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

Phlebotomy book- Chapter 15 Flashcards

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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
Q

Standard operating procedure (SOP) requires the person performing waived testing to follow-

A

designated steps during all phases of the testing process (pre-examination, examination, post-examination)

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21
Q

waived testing regulations- (9)

A

-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.

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21
Q

Facilities that perform waived lab tests must have a designated person-

A

usually a physician or experienced lab supervisor that is responsible for lab supervision. All personnel must follow the guidelines, regulations, & requirements

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21
Q

SOP pre-examination guidelines- (6)

A

-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

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21
Q

SOP examination guidelines- (6)

A

-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

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22
Q

To help ensure the quality of testing, Certificate of Waiver laboratories are also required to participate in-

A

quality assurance/assessment programs for each test they perform.

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22
Q

ESR screens for-

A

inflammation

22
Q

ESR is measured as-

A

distance, in millimeters, that RBCs fall in one hour when allowed to settle in a calibrated tube

23
Q

when inflammation is present in ESR-

A

plasma proteins such as albumin and globulin are increased.

24
Q

increased plasma proteins cause RBCs to-

A

come closer & may result in rouleaux formation, in which the RBCs stick to each other.

25
Q

elevated sedimentation rate indicates inflammation-

A

Several cells sticking together sink faster than a single RBC does

26
Q

ESR methods- (3)

A

-wintrobe
-westergren
-modified westergren

27
Q

The equipment needed for a simple ESR test include- (5)

A

-Specimen transfer pipettes
-ESR kit
-ESR vials containing a premeasured amt of diluent (usually saline)
-Calibrated ESR tubes
-ESR testing rack

28
Q

The amount of blood needed for ESR test varies by-

A

kit manufacturer. Be sure to fill the diluent vial to the mark on the vial

29
Q

factors affecting ESR results- (5)

A

-Time from collection to testing.
-Testing time.
-Temperature.
-Tilting.
-Vibrations.

30
Q

Hematocrit-

A

percentage of whole blood that is made up of red blood cells

31
Q

microhematocrit measured as-

A

packed cell volume (PCV).

32
Q

microhematocrit can be performed directly from- (2)

A

-puncture
-EDTA tube

33
Q

in microhematocrit, blood is placed in _____ tubes-

A

capillary

34
Q

centrifuge microhematocrit to-

A

pack RBCs

35
Q

hematocrit is determined by using-

A

reading device

36
Q

hematocrit is used as a screen test for-

A

anemia

37
Q

Microhematocrit procedure uses capillary tubes, which are narrow-diameter tubes that take up blood using ___ action-

A

capillary action

38
Q

avoid air bubbles in microhematocrit procedures because they may cause-

A

erroneous results

39
Q

for microhematocrit procedures Fill the capillary tubes Directly from dermal puncture- (3)

A

-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
Q

for microhematocrit procedures Fill the capillary tubes From EDTA tube- (4)

A

-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
Q

Some microhematocrit tubes are self-sealing and do not require-

A

sealing clay

42
Q

A microhematocrit centrifuge is used to spin the capillary tubes, the packed cell volume is read using-.

A

microhematocrit reading device, many microhematocrit centrifuges have these reading devices built in

43
Q

reading microhematocrit- (3)

A

-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
Q

Tests available by RDT methods include- (3).

A

-Infectious mononucleosis.
-Human immunodeficiency virus (HIV).
-Syphillis

45
Q

Strep screening is used to determine if-

A

patient’s sore throat is caused by the bacteria Group A Streptococcus

46
Q

Detection for strep screening is important because-

A

untreated Streptococcus infections can lead to rheumatic fever and autoimmune disease.

47
Q

RDT Testing devices contain- (3)

A

-Antibodies to Group A Strep
-A color developer
-Built-in controls

48
Q

General procedure for the test kits used in Certificate of Waiver laboratories- (5)

A

-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
Q

RDTs for respiratory infections are tests to rapidly identify infectious diseases, such as- (4)

A

-Influenza virus.
-Respiratory syncytial viruses (RSV).
-Corona virus.
-group A streptococcus (strep A)

50
Q

urine pregnancy tests confirms/rules out-

A

pregnancy

51
Q

urine pregnancy test tests for-

A

hCG

52
Q

hCG-

A

hormone produced by placenta

53
Q

General procedure for pregnancy test kits used in Certificate of Waiver laboratories- (3)

A

-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
Q

urine chemical screening Physical Components- (2)

A

-Color
-Clarity

55
Q

urine chemical screening Microscopic Components- (3)

A

-Casts
-Cells
-Crystals

56
Q

Urine chemical screening-

A

testing of urine for various chemicals, most not normally present in the urine; part of a urinalysis

57
Q

Urinalysis-

A

testing of urine for physical, chemical, and microscopic characteristics

58
Q

urine chemical screenings Chemical Components- (10)

A

-pH
-Specific gravity
-Blood
-Bilirubin
-Glucos.
-Ketones
-Leukocytes
-Nitrite
-Protein
-Urobilinogen

59
Q

Fecal occult blood-

A

blood found in the feces/stool & may not be visible (occult)

60
Q

Guaiac-

A

chemical that turns blue when blood (hemoglobin) is present

61
Q

Several portions of the stool sample are usually processed in order to-

A

maximize blood detection

62
Q

False-positive fecal occult blood results may occur if patients have ingested- (4)

A

-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
Q

POCT is designed to- (2)

A

-Reduce healthcare costs
-Enhance patient care

64
Q

Typical POCT tests- (12)

A

-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
Q

POCT samples tested-

A

immediately after collection at patient’s side

66
Q

POCT typically requires-

A

small amount of blood from dermal puncture

67
Q

Glucose testing-

A

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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