CIULLA GEN LAB Flashcards
used in most analytical
laboratory procedures; meet the specifications established
by the American Chemical Society (ACS)
Analytic Reagent grade chemicals
have undergone additional processing that makes them suitable for special procedures such as [3]
Ultrapure reagents
AAS
Chromotography
Molecular dx
Reagent grade water meets the specifications of ____________ the standards for which were established by the__________.
Clinical Laboratory Reagent Water
CLSI
_____________
the highest quality and is used in test methodologies where minimum interference and maximum precision and accuracy are needed. Resistivity of greater than or equal to ______ at ____°C is required.
Clinical Laboratory Reagent Water
1OM*cm
25C
Processes required in preparation of reagent grade water (CLRW):
[5]
Prefilters
Activated Carbon
Reverse osmosis
Ion exchange
Submicron filter
glass or cotton microfibers that remove 98% of the particulate matter.
Prefilters
removes organic matter and chlorine.
activated carbon
emoves all particles or microorganisms larger than the membrane pore size.
submicron filter
process that removes 95-99% of bacteria and organic and other particulate matter.
reverse osmosis
a system of resin cartridges or tanks connected in series that remove cations and anions to make deionized water.
ion exchange
May require different preparation than
CLRW according to intended use, such as sterility specification for tissue or organ culture, nucleic acid content for DNA testing, metal content for trace metal analysis, etc.
Special reagent water [SRW]
Special reagent water (SRW): May require different preparation than
CLRW according to intended use, such as sterility specification for [3]
tissue/organ culture
nucleic acid content for DNA testing
metal content for trace materials
Used for internal instrument rinsing, making dilutions, etc., and needs to meet manufacturer’s specifications.
Instrument feed water
Label states intended use;do not substitute for CLRW or SRW unless
label indicates it is of such quality.
water for use as a diluent or reagent supplied by manufacturer
Exercise care because some
plastic containers permit microorganism growth due to air permeability.
Purified water commercially bottled
With purified water commercially bottled, exercise care because some
___________ permit microorganism growth due to __________.
plastic containers
air permeability
Purified to contain only low levels of organics, inorganics, and particulate matter so it does not leave residue on glassware or contaminate solutions and media in autoclaves.
water for Lab dishwashers and autoclaves
highly purified chemicals that are weighed
or measured to produce a solution with an exact concentration.
primary standard
are solutions whose values are determined
by repeated analyses, using a reference method.
secondary standard
provides reference materials for purchase.
National Institute of Standards and Technology [NIST]
NIST provides these 2 reference materials:
Standard reference materials
Certified reference materials
Values of the materials are determined by high-quality analysis, and the chemical composition is certified.
standard reference materials
certified reference materials
Units of measure: _______________ is a system of measurement that is known as ________ may be classified as [3]
System Internationale d’Unites
SI units
Base
Derived
Supplemental
________ are drying agents that absorb water from air or other materials. ___________ is one of the most effective desiccants, and ________ is one of the least hygroscopic. ___________ provide a dry environment for chemical materials.
Dessicants
Magnesium perchlorate
Silica gel
Dessicators
Laboratory supplies such as pipettes, flasks, etc. used for analytical work must meet specific ____________ as designated by the NIST. ________ is the designation used when laboratory supplies meet NIST specifications.
tolerances of accuracy
Class A
is made from soda-lime glass. It is inexpensive and used in making some DISPOSABLE laboratory glassware.
Flint glass
commonly used for laboratory glassware because of its properties, including resistance to heat, corrosion, and thermal shock.
Borosilicate glass
are glasses that can withstand high temperatures. They are made of borosilicate, which has a low alkali content.
Pyrex
Kimax
is alumina-silicate glass that is six times stronger than borosilicate glass.
Corex
It is used to make high-temperature thermometers, graduated cylinders, and centrifuge tubes.
Corex
glass can be heated to 900°C and is used for extremely high temperatures and resists heat shock.
Vycor
Chemically inert resins; generally resistant to acids, alkalis, and salt solutions
Poly-olefins/ethylene/propylene
has a clear appearance and because of its strength may be used for centrifuge tubes. Chemical resistance is less than the polyolefins.
Polycarbonate
Chemically inert and used for temperatures from —270 to +255°C; provide non-wettable surface; used for stir bars and tubing.
