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specimens and special collections, Specimen handling and transport., urine…
specimens and special collections
specimens and tests
fasting specimens
no foodor drink for 12 hours
caffine and nicotine prohibited
verify last food or drink
if less than 12 hours note on the requisition form isf a 12 hours fast was not complete
notify physician if in doubt
scheduled early morning
timed specimens
two hoirs postpradial glucose test
diabetic patients results will be higher than normal
otherwise results will have returned to normal
glucose tolerance test GTT
obtain 12 hour fasting specimn
patient consumes glucose solution
obtain 1 hour and 2 hour postprandial specimens
therapeutic drug monotoring TDM
Trough level- lowest serum level immediately before next drug dose
peak level highest serum level after the drug is administered and takes effect
label specimens with time
blood cultures
blood cultures
performed at times intervals
obtained from multiple sites
cleanse area with alchol or chlorexidine
ratio of blood to culture media is critical
containers used
long necked bottle
shorter bottle
standard evacuated tube
multiple sites on same arm used to identify skin bacteria against bacteria found in the sample
consult attending physican for correct collection container and site
Aerobic sample
cintianes oxygen from exopsure to air
anaerobic sample does not contain oxygen so it is drawn first and not exposed to air
label samples accordingly
blood donor collections
patient screening
registration
obtain and review of medical history
obtain weight blood pressure pulse and hemoglobin level
blood donation
use large vein in antercubital area
donor is asked to pump fist
hemoconcentration does not cause rejection
blood donors
17 years old or older
at least 110 pounds
56 days or larger between donations
hematocrit of 38% or higher
apheresis
allows the removal of plasma from whole blood
male donors must wweigh 130 pounds with height of 61 inches or greater
female donors must weigh 150 pounds with a height of 65 inches or greater
tranfusions
antologous donation
patient donates blood for their own transfusion
therapeutic phlebotomy
a porocess of removing blood as treatment for a disorder
polycythemia
rbcsexcessive production of
hemochromatosis
excess iron in the blood
special collection handling
temperature sensitive
agglutination is the clumping pf particles , the word agglutination comes from the latin word agglutinare (glueing to)
agglutinin level specimens must be kept warm until the serum is seperated from RBCs 98 degrees F oor 37 degrees
C
kept warm or oprewarm a plain red topped tube
place specimen in heel warmer or incubator
transport to laboratory as quickly as possible
these types must be kept warm
cyrofibrinogen
cryoglobulin
must be kept cold
ammonial levels
arterial blood gases
lactic acid levels
places in ice slurry
bright strait to loboratory in 5 min
lactic acid test
do not use tourniquet
patient does not make a fist
light sensitive
protected from light by wrapping in aliminum fdoil
bilirubin level
folate levels
time sensitive
specimens must be taken and anylized within 1 hour
coagulation tests
ammonia levels
prothrobin timePT
can sit at room temperature for up to 24 hours 71.6 degreees F or 22 degrees C
forensic specimens
chain of custody required in legal proceedings
ensures the sample is lways in the custody of entrusted person
prevents tampering mis-identification or interference with test results
chain of custody
patient if identified
consent is signed
document date and time of specimen collection on the form
everyone must sign that they have handles or been in contct with the soecimen,
match case number with requisition
alcohol levels
site must be cleaned with soap and water
tubes must be filled as full as possible
note on requisition form the solution used to clean the site
blood spears
microscopic examination of blood cells for differential
obtained by dermal puncture
smearing is a for of blood on slide or wedge method
specimen processing
PPE must be workl
gloves , full length lab coat buttoned with closed cuffs
protective face gear can include goggles, masks or chin length face shield
central processing
specimens arrive in laboratory ande are sorted
marked with Accession number , identifying and cataloging the sample
pre-centrifugation- the period from specimen collection until centrifuging
after blood clotted for 30 minutes , serum and plasma are seperated using the entrifuge
tubes with their stoppers intact are placed in the cetrifuge
the centrifuge is always filled with an even number of tubes of equal volume across from each other
with only one sample use tuube containing an equal volume of water placed across from is for balance
post centrifugation the period after tubes have been completely spun
aliquots small portions of a specimen
used to distribute to various laboratory areas
portions gatheres with pipet
always wear PPE when reomoving stoppers
formation of aerosol isa risk
microscopic mist of blood can splatter
specimen rejection
impriper identification
hemolysis has occured
incorrect or expired tube
inadequte blood and additive atio
insufficient speimen volume
incorrect specimen timing
contaiminated specimen
informatics
electronic processing methods
bar code scanning
reduce errors
use of technology to inout and access
specimen data
electronic health records
print specimen lables and documents
three basic systems
manual require human interaction
semi automated require partial interaction
automated required interaction only with errors
Specimen handling and transport.
