PT/INR Workflow for Suspected VHF Patients

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We're reviewing our VHF (Ebola/suspected viral hemorrhagic fever) testing workflow and are interested in learning how other institutions are handling POC PT/INR testing.

For those with established VHF or biocontainment protocols:
• What PT/INR platform are you using?
 • Is testing performed inside the patient room, in the anteroom, or in a nearby BSL laboratory?
 • If using a POC device, how are you handling specimen transport and timing requirements?
 • Have you found a workflow that works well while maintaining biosafety?
 
Thanks in advance!

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We are evaluating the Hemochron Signature Elite using Citrate PT test cuvettes (just started).  These cuvettes eliminate the timing limitations of POC capillary/whole blood testing.  Also the cuvettes are not limited for monitoring Warfarin therapy.  I will follow this discussion, since we don't have all of the other logistical components in place either (there is another group working through that). 

Hi.
Part of my job is working with the National Emerging Pathogens Training and Education Centers. One of our roles is preparing frontline hospitals across the US for viral hemorrhagic fever patients such as Ebola, Lassa Fever, Marborg, etc.

My facility has one of 13 Special pathogens units in the US. We have an on-unit lab where we can run samples in a BSL2+ laboratory. We are currently re-evaluating the hemacron but currently utilize the istat for PT/INR. We run this in full PPE with a PAPR, under a hood in a negative pressure room. This takes a lot of coordination with nursing staff to perform.

The other part of my role is running a POCT program for a large hospital. For PT/INR on a patient under investigation of a viral hemorrhagic fever, there are quite a few ways to run this test. The room with the patient is already a hot zone, so running it in the room by a POCT operator with appropriate PPE is a good option.

Running POCT under a hood is also an option but like you said his tough with test viability.

We can't give one solution for all institutions, so we highly recommend doing a risk analysis and mitigating as many risk factors as possible. 

If you have any more questions or would like me to connect you with the NETEC representative in your region my Email is Tori.Nemitz@fairview.org.

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Khanh Nguyen
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