Fluorocarbon resins [Teflon]
types that have the bulb closer to the center and accurately deliver a fixed volume of [viscous flluid/aqueous solution]. They drain by gravity and should not be blown out.
volumetric pipettes
aqueous solution
TD types that have the bulb closer to the delivery tip because they deliver [viscous fluid/aqueous solution]. These pipettes deliver an accurate volume by being “blown out” using a pipetting bulb. An __________ near the top of the pipette indicates the need to “blow out.”
ostwald-folin pipettes
viscous fluid
etched rings/pair of etched rings
transfer pipettes [2]
volumetric
ostwald-folin
are TD types of measuring pipettes that are calibrated to the tip and must be “blown out” to deliver entire volume.
serologic pipettes
are TD types of measuring pipettes that are calibrated between marks and cannot be “blown out.”
Mohr pipettes
Pipettes labeled “to contain” (TC) must be rinsed out to deliver the entire contents. _____ pipettes and some ______ pipettes are in this category.
Sahli
Capillary
are handheld pipettes that use disposable tips, and the laboratorian performs aspiration and dispensing.
semiautomatic pipettes
are electronic and may not require tips. Many use a glass syringe that aspirates and dispenses through the same tube.
automatic pipettes
This method verifies the amount of liquid dispensed by a pipette. All equipment and water must be at room temperature before beginning.
Gravimetric pipette calibration
A specific amount of water is pipetted into a weighed container and the weight of the water is determined. The weight of the water is proportional to the volume of water pipetted.
Gravimetric pipette calibration
: This method uses a dye of known concentration and water.
Volumetric pipette calibration
A specific amount of dye is pipetted into a specific volume of water. Depending on the volume of the pipette, the absorbance of the solution will read a predetermined number. The pipette can then be adjusted, and the calibration repeated.
Volumetric pipette calibration
________accelerate gravitational separation of substances differing in their masses. ___________ is dependent upon several parameters, including mass and the speed and radius of rotation.
Centrifuges
Centrifugal force
Centrifuges are used to separate blood cells from __________, separate particulate matter in __________, and separate two liquid phases of different __________.
plasma or serum
urine
densities
Centrifuge speed should be checked periodically with a ___________ for accuracy.
tachometer
________________
allow the tubes to attain a [vertical/ horizontal position] in the centrifuge when spinning and a [vertical/ horizontal position] when the head is not moving.
horizontal head/swinging bucket centrifuges
horizontal position
vertical position
have angled compartments
for the tubes and allow small particles to sediment more rapidly.
angle head/fixed angle
_______________
are high-speed centrifuges used to separate layers of different specific gravities. They are commonly used to separate __________. The chamber is generally [action] to counter heat produced through friction.
Ultracentrifuges
lipoproteins
refrigerated
_________ is a physical property of matter.
mass
A ________ compares the mass of an unknown against a known mass.
balance
NIST recognizes [#} types of calibration weights for assessing the accuracy of balances.
_________weights are use to check analytical balances for proper calibration.
__________ weights have the quality of a primary standard and are used to check the accuracy of other weights.
5
Class S
Class M
_________: have greater tolerance than Class S weights; are used for routine analytic work
_________: have greater tolerance than Class S-1
_________: are intended for micro analytical work and range from 50 to 0.05 m
CLASS S-1 WEIGHTS
CLASS-P WEIGHTS
CLASS J WEIGHTS
_____________has a single beam with arms of equal length. Standard weights are added manually to the pan on the [left/right] side
to counterbalance the weight of the object on the [left/right-side] pan.
Double-pan balances
right side
left-side
has arms of unequal length. The object is placed on a pan attached to the shorter arm. A restoring _____ is applied
mechanically to the other arm until the indicator is balanced.
Single-pan balances
force
utilizes ___________ force to replace the weights as the counterbalance, with the force being proportional to the weight on the pan.
Electromagnetic force
There are three types of thermometers: ___________ (replaces mercury type), ___________, and __________ (1 example).
liquid-in-glass
digital
electronic
thermistor probe
Thermometers should be calibrated using an ______-certified thermometer; It provides an _________ thermometer with several calibration points, such as _____°C and _____°C.
