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## Complete Summary

#### GUIDELINE TITLE

Transcutaneous bilirubin testing. Laboratory medicine practice
guidelines: evidence-based practice for point-of-care testing.

#### BIBLIOGRAPHIC SOURCE(S)

Kazmierczak S, Bhutani V, Gourley G, Kerr S, Lo S, Robertson A, Sena SF.
Transcutaneous bilirubin testing. In: Laboratory medicine practice
guidelines: evidence-based practice for point-of-care testing.
Washington (DC): National Academy of Clinical Biochemistry (NACB); 2006.
p. 5-12. \[74 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Jaundice in neonates (neonatal hyperbilirubinemia)

#### GUIDELINE CATEGORY

Assessment of Therapeutic Effectiveness\
Diagnosis\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Clinical Laboratory Personnel\
Health Care Providers\
Hospitals\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To examine the application of evidence-based medicine (EBM) to the
    form of diagnostic testing known as point-of-care testing (POCT)

> **Note**: For the purpose of this document, POCT is defined as
> \"clinical laboratory testing conducted close to the site of patient
> care, typically by clinical personnel whose primary training is not in
> the clinical laboratory sciences or by patients (self-testing). POCT
> refers to any testing performed outside of the traditional, core or
> central laboratory.\"

-   To systematically review and synthesize the available evidence on
    the effectiveness of POCT, with specific focus on outcomes in the
    areas of:

    1.  Patient/health

    2.  Operational/management

    3.  Economic benefit

-   To evaluate the available literature and identify those studies that
    clearly demonstrate the utility of transcutaneous point-of-care
    bilirubin testing compared with traditional clinical
    laboratory--based measurement

#### TARGET POPULATION

Healthy, term infants with hyperbilirubinemia

#### INTERVENTIONS AND PRACTICES CONSIDERED

Transcutaneous bilirubin testing

#### MAJOR OUTCOMES CONSIDERED

-   Clinical outcomes such as length of stay and readmission rates

-   Accuracy and cost-effectiveness of transcutaneous bilirubin
    measurement

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

For a specific clinical use, pertinent clinical questions were
formulated and key search terms were ascertained for the literature
search. Searches were conducted on MEDLINE or PubMed and were
supplemented with the use of the National Guideline Clearinghouse, the
Cochrane Group, or evidence-based medicine (EBM) reviews. Additionally,
authors\' personal article collections were used. Acceptable citations
were limited to peer-reviewed articles with abstracts, those published
in English, and those involving human subjects.

To be included in the full systematic review of the clinical question,
articles selected for full text review were examined for at least 1
relevant outcomes measurement.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Evidence**

I.  Evidence includes consistent results from well-designed,
    well-conducted studies in representative populations.

II. Evidence is sufficient to determine effects, but the strength of the
    evidence is limited by the number, quality, or consistency of the
    individual studies; generalizability to routine practice; or
    indirect nature of the evidence.

III. Evidence is insufficient to assess the effects on health outcomes
     because of limited number or power of studies, important flaws in
     their design or conduct, gaps in the chain of evidence, or lack of
     information.

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Abstracts identified by the literature searches were reviewed by 2
individuals to determine initial eligibility or ineligibility for
full-text review, using Form 1 (Appendix A - see the \"Availability of
Companion Documents\" field). If there was not consensus, then a third
individual reviewed the abstract(s). To be included in the full
systematic review of the clinical question, articles selected for full
text review were examined for at least 1 relevant outcomes measurement.
The systematic review consisted of creating evidence tables using Form 2
(Appendix A - see the \"Availability of Companion Documents\" field)
that incorporated the following characteristics:

1.  Study design---Prospective or retrospective, randomized, and
    controlled, patient inclusion/exclusion criteria, blinding, number
    of subjects, etc.

2.  Appropriateness of controls

3.  Potential for bias (consecutive or nonconsecutive enrollment)

4.  Depth of method description---full-length report or technical brief

5.  Clinical application---screening, diagnosis, management

6.  Specific key outcomes and how they were measured

7.  Conclusions are logically supported

For the assessment of study quality, the general approach to grading
evidence developed by the US Preventive Services Task Force was applied
(see the \"Rating Scheme for the Strength of the Evidence\" field). Once
that was done, an assessment of study quality was performed, looking at
the individual and aggregate data at 3 different levels using Forms 3
and 4 (Appendix A - see the \"Availability of Companion Documents\"
field). At the first level, the individual study design was evaluated,
as well as internal and external validity. Internal validity is the
degree to which the study provides valid evidence for the populations
and setting in which it was conducted. External validity is the extent
to which the evidence is relevant and can be generalized to populations
and conditions of other patient populations and point-of-care testing
(POCT) settings.

