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Fundamentals of MLS > Phlebotomy Ch 11 Special Collections and Point of Care Testing > Flashcards

Phlebotomy Ch 11 Special Collections and Point of Care Testing Flashcards

1
Q

What are the identification & labeling requirements for blood bank specimens?

A

Patient’s full name, PHIN#, date & time of collection, phlebotomist’s initials

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2
Q

What are some special identification systems for blood bank specimens?

A

ID bracelet w. self-carbon adhesive label for specimen

Blood ID band w. linear barcoded BBID #s.

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3
Q

What are the specimen requirements (tube types) for blood bank specimens?

A

Blood bank tests required the collection of one or more lavender- or pink-top EDTA tubes 4.5 or 5ml (tall) tubes.
Nonadditive glass red-top may be used

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4
Q

What is required for type, screen and cross-match?

A 
Blood type (ABO) & Rh factor (+ or -) & screen
Cross-match to determine compatibility
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5
Q

Are any errors allowed on blood bank specimens?

A

Blood bank specimens require:

  1. Strict patient identification and specimen labeling procedures.
  2. Labeling errors of any kind or are unlabeled will not be accepted for testing.
  3. This will cause a delay in testing
  4. An undetected error can result in administration of an incompatible blood product and the possibility of a FATAL transfusion reaction.
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6
Q

What are some other reasons for rejecting blood bank specimens?

A

Blood bank testing can be rejected if they:

  1. Are not labeled exactly as described in the laboratory protocol
  2. Grossly hemolyzed
  3. Contain IV fluid
  4. Collected longer than 72 hours before testing
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7
Q

What are some requirements for donor eligibility for blood bank donations?

A
  1. Between ages 17 & 66 years.
  2. Weight at least 110 lb.
  3. Physical examination & medical history required.
  4. Written permission from donor required.
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8
Q

What values are checked every time someone donates blood?

A

Hemoglobin or hematocrit values are checked. Males must have a hemoglobin level of at least 130g/L and females 125g/L
This information is collected each time a person donates no matter how many times they have donated in the past.

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9
Q

What is the lookback program in regards to blood banks?

A
  1. All blood components must be traceable to donor.

2. Requires notification to all blood recipients when donor tests positive for transmissible disease.

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10
Q

What is an autologous donation?

A

Autologous Donation:

Person donates blood for own use (e.g., elective surgery)

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11
Q

What is cell salvaging in regards to blood banks?

A

Cell Salvaging:

Patient’s blood can be salvaged, washed, & reinfused. Salvaged blood must be tested for residual free hemoglobin.

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12
Q

What is the purpose of blood cultures? When is it ordered?

A
  1. Determine presence & extent of infection.
  2. Identify type of organism responsible & best antibiotic to use.
  3. Bacteremia/Septicemia
  4. Ordered because:
    a) Patient has a condition in which bloodstream invasion is possible
    b) Or presence of fever of unknown origin (FUO) or not yet determined
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13
Q

What is bacteremia and septicemia?

A

Bacteremia – bacteria in the blood

Septicemia – microorganism or their toxins in the blood.

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14
Q

What is sepsis?

A

Sepsis

  1. Inflammatory responses throughout the body due to blood infection.
  2. Leading cause of death from infection.
  3. Sepsis is overwhelming, unregulated response by the body to the blood infection that triggers inflammatory responses – tissue damage, organ failure, and death.
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15
Q

What are the symptoms of sepsis (septicemia) (5)?

A 
Indications of Septicemia:
Fever
Chills
Malaise
Low BP
Changes in mental status
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16
Q

What occurs in septic shock?

A

Septic Shock – low bp and other circulatory issues and metabolic abnormalities that increase likelihood of death.

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17
Q

What are blood culture specimen requirements? What about time critical situations?

A

Specimen Requirements
1. Two to four blood culture sets
2. Drawn 30 to 60 minutes apart (unless patient in critical condition)
3. Collected in special bottles, one aerobic & one anaerobic
Note: a) One blood culture consists of blood from a single venipuncture inoculated into two separate bottles to accommodate the optimal blood‐to-broth ratio.
b) For critical situations in which rapid administration of antibiotic is important 2 – 3 cultures one right after another from different sites are required
c) For FUO same as above but if those are negative after 24-48 hours another set is taken

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18
Q

What are timing and volume considerations for blood culture collections?

