POCT Blood Glucose Analyzer: Introduction & Training

(Contour Plus Glucometer)

POCT Workshop
What is POCT – Point of Care Testing?
• Laboratory test performed outside Pathology Laboratories
• Performed by non-laboratory professionals
• Different professional requirements depends on the POCT Complexity
• Blood glucose monitoring devices are classified (level I) complexity
• or Waived test (US Food & Drug Administration from 2000)
• Subject to the lowest level of regulation and are cleared by the FDA for home uses
• Dipstick tests
• Urine pregnancy tests
• Blood glucose monitoring devices
Classification of Complexity of Testing for
POCT/Devices
Complexity of Testing Level I Level II
Description Low complexity of testing Moderate to high complexity of
testing

Type of POCT/ Devices
POCT Operator Requirement
1. Glucometers e.g. Contour
plus
2. Haemoglobinometers
3. Blood ketone
Well-trained hospital staff,
including ancillary staff
All types of POCT/Devices NOT
classified as Level I
Well-trained professional staff
(doctors, nurses, medical
technologists, other specialists)

* All tests performance should adhere to the manufacturer’s instructions including urine dipstick
tests
Information about the tendered BGAs (Old)
Information about the
tendered BGAs (New)

• Measurement range 0.6 to 33.3

• Lo < 0.6 mmol/L
• Hi > 33.3 mmol/L
• For all patients include neonates
• DON”T mix up with different
blood glucose meter
The CONTOURTM PLUS system shows
remarkable accuracy
• The CONTOUR PLUS system met the more stringent accuracy
requirements of ISO 15197:20131,2
• 100% of results were within zone A of the Consensus Error Grid2
• Accuracy was maintained, even at the tighter error limits such as
±10% or ±0.56mmol/L2
As the Margin of Error Increases so does the
predicted risk of missing a Hypoglycemic event

ISO 15197:2003 10 in 100

accuracy standard2 hypoglycemic
events missed at
Probability of missing
hypoglycemic event

20% SMBG error1

ISO 15197:2013 3.5 in 100

accuracy standard3 hypoglycemic
events missed at
15% SMBG error1

1 in 100
hypoglycemic
events missed at
10% SMBG error1

SMBG error (%)

Probability of a BGM missing hypoglycemia as a function of blood glucose level and permitted BGM error. The probability for missing hypoglycemic episodes increases exponentially, which is marked from a permitted error above 5%.
No-Coding Technology

• NO Coding technology
eliminate errors due
to miscoding
• Manual coding error:
1 in 6 patients in
type1 and type 2
diabetes patients –
even when they have
received training
Second-Chance Sampling
• The Contour Plus meter can detect
when the test strip /sensor is under
filled and prompt for sample
reapplication *Within the first 30 seconds.
• Second-Chance® Sampling allows
blood sample reapplication and
prompts for sample reapplication for
up to 30 seconds
• It maintain high accuracy, even after
applying more blood to the same strip
• Estimate: save up to 100 strips per
year via market survey
Information for
Contour plus
Meter Demonstration
Blood Glucose Meter: Contour plus
Contour plus: manual for blood glucose
monitoring
Contour plus: Quality Control Test

開封後有效至 開封後有效
有效日期 至6個月

Label Sticker for High / Low Control

Perform the quality control testing (control L)
Perform the quality control testing (control H)
Quality control on control solution testing