The synthesis of the volume of literature constitutes the second level,
Form 5 (Appendix A - see the \"Availability of Companion Documents\"
field). Aggregate internal and external validity was evaluated, as well
as the coherence/consistency of the body of data. How well does the
evidence fit together in an understandable model of how POCT leads to
improved clinical outcome? Ultimately, the weight of the evidence about
the linkage of POCT to outcomes is determined by assessing the degree to
which the various bodies of evidence (linkages) \"fit\" together. To
what degree is the testing in the same population and condition in the
various linkages? Is the evidence that connects POCT to outcome direct
or indirect? Evidence is direct when a single linkage exists but is
indirect when multiple linkages are required to reach the same
conclusion.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The field of point-of-care testing (POCT), diagnostic testing conducted
close to the site of patient care, was divided into disease- and
test-specific focus areas. Groups of expert physicians, laboratorians,
and diagnostic manufacturers in each focus area were assembled to
conduct systematic reviews of the scientific literature and prepare
guidelines based on the strength of scientific evidence linking the use
of POCT to patient outcome.

Final guidelines were made according to Agency for Healthcare Research
and Quality (AHRQ) classification (see the \"Rating Scheme for the
Strength of the Recommendations\" field). The guidelines are evidence
based and require scientific evidence that the recipients of POCT
experience better health outcomes than those who did not and that the
benefits are large enough to outweigh the risks. Consensus documents are
not research evidence and represent guidelines for clinical practice,
and inclusion of consensus documents was based on the linkages to
outcomes, the reputation of the peer organization, and the consensus
process used to develop the document. Health outcomes, e.g.,
benefit/harm, are the most significant outcomes in weighing the evidence
and drafting guidelines.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Strength of Recommendations**

**A** - The National Academy of Clinical Biochemistry (NACB) strongly
recommends adoption; there is good evidence that it improves important
health outcomes and concludes that benefits substantially outweigh
harms.

**B** - The NACB recommends adoption; there is at least fair evidence
that it improves important health outcomes and concludes that benefits
outweigh harms.

**C** - The NACB recommends against adoption; there is evidence that it
is ineffective or that harms outweigh benefits.

**I** - The NACB concludes that the evidence is insufficient to make
recommendations; evidence that it is effective is lacking, of poor
quality, or conflicting, and the balance of benefits and harms cannot be
determined.

#### COST ANALYSIS

The guideline developers reviewed published cost analyses.

No studies have been performed to evaluate the actual costs associated
with implementation of transcutaneous bilirubin measurements. Some
studies suggest that the increased cost of transcutaneous bilirubin
measurements is offset by a decrease in the need for serum bilirubin
measurements. One set of researchers attempted to evaluate the costs
associated with transcutaneous bilirubin measurements by estimating the
impact of transcutaneous bilirubin measurements on hospital charges.
They found that there were decreased charges as a result of fewer
readmissions of newborns because of hyperbilirubinemia. However, the
decrease in readmissions was offset by increased charges associated with
transcutaneous bilirubin measurements and an increased number of
newborns treated with phototherapy before discharge after the
introduction of transcutaneous measurements. The net result was a small
but statistically insignificant increase in charges after the
introduction of transcutaneous bilirubin measurements. Because these
authors report charges associated with implementation of transcutaneous
bilirubin measurements, it is still not clear what the implementation of
transcutaneous measurements does to actual costs.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The guidelines were presented in open forum at the American Association
for Clinical Chemistry (AACC) Annual Meeting (Los Angeles, CA, USA) in
July 2004. Portions of these guidelines were also presented at several
meetings between 2003 and 2005. Participants at each meeting had the
ability to discuss the merits of the guidelines and submit comments to
the National Academy of Clinical Biochemistry (NACB) Web site for formal
response by the NACB during the open comment period from January 2004
through October 2005.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (I---III) and grades of the
recommendation (A, B, C, I) are presented at the end of the \"Major
Recommendations\" field.

