaluate the reliability of POCG measurements in critical, high (>600 mg/dL) and low (<40 mg/dL) ranges. Design.—One-year retrospective analysis of POCG (ACCU-CHEK glucose meter, Roche Diagnostics Corporation, Indianapolis, Indiana) results for routine patient care were obtained. The frequency and accuracy of repeat testing after critical POCG results was analyzed. A convenience sample of noncritical capillary POCG measurements retested on venous blood specimens by another point-of-care device (RAPIDPoint 405 analyzer, Siemens Medical Solutions USA, Malvern, Pennsylvania) was also evaluated. Results.—Critical values were observed in 2.4 per 1000 POCG tests (256 of 105,928; 0.24%), with the highest rate (76 of 2289; 3.32%) from the emergency department. Twice as many critical high values as critical low values were seen. Nearly 80% of critical POCG tests (204 of 256) were repeated within 10 minutes. Of these 204 repeat measurements, 112 (54.9%) met accuracy criteria (±15 mg/dL of low and ±20% of high initial values). Accuracy was significantly higher when retesting was performed on the same meter or by the same operator (P ≤ .05). Comparison of capillary and venous POCG testing of noncritical results showed no significant difference (P = .95), with 89.8% (125 of 139) meeting accuracy criteria. Conclusions.—POCG measurements in the critical range are frequently erroneous, which is likely caused by preanalytic factors associated with sampling capillary blood. POCG testing practices should include retesting to confirm critical results.

A Comparison of Venous versus Capillary Blood Samples when Measuring Blood Glucose Using a Point-of-Care, Capillary-Based Glucometer

2019 ◽  
Vol 34 (05) ◽  
pp. 506-509
Author(s):  
Jessica Topping ◽  
Matthew Reardon ◽  
Jake Coleman ◽  
Brian Hunter ◽  
Haruka Shojima-Perera ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Point Of Care ◽  
Research Question ◽  
Venous Blood ◽  
Hospital Setting ◽  
Capillary Blood ◽  
Needle Stick Injury ◽  
Blood Samples ◽  
Significant Difference ◽  
Venous Sample

AbstractBackground:Blood glucose level (BGL) is routinely assessed by paramedics in the out-of-hospital setting. Most commonly, BGL is measured using a blood sample of capillary origin analyzed by a hand-held, point-of-care glucometer. In some clinical circumstances, the capillary sample may be replaced by blood of venous origin. Given most point-of-care glucometers are engineered to analyze capillary blood samples, the use of venous blood instead of capillary may lead to inaccurate or misleading measurements.Hypothesis/Problem:The aim of this prospective study was to compare mean difference in BGL between venous and capillary blood from healthy volunteers when measured using a capillary-based, hand-held, point-of-care glucometer.Methods:Using a prospective observational comparison design, 36 healthy participants provided paired samples of blood, one venous and the other capillary, taken near simultaneously. The BGL values were similar between the two groups. The capillary group had a range of 4.3mmol/l, with the lowest value being 4.4mmol/l and 8.7mmol/l the highest. The venous group had a range of 2.7mmol/l, with the lowest value being 4.1mmol/l and 7.0mmol/l the highest.For the primary research question, the mean BGL for the venous sample group was 5.3mmol/l (SD = 0.6), compared to 5.6mmol/l (SD = 0.8) for the capillary group. This represented a statistically significant difference of 0.3mmol/l (P = .04), but it did not reach the a priori established point of clinical significance (1.0mmol/l). Pearson’s correlation coefficient for capillary versus venous indicated moderate correlation (r = 0.42).Conclusion:In healthy, non-fasted people in a non-clinical setting, a statistically significant, but not clinically significant, difference was found between venous- and capillary-derived BGL when measured using a point-of-care, capillary-based glucometer. Correlation between the two was moderate. In this context, using venous samples in a capillary-based glucometer is reasonable providing the venous sample can be gathered without exposure of the clinician to risk of needle-stick injury. In clinical settings where physiological derangement or acute illness is present, capillary sampling would remain the optimal approach.

