Point-Of-Care (POC) Monitoring in Anästhesie und Intensivmedizin - eine Übersicht über die zur Verfügung stehenden Möglichkeiten

Zusammenfassung

Die rasche Bestimmung von Laborparametern ist bei der Versorgung operativer und intensivmedizinischer Patienten von großer Bedeutung. Die Fortschritte in der Mikrotechnologie haben zur Entwicklung von Kleingeräten geführt, mit denen Laborgrößen bettseitig und zeitnah bestimmt werden können. Mit Hilfe des „Point-Of-Care” (POC) Monitoring kann eine Vielzahl von wichtigen Funktionen erfasst werden (Größen des Gasaustausches (z. B. Blutgasanalyse), des Metabolismus (z. B. Blutzucker, Laktat), der Hämatologie (z. B. Hämoglobin), der Gerinnung (z. B. Prothrombinzeit, Thrombozytenfunktion, partielle Thromboplastinzeit), Organschädigung (z. B. Herz, Niere)). Der Grundgedanke des POC-Monitorings ist „je schneller desto besser” („from vein to brain”). Die Bestimmung von Laborgrößen über das Zentrallabor umfasst die Blutabnahme in speziell vorbereitete Röhrchen, den Transport ins Labor, Pipetierung und Separation der Probe sowie die Analyse. Bei den Kosten des jeweiligen Laborparameters dürfen nicht nur Kit-Kosten mitberücksichtigt werden, zusätzliche Kosten müssen ebenso miterfasst werden. Durch die rasche, leicht durchführbare Erfassung von vitalen Laborgrößen und die damit verbundene zeitnahe Therapie sind zudem möglicherweise deutliche Einsparungen möglich. Zahlreiche POC-Systeme sind z. Zt. auf dem Markt. Die vorliegende Übersicht soll es dem an einem POC-Monitoring Interessierten erleichtern, die zur Verfügung stehenden Systeme zu sichten und somit eine Entscheidungshilfe bei der Einführung des POC-Monitoring geben.

Abstract

There is an increasing trend to have data rapidly ready at the patient's bedside. The general principle behind point-of-care (POC) testing is that „faster is better” (‘from vein to brain’). The entire process for laboratory testing includes withdrawal of blood into special (pre-labelled) tubes, transportation of the sample to the central laboratory where the plasma is separated from the blood cells by centrifugation, carefully pippeting of a defined volume of plasma that is placed in the analyzer. POC instruments provide us with the potential to do old things in new ways. With the help of portable POC analyzers a variety of laboratory parameters including coagulation parameters, blood gas analysis, electrolytes, markers of organ function can be measured next to the patient's bed thus significantly shorting turnaround-time (TAT). Cost analyses of new monitoring devices are necessary in today's climate of cost savings. It is important to capture all costs and not only costs of the test kits. Direct costs (e. g. test cartridges, costs for the analyzers, cost for quality control) may constitute only a small percentage of the true costs. Hidden costs consist of overhead costs (e. g. transportation) and the consequences of delayed results. The present overview summarizes the available POC systems in Germany and may serve as a decision maker for those who are interested in introducing POC monitoring systems.

Schlüsselwörter

Point-of-care (POC) - Monitoring - Anästhesie - Intensivmedizin - Kosten - Labor

Key words

Point-of-care (POC) - monitoring - anesthesia - intensive care medicine - costs - laboratory parameters

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