***Note from the National Academy of Clinical Biochemistry (NACB) and
the National Guideline Clearinghouse (NGC)**: The Laboratory Medicine
Practice Guidelines (LMPG) evidence-based practice for point-of-care
testing sponsored by the NACB* have been divided into individual
summaries covering disease- and test-specific areas. In addition to the
current summary, the following are available:

-   [Chapter 1:
    Management](http://www.guideline.gov/summary/summary.aspx?doc_id=10811&nbr=005636)

-   [Chapter 3: Use of Cardiac Biomarkers for Acute Coronary
    Syndromes](http://www.guideline.gov/summary/summary.aspx?doc_id=10813&nbr=005638)

-   [Chapter 4:
    Coagulation](http://www.guideline.gov/summary/summary.aspx?doc_id=10814&nbr=005639)

-   [Chapter 5: Critical
    Care](http://www.guideline.gov/summary/summary.aspx?doc_id=10815&nbr=005640)

-   [Chapter 6: Diagnosis and Management of Diabetes
    Mellitus](http://www.guideline.gov/summary/summary.aspx?doc_id=10816&nbr=005641)

-   [Chapter 7: Drugs and
    Ethanol](http://www.guideline.gov/summary/summary.aspx?doc_id=10817&nbr=005642)

-   [Chapter 8: Infectious
    Disease](http://www.guideline.gov/summary/summary.aspx?doc_id=10818&nbr=005643)

-   [Chapter 9: Occult
    Blood](http://www.guideline.gov/summary/summary.aspx?doc_id=10819&nbr=005644)

-   [Chapter 10: Intraoperative Parathyroid
    Hormone](http://www.guideline.gov/summary/summary.aspx?doc_id=10820&nbr=005645)

-   [Chapter 11: pH
    Testing](http://www.guideline.gov/summary/summary.aspx?doc_id=10821&nbr=005646)

-   [Chapter 12: Renal Function
    Testing](http://www.guideline.gov/summary/summary.aspx?doc_id=10822&nbr=005647)

-   [Chapter 13: Reproductive
    Testing](http://www.guideline.gov/summary/summary.aspx?doc_id=10823&nbr=005648)

Does transcutaneous bilirubin measurement improve clinical outcome,
shorten length of stay, or decrease readmission rate for newborns with
hyperbilirubinemia, compared with measurement of bilirubin in serum?
(Literature Search 3 -- Refer to Appendix B - see the \"Availability of
Companion Documents\" field)

**Guideline 6**. Assessment of hyperbilirubinemia with use of
transcutaneous bilirubin measurements may have utility in decreasing
readmission rate of newborns with hyperbilirubinemia and monitoring
bilirubin concentrations in newborns. To date, only 1 study has been
published that addresses this issue. Further evidence is needed to
evaluate whether transcutaneous bilirubin measurements improve clinical
outcome, shorten length of stay, or decrease the readmission rate for
newborns with hyperbilirubinemia.\
**Strength/consensus of recommendation: I\
Level of evidence: III** (clinical experience, descriptive studies, and
opinion)

Is there an optimum frequency, timing, or site of transcutaneous
bilirubin measurements that results in best agreement with bilirubin
measurements performed using serum? (Literature Search 4 -- Refer to
Appendix B - see the \"Availability of Companion Documents\" field)

**Guideline 7**. Transcutaneous bilirubin measurements performed on the
forehead or sternum are preferable to other sites and provide similar
correlation with bilirubin measurements performed in serum when infants
have not been exposed to sunlight or phototherapy. Bilirubin
concentrations should be assessed by measurement of total bilirubin in
serum or transcutaneous bilirubin measurements within the first 24 h
after birth in all infants who are jaundiced. The need for and timing of
repeated transcutaneous or serum bilirubin measurements should be
assessed with nomograms according to the postnatal age and bilirubin
concentration.\
**Strength/consensus of recommendation: B\
Level of evidence: II and III** (well-designed correlation trials,
clinical experience, and consensus opinion)

Is the measurement of bilirubin by use of a transcutaneous method
contraindicated for use in newborns who are undergoing phototherapy,
premature infants, or newborns who are ill? (Literature Search 5 --
Refer to Appendix B - see the \"Availability of Companion Documents\"
field).

