Phlebotomy Ch 13 Urine and other Nonblood Specimens Flashcards
Give some examples of non-blood specimen types?
Liquid and semiliquid substances produced by the body
In intracellular & interstitial spaces, organs, body cavities, & some joints
Body tissues, hair & nail clippings, breath samples
How should non-blood specimens be labeled?
- Should be labeled w. same ID info. as blood specimens (First name, last name. and PHIN)
- Labeling should include type and/or source of specimen
- Label should be applied to container, not lid, as lid is removed for testing
How should nonblood specimens be handled?
- Familiarity w. handling requirements is needed to protect integrity of specimen & ensure accurate test results
- All body substances are potentially infectious
- Standard precautions must be observed in handling them
Note: Reminder all human specimens are considered infections so remember to always use standard precautions when handling any specimens.
What are examples of non-blood POCT quality control practices?
Waived non instrumented POCT tests performed without instruments
Color reactions on reagent strip after dipping in urine
Daily external liquid quality control
Note: POCT- most are waived tests – easily read via colour reaction visually.
Most manufactures require daily external QC to be run to check on technique and accuracy of results. All control results must be recorded and reviewed for consistency and acceptability.
Why is urine frequently tested?
Urine:
- Most frequently analyzed nonblood body fluid
- Readily available, easy to collect, & inexpensive to test
- Its analysis can aid detecting many conditions and monitoring.
What are reasons for testing urine?
- Providing info. on many of body’s major metabolic functions
- Monitoring wellness
- Diagnosis & treatment of urinary tract infections
- Detection & monitoring of metabolic disease
- Determining effectiveness or complications of therapy
What can affect urine test results?
- Accurate results depend on collection method, container used, transport and handling and timeliness of testing
- Cellular elements decompose
- Bilirubin breaks down to biliverdin,
- And bacteria multiply leading to erroneous results
What do accurate urine test results depend on?
Accurate results depend on:
- Collection method
- Container used
- Specimen transportation & handling
- Timeliness of testing
What are the roles in collection of urine samples for a) inpatients b) outpatients?
Roles in collection
Inpatient collection typically handled by nurses
Outpatient collection often handled by phlebotomists
What mannerism is important to have while collecting urine specimens?
Must explain procedure w/o embarrassing patient
What are the different types of urine specimens?
Types of Urine Specimens
- Random: collected at any time
- First morning/8-hour: collected on waking after 8 hours sleep
- Fasting: second specimen voided after fasting (glucose monitoring)
- Timed: collected at specific times
a) 2-hour postprandial (2 hours after meal)
b) Double-voided (empty bladder, wait specified time, then collect specimen)
c) 24-hour (collection & pooling of all urine voided in 24 hours)
What issues can the first morning specimen have?
First morning – has high specific gravity (more concentrated) may contain formed elements such as cells and casts that would not be detected in a more dilute random specimen.
Which urine test is preferred by lab and which one is easier for patients?
Lab preferred: First morning.
Patients: Random generally more convenient.
What is the 2-hour postprandial (2 hours after meal) urine test used for?
Monitor insulin therapy patients with diabetes. Patients to void shortly before consuming a meal and another specimen 2 hours later.
What is the typical wait time for double-voided specimens and what is tested?
Double voided – emptying bladder then waiting (usually 30 minutes) to collect specimen – glucose and ketones.
What is the purpose of the 24 hrs collection of urine?
24 hr collection – quantitative analysis of analyte. Ex. Creatinine clearance
Some 24 hour collections require preservatives ex. 5-HIAA hydroxyindoleacetic acid.
Used to monitor type of tumor that produces serotonin
What kind of container and labelling is done on 24 hour specimens?
- Large clean wide mouth container that can hold a large volume
- Specimen must be labeled on container at the time given to the patient.
- Label must also state it’s a 24 hour urine
What is the procedure for a 24 hour urine specimen?