NIST
SRM
30
37
Changes in analyte concentration occur at different times during the day, week, or month
Cyclic variation
Variation according to sleeping and waking times
Diurnal variation
Occurs during a 24-hour period
Circadian variation
Occurs twice a year; related to seasonal changes in climate and diet (elevated in the summer, decreased in the winter)
Circannual variation
3 Physical variables affecting laboratory determinations
Exercise
Eating
Stress
Exercise may cause alteration of [8 analytes]
ACCPPPLL
AST
Creatinine
CK
Protein
Potassium
Phosphate
LDH
Lactic acid
Eating causes increased in [ 8 analytes]
CGGIILTs
Creatinine
Gastrin
Glucose
Insulin
Iron
LD
TAGs
Sodium
Stress: May cause increase in [4 analytes] and even decrease hormone production of [2]
ACTH
Cortisol
Cholesterol
Pituitary hormone
ALDO
Short draws for _____________ are not acceptable.
coagulation studies
____________
caused by tourniquet use and repeated fist clenching, as well as improper drawing techniques, can lead to increased serum potassium, proteins, and metabolic by-products, as well as _________ of red blood cells.
Stasis
hemolysis
Increased analytes in prolonged tourniquet
K+
Na
Lactic acid
Potassium
Protein
Increased analytes in fist clenching
Na
Lactic acid
Phosphate
Hemolysis cauases an increased values in analytes [8]
Creatinine
K+
LD
AST
ALT
ALP
Aldolase
Magnesium
Phosphate
interferes with assays for a number of analytes.
Lipemia
Drawing from a vein receiving intravenous (IV) fluid dilutes blood analytes but increases the value of analytes present in the IV fluid [4]
NAKCLGlu [nak sali glue]
Na
K+
Chloride
Glucose
[3] are major concerns in specimen collection. Proper protocol must always be followed.
Px ID
Spx ID
Chain of custody
Although sample transport is always important, it is of special concern for accurate analysis of some analytes. Specimens for [2] analysis should be placed on ICE for transport to the laboratory. [1] specimens drawn in plastic syringes should be transported immediately to the laboratory for analysis.
Ammonia
Lactic acid
Blood gases [pH]
Sample processing involves logging the specimen into a ___________ and assigning the sample an ___________, sorting and delivering specimens to various departments for testing, centrifuging to separate/remove serum or plasma from red blood cells(if not in a gel separator tube),
Laboratory Information System [LIS]
ID number
______________ involves logging the specimen into a laboratory information system (LIS) and assigning the sample an identification number, sorting and delivering specimens to various departments for testing, centrifuging to separate serum or plasma from red blood cells, and removing serum or plasma from red blood cells (if not in a gel separator tube),
Sample processing
Separate serum or plasma from __________ as soon as possible, and preferably within [#] hours of blood draw (may need to be sooner for some analytes).
_____________ are commonly used in hospital situations, and they provide a good alternative for off-site collection provided a centrifuge is available (physician offices, clinics).
RBC
2hrs
Gel separator tubes
Serum/plasma can generally be stored at _____°C for 2-3 days; for long periods, storage at ___°C is recommended for many analytes.
2-8C
-2OC
2) For an inpatient, compare the patient’s name and identification number
on the patient’s ________ to the laboratory requisition. _________ may be used to scan patient identification band for confirmation.
ID band
Electronic scanners
3) If the patient is an inpatient and an identification band is not present, the px’s [2 subjects] must be asked to identify the patient. Their name must be recorded on the laboratory requisition.
nurse
physician
If the patient is an out patient without an identification band, the patient must provide ___________` for proper identification.
2 unique identifiers
Select the venipuncture site: The preferred collection site includes the [2] as a last resort, the _________ can be used but caution must be taken because of its close proximity to the median nerve and the brachial artery.
median cubital vein
cephalic vein
basilic vein
Gloves, alcohol swabs [__________ for blood cultures and alcohol levels], gauze, tape or band aids, evacuated blood collection tubes, needles, needle holders with safety, and tourniquets [Velcro or latex band; alternative non-latex, _________: should be used because of latex allergies].
____________ are used for finger sticks.
betadine
nitrile materials
lancets
When selecting blood collection tubes, use tubes with the smallest volume necessary for testing to prevent _____________
iatrogenic anemia
Apply the tourniquet and palpate using two fingers to select the most appropriate collection site. The phlebotomist should never leave the tourniquet on the patient more than 1-2 minutes. Patient results will be affected; blood may become more [diluted/concentrated] because of blood flow _______. If the tourniquet is left on the arm for a prolonged time period, it could also increase the chance of pain and discomfort to the patient and the possible formation of a ___________.
concentrated
stasis
hematoma
Needles are usually ________ gauge. A higher number means a smaller needle diameter.