scholarly journals COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

2021 ◽  
Vol 18 (5) ◽  
pp. 2650
Author(s):  
Giuseppe Vetrugno ◽  
Daniele Ignazio La Milia ◽  
Floriana D’Ambrosio ◽  
Marcello Di Pumpo ◽  
Roberta Pastorino ◽  
...  
Keyword(s):  
Blood Test ◽  
Healthcare Workers ◽  
Point Of Care ◽  
Venous Blood ◽  
Administrative Staff ◽  
Serological Tests ◽  
Predictive Values ◽  
Work From Home ◽  
Significant Difference ◽  
Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

Effects of Different Methods Used to Take Blood Samples on Blood Glucose Measurements

2021 ◽  
pp. 105477382110247
Author(s):  
Eda Ergin ◽  
Ayten Zaybak
Keyword(s):  
Blood Glucose ◽  
Glucose Tolerance Test ◽  
Venous Blood ◽  
Tolerance Test ◽  
Capillary Blood ◽  
Oral Glucose ◽  
Blood Samples ◽  
Significant Difference ◽  
Measurement Results ◽  
Quasi Experimental

The purpose of this study is to compare whether or not there is a difference between venous and capillary blood samples in blood glucose measurements and investigate the effects of different aseptic methods used in skin cleaning before collecting blood samples on measurement results. This quasi-experimental study was conducted with 109 patients. The capillary first and second blood drop values taken from the patients after fasting and at 2 hours following 75 g oral glucose tolerance test (OGTT) and capillary and venous blood glucose values were compared. There was no significant difference between the median venous blood glucose value and the capillary second blood drop value taken after wiping the finger with alcohol. There was no significant difference between the first and second blood drop values of capillary blood glucose 2 hours after OGTT.

scholarly journals Patterns of Sharps Handling and Disposal Among Insulin-Using Patients With Diabetes Mellitus

2019 ◽  
Vol 15 (1) ◽  
pp. 60-66
Author(s):  
Jordan M. Montoya ◽  
Bithika M. Thompson ◽  
Mary E. Boyle ◽  
Melinda E. Leighton ◽  
Curtiss B. Cook
Keyword(s):  
Public Health ◽  
Diabetes Mellitus ◽  
Insulin Pump ◽  
Point Of Care ◽  
Health Hazard ◽  
Public Health Campaign ◽  
Health Campaign ◽  
Continuous Glucose Monitor ◽  
Convenience Sample ◽  
Patients With Diabetes

Background: The objective of this study was to assess disposal patterns for “sharps” among a cohort of patients with diabetes mellitus (DM) receiving insulin therapy. Method: A convenience sample of inpatients and outpatients was surveyed about how they disposed of sharps, how often they reused lancets and needles, and what education they had received about proper disposal. Safe disposal was defined as discarding sharps into a formal sharps or sealable container; otherwise, disposal was categorized as unsafe. Results: Of 150 respondents, 56% were men and 75% were white. The mean (SD) age was 56 (15) years; duration of DM, 20 (13) years; and hemoglobin A1c, 8.1% (2.0%). Half the respondents reused a lancet two or more times, and 21% reused an insulin needle two or more times. Thirty-eight percent of respondents discarded lancets unsafely, and 33% discarded insulin needles unsafely, typically by throwing these items into household trash. Most respondents (75%) discarded insulin pens, vials, cartridges, insulin pump supplies, and continuous glucose monitor sensors into household trash. Most (64%) indicated that they had not received education on safe sharps-disposal practices, and 84% had never visited their municipal website for information on medical waste disposal. Conclusion: Approximately one-third of patients unsafely disposed of sharps. Unsafe disposal could cause millions of sharps to appear in the municipal solid waste stream, thereby posing a substantial public health hazard. Point-of-care patient education is important, but a broader public health campaign may be required.

scholarly journals Capillary blood tests may overestimate ketosis: triangulation between three different measures of β-hydroxybutyrate