**Guideline 8**. Transcutaneous bilirubin measurements should not be
performed on infants undergoing phototherapy. The guideline developers
also note that light exposure of infants who are discharged may also
adversely affect the utility of transcutaneous measurements. The effect
of gestational age on transcutaneous bilirubin measurements is less
clear. Some reports suggest limiting the use of transcutaneous bilirubin
measurements to newborns \<30, 32, or 34 weeks\' gestation, whereas
others suggest no effect of gestational age. There are too few studies
available that address the effect of underlying illness in newborns and
its effect on use of transcutaneous bilirubin measurements.\
**Strength/consensus of phototherapy recommendation: C\
Level of evidence: II and III** (well-designed clinical trials,
descriptive studies, and consensus opinion)\
**Strength/consensus of premature/gestational age recommendation: C\
Level of evidence: II** (well-designed clinical trials, descriptive
studies)\
**Strength/consensus of underlying illness recommendation: I**

Are transcutaneous bilirubin measurements associated with decreased
blood sampling compared with serum bilirubin measurements? Do
transcutaneous bilirubin measurements decrease the incidence of
complications associated with blood collection such as infection or
osteomyelitis? (Literature Search 6 - Refer to Appendix B - see the
\"Availability of Companion Documents\" field).

**Guideline 9**. There is insufficient evidence available to judge the
impact of transcutaneous bilirubin measurements on number of blood
samples collected from newborns. Whether there is any effect on
complications of blood collection such as infection or osteomyelitis has
not been adequately studied.\
**Strength/consensus of recommendation: I**

How does the accuracy of transcutaneous bilirubin measurements compare
with total bilirubin measured in serum? (Literature Search 7- Refer to
Appendix B - see the \"Availability of Companion Documents\" field).

**Guideline 10**. The guideline developers cannot recommend use of the
ColorMate III (Chromatics Color Sciences International Inc., New York,
NY) bilirubinometer, because of the limited number of published articles
describing the performance of this instrument. Evaluation of jaundice
with the Air-Shields or BiliChek seems to provide accuracy similar to
that of serum bilirubin measurements. The BiliChek and Air-Shield have
the advantage, compared with the ColorMate III, of not requiring a
baseline measurement. Finally, the guideline developers do not recommend
assessment of bilirubin with use of the Ingram icterometer (Thomas A.
Ingram and Co, Birmingham, England; distributed in the United States by
Cascade Health Care Products, Salem, OR), because of its reliance on
observer visualization of depth of yellow color of the skin.\
**Strength/consensus of recommendation: B\
Level of evidence: II** (well-designed correlation trials, clinical
experience, descriptive studies, and opinion)

Is measurement of bilirubin with a transcutaneous device more
cost-effective compared with bilirubin measurements performed in the
clinical laboratory? (Literature Search 8 - Refer to Appendix B - see
the \"Availability of Companion Documents\" field)

**Guideline 11**. There is insufficient evidence to evaluate the
cost-effectiveness of transcutaneous bilirubin measurements.\
**Strength/consensus of recommendation: I\
Level of Evidence: III** (descriptive studies, opinion)

**Definitions**:

**Levels of Evidence**

I.  Evidence includes consistent results from well-designed,
    well-conducted studies in representative populations.

II. Evidence is sufficient to determine effects, but the strength of the
    evidence is limited by the number, quality, or consistency of the
    individual studies; generalizability to routine practice; or
    indirect nature of the evidence.

III. Evidence is insufficient to assess the effects on health outcomes
     because of limited number or power of studies, important flaws in
     their design or conduct, gaps in the chain of evidence, or lack of
     information.

**Strength of Recommendations**

**A** - The National Academy of Clinical Biochemistry (NACB) strongly
recommends adoption; there is good evidence that it improves important
health outcomes and concludes that benefits substantially outweigh
harms.

**B** - The NACB recommends adoption; there is at least fair evidence
that it improves important health outcomes and concludes that benefits
outweigh harms.

**C** - The NACB recommends against adoption; there is evidence that it
is ineffective or that harms outweigh benefits.

**I** - The NACB concludes that the evidence is insufficient to make
recommendations; evidence that it is effective is lacking, of poor
quality, or conflicting, and the balance of benefits and harms cannot be
determined.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

It is hoped that these guidelines will be useful for those implementing
new testing, as well as those reviewing the basis of current practice.
These guidelines should help sort fact from conjecture when testing is
applied to different patient populations and establish proven
applications from off-label and alternative uses of point-of-care
testing (POCT). These guidelines will also be useful in defining
mechanisms for optimizing patient outcome and identify areas lacking in
the current literature that are needed for future research.

#### POTENTIAL HARMS

Not stated

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Transcutaneous bilirubin measurements should not be performed on infants
undergoing phototherapy.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The material in this monograph represents the opinions of the
    editors and does not represent the official position of the National
    Academy of Clinical Biochemistry or any of the cosponsoring
    organizations.

