Point-of-care testing of activated clotting time in the ICU: is it relevant?
BACKGROUND
Over the past 50 years there have been significant advances in both the clinical techniques and equipment used in the intensive care environment. One traditionally used point-of-care test is activated clotting time (ACT), a coagulation test primarily used during cardiopulmonary bypass surgery to monitor the anticoagulation effects of heparin. The ACT test has since emerged into the intensive care environment to guide clinical assessment and management of haemostasis in postoperative cardiac patients.


OBJECTIVE
The aim of this integrative systematic review was to critique the available research evaluating the effectiveness of ACT point-of-care testing in the intensive care unit for adult patients following cardiopulmonary bypass and cardiac surgery and any impacts this may have on nursing care.


METHODS
A systematic search of Medline, CINAHL and PubMed was undertaken.


RESULTS
The search identified five research papers reporting on the use of ACT point-of-care testing in the intensive care unit for adult cardiac surgical patients. Meta-analysis was not performed due to the lack of homogeneity between the papers included.


CONCLUSIONS
There was a lack of clear evidence for the use of the ACT point-of-care test after cardiac surgery in the intensive care environment. This review has highlighted that conventional laboratory tests are generally more accurate and reliable than this point-of-care test in guiding nursing care management.
Nurse Unit Manager, Intensive Care Unit, St Vincent's Private Hospital, Melbourne, Australia.
Ellenora
E
Brown
Clinical Nurse Educator, Intensive Care Unit, St Vincent's Private Hospital, Melbourne, Australia.
Jody
J
Clarke
Associate Professor of Nursing Research, Faculty of Health Sciences, Australian Catholic University, and Director/Chair, Nursing Research Unit, St Vincent's Private Hospital, Melbourne, Australia.
Karen-leigh
KL
Edward
Research Associate, Faculty of Health Sciences, Australian Catholic University and Nursing Research Unit, St Vincent's Private Hospital, Melbourne, Australia.
Jo-Ann
JA
Giandinoto
D000925:Anticoagulants / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000175:diagnosis*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D064648:Critical Care Nursing / Q000379:methods*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007362:Intensive Care Units; D000067716:Point-of-Care Testing; D011182:Postoperative Care / Q000379:methods*; D014914:Whole Blood Coagulation Time / Q000379:methods*
D000925:Anticoagulants; D006493:Heparin
Activated clotting time; Intensive care unit; Nursing assessment; Point-of-care testing; Systematic review