L3: Specimen Collection, Handling, and Storage Flashcards
1
Q
Examples of methods that lead to improperly collected, handled, and stored sample (may lead to false negative/positive results) :
A
- Contamination due to poor collection technique
- Poor specimen quality
- Wrong timing
- Insufficient quantity
- Suboptimal storage
2
Q
A blood sample that is cloudy or turbid has lots of fat. What do you call this sample?
A
Lipemic
3
Q
In routine handling of mixing tubes by inversion, Number of inversions depend on
the _______________, but it is usually 3-10 gentle inversions
A
type of additive or anticoagulant
4
Q
What does rough handling do to blood specimens when transporting?
A
- hemolyze the specimens,
- activate platelets,
- affect the coagulation, and even
- break the glass tube
5
Q
Why should specimen tubes be transported with the stoppers?
A
- avoid spillage of the specimen
- minimize agitation
- aid in clot formation for serum tubes
6
Q
Transport mediums allows the growth of both the pathogen and contaminants, but some have chemicals that prevent contaminants from growing. What do you call these chemicals?
A
inhibitors
7
Q
What could happen to a swab sample if it’s not placed in a transport medium?
A
It will dry up and be rejected
8
Q
T or F. The transport medium is non-nutritive so it does not allow proliferation of organisms
A
T
9
Q
What are the 2 characteristics of the enterobacteriaceae family?
A
- gram negative (pink)
- Medically significant
10
Q
Transport Media to be used is dependent on the suspected pathogen. What are used for bacteria, viruses, and parasites?
A
- Bacteria –Cary Blair for enterics, Amies for other bacteria
- Viruses – virus transport media (VTM)
- Parasites – 10% formalin to preserve morphology of trophozoites
11
Q
Who are the members of the Enterobacteriaceae family (enterics)
A
EKESS
12
Q
What are the Characteristics of trophozoites?
A
- morphologic form
- multiplies
- has pseudopods
- isolated from watery stool
13
Q
What happens to some specimens when cooled below body temp?
A
precipitate or agglutinate - REJECT
14
Q
Tubes should be prewarmed at what temperature?
A
37 deg C
- using portable heat blocks which could hold the temp for 15 minutes from removal from the incubator
15
Q
When should you use heel warmers?
A
used for specimens that can withstand a temperature slightly higher than 37 °C
16
Q
What 3 important analytes should be used if the sample is transported below the body temp?
A
- Cold agglutinins,
- Cryofibrinogen, and
- Cryoglobulins
17
Q
What are some examples of analytes to be tested from chilled specimens?
A
- ACTH,
- acetone,
- angiotensin-converting enzyme (ACE),
- ammonia,
- catecholamines,
- free fatty acids,
- gastrin,
- glucagon,
- homocysteine,
- lactic acid,
- PTH,
- pH/blood gas,
- pyruvate, and
- renin
18
Q
What are some Examples of analytes that are light sensitive?
A
- Bilirubin,
- carotene,
- red cell folate,
- serum folate
- Vitamin B2, Vit. B6, Vit. B12, Vit. C,
- urine porphyrins, and
- urine porphobilinogen
19
Q
What should be done to speciments after collection? (4)
A
(1) identified,
(2) logged or accessioned,
(3) sorted by department and type of processing, and
(4) evaluated for specimen suitability.
20
Q
Any specimen will be rejected for the following reasons:
A
- Specimens not identified properly
- Inadequate volume to complete the test
- Hemolyzed
- Wrong collection tube used
- Outdated tube
- Improper handling/Improper mixing
- Contaminated specimen
- Specimen is insufficient
- Incorrect collection time
- Specimen exposed to light
- Procedure did not follow testing time limits
- Delay or error in processing
21
Q
How many minutes is routine blood specimen expected to reach the lab?
A
45 minutes
22
Q
How long should centrifugation be done?
A
1 hour
23
Q
What hematology test is prepared 1 hour from collection and is stable until 6 hrs?
A
Blood smear from EDTA specimen
24
Q
What test is carried out 4 hours
(RT) and 12 hours (refrigerated)?