A

Timing Considerations:
1. Collection as close as possible to the time ordered.
2. Obtain second set from separately prepared site on opposite arm if possible.
Note: A “set” of blood cultures includes 2 sites = 3 bottles

Recommended Volume:

  1. Identification of pathogens increases in direct proportion to the volume of blood cultured.
  2. Weight-based recommendations.
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19
Q

What if you are not able to collect enough blood in both bottles?

A

IF you don’t collect enough blood in the bottle, blood should be added to aerobic bottle first; any remaining blood should be then added to anaerobic bottle. Because most bacteremia is caused by aerobic and facultative (Able to live with or without oxygen) bacteria. Also, pathogenic yeasts are recovered from aerobic bottles.

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20
Q

What are the skin cleaning requirements for blood cultures? What are acceptable antiseptics?

A

Skin antisepsis, Purpose:

  1. Destroy skin microorganisms
  2. Prevent misinterpretation of microorganism as pathogenic

Acceptable antiseptics:
1. Chlorhexidine gluconate
2. Tincture of iodine or povidone
Requires 30- to 60-second friction scrub.

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21
Q

What is the recommended antiseptic for infants 2 months and older and patients with iodine sensitivity?

A

According to the CLSI, chlorhexidine gluconate is the recommended blood culture site disinfectant for infants 2 months and older and patients with iodine sensitivity.

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22
Q

What are the media inoculation methods:

A

Media inoculation methods

  1. Direct inoculation:
    a) Collect specimen directly into blood culture medium
    b) Use butterfly & specially designed holder
  2. Syringe inoculation:
    a) Transfer blood to bottles after draw is completed
    b) Safety transfer device is required
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23
Q

Why should you inoculate the anaerobic bottle first and then aerobic for a syringe inoculation?

A

The anaerobic bottle is filled first and the aerobic bottle is filled last because any air in the top of the syringe could be drawn into the last bottle filled. For a butterfly direct inoculation, the aerobic bottle is filled first because air in the tubing will be drawn into it before the blood.

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24
Q

Give the blood collection procedure for blood cultures?

A

Collection procedure
ID patient, explain procedure, obtain consent
Sanitize hands, don gloves
Apply tourniquet, identify venipuncture site, release tourniquet
Aseptically select & assemble equipment
Perform friction scrub 15-30 seconds one side one direction and 15-30 seconds flip over chlorohexidine swab other direction
Allow site to dry
Remove flip-off cap & inspect bottle for visible defects
Cleanse culture bottle stoppers while site is drying
Mark min. & max. fill on culture bottles
Reapply tourniquet & perform venipuncture w/o. touching or repalpating site
Direct draw: fill bottles, invert several times
Withdraw needle, place gauze, activate needle safety feature, apply pressure
Direct draw: Discard blood collection unitSyringe draw: Remove & discard needle, attach transfer device, fill & mix bottles
Clean patient’s skin if applicable
Label specimen containers w. required ID info.
Dispose of used & contaminated materials
Thank patient, remove gloves, sanitize hands
Transport specimens to lab as quickly as possible

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25
Q

What are the special requirements for coagulation specimens?

A

Coagulation Specimens

  1. A “clear” or discard tube is required for all coagulation tests except for PT or PTT
  2. Sodium citrate tubes must be filled until vacuum is exhausted
  3. Never pour two partially filled tubes together
  4. CTAD tubes:
    a) Cooling on ice during transport may be required
    b) When drawing from an indwelling catheter: draw & discard 5 mL of blood or six times the dead-space vol. of catheter
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26
Q

What are CTAD tubes?

A
  1. CTAD tubes for anti-factor Xa – Contain Citrate, theophylline, adenosine and dipyridamole.
  2. Used to inhibit thrombocyte activation between collection of specimen and testing
27
Q

What coagulation factors if tested for are unstable and needs to be tested in 4 hours?

A

Factors V and VIII coagulation study – highly unstable and if can not be tested within 4 hours must be centrifuged and plasma frozen.

