Pre-analytical phase in chemistry assay Flashcards
determine and address the root cause problem identified by QC and QA.
Quality improvement (QI)
The application of this in the clinical laboratory is identification of problem with a process that likely to cause error.
Quality improvement (QI)
work to eliminate the waste, such as streamlining a process to reduce wait times or modifying a process to reduce cost
Lean principles
These are business philosophy and methodologies focusing on improving quality of products or services.
The Six Sigma business strategy was developed by
Motorola, Inc.
Lean principles
Defects
overproduction
waiting
unused talent
transportation
inventory
motion
extra-processing
It seeks to improve the performance of a process by identifying and eliminating causes of defects and errors, resulting in eliminating variation in the process.
Lean Six sigma ( σ )
Simplification of the process to reduce cycle time (turn around time) and by eliminating non-value adding steps.
Eliminates waste.
Lean principles
refers to the number of SDs from the mean.
6 sigma
It is the capability of process to meet or exceed the process specification or requirements.
Identifies and eliminates error and defects to minimize variations in the process.
6 sigma
Lean Six sigma ( σ ) problem-solving methodology
DMAIC- define, measure, analyze, improve and control
identify who use the services and expectations, different persons responsible in generating the service and mapping the laboratory work flow.
Define
creating solutions to prevent errors from reoccurring.
improve
data collection. determining the turn around time and defects in a certain test. It also includes surveys using the process.
measure
data collected examination to identify the root cause of errors
analyze
Lean 6 sigma levels of training to denote expertise
master black belt
black belt
green belt
yellow belt
long term monitoring of the process over time.
control
with a minimum 2 years experience, able teach lean 6 sigma.
Master black belt-
full time project leader
Black belt-
focus on the use of DMAIC and lean principles.
Green belt-
awareness of the lean 6 sigma
Yellow belt-
Nothing to eat or drink except water for at least 8 hours.
Fasting
Fasting hours for blood glucose
8-12 hours, should not exceed more than 16 hours
Fasting hours for lipid profile
12-14 hours
Fasting is preferred collected in the?
Early in the morning
Patient preparation for fasting (chemistry tests)
Fasting blood sugar
Oral glucose tolerance test
Lipid profile test
Gastrin
Inulin
Aldosterone/Renin
Increase:
lactate, fatty acid, ammonia, CK, LD, testosterone, LH, urine protein
Decrease:
Cholesterol, TAG, FSH and LH
Exercise
Serotonin rich food
banana, pineapple, tomato and avocado
Caffeine increases?
increases glucose and catecholamine
Fatty food increases
potassium, ALT, TAG
High protein, low carb diet increase?
ketone in urine (ketonuria)
Increase
Glucose, cholesterol, TAG, cortisol, growth hormone, catecholamine.
Decrease
Vitamin B12
Smoking
Increase
TAG and gamma glutamyl transferase
Decrease
Glucose
Alcohol
Increase
Glucose Cortisol Insulin Albumin Catecholamine
Prolactin
Stress/Anxiety
plasma volume reduction
From supine to sitting/standing
causes hemoconcentration (increase lipids decrease K and Cl).
From sitting to supine
causes hemodilution
Standing to supine
Factors in physiologic variations
age
gender
diurnal variation
posture
activity
stress
race
decrease plasma albumin
Prolong bed rest
Diurnal variation-high in the morning
ACTH, cortisol, aldosterone
Diurnal variation high in the evening
GH, PTH, TSH, ACP
increase albumin, K and Ca when standing,
Posture
Sites to be avoided
IV in both arms
Burned or scarred areas
Hematoma
Thrombosed veins
Edematous arm
Area of mastectomy
Arms with fistula
Cast on arms
Evacuated tube system additive
red (glass)
red (plastic)
red/black gold
green/gray
orange or gray yellow
tan (glass and plastic)
lavender or pink
Light blue
Yellow
none
clot activator
clot activator and gel seperator
lithium heparin and gel seperator
thrombin
Na heparin and EDTA
EDTA
Na citrate
Sodium polyanethol sulfonate (SPS)
Specimen collection things to consider/avoid
Hemolyzed sample
pumping of fist during extraction
IV fluid contamination
Wrong evacuated tube
exposure to light
inadequate centriguation
delay seperation of serum
storage temperature
mostly interfere with spectrophotometric analysis.
hemolyzed sample-
decrease bilirubin.
Exposure to light-
Types of specimen in CC
Whole blood
Serum- most common
Plasma
Arterial blood
Capillary blood
Urine
CSF
Synovial, Pleural, pericardial and peritoneal fluid
Amniotic fluid
additive - enhances the clotting of blood, e.g., thrombin, silica particles and diatomite.
Clot activators
additive - an inert particle found at the bottom of the tube. forms a physical barrier between packed cells and liquid portion after centrifugation.
gel separator
Red or pink serum
Hemolysis
Contain bilirubin (430 mmol/L)
Icteric sample
Yellow to orange serum/plasma
Icteric sample
Milky serum
Lipemic sample
Contains serum TG exceeding 300 mg/dl.
Lipemic sample
For serum collection allow clot formation for
10-30 minutes
All assay should be performed within
1 hour after collection.
Centrifugation: 3000 RCF for
10 minutes.
Serum is separated from clot within
30 minutes.
Serum or plasma must be stored at __.if test is to be delayed. Can be freeze at __ for longer storage
4°C – 6 °C
−20°C
