1010 Unit 4 Flashcards
What is in the hepatic (river) package/panel
- ALT
-AST - bilirubin
-ALP
-ALB
What is in the cardiac panel/package?
-CK
-LDH
- troponin
-CK-MB
What is in the lipid package/panel?
- Triglycerides, cholesterol
What is in the kidney panel/package?
-BUN
-TP
- creatinine
-ALB
Describe specimens collected in lavender tops
-EDTA gel
-used for hematology testing
-examples
→CBC
→G6-PD
→ hgb
→ hct
→ESR
→HA1c
What is the draw order for ETS?
1) blood culture or sterile yellow tube
2) light blue
3) red
4) SST
5) PST
6) green
7) lavender
8) gray
What is plasma?
Liquid portion of non-clotted blood
What are input devices?
- Monitors
- touch screen
- barcode readers
What is a buffy coat?
Middle layer of plasma speciemen which contains platelets and leukocytes
Describe heel stick procedure
1) Warm feet ‘
2) use tender foot lancet
3) pierce <2.0 mm deep on medial or lateral surface
4) wipe away first drop
5) note how much blood is drawn from neonate
What is a hematoma?
Collection of blood under skin
→ can be caused by failure to remove tourniquet before removing needle
What is interface?
Ability of computers to talk to each other
What is an output device?
- Monitors
- printers
- on board instrument displays
What is middleware?
Software that connects software components or applications
What is serum?
Liquid portion of clotted blood, does not contain fibrinogen
Hemoconcentration
Concentration of hemoglobin caused by leaving the tourniquet on longer than one minute
What are tests that need to be put on ice?
- Lactic acid
- ammonia
What is order of draw for capillary?
- Blood gases
- EDTA
- other additives
- serum
What are post analytical functions of LIS?
- Laboratory report
- critical patient results
What are analytical functions of LIS?
- Molecular and genetic data
-autoverification
Describe green top tubes
-chemistry department
- contains sodium heparin or lithium heparin
Describe pink top tube
- contains EDTA
- used for blood bank
- examples
→ABO/Rh
→ type and crossmatch
→ type and screen
What are common sites for venipuncture?
- Median cubital vein (preferred)
- cephalic vein
- basilic vein
What is a sign of icterus?
Brown or yellowish serum or plasma due to excess bilirubin
What is a sign of lipemia?
Plasma or serum that looks milky due to high lipid counts
What is a sign of hemolysis?
Plasma or serum that looks red or pink due to lysed RBCs
What needs to be protected from light?
- Vitamins
- bilirubin
What are the 5 identifiers?
- Patient name
- ID number
- date
- time
- tech initials
What is the most important step in infection control between patients?
Washing hands
What are pre analytical function of LIS?
- Patient demographics
- testing ordering
What color tube tops are for serum?
- Red
- marble
- gold
What is autoverification?
Computer based algorithms automatically perform actions on a defined subset of laboratory results without the need for manual intervention
What should you do it patient has IV in one arm?
Draw the other arm or below one in both arms
What colors represent plasma tubes?
- Lavender
- light blue
- green
What occurs when drawing blood from a vein too quickly from small or delicate veins?
Vein collapse
What color tube is associated coagulation?
Light blue
How are needles color coded?
By their gauge size
What does the royal blue top for?
To minimize trace elements contamination ( heavy metals)
What happens of patient has no ID band?
Notify patients nurse. No blood can be drawn without an I’d band.
What tube color and department will you find GS -PD?
- Lavender
- hematology
What are reasons for skin puncture to be preferred ?
- Mastectomy
- IV in both arms
- burn patients
- obesity
- damaged veins/too fragile/too small
- geriatric and pediatrics
- diabetes
- chemotherapy
What tube color top is for antibody ID?
Pink/purple
Define quality assessment
- Maintain and control processes involving the patient and laboratory analysis of specimens
What do you do when an adult patient refuses their blood to be taken?
- Just document on requisition, ,It is their right
Describe things to keep in mind when dealing with geriatric patients
-treat w/dignity and respect
- address as Mr. And Mrs.
- be aware of difficulties such as dementia, hearing and sight loss
What is isolation as safety system?
Separation of a seriously ill patient to stop the spread of infection or to protect the patient from irritating factors
What are standard and additional precautions tor infection control?
- Contact precautions
-airborne precautions - droplet precautions
- reverse isolation precautions
What are some things that could affect blood collection?
-fasting/non-fasting
-medicines
- activity
- time of day (circadian/diurnal)
- posture
- smoking
- alcohol
What are two blood collection procedures?
- Venous blood
→ veins - peripheral
→ capillary or skin
→ → finger sticks
→ → heel sticks
How can you tell plasma and serum apart?
Plasma has fibrinogen
What is an additive?
- Substance added to the blood draw tube
What are anticoagulants?
Substances that prevent blood from clotting
Describe the sodium fluoride additive
-antiglycolytic agent
-keep glucose from breaking down
What are common anticoagulants and what are their roles ?
- Dipotassium EDTA → binds or chelates calcium
- sodium citrate → binds calcium
- heparin → inhibits thrombin
-oxalates→precipitate calcium
What are some adverse effects of additives?
-interferes with assay
-removal of constituents
- effect on enzyme action
- alteration of cellular constituents
- incorrect amount of anticoagulant
What components are needed for syringe techniques?