28
Q

What does postprandial (PP) mean?

A

Postprandial (PP) means after a meal.

29
Q

Why is the Two-Hour Postprandial Glucose

test done?

A

Two-Hour Postprandial Glucose:

  1. Glucose in diabetics is significantly increased 2 hours after meal
  2. Excellent screening test for diabetes

2 hours after a meal in normal persons glucose rarely elevated, but may in diabetic
Can also be used to regulate insulin therapy
Correct timing of collection is important – too early or too late can result in misinterpretation of results.

30
Q

What is the purpose of the Glucose Tolerance Test (GTT)

A

Glucose Tolerance Test (GTT):
1. Used to diagnose problems of carbohydrate metabolism
2. Monitors patient’s tolerance to high levels of glucose
Note:
Hyperglycemia: increased blood glucose level
Hypoglycemia: decreased blood glucose level

31
Q

Describe the steps for Glucose Tolerance Test (GTT)preparation.

A

Glucose Tolerance Test (GTT) Preparation:
Patient must:
1. Eat balanced meals w. 150 g of carb for 3 days before test
2. Fast at least 8 hours but not more than 16 hours before test
3. Drink water during fast & test
4. Avoid excessive exercise for 12 hours before test
5. Avoid smoking or chewing gum for 8 hours before test
6. Receive both verbal and written instructions

32
Q

Describe the Glucose Tolerance Test (GTT) procedure.

A

Glucose Tolerance Test (GTT) Procedure

  1. Follow normal ID protocol & explain collection procedure; advise of fasting requirements
  2. Draw fasting specimen & check for glucose
  3. Ask patient to collect fasting urine specimen (if doctor requested)
  4. Give patient determined dose of glucose beverage
  5. Remind patient to finish beverage within 5 minutes
  6. Note time patient finishes, start timing, calculate collection times
  7. Give a copy of collection times to patient
  8. Collect blood & urine specimens at computed times
  9. Label all specimens w. collection times, intervals, patient ID
  10. Deliver or send specimens to lab ASAP
33
Q

What is the Lactose Tolerance Test

A

Lactose Tolerance Test

  1. Determine if a patient lacks the mucosal enzyme lactase – necessary to convert lactose into glucose and galactose
  2. Performed (?) as the 2-hour GTT but lactose substituted for glucose.
  3. Result:
    a) If patient has mucosal lactase – curve similar to GTT
    b) If patient lacks enzyme (lactose intolerant), glucose levels will rise only slightly from the fasting level, resulting in a ‘flat’ curve
34
Q

Describe the Oral Glucose Challenge Test (OGCT) (one-hour Glucose Screening Test).

A

Oral Glucose Challenge Test (OGCT) (one-hour Glucose Screening Test)

  1. Patient is given drink cont. 50 g of glucose
  2. Patient blood specimen collected after 1 hour
  3. If glucose result is >7.8 mmol/L, then suggested that patient complete follow-up OGTT within 1 week
35
Q

Why is molecular genetic testing done and what type of blood tubes are used?

A

Molecular Genetic Testing

  1. Determining whether an individual has or is at increased risk for a certain genetic disease
  2. Classifying an individual’s genetic makeup to determine drug/dosage suitability
  3. Examining the whole genome to discover genetic alteration that may cause disease
  4. Specimen Requirement: Sterile whole blood lavender EDTA tube, special tube white top or ACD, Na Citrate, or Sodium Heparin.
36
Q

What does paternity testing accomplish and what is involved?

A
  1. Excludes possibility of paternity rather than proves it
  2. Requires a chain-of-custody protocol & specific ID procedures
  3. Mother, child, & alleged father are all tested
  4. Blood samples preferred, but cheek swabs increasingly used
  5. Blood sample testing includes ABO & Rh typing
37
Q

What is chain of custody?

A

Special strict protocol for forensic specimens that requires entailed documentation tracking the specimen from the time it is collected until the results are reported.

38
Q

What is the purposes and uses of Therapeutic Drug Monitoring?

