Phlebotomy Book- Chapter 11 Flashcards
the simplest way to transport specimens within a facility is to-
walk to the lab, many facilities have other devices that simplify or speed up the process of transporting specimens
pneumatic tube system- (2)
-specimen is properly labeled & enclosed in a biohazard bag for transport & is put in capsule
-capsule is loaded into pneumatic tube & sent to lab
for example, some pneumatic tube systems may agitate/disturb specimen resulting in- (2)
-hemolysis
-other adverse effects
use of tube system for specimen transport must be validated to establish policy that-
allows alternate delivery methods for specimens that would be hemolyzed or suffer other harmful effects if delivered
different specimen transports within the facility- (5)
-pneumatic tube
-dumbwaiter
-Automated tracks
-Robotics
-Conveyor belts
dumbwaiter transport-
small elevators dedicated to transporting specimens to the lab
Specimens for STAT Tests must be collected & processed-
immediately, especially if phlebotomy area is in a different part of building than lab
results for specimens for STAT tests are expected-
within 1 hour of order
Specimens for STAT tests that require centrifugation- (2)
-take to lab within 45 min
-centrifuge within 1 hr
CLSI standard Specimens for STAT tests that require centrifugation-
2 hours between collection & centrifugation for serum or plasma separation
if unsure of specimen requirements, look them up in-
procedure manual
test results will be inaccurate if-
specimen handling & processing guidelines are not met
courier services are used to-
transport specimens outside the facility
directions to follow when transporting specimens outside the facility- (3)
-specimens placed in locked box
-may need to be processed before transport
-policy needed for time & temperature
outpatient facilities often need to send specimens to reference lab or another facility because-
hospital’s lab does not perform the tests for processing
labs may provide clients such as doctors’ offices with lab courier service for ease of delivering specimens collected- (3)
-specimens placed in a courier pickup lock box
-lab policy dictates how long specimens can stay in box & how specimens are protected from extreme temperatures
-couriers follow a predetermined pickup schedule & help ensure specimen integrity by maintaining specific specimen requirements, such as using proper insulated transport containers
reference labs offer a larger variety of tests than-
most community hospital labs
some reference labs provide their own courier service because-
they often travel longer distances, so extra attention must be paid to preparation
specimens sent through mail or by an express delivery service (FedEx) must comply with-
local, state, & federal laws governing packaging & biohazard identification
packaging requirements for shipping specimens- (6)
-shipping container
-watertight secondary container (ziplock bag, plastic canister, or Styrofoam box)
-watertight primary container
-specimen documentation
-absorbent material
-ice pack
to protect personnel, place specimen tubes in biohazard bags for- (2)
-shipping
-transporting by pneumatic tube
when opening packaging or pneumatic tube wear appropriate PPE- (3)
-gloves
-lab coat
-face protection
if specimen has spilled in a pneumatic tube, follow-
facility policy to decontaminate the tube
when tracking specimen transit, enter info into LIS using- (2)
-manual entry
-bar code reader
documentation of specimen collection & transit are essential because- (2)
-enables proper recordkeeping
-allows follow-up on problem specimens
phlebotomist enters the following data into LIS- (3)
-all collection info, including date & time of collection
-phlebotomist identification code
-any comments pertaining to the specimen or collection such as “collected from below IV site of right arm”
some facilities use bar code scanners to provide-
real-time tracking so a glance at records in LIS shows latest info about the specimen & its location
specimens that require warmth during transit- (2)
-cold agglutinins
-clot reaction
cold agglutinins- (2)
-antibodies that react at cooler temperatures
-tested when patient is suspected of having atypical pneumonia; can cause them to produce autoantibodies
guidelines for specimens that require warmth during transit- (3)
-tubes must be pre-warmed to 37°C & kept warm throughout collection process
-tubes must be delivered directly to lab & placed in incubator/water bath in lab, set at 37°C
-specimen must be kept at body temp until serum/plasma has been separated from cells within 1 hr
tests that require cooling- (3)
-arterial blood gases
-ammonia
-lactic acid
chilling specimens slows-
metabolic process