A
EDTA specimen for ESR determination
25
What test is analyzed within 6 hours but is
stable 24 hours from collection if stored at RT?
EDTA specimen for CBC
## Footnote
IDEAL: 2 HRS
26
What test has a specimen stable for 6 hours at RT and 72 hours if refrigerated?
EDTA specimen for retics count
27
What test has a specimen stable for 24 hours at RT but stable up to 48 hours when refrigerated at 2°C 8°C?
Glucose test drawn in sodium fluoride tubes
28
What test has a specimen stable for 24 hours?
Prothrombin time
29
What test should be analyzed within 4 hours from collection regardless of storage conditions?
APTT
## Footnote
- shorter time or must be analyzed quickly since ang clotting factors for this are very sensitive to storage conditions
30
What should you use if your tube does not have a stopper and is prepared for centrifugation?
Use a nescofilm
31
Why should the tubes have stoppers during centrifugation?
- To avoid contamination
- To avoid evaporation
- To avoid aerosol formation (anything that
introduces movement which can agitate the sample) → inversion, mixing, vibration, break mechanism
- To prevent pH changes
32
What tubes are centrifuged immediately without delay?
Heparin gel-barrier tubes (PSTs)
33
What will happen if you directly spin tubes such as the Non-additive and gel-barrier serum tubes (SSTs)?
Only a small amount of the serum will be obtained (QNS)
34
What is the timing of collection for Blood smears?
Anytime of the day
35
What is the method of collection for blood smears?
Capillary puncture
36
How many hours is the transport/shipment conditions for blood smears?
24 hours at RT
37
Blood smears are collected anytime of the day, what are 2 situations when you can make a smear?
1. Ex: platelet monitoring - skin puncture- transfer slide- smear on bedside
2. Venipuncture - bring to lab - make smear - better since you can repeat the preparation many times (pasteur pipet, capillary tube, or invert tube to slide)
38
Why is thick smear not recommended for PBS?
- harder to count formed elements because they are near to each other
39
What is the skin disinfection for Blood culture collection?
3 changes of 70% alcohol & 2% iodine for 1 minute prior to collection
40
What is the frequency for Blood culture collection?
2-3 different sites within 24 hrs
41
What amount/volume of blood should be collected from adult and children for blood culture?
Adult = 10-20 mL
Infants = 1-5 mL
42
What is the blood:broth dilution for blood culture tubes?
1:10
43
What possible causes lead to introduction of bacteria in blood (bacteremia)?
- needlestick injury
- appendix explodes
44
What should you add if you use SPS in handling microorganisms such as Neisseria, Garnerella, and streptobacillus?
1.2% gelatin
45
what is the primary inoculation medium for blood culture collection?
Nutrient Broth or BHIB (Brain Heart Infusion Broth)
46
What should be used for blood culture if the patient is on antibiotic treatment?
ARD or Antibiotic-resistant device or resin bottles to prevent the action ofthe SPS to antibiotics and to still isolate bacteria
47
What is the relationship between volume of blood and rate of positive results? (gen rule?)
direct relationship
As a general rule, about **4%**of a patient’s total blood volume can be taken safely for culture. The optimal ratio of blood to culture medium is about **1:5 to 1:10.**
Age-volume protocol
AGE
<10 years = 1 mL of blood for each year of life
≥10 = 20 mL
≥10 (poor veins) = <20 mL
48
In intermittent bacteremia, what do you call the microorganism that grows best in moderate temperature?
Mesophiles
49
What is the volume of the anticoagulant used in blood culture media?
Anticoagulant: 0.025% - 0.050% sodium polyanethol sulfonate
(SPS)
50
What are the functions of SPS?
- Anticoagulation
- Neutralization of bactericidal activity (i.e. complement proteins & lysozyme) of human serum
- Prevention of phagocytosis
- Inactivation of certain antimicrobial agents (e.g. streptomycin, kanamycin, gentamicin, polymyxin B)
51
What bacteria are inhibited by SPS?