A
  1. Establishes & maintains drug dosage at therapeutic level
  2. Avoids drug toxicity
  3. Typically used for drugs w. narrow therapeutic ranges
39
Q

What is the theory behind Therapeutic Drug Monitoring and what typically is the goal?

A
  1. When a patient takes a dose, it rises initially and peaks, then falls
  2. Typically reaching its lowest or TROUGH LEVEL just before the next dose
  3. For drug to be beneficial, the PEAK LEVEL must not exceed toxic levels and trough level remain within therapeutic range
40
Q

When do the typical peak levels occur with the various methods of introduction of medications (IV, IM or oral)? Trough level?

A 
PEAK LEVEL: 
30 MIN after IV
60 MIN after IM
1-2 HR after oral
TROUGH LEVEL:
Immediately prior to next dose
41
Q

How do you coordinate collection of blood specimens for therapeutic drug monitoring?

A
  1. Timing of specimen collection in relation to dosage administration is critical for safe and beneficial treatment and must be consistent.
  2. Coordination of staff is key – pharmacy, nursing and lab staff
  3. PEAK LEVELS collected when the highest serum concentration of the drug is anticipated typically 30 minutes after IV administration and 60 minutes after IM and 1-3 HOURS after oral intake
42
Q

For what drugs is timing of blood specimens for therapeutic drug monitoring more critical for? Which ones are less critical?

A
  1. Timing is critical for aminoglycosides: amikacin, Gentamicin and Tobramycin have short half lives.
  2. Less critical for medications that have longer half lives like phenobarbital (barbiturate or ‘downer’) and digoxin (heat medication – controls heart rate).
43
Q

What is Therapeutic Phlebotomy? What is it used to treat?

A
  1. Withdrawal of large volume of blood (~500 ml).
  2. Can be used to treat:
    a) Polycythemia – over production of RBCs
    b) Hemochromatosis – Iron overload
44
Q

What are the four type of toxicology specimens and their purposes?

A
  1. General: scientific study of toxins (poisons), Concerned with detection of toxins & treatment of effects
  2. Forensic blood alcohol (ethanol) specimens: Often requested by law enforcement officials. Used to determine levels in breath, urine, or blood. Specimen collection must follow chain of custody.
  3. Blood alcohol (ethanol) specimens:
    Normally ordered by physician for treatment purposes. Required in connection to on-the-job injury, employee insurance programs, & employee drug screening
  4. Drug screening: Required by many healthcare organizations, sports associations, & major companies. May be random. May detect a specific drug or screen for up to 30 drugs.
45
Q

What preparation is required for Blood alcohol (ethanol) toxicology specimens?

A
  1. Chain of custody not required, but follow standard protocol
  2. Skin preparation: don’t use alcohol-based disinfectant. Use instead benzalkonium chloride or povidone-iodine OR regular soap and water.
  3. Specimen requirements: gray-top sodium fluoride tube; fill tube until vacuum is exhausted & don’t remove stopper.
46
Q

Why would it be important that you MUST have a full tube and don’t remove stopper for Blood alcohol (ethanol) toxicology specimens?

A

Because ethanol can evaporate!

47
Q

What other specimens could be tested for toxicology?

A

Could be testing blood, hair, urine, and other body substances that exist in very small amounts.

48
Q

Why are glass tubes preferred for blood alcohol specimens?

A

Glass tubes are preferred for blood alcohol specimens because of the porous nature of plastic tubes.

49
Q

What are the blood collection requirements for drug screening?

A
  1. Chain of custody is required
  2. Synthetic stimulants and hallucinogenic drugs collection: Use light blue for stimulants and EDTA for inhalants. (check interpretation with text book).
50
Q

What trace elements are tested for? Why must special “free tubes” be used? What is the tube colour and additive for these tubes?

A
  1. Trace Elements: Tests for aluminum, arsenic, copper, lead, iron, & zinc
    Measured in small amounts
  2. Traces of them in glass, plastic, or stopper material can leach into specimen
    Special trace element–free tubes must be used
  3. Royal blue & contain EDTA, clot activator, or no additive.
51
Q

How many trips to the lab are required for skin testing versus blood testing for tuberculosis?