Void into toilet as usual on waking
Note time & date on label, place on container, begin timing
Collect all urine voided for next 24 hours
Refrigerate specimen throughout collection period (if required)
Collect urine before anticipated bowel movement, not after
Drink normal amount of fluid unless instructed otherwise
Void one last time at end of 24 hours
Seal container, place in cooler, transport to lab ASAP
What are the different collection methods for urine samples?
Urine Collection Methods
- Regular voided: patient voids into clean container
- Midstream: patient voids into toilet first, then container
- Midstream clean-catch: requires special cleaning of genital area before collection
- Catheterized: collected from sterile catheter inserted through urethra into bladder
- Suprapubic aspiration: collected by inserting needle directly into bladder & aspirating
- Pediatric: collected in plastic bag, for children not potty trained
How is a midstream sample collected?
Midstream – free of genital secretions, hair and bacteria. Initially patient void into toilet (getting rid of any contaminants). The container is brought into the the urine flow and sufficient urine is collected. The last of the urine flow is voided into the toilet.
How is a clean-catch urine sample collected?
Clean –Catch – collected in sterile container suitable for culture and sensitivity for microbiology.
Special cleaning See Procedure in 13-2
When is a catheterized urine sample taken?
Catheterized – from cath inserted through urethra into bladder
Collected when patient has trouble voiding or if patient is cathed for other reasons
Babies
Female to prevent vaginal contamination
Or bedridden patients
What are the requirements for a suprapubic aspiration urine sample?
Suprapubic aspiration – inserting needle into baldder
Specimen is transferred to a sterile container
Requires local anesthetic and performed by physician
Microbiology or cytology or uncontaminated samples of infants and young children
How is a pediatric urine sample taken?
Suprapubic aspiration – inserting needle into baldder
Specimen is transferred to a sterile container
Requires local anesthetic and performed by physician
Microbiology or cytology or uncontaminated samples of infants and young children
What is the purpose of the most requested urine test, a routine urinalysis (UA)?
Routine urinalysis (UA)
1. Most requested urine test
2. Screens for urinary & systemic disorders
3. Ordered as part of a physical or
during hospitalization
4. Includes physical, chemical, & microscopic analysis.
What are the sample requirements for routine urinalysis?
Avoid contamination by using midstream collection
Collect in clear, dry, chemically clean containers
May be kept at room temp. for up to 2 hours or refrigerated
Why are culture and sensitivity urine tests ordered?
Ordered for patients w. symptoms of urinary tract infection
What are the procedural steps for a culture and sensitivity urine test?
Place measured portion of urine on special nutrient medium that encourages growth of microorganisms
Incubate for 18 to 24 hours
Check it for growth
Identify any microorganisms that grow
If microorganism is identified, sensitivity test is performed to determine which antibiotics will be effective
What are the symptoms of a UTI?
UTI symptoms are frequent urge to urinate or pain or burning on urination
What type of specimen does a culture and sensitivity urine test require?
Requires midstream clean-catch collection in sterile container
Why are urine cytology studies performed?
Urine cytology studies: For detecting cancer, cytomegalovirus, & other diseases
How is a urine cytology study performed (list main steps)? What kind of specimen is required?
- Cells from lining of urinary tract are shed into urine
- A smear containing these cells is prepared from urinary sediment or filtrate
- Smear is stained by PAP method & examined under microscope for abnormal cells
- Examine specimen ASAP after collection or preserve in alcohol
Fresh clean-catch specimen is required
What is the Papanicolaou PAP method?
Good question.
What should be done if processing of a C&S specimen can’t be avoided?
Urine specimens for C&S and other microbiology tests should be transported to the lab and processed immediately. If a delay in transportation or processing is unavoidable, the specimen should be refrigerated or preserved
Why is urine ethanol/alcohol testing
performed?
Urine ethanol/alcohol testing
Imprecise for evaluating degree of intoxication
Why is Urine glucose & ketone testing
performed?
Urine glucose & ketone testing:
To screen for diabetes & monitor glucose & ketone levels in diabetics
What is tested in a urine pregnancy test? What is the preferred specimen?
