CAP Pro Course - Point-of-Care Testing - Prothrombin Time (PT) and INR

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Author: Alice Travanty, BS, MT(ASCP)
Reviewer: Alexandru Casapu, MBA, MLS(ASCP)CM, PBTCM

Continuing Education Credits

Objectives

  • Explain the principles and utilization of the prothrombin time (PT) test and the International Normalized Ratio (INR).
  • Demonstrate knowledge of the proper procedures for patient identification and sample collection.
  • Follow the correct procedure for performing the POC PT/INR and identify potential sources of error in the testing and demonstrate knowledge of quality practices that will help to minimize error.
  • Discuss the factors affecting the results of a finger-stick INR and the possible side effects of warfarin therapy.

Course Outline

  • Explain the principles and utilization of the prothrombin time (PT) test and the International Normalized Ratio (INR).
      • Understanding Hemostasis and the Coagulation Cascade
      • Prothrombin Time (PT) and Warfarin Therapy
      • Point-of-Care (POC) Monitoring of Warfarin Therapy
      • Clinical Indications for Warfarin Therapy
      • What units are INRs reported in?
      • Which of the following coagulation factors is not part of both the intrinsic and extrinsic pathways?
      • An INR test monitors warfarin therapy. Which of the following is not a condition that is treated with warfarin?
      • Which of the following patients is a good candidate for whole-blood prothrombin (PT)/INR testing?
      • Warfarin is an oral anticoagulation medication that works by interfering with the hepatic synthesis of the vitamin K-dependent coagulation factors. Fa...
  • Demonstrate knowledge of the proper procedures for patient identification and sample collection.
      • Patient Identification and Specimen Labeling
      • Capillary Blood Sample Collection
      • Venipuncture for POC PT/INR Testing
      • Blood Sample Collection for PT/INR Testing by the Laboratory
      • When performing a venipuncture, what is the correct ratio of blood to anticoagulant for a PT/INR test?
      • When drawing blood to send to the laboratory for a comparison on a patient with a high POC INR, the technician notices that the tube is not filled ade...
      • A patient in the coagulation clinic has an abnormally high PT/INR result and requires a venous blood draw to be tested in the hospital laboratory for ...
      • A male patient known to have an elevated hematocrit due to polycythemia comes to the outpatient clinic for routine monitoring of his warfarin therapy....
      • The manufacturer's instructions for the POC PT/INR meter that is used at ABC Anticoagulation Clinic require this testing sequence.Take a test strip ou...
  • Follow the correct procedure for performing the POC PT/INR and identify potential sources of error in the testing and demonstrate knowledge of quality practices that will help to minimize error.
      • Minimizing Error in POC INR Testing
      • Advantages and Limitations of POC PT/INR Testing
      • Quality Management
      • Table: Quality Practices
      • POC INR System Differences
      • How often should the portable POC INR analyzer be cleaned?
      • How long does the printout from the POC INR analyzer need to be kept if the results are not transmitted to a computer system?
      • The coagulation section of the laboratory uses an analyzer that is nonwaived. An individualized quality control plan (IQCP) approved by the laboratory...
      • Mary, a laboratory technologist, works every other week at the clinic on days when patients come for whole-blood prothrombin time (PT)/INR testing. Wh...
  • Discuss the factors affecting the results of a finger-stick INR and the possible side effects of warfarin therapy.
      • Factors Influencing Warfarin Response
      • Correlate the patient's condition
      • Which of the following symptoms do not correspond with an INR greater than 4.0?
      • What is the half-life of warfarin?
      • A patient on warfarin therapy decides that she should improve her diet. Her friend tells her how good kale is and what great nutritional value it has....
      • A patient who comes to the coagulation clinic informs the tech that he has been diagnosed with hepatitis. What effect will hepatitis have on the patie...
      • A patient on warfarin therapy arrives for her PT/INR test and informs the tech that her toes are purple. What would you expect her INR result to be?
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: This program is designed as an educational and training tool for MLS, MT, and MLT personnel, phlebotomists, medical laboratory science students and interns, pathology residents, and practicing pathologists.
Author Information: Alice Travanty, BS, MT(ASCP) was the Point-of-Care Coordinator for St. Joseph Hospital, Milwaukee, Wisconsin until her recent retirement from that position. She serves as a technical consultant for Tosa Pediatrics. Alice is the author of article "Connectivity Aids Compliance" in Advance for Administrators of Laboratory Vol 20, Issue 11, page 18. She graduated from Marquette University with a degree in Medical Technology and holds a Point-of-Care Specialist certificate from AACC.
Reviewer Information: Alexandru Casapu, MBA, MLS(ASCP)CM, PBTCM, has over 20 years of experience as a medical laboratory scientist, section supervisor, and laboratory manager. He is the former Director of Clinical Laboratory Technology Program at Georgia Piedmont Technical College. He is currently a Program Director at MediaLab, Inc. Alex holds BS degrees in Biology and Medical Technology from Clark Atlanta University and an MBA from the University of Georgia.

This course is part of the CAP Competency Assessment Hub.

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