By Lisa Fratt

The Hemochron Response whole blood coagulation system is a future-oriented system based on International Technidyne Corp’s (ITC) decades of experience in point-of-care coagulation monitoring. Hemochron technology has served as the standard for activated clotting time (ACT) testing for years. In fact, ITC developed the first semiautomated system for point-of-care coagulation and ACT monitoring, according to Marcia Zucker, PhD, director of clinical research for ITC.

Recent additions to the Hemochron product line offer solutions to prevalent hemostasis management issues. ACT testing enables hospitals to safely perform cardiac bypass surgery, and the ACT originally worked as a manual test. “Hemochron is designed to reduce operator variability in running an ACT by automating test heating and clot detection,” says Zucker. The system extends beyond basic ACT testing and provides a robust, flexible hemostasis management instrument. The Hemochron Response V2.0 offers a means to assist with oversight of point-of-care testing; it also provides a means to monitor and oversee operator use. Data generated by the Hemochron system can be used to facilitate staff education and compliance programs. Finally, the system enhances patient care by providing rapid results during critical-care procedures. “Our goal in developing the Hemochron was to keep the instrument as flexible as possible. We never dictate how things should be done, but rather give sites the opportunity for tight controls,” Zucker says. The end result is a system that can enhance both clinical care and compliance.

Hemochron and Clinical Care
How does the clinical-care aspect of Hemochron work? The system is actually quite simple, according to Zucker. The Hemochron Response whole blood coagulation system includes the RxDx Analysis Module for heparin and protamine dosing. This point-of-care coagulation analyzer enables clinicians to customize doses of heparin and protamine for individual bypass patients by calculating each patient’s predicted optimal dose of the agents. This is particularly key with heparin as patients can vary twelvefold in their sensitivity to, and metabolism of heparin. And with protamine it is advantageous to administer the minimal effective dose due to potential complications associated with its use.

The RxDx in vitro dosing module minimizes variability associated with manual ACT monitoring. After patient demographic information and test results are entered, Hemochron calculates the appropriate dose of heparin. At the end of the surgery, the system determines the appropriate dose of protamine required to reverse the anticoagulation effects of heparin. Finally, the cycle is complete with an additional assay used to verify successful neutralization of heparin.

Hospitals use the Hemochron Response System in a number of settings. Lahey Clinic Medical Center in Burlington, Mass has 11 Hemochron Response instruments deployed in critical-care settings throughout the hospital, including cardiothoracic surgery and cardiac catheterization departments. The system enhances patient care by providing rapid results. Annmarie Gill, point-of-care coordinator for Lahey Clinic, explains, “Hemochron provides rapid turnaround of results, enabling physicians to make the quick therapeutic decisions required during critical-care procedures.”

Hemochron and Compliance
The Hemochron System also facilitates other aspects of point-of-care testing. “Most point-of-care coordinators deal with operator issues,” says Gill. “Hemochron forces them to make sure they’ve taken all of the right steps.” This is accomplished via a lockout mechanism for quality control (QC) and user identification. Hemochron monitors various aspects of QC and locks out users if QC is not performed or is unacceptable. For example, an operator cannot access the system if he has not entered his user number in the database. Hemochron also locks out users who fail to run checks for abnormal and normal levels during a shift. The lockout feature not only provides immediate results by locking users out of the system and potentially preventing errors, but it also facilitates longer-term staff education programs.

At Lahey Clinic, Gill completes a monthly sneaker net, during which she downloads operator, QC, and patient data into a spreadsheet. She analyzes the data to pinpoint quality-assurance issues, including operator issues. For example, if an operator is inputting patient identification numbers incorrectly or neglecting daily QC, Gill can notify the appropriate manager and recommend retraining or educational programs fine-tuned to meet the needs of specific departments or users. “This facilitates good patient safety and QC,” Gill says.

Hemochron addresses QC on a number of fronts. For example, the system allows the point-of-care coordinator to program acceptable ranges for QC. If results don’t fall in the acceptable range, the system locks the user out. The instrument can also read the bar code on every test, so that an expired reagent is never used.

Site-Based Customization
Each site can determine the best use of the Hemochron system to meet its needs. “The system is completely configurable from a standard PC,” Zucker says. “Each clinical site can decide on the features that will best meet its needs.” For example, the point-of-care coordinator can decide on QC frequency. ITC recommends that hospitals perform liquid QC once per box of reagent; however, some sites prefer to complete liquid QC weekly. The point-of-care coordinator can program various features of the system to improve compliance.

Many sites customize Hemochron throughout the hospital to best meet the needs of different departments. For example, in the hospital operating room multiple tests are run on the same patient during surgery. Hemochron can be configured to eliminate time-consuming testing steps in the OR. Instead of forcing users to enter the operator and patient identification with every single test, the system can be set for all tests prior to surgery. In critical care, however, the needs are different. Hemochron is typically programmed so that each and every test is tagged with the appropriate operator and patient information.

If the ability to customize an instrument is important, the ability to customize with ease is critical. “This is a system with a lot of useful features,” Gill says. “I’ve optimized it to meet our needs, and it works very well. I will continue to tweak it to meet our needs in the future.”

For additional information, contact International Technidyne Corp, (800) 631-5945, www.hemochron.com.

Lisa Fratt is a contributing writer for Clinical Lab Products.