Tests for HCG, a hormone appearing in urine after conception
First morning specimen is preferred due to higher concentration
What are some other urine tests performed?
Electrophoresis, heavy metals (copper & lead), myoglobin clearance, creatinine clearance, & porphyrins
What is HCG?
HCG- human chorionic gonadotropin a hormone produced by cells within the developing placenta that appears in serum and urine 8-10 days after conception.
When do levels of hCG peak?
Peak urine levels of hCG occur about 10 weeks after gestation.
Is HCG tested on males?
Can be done on males for tumors of the testes, and cancer including breast, lung or kidney.
What is amniotic fluid?
Amniotic Fluid
Clear/pale yellow fluid that fills membrane surrounding & cushioning fetus
By who, when, and how is amniotic fluid collected?
Collected after 15 weeks of gestation
Obtained by physician in transabdominal amniocentesis
Needle is inserted into mother’s abdominal wall into uterus
About 10 mL of fluid from amniotic sac is aspirated
Why is amniotic fluid tested?
Analyzed to detect genetic disorders & problems in fetal development
What are the container and time requirements for amniotic fluid testing?
Must be collected in sterile container, protected from light, & delivered to lab ASAP. Depending on test some require sample on ice (chemistry) some at room temp. (chromosome)
What is disease can be detected by measuring AFP (alpha-fetoprotein) in amniotic fluid?
Detection of spina bifida – neural tube defect can be detected by measuring AFP (alpha-fetoprotein) found in amniotic fluid and mothers serum, abnormal levels could indicate problems in fetal development or potential for down syndrome.
First mothers serum tested and if abnormal then amniotic fluid tested
What is condition is detected by measuring lecithinto-sphingomyelin (L/S ratio)?
Fetal Lung Maturity – Phospholipids that act as a surfactant to keep alveoli of lungs inflated.
Reported as a lecithinto-sphingomyelin (L/S ratio) immature if ratio is less than 2
What is Cerebrospinal Fluid?
Clear, colorless liquid that surrounds brain & spinal cord
Who and how are CSF samples obtained?
Specimens are obtained by physician via lumbar puncture.
What are CSF fluids used to diagnose? and what tests are performed?
Used to diagnose: Meningitis Brain abscess CNS cancer Multiple sclerosis Routine tests: cell counts, chloride, glucose, & total protein
What are each CSF test tube used for? (i.e. dept)
Tube #1 – Chemistry/Immunology
Tube #2 – Microbiology
Tube #3 - Hematology
Tube #4 Cytological examination or other tests ordered
How are CSF fluid specimens handled?
Specimen Handling: Room temp/ice, STAT and analyzed immediately
Why are 4 tubes typically collected? What if some of the tests are needed right away?
Because CSF can not be easily recollected can be uncomfortable and costly, patient anxiety and greater risk.
IF CSF needs to be delayed: Chemistry – CSF frozen, Micro – room temp, Hematology- refrigerated.
>24 hours before received in lab is usually rejected.
Why are CSF test tube collected are in the order they are?
Good question.
What is the purpose of Gastric Fluid/Gastric Analysis?
Gastric Fluid/Gastric Analysis
Examines stomach contents for abnormal substances
Measures gastric acid concentration to evaluate production
What is basal gastric analysis?
Basal gastric analysis – aspirating sample of gastric fluid
Determine acidity
Multiple samples collected at timed intervals
May require blood for gastrin hormone levels
How is a basal gastric analysis sample collected?
Basal gastric analysis
Tube is passed through mouth & throat (or nose & throat) into stomach after fasting
Sample of gastric fluid is aspirated
Sample is tested to determine acidity prior to stimulation
Stimulant is administered by IV
Several more samples are collected at timed intervals
What are Nasopharyngeal Secretions?
Nasopharyngeal Secretions From nasal cavity & pharynx.
What conditions are Nasopharyngeal Secretions used to detect?
Cultured to detect presence of microorganisms causing:
- Diphtheria
- Meningitis
- Pertussis (whooping cough)
- Pneumonia
How are nasopharyngeal secretions collected?