* Peptostreptococcus anaerobius
* Streptobacillus moniliformis
* Neisseria gonorrhoeae
* Neisseria meningitidis
* Gardnerella vaginalis
52
What are the purposes of urine examination?
Purposes of urine examination:
1. Provides information on many metabolic processes in the body.
2. Helps monitor wellness
3. Helps in diagnosis and treatment of UTI
4. Detects and monitors progress of treatment in metabolic diseases
5. Identify the effectiveness of an administered therapy.
MWUPE
53
What are the factors that affect the accuracy of Urine Analysis?
1. Collection method
2. Container used
3. Transportation and handling of specimens
4. Timeliness of the testing
CCTT
54
What are the types of Urine Specimens?
1. Random
2. First Morning/8-hour urine
3. Timed
4. Fasting
55
Why is random urine the most commonly received speciment?
- ease of collection
- convenient for the patient
56
What type of urine specimen is useful for routine screening tests to detect obvious abnormalitites?
Random urine
57
What are the other names for first morning/8-hour urine?
- First voided,
- overnight, or
- early morning specimen
58
What type of urine specimen is ideal screening specimen?
First morning/8-hour urine
59
What urine specimen must be delivered within 2 hours or kept refrigerated?
First morning/8-hour urine
Collected immediately upon waking up from 8 hours of sleep and must be delivered within 2 hours or kept refrigerated
60
What type of urine specimen is requested to confirm the results of random specimens and specimens with no SG?
First morning urine/8-hour urine
61
What is the second morning or second specimen voided urine?
Fasting urine
62
What type of urine specimen requires individual urine specimens collected serially at specific times corresponding with the timing of blood collection?
Tolerance test (Oral Glucose Tolerance test)
63
What type of urine specimen is collected two hours after a meal and tested for **glucose** and used to **monitor insulin therapy of a patient with DM**
2-hour postprandial
64
What type of urine specimen is collected to allow quantitative analysis of urine analyte?
24-hour
65
What is the best time to begin collection of the 24-hour urine?
When the patient wakes up in the morning (between 6-8 am)
- may require addition of a preservative prior to collection
66
In addition to standard patient identification, what else should be included in the container of a 24-hour urine?
(1) it is a 24-hour specimen,
(2) Type of preservative added;
(3) any precautions associated with it because some preservatives may burn the skin of the MT
67
What type of urine specimen requires emptying the bladder and then waiting a specific amount of time (30 mins) before collecting the specimen? What is this commonly tested for?
Double-voided
- tested for glucose and ketones
68
What is the common method used for collecting random specimen wherein the patient voids into a clean container/sample cup?
Regular voided
69
What are the urine collection methods?
1. Regular voided
2. Catheterized specimen
3. Midstream
4. Midstream clean-catch speciment
5. Suprapubic aspiration
6. Pediatric
70
What urine collection method is preferred for bacterial culture and routine urinalysis?
Midstream clean-catch specimen
71
# Identify
The sample collected from this method of urine collection is more representative of the actual urine than the routinely voided/midstream
Midstream clean-catch Specimen
72
What type of urine collection method provides a sample for bacterial culture and cytologic examination?
Suprapubic aspiration
73
The Physician collects urine through suprapubic aspiration. When can nurses collect the specimen through aspiration?
if patient has catheter then the specimen can be collected by a nurse using sterile needle and syringe
74
What urine collection method collects a STERILE URINE SAMPLE?
Suprapubic aspiration
75
Pediatric method of urine collection is collected in a plastic bag checked every how many minutes?
15 min
76
What are some characteristics of containers for urine collection?
- clean
- dry
- Disposable
- wide mouth
- capacity of 50 mL
- clean and transparent
- labeled properly
77
What should the label include in urine specimens?
- patient’s complete name and
- identification number, the
- date and time of collection ,
- age and
- physician’s name.
78
What is the most frequently ordered urine test?
Routine urinalysis
79
What are the common urine tests and the ideal or recommended specimen/collection method for each?