guidelines for specimens requiring cooling- (3)
-placed in a slurry of crushed ice & water
-place in bag with cool pack
-must NOT be allowed to freeze
when placing specimens in ice bath, to protect specimen label from moisture-
place specimen in plastic bag or double-compartment specimen transport bag with ice or cold pack in a separate compartment
light sensitive specimens- (2)
-Bilirubin
-Beta-carotene
used to protect light sensitive specimens- (2)
-amber tubes
-wrap tubes in foil
bilirubin levels are commonly performed on-
newborn infants
an infant known to have excess bilirubin is commonly placed under uv light to help break down bilirubin, if patient under uv light, it’s important to turn off light before collecting because-
UV light will destroy some bilirubin in specimen as you collect it, yielding false results
specimen results that may be used in a court of law- (3)
-blood alcohol levels
-forensic specimens
-toxicology specimens
specimens pertaining to any legal matter must be handled very carefully, specimens include- (3)
-blood alcohol
-forensic testing
-toxicology specimens
specimens for chain of custody- (3)
-uninterrupted control of authorized personnel
-if broken, specimen & tests are invalid
-COC form must be completed
chain of custody accounts for the specimen from the time of collection to-
final disposition of the specimen
to ensure there are no breaks in the chain of custody- (2)
-each person who handles the specimen must sign & date chain-of-custody form
-specimen is kept in a locked container or tube, must be sealed with a tamper-proof label or wax at all times
proceeding with blood alcohol testing without patient consent or court order is considered-
assault and battery
most blood alcohol tests require what kind of tube-
potassium oxalate tube (gray topped) filled to the top
don’t use alcohol to cleanse the site for blood alcohol tests because- (3)
-will cause the legal system to question the blood alcohol result (cause false positive)
-no iodine swabs, also contain alcohol
-alcohol from the prep pad will affect the test result
use disinfectants to cleanse site for blood alcohol tests- (2)
-green surgical soap
-hydrogen peroxide
forensic testing is usually done for-
usually for legal cases
check specific guidelines for forensic testing for- (2)
-Special evidence kits
-proper training
general guidelines for collecting forensic specimens- (8)
-Avoid contamination by wearing gloves at all times
-Collect the specimen as soon as possible
-Ensure specimen is packed, stored, & transported correctly
-fluids are refrigerated & other specimens are kept dry at room temp
-Label each specimen w/ patient’s name & DOB, name of person collecting, type of specimen, & date & time of collection
-Make sure the specimen is packed securely & is tamperproof, only authorized people should touch the specimen
-Record all handling of the specimen, usually on a chain-of-custody form
-Perform forensic testing specimen collection only if you have had the proper training
reasons for toxicology specimens- (2)
-Detect poisons or medications
-Detect trace elements
follow facility protocol for toxicology specimens for- (3)
-collection
-type of specimen
-equipment usage
Following lab facility’s policy for toxicology specimens is critical because many things can contaminate/react with some of the analytes, including- (3)
-Oil or bacteria from hands
-Glass
-Plastic materials
samples collected for forensic purposes- (12)
-Blood
-Bones
-Hair
-Nails
-Saliva
-Skin
-Sperm
-Sweat
-Teeth
-Vaginal
-Mud
-Vegetation
tube used for lactic acid blood collection-
gray (sodium fluoride)
requirements for lactic acid blood collection- (5)
-Tourniquet may be applied briefly to locate vein
-Remove tourniquet before collection
-Arm must be at rest for 2 minutes before collection
-Place specimen on ice
-Deliver to laboratory STAT
Lactic acid forms during carbohydrate metabolism in the muscles, its blood level can be affected by- (3)
-Exercise
-Vigorous hand pumping prior to blood collection
-Application of a tourniquet during blood collection
types of special coagulation studies- (3)
-Factor assay
-Platelet function studies
-Coagulation inhibitor assays
bore needle for special coagulation studies-
21G or larger
trauma of venipuncture for special coagulation studies activates-
clotting system at the site of puncture
if you are obtaining specimens for multiple tests, always draw-
the coagulation studies (light blue-topped tube) first
if using a butterfly needle assembly for coagulation studies, use-
discard tube first before drawing the specimen
Perform procedure for special coagulation studies quickly to-
minimize amount of time the tourniquet is applied