• Check the expiry date and discard after 6 months after opening
• Do not use the solution past discard date/ expiry date printed on
the label
• Proper labelling after opening
• Control solution (to minimize crystallize)
• Shake well before use (about 15 times)
• Discard the first drop
• Use a tissue to wipe away any solution around the bottle tip before
dispensing a drop and after use (before recap)
• Using other control solution may cause inaccurate results (use only
CONTOUR plus control solutions)
Quality control on control solution testing
• Proper storage
• Ensure tightly capped or intact foil wrap
• Keep in room temperature, away from direct sunlight or heat source
• Discard to use if humid or wet; bent, scratched or damaged
• Do not handle test strips with wet hands
Quality control on control solution testing
• If QC tests failed (result does not fall within the listed range)
• Check the steps for control testing (improper technique)
• Check the strip (quality and storage)
• Check the quality solution (deteriorated/ expired)
• Check the meter function
• Do not use the meter with abnormal testing result for blood glucose monitoring until the issue resolved
• Change the set of test strip or control solutions
• Inform staff and handle according to hospital guideline
• Check with the manual/ user guide or customer services
Contour plus: change battery

•當血糖測試儀顯示更換電池符號，應更換電池
•先關閉血糖測試儀，用力按壓電池蓋，然後向箭頭所指方向滑動
•更換電池留意「+」的一頭朝上 (使用兩顆3伏特CR2032 或DL2032
鋰電池)
Contour plus: Error codes and symbols
Contour plus: Error codes and symbols
Revision on obtaining a blood sampling
• Preparation your patient
• Explain the procedure
• Appropriate information and instructions
• consent
• Check the patient identify and related health history
• Check the patient record and prescription accordingly
• Hstix: Date, time and frequency
• Medication e.g. sliding scale of insulin injection
• Patient’s mealtime
Revision on obtaining a blood sampling
• Comfort and reassurance
• Correct recording (time and blood glucose results)
• Report on time for any abnormal result
• Always observe patient’s clinical presentation if it matched with the blood glucose result
• Hypoglycaemia/ hyperglycaemia
Revision on obtaining a blood sampling
• Preparation of procedure The depth of penetration
• Hand hygiene should not go beyond
• Gloves if needed 2.2mm (WHO guideline)
• Alcohol wipe/ swab (70%) Increase pain
• Glucose monitor Increase blood volume
• Test strips
• Spring loaded lancet
• appropriate length of lancet
• Sterile gauges
Revision on obtaining a blood sampling

• Wipe the finger by alcohol pad (70%)

• Await 15- 30secs for dry
• Get a round drop of blood
WHO guideline
on capillary
sampling
Ideal sites for finger
prick (WHO)

• The ball of the finger

• The middle and ring fingers recommended
• The thumb and index fingers are precluded because of
the potential for calluses
• the little finger because the tissue is thin and there is a
higher risk of hitting bone
• Prick the side of the fingers for adult patients (less
painful)
• Minimize to get blood sampling from swollen sites
• Minimize on fingers of hand with infusion
performed
• Observe the puncture sites and complications e.g.
site infection, haematoma, scarring, nerve damage
or localized necrosis or skin breakdown
 Summary

Follow maintenance Suggest blood Correct skills of Always observe the

Perform quality No calibration is
guide for user and glucose test if any blood sampling for clinical signs of
control testing for required for Contour
proper cleansing suspected result POCT patient if matched
validate the quality plus new test strips
with the POCT
of BGAs
results
Proper storage of
Simple functional
strips and QC
test by checking
solution
paired QC solutions
Note for expiry/ use
Perform internal QC
before date of all
at least once per day
opened control
solution
References
1. Contour plus: user guide on blood glucose monitoring system. Retrieved from:
https://www.diabetes.ascensia.hk/siteassets/art85877461_cntrplus_ug_r04-
17-quick-english.pdf
2. Mackenzie, T. (2019). Capillary sampling for HbAlc testing. Medical Laboratory.
Retrieved from: https://images.app.goo.gl/pUbdsVrV9KFXBRqV7
3. U.S. Department of Health & Human Services. CLIA-Tests waived by FDA from
January 2000 to present: Glucose monitoring devices. Retrieved from:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfClia/testswaived.cfm
4. World Health Organization (2010). WHO guidelines on drawing blood: best
practices in phlebotomy. Retrieved from:
https://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-
guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua=1
Thank you