1. Routine urinalysis = Midstream clean catch specimen
2. Urine culture and sensitivity = Midstream clean catch specimen
3. Urine cytology studies = Fresh clean-catch specimen
4. Urine drug testing = Random sample placed in a chemically clean container with lid
5. Urine Pregnancy Testing = First morning urine
6. Urine glucose and ketone testing = clean-catch, midstream urine specimen (double-voided)
80
For routine urinalysis, after collection, specimen should be transported to the lab
immediately, but it could be held at RT for _____ hours or it could be refrigerated if transport will take longer than prescribed
After collection, specimen should be transported to the lab immediately, but it could be held at RT for **2 hours** or it could be refrigerated if transport will take longer than prescribed
81
In what section is urine culture and sensitivity performed?
Microbiology section
82
In Urine CS, how long is the measured portion of the sample cultured in a special nutrient medium?
18-24 hours (plate incubation)
83
What is performed if bacteria are present and identified from urine CS?
AST (Antibiotic susceptibility test)
or antimicrobial susceptibility testing (AST)
= to determine the possible antibiotics that can be given to patient by the physician
84
In the antibiotic disc, what do you call the clearing surrounding the bacteria? What does it indicate?
ZONE OF INHIBITION: tells you the antibiotic is effective
85
What method is used in the smear of Urine cytology studies?
PAP Method (Pap stain/Papanicolaou method)
86
What specific cells are present that indicate bladder cancer in urine cytology studies?
**Malignant Urothelial cells**
- malignant urothelial cells take up the stain
87
If delays can't be avoided, what should be done in the specimen for urine cytology studies?
If delays can’t be avoided, specimen must be preserved with **50% ethanol in a 1:1 ratio.**
88
What urine test is performed to screen diabetes and to determine the glucose level of patients who are already diabetic?
Urine Glucose Testing
89
What urine test is used to determine if the patient is suffering from diabetic ketoacidosis?
Urine Ketone
90
How do Ketones form inside our bodies?
1. Body breaks down fat for energy because diet if deficient of carbohydrates
2. Body does not metabolize glucose properly
91
How many seconds is Ketone and Glucose read at?
Ketone (15 s or 40?)
Glucose (30 s)
92
What is the volume of amniotic fluid collected from transabdominal amniocentesis?
10 mL
93
What are some specimens that need to be protected from light?
- Urine
- Seminal Fluid
- Amniotic fluid
94
What is the purpose of testing the amniotic fluid?
- Detection of genetic disorder,
- check any problem in fetal development, and
- verify gestational age
- also used to test and identify hemolytic disease resulting from incompatibility of mother and fetus
- check for fetal lung maturity
95
What are the 3 sterile tubes where CSF is placed?
○ 1st tube: Chemistry and immunology
○ 2nd tube: Microbiology studies
○ 3rd tube: Cell counts (Hematology)
Routine test:
- Cell counts,
- chloride,
- glucose, and
- total protein
MUST BE KEPT AT RT and sent immediately to the lab
96
What is administered intravenously in order to collect gastric fluid?
Gastric stimulant: HISTAMINE OR PENTAGASTRIN
97
T or F. Gastric fluid should be collected after fasting
T
Gastric samples are collected at time intervals and are collected in sterile containers
98
What is the role of the Phlebotomist in collecting gastric fluid or in gastric fluid analyses?
- help label specimen
- draw blood for serum gastrin determination
*serum gastrin:* a hormone that stimulates gastric secretions in stomach
99
What is the timing of collection of NASOPHARYNGEAL SWAB FOR BACTERIAL TEST?
As soon as suspicion arises and before antibiotic therapy
100
What is the method of collection for nasopharyngeal swab for bacterial test and how is it stored and transported?
Use cotton swab with calcium alginate for bacteriology
STORE in REF TEMP (2°C-8°C)
TRANSPORT with ICE PACKS
101
The collected and cultured specimen from NASOPHARYNGEAL SWAB
FOR BACTERIAL TEST determines the presence of bacteria that can cause the ff:
- diphtheria
- meningitis
- pertussis or
whooping cough
- pneumonia
102
What is the timing of collection and amount to be collected for OROPHARYNGEAL AND
NASOPHARYNGEAL SWAB FOR VIRAL
TEST?