if you’re collecting blood through a venous access device, flush the line with-
saline
steps for collecting blood through a venous device- (6)
-Flush line with saline
-Draw at least 10–20 mL of fluid & blood by syringe & discard
-Use new syringe to collect required amount of blood for coagulation studies
-Transfer immediately to light-blue-topped evacuation tubes
-Invert tubes required number of times
-Deliver all specimens to lab immediately
centrifuging separation procedure for specimens-
spinning to separate cells from liquid portion of blood
separation procedures for aliquoting specimens-
dividing/separating specimens into separate containers
For most tests, separation of specimens should be completed within-
2 hours of collection
centrifuging specimens separates-
blood cells from liquid components
speed & time of centrifuge depend on-
specimen
Typical speed of centrifuge-
1,000 to 3,000 rpm
typical time to centrifuge specimens-
15 minutes
spinning action of a centrifuge forces relatively heavy red blood cells to-
bottom of the tube
spinning action of a centrifuge forces lighter liquid to remain-
on top
If tube contains a gel separator in the centrifuge, it migrates to-
middle to separate the blood cells from the fluid
guidelines for using a centrifuge- (6)
-Balance centrifuge
-Set for correct speed
-Close lid securely
-Set timer for correct time
-Wear face shield when removing tubes
-Open lid slowly after centrifuge stops completely
different centrifuge styles- (3)
-refrigerated
-floor models
-tabletop models
tabletop centrifuge models are designed to-
spin blood specimens separating cells from liquid portion
Non-additive tubes & serum separator tubes (SSTs) must be _____ prior to centrifugation-
completely clotted
critical to balance centrifuge because an unbalanced centrifuge can- (3)
-break tubes
-ruin lab specimens
-can be dangerous for user
pre-exam. errors- (3)
-Patient ID errors
-Specimen collection errors
-Specimen handling errors
specimen re-collection may be required if-
abnormalities are detected
Accurate test results depend on-
specimen quality
Lab personnel will see obvious characteristics of a poor specimen collection, such as- (3)
-hemolysis
-clots
-under-filled tubes
hemolysis- (2)
-Destruction of RBCs
-Can result from improper collection/handling
common causes of hemolysis- (7)
-Not allowing the alcohol to dry prior to puncture
-Continuing blood draw during hematoma formation
-Forcefully squeezing during dermal puncture
-Vigorously mixing the collection tube
-Forcing blood when using a syringe transfer procedure by pushing on the plunger
-Handling specimen roughly during transport
-Freezing & thawing specimens in transit (uncontrolled environmental temperatures)
clotted anticoagulant specimens often due to-
collection issues
lab tests require ___ specimens collected in anticoagulant tube (designed to prevent clotting)- (3)
-whole blood
-plasma
-cells
Common causes of specimen clotting in anticoagulant tubes- (5)
-Incorrect order of draw
-Failure to mix each tube as it’s removed from evacuated tube holder or tap microcollection container between each drop
-Delay in transferring specimens from a syringe to an evacuated tube
-Difficult blood draws in which the blood flows very slowly into the tube
-Use of an expired tube
incomplete collection- (2)
-May be rejected as “quantity not sufficient” (QNS)
-Causes improper additive-to-blood ratio ( balance between amount of additive or anticoagulant & amount of blood)
Common causes of incomplete collection- (7)
-Loss of vacuum during venipuncture
-Loss of vacuum during shipping
-Failure to purge air from butterfly needle tubing using a discard tube
-Use of expired tubes
-Removal of the tube before its fill level is reached
-Veins collapsing during venipuncture
-Dermal puncture site clotting before enough specimen is obtained
Other Causes for Rejection- (9)
-Incorrect tube collected
-Incorrect draw order
-Hemoconcentration
-Not easily detected
-Results may be questioned if delta check fails
-Icterus
-Lipemia
-Special requirements not followed
-Missing or inadequate documentation
hemoconcentration-
prolonged tourniquet application
icterus- (3)
-Dark-yellow to greenish-yellow color
-Caused by bilirubin
-abnormal color of icteric plasma interferes with some chemistry tests, such as creatinine
Lipemia- (2)
-Cloudy plasma
-Caused by abnormal amount of fats
Causes of incorrect tube collection- (4)
-Procedure manual not consulted or information was misinterpreted
-Tube delivered to the wrong laboratory section (switch occurred)
-Wrong tube collected by mistake
-Misinterpretation of requisition
-Delta check
-Icterus
Delta Check-
comparison of results with previous results on same patient