2020 ◽  
Vol 318 (2) ◽  
pp. E184-E188 ◽  
Author(s):  
Jakob Norgren ◽  
Shireen Sindi ◽  
Anna Sandebring-Matton ◽  
Ingemar Kåreholt ◽  
Ulrika Akenine ◽  
...  
Keyword(s):  
Regression Models ◽  
Ketone Body ◽  
Point Of Care ◽  
Venous Blood ◽  
Capillary Blood ◽  
Dietary Interventions ◽  
Healthy Older Adults ◽  
Time Points ◽  
Blood Tests ◽  
Good Agreement

The ketone body β-hydroxybutyrate (BHB), assessed by a point-of-care meter in venous whole blood (BHBv), was used as the main outcome in a study on nutritional ketosis in healthy older adults. Two other BHB measures were also used in the study for validation and exploratory purposes, and here we report findings on correlation and agreement between those three methods. Ketosis in the range of 0–1.5 mmol/L was induced in 15 healthy volunteers by intake of medium-chain fatty acids after a 12-h fast. BHBv was assessed at 12 time points for 4 h. The same point-of-care meter was also used to test capillary blood (BHBc) at three time points, and a laboratory test determined total ketones (TK) in plasma (BHBp + acetoacetate) at four time points. A total of 180 cases included simultaneous data on BHBv, BHBc, BHBp, and TK. TK correlated with BHBp (Pearson’s r = 0.99), BHBv ( r = 0.91), and BHBc ( r = 0.91), all P < 0.0001. BHBv and BHBp had good agreement in absolute values. However, the slope between BHBc and BHBv, measured with the same device, was in the range of 0.64–0.78 in different regression models, indicating substantially higher BHB concentrations in capillary versus venous blood. We conclude that all three methods are valid to detect relative changes in ketosis, but our results highlight the importance of method considerations and the possible need to adjust cutoffs, e.g., in the management of ketoacidosis and in the evaluation and comparison of dietary interventions.

scholarly journals Determination of ethanol in micro-volumes of blood by headspace gas chromatography: Statistical comparison between capillary and venous sampling sites

2020 ◽  
pp. 002580242092863
Author(s):  
Luke Taylor ◽  
Vytautas Remeškevičius ◽  
Lili Saskoy ◽  
Tara Brodie ◽  
Jeshan Mahmud ◽  
...  
Keyword(s):  
Gas Chromatography ◽  
Sample Preparation ◽  
Venous Blood ◽  
Forensic Toxicology ◽  
Capillary Blood ◽  
Blood Alcohol ◽  
Venous Sampling ◽  
Preparation Methods ◽  
Significant Difference ◽  
The Uk

Ethanol is the most commonly encountered drug in forensic toxicology, with widespread use throughout society. For this reason, it is important that there are a variety of reliable and robust methods to detect and quantify the content of alcohol in blood samples of suspected drink drivers. A common method of detection is gas chromatography with flame ionisation detector, with a number of sample preparation techniques employed. Typically, venous blood is sampled and used in the analysis. However, there is currently no legal specification in the UK of the blood sample source. This study investigates the use of capillary blood as an alternative to venous blood alongside two different sample volumes: 100 and 10 µL. Venous and capillary blood were collected from volunteers who had consumed alcohol. All blood sampling was carried out one hour after cessation of drinking. The results show a statistically significant difference between venous and capillary samples, with an average difference of 3.38 ± 1.99 mg/100 mL at 100 μL and approximately 4.13 ± 2.42 mg/100 mL at 10 μL, respectively. Predominantly, venous blood was detected at higher concentrations than the corresponding capillary samples. The deviations in alcohol samples between venous and capillary blood are consistent with previous studies. However, our research indicates that capillary blood is a viable matrix to test for alcohol, albeit one that underestimates blood-alcohol content in relation to venous sampling. There was no statistically significant difference between the 100 and 10 µL sample preparation methods on an individual basis, which infers that micro-volumes of alcohol are suitable for forensic blood-alcohol analysis.