-   Point-of-care testing (POCT) is an expanding delivery option because
    of increased pressure for faster results. However, POCT should not
    be used as a core laboratory replacement in all patient populations
    without consideration of the test limitations and evaluation of the
    effect of a faster result on patient care.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Kazmierczak S, Bhutani V, Gourley G, Kerr S, Lo S, Robertson A, Sena SF.
Transcutaneous bilirubin testing. In: Laboratory medicine practice
guidelines: evidence-based practice for point-of-care testing.
Washington (DC): National Academy of Clinical Biochemistry (NACB); 2006.
p. 5-12. \[74 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006

#### GUIDELINE DEVELOPER(S)

National Academy of Clinical Biochemistry - Professional Association

#### SOURCE(S) OF FUNDING

National Academy of Clinical Biochemistry

#### GUIDELINE COMMITTEE

Guidelines Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee Members*: Robert H. Christenson, Ph.D., FACB, University of
Maryland School of Medicine, Baltimore, Maryland, USA; William Clarke,
Ph.D., Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Ann
Gronowski, Ph.D., FACB, Washington University, St. Louis, Missouri, USA;
Catherine A. Hammett-Stabler, Ph.D., FACB, University of North Carolina
Chapel Hill, Chapel Hill, North Carolina, USA; Ellis Jacobs, Ph.D.,
FACB, New York State Department of Health, Albany, New York, USA; Steve
Kazmierczak, Ph.D., FACB, Oregon Health and Science University,
Portland, Oregon, USA; Kent Lewandrowski, M.D., Massachusetts General
Hospital, Boston, Massachusetts, USA; Christopher Price, Ph.D., FACB,
University of Oxford, Oxford, UK; David Sacks, M.D., FACB, Brigham and
Women\'s Hospital, Boston, Massachusetts, USA; Robert Sautter, Ph.D.,
Carolinas Medical Center, Charlotte, North Carolina, USA; Greg Shipp,
M.D., Nanosphere, Northbrook, Illinois, USA; Lori Sokoll, Ph.D., FACB,
Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Ian
Watson, Ph.D., FACB, University Hospital Aintree, Liverpool, UK; William
Winter, M.D., FACB, University of Florida, Gainesville, Florida, USA;
Marcia L. Zucker, Ph.D., FACB, International Technidyne Corporation
(ITC), Edison, New Jersey, USA

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[National Academy of Clinical Biochemistry (NACB) Web
site](http://www.aacc.org/NR/rdonlyres/AD87CDD7-FA12-48C0-BA0F-BB95F15F798F/0/POCTLMPG.pdf).

Print copies: National Academy of Clinical Biochemistry publications are
available through American Association for Clinical Chemistry (AACC)
Press. To make a purchase or request a catalog, contact AACC Customer
Service at 202-857-0717 or <custserv@aacc.org>.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Preface and introduction. In: Laboratory medicine practice
    guidelines: evidence-based practice for point-of-care testing.
    Washington (DC): National Academy of Clinical Biochemistry
    (NACB); 2006. p. i-xvi.

-   Appendix A: NACB LMPG data abstraction forms. In: Laboratory
    medicine practice guidelines: evidence-based practice for
    point-of-care testing. Washington (DC): National Academy of Clinical
    Biochemistry (NACB); 2006. p. 149-153.

-   Appendix B: literature searches. In: Laboratory medicine practice
    guidelines: evidence-based practice for point-of-care testing.
    Washington (DC): National Academy of Clinical Biochemistry
    (NACB); 2006. p. 154-186.

Electronic copies: Available in Portable Document Format (PDF) from the
[National Academy of Clinical Biochemistry (NACB) Web
site](http://www.aacc.org/NR/rdonlyres/AD87CDD7-FA12-48C0-BA0F-BB95F15F798F/0/POCTLMPG.pdf).

Print copies: National Academy of Clinical Biochemistry publications are
available through American Association for Clinical Chemistry (AACC)
Press. To make a purchase or request a catalog, contact AACC Customer
Service at 202-857-0717 or <custserv@aacc.org>.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI Institute on August 10, 2007. The
information was verified by the guideline developer on September 24,
2007.

#### COPYRIGHT STATEMENT

National Academy of Clinical Biochemistry\'s (NACB) terms for
reproduction of guidelines are posted with each set of guidelines.

### DISCLAIMER

#### NGC DISCLAIMER

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Date Modified: 11/10/2008