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Clinical Lab Science Lecture > Phlebotomy book- Chapter 15 > Flashcards

Phlebotomy book- Chapter 15 Flashcards

1
Q

CLIA 88 ID 3 levels of complexity for-

A

medical lab tests

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2
Q

Provider-performed microscopy was added to CLIA 88 in 1997 as a-

A

subcategory of moderate complexity tests

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3
Q

high complexity tests require- (3)

A

-close attention to detail
-specialized training & substantial experience
-interpretation & troubleshooting skills

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4
Q

high complexity tests involve-

A

manual manipulation of complex equipment & reagents

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5
Q

Examples of high complexity tests- (3)

A

-Manual DNA extraction procedures
-Special staining procedures
-Complex analyzers that require detailed setup or operator interaction

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6
Q

moderate complexity tests require- (4)

A

-formal training
-little manual manipulation
-may require direct supervision
-personnel required to have proper training & experience

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7
Q

ex of moderate complexity tests-

A

Tests that involve running simple automated instruments

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8
Q

Provider-performed microscopy procedures are a subcategory of-

A

moderate complexity testing that allows healthcare providers to perform certain tests only for their own patients

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9
Q

ex of provider performed microscopy procedures- (9)

A

-Direct wet mounts.
-Potassium hydroxide (K O H) preparations.
-Pinworm examinations.
-Fern tests.
-Post-coital qualitative tests
-Urine sediment examinations
-Nasal smears for granulocyte
-Fecal leukocyte examinations
-Qualitative semen evaluation

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10
Q

Waived tests-

A

FDA-approved laboratory tests that are minimally complicated and pose little risk of harm to the patient

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11
Q

Examples of waived tests- (6)

A

-Blood glucose levels by glucose monitoring devices cleared by the FDA specifically for home use
-Erythrocyte sedimentation rate
-Fecal occult blood
-Spun microhematocrit
-Urine chemical testing
-Urine pregnancy tests

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12
Q

Erythrocyte sedimentation rate-

A

non-automated

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13
Q

Spun microhematocrit-

A

manual procedure for determining hematocrit that requires only a small amount of blood

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14
Q

urine pregnancy tests- (2)

A

-visual color comparison tests
-the testing of urine for the presence of human chorionic gonadotropin, indicating pregnancy

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15
Q

waived tests require-

A

less training than higher complexity tests, on-the-job training possible

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16
Q

all medical labs must comply with-

A

CLIA 88

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17
Q

A Certificate of Accreditation (COA) is awarded to laboratories that perform-

A

moderate & high complexity testing & meet the standards of a private not-for-profit accreditation program. These labs must be surveyed every other year.

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18
Q

A Certificate of Compliance (COC) is awarded to laboratories that perform-

A

moderate & high complexity testing after inspectors find that the lab is in compliance with all applicable CLIA requirements. These labs must also be surveyed every other year.

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19
Q

A Certificate of Registration (COR) is granted to laboratories that have- (2)

A

-applied for either COA or COC
-enables the lab to perform moderate & high complexity testing until it has been inspected & verified to meet all requirements for COA or COC.

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19
Q

A Certificate for Provider-Performed Microscopy Procedures is granted to labs at facilities where-

A

physicians, mid-level practitioners, or dentists perform only certain microscopy procedures.

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20
Q

The Clinical Laboratory Improvement Advisory Committee (CLIAC) has made several recommendations for-

A

good practice in a Certificate of Waiver laboratory.

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20
Q

A Certificate of Waiver must be granted before-

A

a laboratory can perform waived tests. These labs must submit to random inspections & investigation if indicated.

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21
Q

ESR-

A

Rate at which RBCs settle in whole blood.

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21
Q

SOP post-exam guidelines- (3)

A

-Report test results to the physician in a timely manner.
-Follow package insert recommendations for follow-up or confirmatory testing.
-Follow OSHA regulations for disposing of biohazardous waste.