* Timing of collection: **Within 7 days** from onset of illness
* Amount to be collected: **One nasopharyngeal and one oropharyngeal swab** combined into one VTM
103
What is the method of collection, storage, and transportation conditions of the specimen from the OROPHARYNGEAL AND
NASOPHARYNGEAL SWAB FOR VIRAL
TEST?
Method of Collection: dacron/rayon tipped swab
Storage: Store in ref temp (2-8)
Transport conditions: With iced packs
104
In what section in the laboratory is the seminal fluid tested?
Clinical chemistry
105
What should be the storage conditions for seminal fluid?
Collected specimen is placed in a sterile container, kept warm (37), and protected from light.
106
To ensure accurate results in seminal fluid collection, make a complete collection. But what portion of the fluid are the sperm majorly contained?
First portion of the ejaculate
107
When is seminal fluid collected?
Specimens are collected following a period of sexual abstinence of 2 – 3 days to not longer than 5 days.
108
In testing for Seminal fluid for fertility, How many abnormal samples are considered significant?
When performing fertility testing, two or three samples are usually tested at 2 weeks interval with **two abnormal samples considered significant.**
109
SPECIMEN COLLECTION FOR SEMINAL FLUID
* The laboratory should provide a _________.
The specimen should be kept at room temperature and delivered to the laboratory within ___ hour/s of collection. Time of collection must be noted.
SPECIMEN COLLECTION FOR
SEMINAL FLUID
The laboratory should provide a **warm sterile glass or plastic containers**. The specimen should be kept at room temperature and delivered to the laboratory within **1 hour** of collection. Time of collection must be noted.
110
Seminal Specimens waiting for analysis should be kept at ____°C. For artificial insemination, it can be preserved in frozen state and stored for one year at ____°C (seminal banks).
Specimens waiting for analysis should be kept at **37°C.**
For artificial insemination, it can be preserved in frozen state and stored for one year at **-85°C** (seminal banks).
111
What is the best method of collection for seminal fluid?
**Self production or masturbation**
= best method since it is not prone to contamination
112
What method of seminal fluid collection uses a non-spermicidal, non-lubricated – containing rubber or polyurethane condoms?
Silastic condom collection
113
What are the 3 serous fluids?
- Peritoneal
- Pericardial
- Pleural
114
What is the use for serous fluid samples collected in each tube?
Sample collected in EDTA?
Sterile heparinized evacuated tubes?
Plain tubes or heparinized tubes?
**Sample collected in EDTA** – used for cell counts and differential counts (Hematology)
**Sterile heparinized evacuated tubes** – used for microbiology and cytology
**Plain tubes or heparinized tubes**– used for chemistry tests
115
What do you call the accumulation of excess Peritoneal fluid in the peritoneal cavity? What is the fluid called in this case?
called **ASCITES** but the fluid itself is called **ASCITIC FLUID**
116
Serous fluid is normally present in small amounts but when does the volume increase?
volume increases (EFFUSION) when there is the presence of
- inflammation
- infection or
- when serum protein levels decrease.
117
When is collection done for sputum samples?
Collection is done first thing in the morning since a larger volume has accumulated overnight, and at least 1 hour before meal to avoid gagging
118
What is the needed volume of sputum sample and how is it transported?
- steps repeated until adequate amount collected (3-5 mL) but container capacity is 50 mL
- specimen transported at RT and immediately processed
119
What are the characteristics of the container used for sputum collection?
- 50 mL capacity
- Translucent or clear material
- Single-use combustible material
- Screw-capped with a water tight seal
- Easily-labeled walls
120
What sample is used to analyze chloride content of patient under the age of 20 for
symptoms of cystic fibrosis?
Sweat
121
What is the sweat stimulating drug transported into the skin through electrical stimulation in the forearm for sweat collection?
Pilocarpine
122
What is the exocrine gland disorder and genetic disease that causes sticky/thick mucus to build up in your body which can damage lungs, pancreas and other organs?
Cystic Fibrosis
123
What specimens can used to determine illegal use of drugs?
- Urine
- Saliva
- Sweat
- Hair
124
Synovial fluid is collected in what tubes?