The prevalence of anaemia among Saudi school girls: a comparison of two techniques

2016 ◽  
Vol 13 (2) ◽  
pp. 82-88
Author(s):  
Elham Abbas Aljaaly ◽  
Nahlaa Abduwahab Khalifa
Keyword(s):  
Venous Blood ◽  
National Sample ◽  
Capillary Blood ◽  
Primary Data ◽  
Content Type ◽  
Jeddah City ◽  
System Method ◽  
Significant Difference ◽  
High Prevalence ◽  
School Girls

Purpose – Continuous integration of health screens to investigate and track variations in the students’ healthiness over time is essential. However, the sustainability of this practice remains challenging. The purpose of this paper is to identify the prevalence of anaemia based on haemoglobin (Hb) estimation among Saudi school girls in Jeddah city by examining capillary and venous blood. Design/methodology/approach – The design is investigative, using primary data to define the prevalence of anaemia based on two techniques. Samples of venous (n=408) and capillary (n=797) blood from Saudi school girls in Jeddah city was collected and compared using: Reflotron Plus System method (capillary blood) and ABX MICROS 60-OT Automated Haematology Analyser for (venous blood). Findings – When the capillary blood was used, the prevalence of anaemia was 40 per cent (n=319 out of 797). Using the venous blood, the prevalence was 29.4 per cent (n=120 out of 408). Comparison of Hb data for both tests showed a significant difference in Hb levels with levels between the 10g and 12 g/dl particularly and both measurements demonstrated good agreement (ICC=0.87, 95 per cent CI (0.845, 0.892)). Research limitations/implications – The data were collected only in Jeddah city. Further studies should include a national sample that is representative of both gender from different backgrounds and geographical areas in the kingdom of Saudi Arabia. Practical implications – The high prevalence of anaemia within the school girls’ population require decision makers to devise a set of maintainable projects to progress students’ general health, including health education and supplementation such as iron, particularly if anaemia is diagnosed to be nutrition-related. This particularly applied to the health centres at female schools that have anaemia screening programmes that going on in Saudi schools. Originality/value – This study reveals a technique-based measures of anaemia prevalence that have public and practical health implications.

scholarly journals Head to head comparisons in performance of CD4 point–of-care assays: A Bayesian meta-analysis (2000-2013)

2014 ◽  
Author(s):  
Samantha Wilkinson ◽  
Tiago Chiavegatti ◽  
Benedicte Nauche ◽  
Given Names Deactivated Family Name Deactivated ◽  
Nitika Pant Pai
Keyword(s):  
Flow Cytometry ◽  
Point Of Care ◽  
Meta Analysis ◽  
Venous Blood ◽  
Capillary Blood ◽  
Sufficient Data ◽  
Bayesian Hierarchical ◽  
Cell Counts ◽  
Meta Analyses ◽  
Cd4 Cell

Background: Timely detection, staging, treatment initiation are pertinent to controlling HIV Infection. CD4+ cell-based point-of-care (POC) devices offer the potential to rapidly stage patients, and decide on initiating treatment, but a comparative evaluation of their performance has not yet been performed. With this in mind, we conducted a systematic review and meta-analyses. Methods: For the period Jan 2000 to April 2015, 19 databases were systematically searched, 6619 citations retrieved, and 25 articles selected. Diagnostic performance was compared across devices (i.e., PIMA, CyFlow, miniPOC, MBioCD4 System) and across specimens (i.e., capillary blood vs. venous blood). A Bayesian approach was used to meta-analyze the data. The primary outcome, the Bland-Altman (BA) mean bias (which represents agreement between cell counts from POC device and flow cytometry), was analyzed with a Bayesian hierarchical normal model. Findings: We performed a head-to-head comparison of two point-of-care devices, PIMA and PointCareNOW CD4. PIMA appears to perform better vs. PointCareNOW with venous samples (BA mean bias: -9.5 cells/μL; 95% CrI:-37.71 to 18.27 vs. 139.3 cells/μL; 95% CrI:-0.85 to 267.4, mean difference = 148.8, 95% CrI: 11.8, 285.8); however, PIMA’s best performed when used with capillary samples (BA mean bias: 2.2 cells/μL; 95% CrI:-19.32 to 23.6). Sufficient data was available to allow pooling of sensitivity and specificity data only at the 350 cells/μL cutoff. For PIMA device sensitivity 91.6 (84.7 to 95.5) and specificity was 94.8 (90.1 to 97.3) respectively. There was not sufficient data to allow comparisons between any other devices. Conclusions: PIMA device was comparable to flow cytometry. The estimated differences between the CD4+ cell counts of the device and the reference was small and best estimated in capillary blood specimens. As the evidence stands, the PointCareNOW device will need to improve prior to widespread use and more data on MBio and MiniPOC are needed. Findings inform implementation of PIMA and improvements in other CD4 POC device prior to recommending widespread use.