- Collected using sterile Dacron or cotton-tipped flexible wire swab
- Swab is inserted into nose & passed into nasopharynx
- It is rotated, removed, placed in sterile container, labeled, sent
- Think of the Rapid Influenza/PCR (covid-19)
See slide 23 for further detail.
What is saliva used to detect? What is the advantage of using saliva?
Saliva
Fluid secreted by glands in mouth
Used to monitor hormone levels & detect alcohol & drug abuse
Can be collected quickly & easily in a noninvasive manner
Why is sperm samples collected?
Sperm-containing fluid discharged during male ejaculation
Analyzed to assess fertility or effectiveness of sterilization
Examined for forensic reasons in criminal sexual investigations
What are the handling requirements for sperm collections?
Collected in sterile containers, kept warm, & protected from light
What is serous fluid?
Found between double-layered membranes enclosing pleural, pericardial, & peritoneal cavities
Allows membranes to slide past one another w. minimal friction
How is serous fluid collected? Labelling and tube requirements.
- Can be aspirated for testing purposes by physician
- Types of serous fluid should be indicated on label (very important!!):
Pleural fluid (lungs)
Peritoneal fluid (abdominal cavity)
Pericardial fluid (heart) - Can be collected in EDTA tubes if cell count, heparin or Na fluoride for chemistry and sterile tube for culture.
What is effusion? What may cause it?
Effusion – An increase in fluid volume (serous).
Usually under normal conditions is present in small amounts, but volumes increase when inflammation or infection is present or serum protein levels decrease.
What is the meaning of these terms: pleurocentesis, pleuritis, paracentesis, pericardial fluid pericardiocentesis?
Pleural Fluid – from pleural space aspirated (pleurocentesis). Inflammation of the membrane (pleuritis)
Peritoneal fluid – procedure called paracentesis
Pericardial fluid – from pericardial cavity surrounding the heart (pericardiocentesis), inflammation of pericardial space pericarditis.
What is sputum and why is it collected?
Sputum
- Mucous or phlegm ejected from trachea, bronchi, & lungs
- Collected for diagnosis or monitoring of lower respiratory tract infections (tuberculosis). Also common sample to identify pneumonia – different bacteria that would cause ex. Klebsiella pneumonia – mucoid bacteria.
How are sputum samples collected?
First morning specimens are preferred (larger volume)
Collect at least 1 hour after a meal to avoid gagging or vomiting
Patient removes dentures & gargles w. water
Patient takes three or four deep breaths & then coughs forcefully, expelling sputum into container
Why would sweat also be analyzed in the lab?
Analyzed for chloride content in diagnosis of cystic fibrosis.
CF patients sweat can be up to 5X more saltier than normal because it contains higher levels of chloride.
What is the sweat chloride test?
Sweat chloride test
Pilocarpine (sweat-stimulating drug) is transported into skin by electrical stimulation (iontophoresis)
Sweat is collected, weighed, & analyzed for chloride content
How is a sweat test used to detect illicit drug use?
Also used to detect illicit drug use; collected via skin patches.
What is synovial fluid and what can affect its quantity?
Synovial Fluid
Clear, pale-yellow, viscous fluid that lubricates movable joints
Normally occurs in small amounts
Increases when inflammation is present
What are reasons to test synovial fluid?
Can be tested to identify or differentiate arthritis, gout, & other inflammatory conditions.
What three type of tubes are used for synovial fluid collection?
Typically collected in three tubes:
EDTA/heparin: for cell counts, ID of crystals, smear prep.
Sterile: culture & sensitivity
Nonadditive: macroscopic appearance, chemistry, & immunology tests & to observe clot formation
What can be done at the same time as a synovial fluid sample for the patient?
Fluid can be removed for therapeutic reasons – to release pressure or diagnostic and sent for analysis.
Why is bone marrow tested?
Bone Marrow
- Aspirated & examined to detect & identify blood diseases
- Site of blood cell production.