20 or 21
Assemble the needle and needle holder with the evacuated tube, or needle and ______ for blood cultures or collection from fragile veins. Because of small-diameter needles (23 gauge), some phlebotomists prefer using the ________ for difficult draws. It is, however, more difficult to collect large quantities of blood using this.
syringe
butterfly method
1) Needle should enter the site at a _________-degree angle, with the bevel of the needle facing [up/down].
2) Advance the evacuated tube onto the needle; change tubes carefully without moving the needle. If the collection tube has an anticoagulant, invert [#] times before progressing to the next tube.
3) Once good blood flow is established or the last tube has been advanced onto the needle, the tourniquet should be removed.
15- to 30
up
2-3 times
Remove the needle and then immediately apply [action] to the site using a gauze pad.
Engage the safety on the needle immediately and discard needle into shaips container. Phlebotomists should [recap/never] contaminated needles.
If bar coding is not used, label all tubes completely. Although labeling
requirements vary among facilities, most require date and time of collection, name or initials of phlebotomist, and patient’s name and ____________.
pressure
NEVER RECAP
tubes used when serum is required for the test
Red stopper
SST
May be used for routine chemistries, therapeutic drug levels,
immunohematology, and serology
Red stopper tubes
tubes contain ethylenediaminetetraacetate (K3 EDTA),
an anticoagulant.
tubes contain ethylenediaminetetraacetate (K2 EDTA),
an anticoagulant.
Lavender
Pink
EDTA ratio is [#] mL of whole blood. Coagulation is prevented by [Action], which forms an _____________+.
1mL
chelation
insoluble calcium salt
Used in hematology for complete blood count, slide preparation, and other routine hematology procedures; also used in immunohematology and for some special chemistry assays
Lavender tube
Alternative formulation of Lavender tube ___________ may be used in immunohematology.
Pink stopper [K2 EDTA]
____________ tubes contain sodium citrate, an anticoagulant
Blue
Sodium citrate (3.2%) in a _____ ratio, [#] part sodium citrate to [#] parts
whole blood
1:10
1
9
Prevents coagulation by removing ionized calcium (chelation)
[3 tubes]
Lavender
PInk
Royal Blue
Used for coagulation studies (e.g., prothrombin time and activated
partial thromboplastin time)
Blue
_________ tubes contain heparin, an anticoagulant.
Green
Several forms of heparin are available [2]
Sodium
Lithium
ratio is 0.2 inL/1 mL of whole blood.
Heparin- Green
Prevents coagulation by inactivating thrombin
Green
Used for routine and special chemistry and cytogenetic testing
Green
contain a gel separator and often contain clot activators.
Speckled, tiger, or marbled top serum separator tubes [SSTs]
They are used frequently
in clinical chemistry for a number of assays. ______________ are
not recommended for immunohematology or drug levels.
Serum-separator tubes
contain a gel separator and an anticoagulant. In some cases, the PST stopper color is ________, which indicates that _____________ is the anticoagulant.
Speckled, tiger, marbled top plasma separator tube [PSTs]
green
lithium heparin
For PSTs/SSTs,
The separator is a ____________ that forms a barrier between the cells and the serum during centrifugation.
thixotropic gel
PST or SST
These tubes are useful when serum is needed
These tubes are useful when plasma is needed.
SSTs
PSTs
_______________
reduce the time needed for clot formation and thus speed up the assay process. They are used frequently in clinical chemistry for a number of assays but are not recommended for immunohematology.
PSTs
RED no additive
RED SSTs
Which of which is not recommended for immunohematology and drug levels
RED SSTs
To prevent anticoagulant carryover and contamination when using a
needle and needle holder for blood collection, the following order of draw should be used:
1. sterile specimen [_________]
2.
3.
4.
5.
Blood culture
Light blue/Na Citrate - Coagulation
Plain RED/SST
Green/PST
Lavender/EDTA
When using the butterfly (winged collection set) to collect a sodium citrate tube, if it is the first tube to be collected, then a _________ [2 options] must be collected first to remove the _____ from the tubing.
Sodium citrate tubes must be [partially/completely] filled to ensure the correct plasma: anticoagulant ratio, or the test results could be compromised.
Discard tubes
Plain red
Another Na citrate
air
completely