scholarly journals Analytical performance of lateral flow immunoassay for SARS-CoV-2 exposure screening on venous and capillary blood samples

2020 ◽  
Author(s):  
Margaret A Black ◽  
Guomiao Shen ◽  
Xiaojun Feng ◽  
Wilfredo Garcia Beltran ◽  
Yang Feng ◽  
...  
Keyword(s):  
Whole Blood ◽  
Colloidal Gold ◽  
Venous Blood ◽  
Capillary Blood ◽  
Lateral Flow ◽  
Antibody Detection ◽  
Lateral Flow Immunoassay ◽  
Blood Samples ◽  
Significant Difference ◽  
Finger Stick

Objectives: Numerous serologic immunoassays have been launched to detect antibodies to SARS-CoV-2, including rapid tests. Here, we validate use of a lateral flow immunoassay (LFI) intended for rapid screening and qualitative detection of anti-SARS-CoV-2 IgM and IgG in serum, plasma, and whole blood, and compare results with ELISA. We also seek to establish the value of LFI testing on blood obtained from a capillary blood sample. Methods: Samples collected by venous blood draw and capillary finger stick were obtained from patients with SARS-CoV-2 detected by RT-qPCR and control patients negative for SARS-CoV-2. Samples were tested with the 2019-nCoV IgG/IgM Detection Kit (Colloidal Gold) lateral flow immunoassay, and antibody calls were compared with results obtained by ELISA. Results: The Biolidics LFI kit shows clinical sensitivity of 92% at 7 days after PCR diagnosis of SARS-CoV-2 on venous blood. Test specificity was 92% for IgM and 100% for IgG. There was no significant difference in detecting IgM and IgG with Biolidics LFI and ELISA at D0 and D7 (p=1.00), except for detection of IgM at D7 (p=0.04). Finger stick whole blood of SARS-CoV-2 patients showed 93% sensitivity for antibody detection. Conclusions: Clinical performance of Biolidics 2019-nCoV IgG/IgM Detection Kit (Colloidal Gold) is comparable to ELISA and showed consistent results across different sample types. Furthermore, we show that capillary blood obtained by finger stick shows similar sensitivity for detecting anti-SARS-CoV-2 IgM and IgG antibodies as venous blood samples. This provides an opportunity for decentralized rapid testing in the community and may allow point-of-care and longitudinal self-testing for the presence of anti-SARS-CoV-2 antibodies.

scholarly journals Validation of a point-of-care capillary lactate measuring device (Lactate Pro 2).

2020 ◽  
Author(s):  
Anette Raa ◽  
Geir Arne Sunde ◽  
Bjørn Bolann ◽  
Reidar Kvåle ◽  
Christopher Bjerkvig ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthy Volunteers ◽  
Blood Lactate ◽  
Point Of Care ◽  
Reference Method ◽  
Capillary Blood ◽  
Handheld Device ◽  
Intensive Care Patients ◽  
Arterial Blood ◽  
Significant Difference

Abstract Background: The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation. Aim: The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate. Methods: Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included. Results: There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29% to 68%), p<0.001) and 27% (95% CI (11% to 45%), p<0.001) higher, respectively, than the corresponding arterial blood lactate. In the healthy volunteers, we found that capillary blood lactate in the fingertip was 14% higher than arterial blood lactate (95% CI (4% to 24%), p= 0.003) and no significant difference between capillary blood lactate in the earlobe and arterial blood lactate.Conclusion: Our results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.

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