How is bone marrow collected?
- Physician inserts large-gauge needle into bone marrow in hip bone (iliac crest) or sternum
- Volume of 1.0 to 1.5 mL of specimen is aspirated using syringe
- Tubes: EDTA for Hematology and/or Formalin for Histology, sterile for micro
- Hematology MLT is present to produce slides from the marrow.
- Additional samples may be for chromosome or for bacterial culture.
Why are breath samples collected?
Breath Samples
C-urea breath test
Used to detect Helicobacter pylori (a type of bacteria that damages stomach lining)
Why is a hydrogen breath test sometimes done?
Hydrogen breath test
- Helps identify problems w. digestion of lactose & fructose
- Thought to be most accurate lactose tolerance test
- Also used to detect bacterial overgrowth in small intestine
Why is feces tested in the lab?
Feces (Stool)
- Useful in evaluation of gastrointestinal disorders
- Stool specimens can be:
a) Evaluated for presence of intestinal parasites & their eggs
b) Checked for fat & urobilinogen content
c) Cultured to detect presence of pathogenic bacteria & viruses
d) Tested for presence of occult blood using guaiac test
What is being tested in feces in parasitology, chemistry and microbiology?
Parasitology - Ova and parasites samples – usually multiple samples over a period of time
Chemistry tests include Quantitative fecal fat analysis and urobilinogen are examples of tests that require 72-hour stool collection.
Microbiology – identification of C. difficile, Salmonella, Shigella, Campylobacter, E. coli (enterohemorrhagic)
What are the handling requirements for feces specimens?
Usually in a clean, dry wide mouth container
Sent to lab immediately
Preservative for O&P (Formalin and PVA polyvinyl alcohol
Large gallon containers look like paint cans used for 24/48/72 hour collections – normally need to be refrigerated throughout collection.
Why is fecal occult (hidden) blood tested for? How is this testing made convenient?
Fecal occult (hidden) blood is used to screen for colorectal cancer and other digestive disorders that result in bleeding
Diverticulosis, ulcers, colitis and polyps.
Kits available
Cards sent (mail) to lab for testing – can be held at Room Temp
What is the cologaurd test?
Cologaurd - DNA stool test (new) analyzes stool for altered DNA associated with colon cancer precancerous polyps and lesions.
Why is hair sometimes tested in the lab?
Hair
- Collected for trace & heavy metal analysis & detection of drugs or fungal dermatophytes
- Easy to obtain & cannot easily be altered or tampered with
- Shows evidence of chronic rather than recent drug use (months)
Why are nail clippings tested and what for?
Nail Clippings
Heavy metal testing or fungal for dermatophytes
Why are skin tests performed? How are they done?
Skin Tests
Skin prick/puncture/scratch test for allergic reactions
Tuberculin test
Fungal for dermatophytes
Who, what, why and how are throat swabs collected?
Throat Swabs
- Collected to aid in diagnosis of strep infections
- Nurses collect
- Collected w. sterile polyester-tipped swab in covered transport tube containing transport medium
- Room temp. as swab is in transport medium. Extended period of time can be refrigerated.
What do kits for throat swabs test? Time to perform?
Kits are available for direct detection for group A strep on throat swab specimens
Rapid test: 2 steps, one extraction from swab, two chromatographic immunoassay detection of strep antigen
Only takes about 5 minutes mostly seen in rural hospitals in Manitoba
Note: In Canada MLT’s or phlebotomist don’t collect throat swabs.
What are tissue specimens called? How are they processed?
Tissue Specimens
1. Biopsy: removal of tissue sample for examination
2. Most arrive at lab in formalin or other solution & only need to be accessioned & sent to proper department
3. Some, however, may not be in proper solution
4. Phlebotomist should check procedure manual (LIM) to determine proper handling for any unfamiliar specimen
Improper handling can ruin a specimen
Why might a tissue sample not be put in formalin?
Common for biopsy samples to not be put in formalin for microbiology or genetic analysis as this will kill bacteria.