time constraints
if not centrifuged deliver specimen to lab within 45 min
once centrifuged sample can be held for longer periods
General guidlines
blood tubes with additives are inverted 5-10 times
use gengtal technique to prevent hemolysis
properly label specimen containers
place requiaitions in font pouch of leak proof biohazard bag
crash proof containers are used for transporting from one facility to another
keep tubes upright
Glycolysis
timing is critical
tests impacted
glucose
potassium
phosphorous
thermalabile specimens
must be kept cold using in aice slurry
ammonia
lactic acid tests
phhotosensitive specimens
bilirubin is most sensitive to lightd
drawn in amber colored tube
wrapped in aluminum foil
amber brown biohazard bag
methods of transport
pneumatic tube system
hand delivery
automated transport vehicle
shipment to anotther facility
use watertight inside and outside containers
include coolnts if necessary
urine and fecal specimens
three tpes of urine samples
random
used to measure elements and detect metavllic abmoralities
first morning
more concentrated and used to detect chemicals not found in more dilute specimen
timed
collect all but th first morning specimen for 24 hours
used to measure elelments and detected metabolic abnormalities
urnie collection
midstream clean cath is most common using sterile container
requires cleaning the area surrounduing the urethra
initial and final stream of urine is voided into toilet
drug testing
collection of urine specimen
testing for adulteration
chain of custody
poper identification of the patient
anyone who handles the specimen must document each step and provide signature
fecal specimen
collection for intestinal infections parasites and colorectal cancer
three types
occult
sreeening
avoid eating meat for three days
avoid vitamin C and asprin
randon
72 hour
testing for other specimensa
semen specimen
determine
viability of sperm
fertility of sucess of a vasectomy
rape kit results
facility requirments for collection
use sterile container
keep warm and awayh from light
label and deliver to lab within one hour
respiratory tract specimen
salva
collected from the mouth
Sputum
is collected from the lungd wtih deel coughing before eating or drinking
throat swab collected from back of throat and tonsils
buccal swab collected from inside of cheek
point of care
CLIA waved tests
Fecal occult blood POCT
non blood specimen
kit used with reagent card
urinaysis POCT
dipstick with reagent
pregnancy rest determines presence of hCG using first morning urine specimen
infectious diseases
rapid group A Streptoccus
respiratory syncytial virus RSV
influenza A and B
helicobacter pylori
infectious mononucleosis
human immunodeficiency virus HIV
infectious disease CLIA waived tests
conducted using kits
inclide necessary reagents and cassettes
require throart , nose, or whole blood specimens
report resukts immediatly to physician
rapid group A streptococcus POCT
requires throat swab
negative pr positive results in 3-5 minutes
respiratory syncytial virus RSV and influenza A & B POCT
require nasal or nasopharyngeal swab
kit will provide directions for quality control ad test coimpletion
POCTnreuiring whle blood
helicobacter pylori
mononucleosis or epstein Barr virus
human immunodeficiency virus
common CLIA waved tests
point f care testing POCT
Electrocardiograms ECGs
fecal occult blood
urinalysis UA
pregnancy testing
strept throat testing
HIV testing
CLia Waved tests
Approved by FDA for home use
easy to use
risk of error is low
common POCT
CLIA waived tests
Hematology
hemoglobin
conducted using a hand held analyzer
capillary puncture
g / dL
woemn
12-16
men
14-18
hematocrit
capilary blood
microhematocrit tube used
spun with centrifuge
normal range
42-52 males
36-48 females
RBC WBC can also be found using these methods
coagulation
coagulation tests for clotting disorders
prothrombin time PT
normal 10.4-15.7 seconds
international normalized ratio INR normal 0.8-0.12 seconds
chemistry
tested fo
glucose
glucometer is used
calibrated to determine accuracy
quality control determines accuracy of test strips when a new package is opened
normal fasting glucose is 70-100 mg/dL
a low glucose causes an abnormally fast heart rate
hemoglobin A1C tested with handheld device
determines long term effectivness of diabetic therapy
electrolytes
sodium
potassium
chloride
calcium
magnesium
cholesterol
HDL
LDL
normal total cholesterol is below 200 mg / dL
point of care abbreviations
for testing procedures
POCT
point of care testing
POC
Point of care
CLIA
Clinical laboratory imporvment amendment
FDA
Food and drug administration
ABGs
Arterial Blood gasses
HCT HGB
Hematocrit
hemoglobin
PT
Prothrombin time
INR
internatinal normalized ratio
oither tests done using special tecniques
HIV
Human immunodeficiency virus
EBV
Epstein Barr Varius
RSV
Respiratory syncytial Virus
NP
Nasopharyngeal
g/dL mg/dL
phlebotomy key terms
terms that are for phlebotomy and the lab
quality phlebotomy
strives to achive the highest quality of care
reduces errors
increases efficiency
total quality mnagment TQM
entire set of approaches providing patient satisfaction
continuous quality improvement CQI
used to continually monitor and improve quality
qualitry assurnace QA
larger set of methods used to guarantee quality care
quality control QC
qualitiative method used to ensure accurate results
delta check
part of QA that helps spot identification errors
pre-analytic variables
conditions that affecnt test results prior to analysis
procedure manual
contains protocals and information about tests performed in the laboratory suc as policies and procedures
montoring variables
pre-analytic variables
patient wait time
accuratee identification
technical proficiency
specimen handling
laboratory requisitions
includes patients number test ordered and priority
be sure there are no duplicates
equiptment supplies for expiration dates
check equipment for defects
speciment collection
proper identificationand preperation
proper technique and timing
attentio to asepsis
consideration or the patient
additional pre analytic variables
proper transportation methods
proper processing of specimens
additional pre anylytic variables
report maintenenance needs to the laboratory technician to complete
properly handle and lable specimens and aliquots
analytic variables
most testing is performed by the laboratory scientists or technician
CLIA waived testing performed within contol of the phlebotomist
make sure instruments are calibrated and quality control is complete
post analytiuc variables
report point of care test results to physician
conduct delta check
quality phlebotomy
Qulity Assurance QA
sets the standards for procedure performance
monitors compliance woith written procedures
tracks patient outcomes
evaluates laboratory processes
delta check can detect ID errors
coompares previous patient results with current results
can alert lab personnel to possible error
Quality Control QC
quantitative methods used to monitor procedure quality anbd accuraacy
assure devices worlk properly
determine accuracy of testing supplies
procedure manual
test protocals
purpose of test
specnimen required
collection method
equiptment needed
directory of services
correlates nuring staff and laboratory personnel
test schedukes
collection schedules
schedule changes
patient preparation information
normal test values