*** Sterile tube** – for Gram stain and culture (microbiology section)
*** Heparin/EDTA** – for cell counts, ID of crystals, smear preparation
*** Plain tube** – macroscopic appearance, chemistry, immunology tests, and observing the clot formation
**Sodium fluoride tube** – for glucose analysis
125
What are 2 ways of performing DNA analysis?
1. Blood Collection
2. Cheek Swab
126
What sample is examined to identify blood diseases such as some types of anemia, infections, leukemia, and other blood cancers and disorders?
BONE MARROW
127
What samples are used for the detection of microorganisms that can cause harm to the Gastrointestinal tract?
Breath samples
128
How is C-UBT collected?
- patient asked to drink a substance that has
a **synthetic urea** and asked to breath into a **mylar balloon** in a specified interval
- breath specimens are analyzed for the presence of **carbon 13:** unique substance produced by **H. pylori**
129
What are some things to be observed/to be done/ preparation by the patient before conducting a Hydrogen breath test?
- patient must not take antibiotics 2 weeks prior to scheduled test
- must not eat certain food 24 hrs before collection
- fasting on day of test must be observed
130
What test Helps in the detection of carbohydrate digestion problems such as lactose and fructose. Also done to detect bacterial overgrowth in the small intestine?
Hydrogen breath test
131
How is the sample taken in Hydrogen breath test?
- Baseline breath sample is taken before giving the special drink
- Additional breath samples are taken every 30 minutes for three hours
132
What sample is Collected to:
* Determine GI disorder
* Analyze presence of intestinal ova and parasites
* Determine presence of pathogenic bacteria and virus through culture ?
Feces (Stool sample)
133
Aside from testing for the presence of occult blood, Feces is also used to check what body content/analyte?
Fat and urobilinogen
134
In the stool testing, how many samples may be requested for Ova and Parasite? How many samples are recommended to rule out a negative result?
- For O & P a total of **3 samples may be requested**, on alternate days or no more than a *10-day interval*.
- Intestinal parasites are not consistently shed in the feces, therefore **more than 1 sample is recommended to rule out a negative result.**
135
How is stool preserved if not examined within 2-hr limit?
Stool samples must be adequately mixed with the selected preservative in a proportion of 1 part stool to 3 parts preservative
* Formalin (10%)
* Considered an all-purpose fixative.
* Fixative has a long shelf-life and preserved samples have a long shelf-life as well
136
What are the major salivary glands?
Parotid, submandibular, and sublingual glands
137
What specimen is used to check the hormone levels and to determine alcohol and drug or substance abuse
* Collection is easy and non-invasive
* Specimens needs to be frozen to ensure stability prior to delivery to the clinical lab?
Saliva
138
What specimen is used to analyze for traces of heavy metals or fungal infections?
Hair
139
What is the purpose of bile?
Yellow-green fluid produced by the liver that helps digests fats and eliminates waste
140
Where is bile stored and what signals its release?
Stored and concentrated in the Gall bladder and produced by the liver when eating fatty foods
141
What is the method of collecting bile?
Direct aspiration of the gall bladder by duodenal intubation or by T-tube drainage
142
What are some tests performed for bile and how is it stored and transported?
**Tests performed:**
- bile acid analysis
- bilirubin testing
- bile culture
**Storage and transport conditions:**
- immediate transport to the lab with minumum delay; refrigerate samples if transport is delayed
143
What are the criteria for Acceptance and rejection of specimen?
GENERAL RULES TO FOLLOW FOR SPECIMEN ACCEPTANCE:
- N ever refrigerate spinal fluids, anaerobic or gonococcal specimens
- S et up within 2 hours collection
- A ppropriate collection devices
- M aterial from infection area
- O ptimum time (e.g. S. typhi – 1st week: culture blood, 2nd & 3rd week: stool)
- C ollect prior to antibiotic therapy
- S ufficient quantity
CRITERIA FOR REJECTION:
- P reservative used
- I nsufficient quantity
- L eaky containers – contaminated specimen as well as biohazard
- D ry swab