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21
Standard operating procedure (SOP) requires the person performing waived testing to follow-
designated steps during all phases of the testing process (pre-examination, examination, post-examination)
21
waived testing regulations- (9)
-Follow federal, state, and local regulations. -Perform waived tests only. -Follow manufacturer instructions. -Do not modify instructions. -Allow random inspections. -Establish lab safety plan that follows OSHA guidelines. -Have a designated area with adequate space & conditions. -Have enough personnel & train them appropriately. -Have written documentation of each test performed.
21
Facilities that perform waived lab tests must have a designated person-
usually a physician or experienced lab supervisor that is responsible for lab supervision. All personnel must follow the guidelines, regulations, & requirements
21
SOP pre-examination guidelines- (6)
-Confirm written test orders. -Establish procedure for patient ID. -Give pre-test instructions and determine whether patients followed them. -Collect specimens according to package insert instructions. -Label specimens appropriately. -Never use expired reagents or test kits
21
SOP examination guidelines- (6)
-Perform quality control testing. -Correct problems discovered during QC testing before testing patient samples. -Establish policy for control testing frequency. -Follow test-timing recommendations. -Interpret test results as directed. -Record test results according to office policy
22
To help ensure the quality of testing, Certificate of Waiver laboratories are also required to participate in-
quality assurance/assessment programs for each test they perform.
22
ESR screens for-
inflammation
22
ESR is measured as-
distance, in millimeters, that RBCs fall in one hour when allowed to settle in a calibrated tube
23
when inflammation is present in ESR-
plasma proteins such as albumin and globulin are increased.
24
increased plasma proteins cause RBCs to-
come closer & may result in rouleaux formation, in which the RBCs stick to each other.
25
elevated sedimentation rate indicates inflammation-
Several cells sticking together sink faster than a single RBC does
26
ESR methods- (3)
-wintrobe -westergren -modified westergren
27
The equipment needed for a simple ESR test include- (5)
-Specimen transfer pipettes -ESR kit -ESR vials containing a premeasured amt of diluent (usually saline) -Calibrated ESR tubes -ESR testing rack
28
The amount of blood needed for ESR test varies by-
kit manufacturer. Be sure to fill the diluent vial to the mark on the vial
29
factors affecting ESR results- (5)
-Time from collection to testing. -Testing time. -Temperature. -Tilting. -Vibrations.
30
Hematocrit-
percentage of whole blood that is made up of red blood cells
31
microhematocrit measured as-
packed cell volume (PCV).
32
microhematocrit can be performed directly from- (2)
-puncture -EDTA tube
33
in microhematocrit, blood is placed in _____ tubes-
capillary
34
centrifuge microhematocrit to-
pack RBCs
35
hematocrit is determined by using-
reading device
36
hematocrit is used as a screen test for-
anemia
37
Microhematocrit procedure uses capillary tubes, which are narrow-diameter tubes that take up blood using ___ action-
capillary action
38
avoid air bubbles in microhematocrit procedures because they may cause-
erroneous results
39
for microhematocrit procedures Fill the capillary tubes Directly from dermal puncture- (3)
-Wipe away first drop. -Touch a red-tipped capillary tube to the edge of the next blood drop without touching the skin. -Keep the capillary tube angled upward to avoid air bubbles.
40
for microhematocrit procedures Fill the capillary tubes From EDTA tube- (4)
-Remove the cap from an EDTA tube filled with blood. -Tilt the specimen tube slightly & insert one end of the capillary tube. -Keep the capillary tube angled upward to avoid air bubbles. -fill 2 capillary tubes 3/4 full
41
Some microhematocrit tubes are self-sealing and do not require-
sealing clay
42
A microhematocrit centrifuge is used to spin the capillary tubes, the packed cell volume is read using-.
microhematocrit reading device, many microhematocrit centrifuges have these reading devices built in
43
reading microhematocrit- (3)
-Place bottom of RBC layer at 0% mark. -Adjust scale so top of plasma layer is at 100% mark. -Read hematocrit value at top of RBC layer on scale
44
Tests available by RDT methods include- (3).
-Infectious mononucleosis. -Human immunodeficiency virus (HIV). -Syphillis
45
Strep screening is used to determine if-
patient’s sore throat is caused by the bacteria Group A Streptococcus
46
Detection for strep screening is important because-
untreated Streptococcus infections can lead to rheumatic fever and autoimmune disease.
47
RDT Testing devices contain- (3)
-Antibodies to Group A Strep -A color developer -Built-in controls
48
General procedure for the test kits used in Certificate of Waiver laboratories- (5)
-Swab specimen is taken from back of throat. -Swab is placed in a vial that contains premeasured amounts of extraction reagent to remove the bacteria from the swab. -Vial is set onto a testing device treated with antibodies to the bacterial antigens and color developers. -Results are read after a specified period of time, usually less than 10 minutes. -For the results to be valid, the control (“C” in the tests shown on this slide) must show a positive result.
49
RDTs for respiratory infections are tests to rapidly identify infectious diseases, such as- (4)
-Influenza virus. -Respiratory syncytial viruses (RSV). -Corona virus. -group A streptococcus (strep A)
50
urine pregnancy tests confirms/rules out-
pregnancy
51
urine pregnancy test tests for-
hCG
52
hCG-
hormone produced by placenta
53
General procedure for pregnancy test kits used in Certificate of Waiver laboratories- (3)
-Place required number of drops of urine onto the testing device. -Read the results according to the manufacturer’s directions. (The test shown on this slide is negative.) -Built-in control verifies that the test has been performed correctly.
54
urine chemical screening Physical Components- (2)
-Color -Clarity
55
urine chemical screening Microscopic Components- (3)
-Casts -Cells -Crystals
56
Urine chemical screening-
testing of urine for various chemicals, most not normally present in the urine; part of a urinalysis
57
Urinalysis-
testing of urine for physical, chemical, and microscopic characteristics
58
urine chemical screenings Chemical Components- (10)
-pH -Specific gravity -Blood -Bilirubin -Glucos. -Ketones -Leukocytes -Nitrite -Protein -Urobilinogen
59
Fecal occult blood-
blood found in the feces/stool & may not be visible (occult)
60
Guaiac-
chemical that turns blue when blood (hemoglobin) is present
61
Several portions of the stool sample are usually processed in order to-
maximize blood detection
62
False-positive fecal occult blood results may occur if patients have ingested- (4)
-Fish -Heme-laden meat (such as beef and lamb) -Fruits that contain peroxidase (bananas, cantaloupe, pears, plums) -Vegetables that contain peroxidase (broccoli, cauliflower, horseradish, turnips)
63
POCT is designed to- (2)
-Reduce healthcare costs -Enhance patient care
64
Typical POCT tests- (12)
-Glucose -Hemoglobin -Electrolytes (sodium, potassium, chloride, bicarbonate) -Ionized calcium -Cholesterol -Blood ketones -Blood gases -Coagulation studies (such as prothrombin time) -Urine dipstick (plastic strip with reagent pads containing chemicals for urine or blood testing) -Urine pregnancy -Fecal occult blood -Strep screening
65
POCT samples tested-
immediately after collection at patient's side
66
POCT typically requires-
small amount of blood from dermal puncture
67
Glucose testing-
Screening for abnormal glucose levels and to monitor glucose levels in patients with diabetes mellitus

Clinical Lab Science Lecture (10 decks)

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