- Needles(21 - 23 gauge and 1-1 1/2inch)
- syringe ( barrel, graduated and plunger)
- syringe transfer device
What is the order of draw for syringes?
- Yellow ‘
-light blue - lavender
- green and grey
- gold
- red
What supplies is needed for venous blood collection?
- Gloves
- antiseptic→70% isopropyl alcohol, povidone-iodine, and 0.5% chlornexidine gluconate
- gauze
- bandages
- needle/sharps container
- sharpie
-tourniquet
-needles
→ gauge
→ length
Describe gauges
- Number related to diameter of lumen
- larger the gauge number,the smaller the actual diameter of needle
Describe length of needle
- 1 to 1 1/2 inch most common
- slightly longer to accommodate reshearthing feature
- 1/2 to 3/4 inch for butterfly needle
What is the most common method of blood collection?
Evaluated tube system
Describe syringe system
- Most unsafe
- different draw order
-No anticoagulant in syringe
Describe infusion winged set
- Most effective for small veins
-Very costly
What are the 2 combination systems in blood collection?
1) winged with ETS
2) winged with syringe
What is the initial steps to blood collection ?
- Properly ID patient
– wash hands - assemble an equipment
- put on gloves
How do you prepare the venipuncture site?
-clean site with antiseptic in concentric circle
-wipe dry w/ gauze using sterile technique
Describe termination of the blood collection
- Release tournishet before removing needle
- if pressure not applied after removing needle, it will cause a hematoma
-label all tubes
-Clean area appropriately
-thank patient and wash hands
What are complications of blood collection?
- Vascular (bleeding from site and hematomas most common
-infections (2nd most common) - anemia
-neurological - cardiovascular (hypotension ,syncope, shock and cardiac arrest)
- dermatological (allergies to iodine)
Describe blood culture collection
- Must be sterile
- clean with alcohol followed by iodine
- special tubes (yellow) or bottles are used
-A request for 2 blood cultures→ collect in two different locations
What is an important step when performing skin puncture?
- Must always wipe away first drop,
What is found in capillary blood?
-venous
-arterial fluids
-tissue fluid
What is the use for skin punctures?
- Blood clot collection for neonatal screening programs
- capillary blood for testing at the bedside (point-of-care testing)
What are the supplies needed for skin puncture?
- Lancets
- capillary tubes
- gauze pads
-band-aids
How do you prepare site for skin puncture?
-use alcohol to cleanse
- wipe dry w/ gauze pad
Describe process of the actual skin puncture
- Use a lancet for finger sticks
- use a tenderfoot lancet for need sticks ( equal to or less than 2.00 mm)
- always wife away first drop
What is the appropriate site for a heel stick?
-medial or lateral plantar surface
- never arch or the heel
What is the appropriate site for a finger stick?
-used 3rd or 4th finger
-puncture to the side of the whorls
Describe procedure for capillary blood for microspecimens
- Wife away 1st drop, apply slight pressure
-touch 2nd drop to lip of microtube - continue applying slight pressure and release to collect enough speciemen
Describe procedure for collection of blood for slides
-wife away 1st drop, touch 2nd drop to slide
- do not touch the skin
Describe laser equipment in skin puncture
-Vaporizes tissue about 1-2 mm into capillary bed
- can draw 100 ul blood sample
Describe processing blood specimens
-use of serum separator tubes
→→ gel barrier: weight is in between serum and cells
- centrifuging the specimens
→→ once clotting has taken place, specimens must been spun down for testing
What are unacceptable specimens?
-hemolyzed
- icteric
-lipemic
What are drug effects on specimens?
- Certain medications give invalid chemistry results
-in vivo or in vitro
Describe logging and reporting processes
- All laboratory specimens must be logged in to the laboratory
- all reports must be printed and sent to the physician
Describe preserving and storing specimens
- Storage of processed specimens
→prefer to test laboratory specimen immediately
→ if testing is delayed, specimen can be refrigerated or put in the freezer (lower temperature give agreater stability of chemical constituents)
→ never freeze CSF - always check the laboratory manual for details concerning test storage
- some test must be protected from light or put on ice
What are the types of urine specimens?
1) random specimen ‘
2) first morning specimens
3) midstream clean-catch speciemen
4) 24 hour or timed specimen
5) catheter collection specimen
6) suprapublic aspiration specimen
7) pediatric specimen collection
What is a random specimen?
Anytime
Describe a 24 hour or timed speciemen
Collected over a period of time
Describe suprapubic aspiration specimen
Collected by a needle inserted into the bladder from the abdominal wall
What are some containers for urine collection?
-urine collection cups
-urinalysis tubes
- 24 hour collection container (some contain acid)
-urine culture containers
- urine transport tubes
Describe preservation of urine specimens
- Decomposition of urine begins in 30 minutes
- refrigerate if testing must be delayed
Describe labeling and processing of urine specimens
- Labels ‘
- collection date and time
- collection method
- proper preservation
-light protection
What is an synonyms of bronchoalveolar savage?
-bronchial washings
What are cerebrospinal fluid synonyms?
-spinal fluid
-lumbar puncture fund
- ventricular fluid
- meningeal fluid
What are synonyms of peritoneal fluid?
- Dialysate fluid
- paracentesis fluid
- ascitic fluid
What are synonyms of pericardial fluid?
-fluid from around the heart
- pericardiocentesis fluid