A

Tuberculosis Blood Tests:

Skin testing requires two visits; blood testing requires only one, increasing compliance

52
Q

What is the basis of the blood tuberculosis test? What tubes are collected and their purpose?

A

Interferon-gamma release assays – measures immune response to M. tuberculosis by mixing pt. WBC with TB-Ag. When mixed cells release INF-gamma = pos.

53
Q

What tubes are collected the blood tuberculosis test, their purpose, and precautions to be taken?

A

TB - Gold test 1mL of blood collected into 4 tubes
1. Gray Neg control
2. Green TB1 Ag –CD4 response
3. Yellow TB2 Ag – CD4/CD8 response
4. Purple Pos control
- TB gold – tubes are drawn slowly so leave in place for several seconds
- If using butterfly needle need a discard tube first
- Shake each tube 10X ensure the surface of the inside of tube is coated with blood
Transferred to incubator w/in 16 hours of collection
- ORDER usually as seen (see slide 45, grey, green, yellow, purple).

54
Q

What are the purposes of point of care testing?

A
  1. Brings lab testing to location of patient
  2. Made possible by development of small, portable testing devices
  3. Offers convenience to patient & short turnaround time
  4. Requires carrying out quality control & maintenance procedures necessary to ensure that results are accurate
55
Q

What are the quality controls for point of care testing?

A
  1. Waived versus nonwaived quality control checks
  2. Electronic quality control (EQC) built into POC instruments
  3. Specimen collection & handling not checked by EQC
  4. Daily external liquid QC for non-instrumented POCT
56
Q

Describe what checks the lab does for POCT?

A

Must have checks to make sure the test is performed properly, and results correlate with same test in lab.
Waived and nonwaived tests:
a) Waived do not require the same level of quality checks. Required that external controls be performed only by manufactures instructions ( new shipment/new batch)
b) Nonwaived are moderately or highly complex tests.

57
Q

What risk does POCT instruments posse for patients and how is this minimized?

A

POCT Infection Control

  1. POC instruments become possible fomites for disease
  2. a) Disinfect regularly (10% bleach)
    b) Reduce cross-contamination between patients
58
Q

What coagulation tests are performed by POCT?

A

Coagulation tests that are monitored:

a) Prothrombin time (PT) & international normalized ratio (INR)
b) Activated partial thromboplastin time (APTT or PTT)
c) Activated clotting time (ACT)
d) Platelet function

59
Q

What does PT and INR Prothrombin time use? What does INR stand for?

A

PT and INR Prothrombin time use dot monitor warfarin therapy – how long it takes for a patients blood to clot.
INR is international normalized ratio

60
Q

What instruments perform coagulation monitoring by POCT?

A

Coagulation Monitoring Instruments by POCT:

  1. CoaguChek XS Plus—PT/INR
  2. Hemochron Signature Elite—ACT
  3. i-STAT—ACT, PT/INR
  4. VerifyNow—Platelet
61
Q

What arterial blood gases can be monitored with POCT instruments?

A

pH – potential H+
pCO2 – pressure exerted by dissolved CO2
pO2 – Pressure exerted by dissolved O2
sO2 – Percentage of hemoglobin binding sites occupied by O2

62
Q

What electrolytes can be measured by POCT instruments?

A 
Electrolytes measured:
Sodium
Potassium
Chloride
Bicarbonate ion
Ionized calcium
63
Q

What kind of tests can Multiple-Test-Panel Monitoring by POCT perform? Examples of instruments?

A

Multiple-Test-Panel Monitoring by POCT:
Commonly ordered stat tests such as blood gases, electrolytes, & hemoglobin

Instruments with a menu of several different tests:
GEM Premier
i-STAT
NOVA Stat Profile Analyzer
ABL80 Flex
64
Q

What are some other tests that can be performed by POCT? (Name 3 or 4).

A 
Other Tests Performed by POCT:
B-type natriuretic peptide
Bilirubin 
Cardiac troponin T & I
Complete blood count
C-reactive protein
Glucose
Glycosylated hemoglobin
Hematocrit
Hemoglobin
Lactate
Lipid/Cholesterol
Rapid syphilis

Fundamentals of MLS (18 decks)

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