Special Collection and POCT Flashcards by Do Re Mi

These are non-routine laboratory tests that may not only involve additional preparation and procedure, but may require other specimens such as urine or feces. These can be applied for special cases such as blood donation.

Special collection procedures

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What test is this?
Purpose: Determines the blood type and Rh factor
Special req.: none

Blood bank: Blood type & screen

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What test is this?
Purpose: Checks the compatibility of the blood between the donor and the recipient
Special req.: Patient’s serum or plasma and the donor’s RBCs

Blood bank: Cross-match test

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What test is this?
Purpose: Determines the presence of infection, identifies the type of organism involved and the measure the extent of infection
Special req.:
* blood volume should be 20 - 30 mL per culture with a minimum of 10 mL per draw for patients weighing more than 80 lbs. For infants, it should only be 1 to 4% of the total blood volume

Blood culture

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What test is this?
Purpose: Evaluates the blood clotting function
Special req.: Microclots are avoided by gently inverting anticoagulants tubes three or four times from collection

Coagulation test

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What test is this?
Purpose: screening for diabetes and other metabolic disorders
Special req.: Must be obtained 2 hours after meal

2-hour Postprandial Glucose

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What test is this?
Purpose: Diagnose problems in carbohydrate metabolism and checks the ability to metabolize glucose through tolerance test
Special req.: 1 hr for gestational diabetes and 3 hours for other glucose metabolism evaluation

Glucose tolerance test (GGT) and Oral Glucose Tolerance test (OGGT)

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What test is this?
Purpose: Determine the lack of mucosal lactase which is responsible for conversion of lactose into glucose
Special req.: same procedure as 2-hour GGT but an equal amnt of lactose is substituted for glucose

Lactose tolerance test

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What test is this?
Purpose: Verifies the probability that the patient fathered a particular child
Special req.: follows the chain-of custody protocol and specific identification procedures

Paternity/parentage testing

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What test is this?
Purpose: Tests the drug levels at specific interval to establish proper drug dosage and avoid toxicity
Special req.: collection timing should include the peak and trough level

Therapeutic Drug Monitoring

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What test is this?
Purpose: Used as treatment to polycythemia and hemochromatosis
Special req.: involves withdrawal of approximately 500 mL as part of the treatment

Therapeutic Phlebotomy

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What test is this?
Purpose: Checks the presence of toxins in the blood, hair, urine, and other substances
Special req.: Toxins usually exist in very small amounts

Toxicology test

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What test is this?
Purpose: Checks for presence of aluminum, arsenic, copper, lead, iron, and zinc
Special req.: measured in small amounts

Trace elements

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PATIENT IDENTIFICATION, TYPES OF SPECIMEN, LABELING PROCEDURES REQUIRED FOR BLOOD BANK TESTS. Information required:

Full name including middle initial
Hospital ID Number
Social Security Number for out patients
4.Date of Birth
Date & time of collection
6.Initials of the phlebotomist.
Note: Room number and bed number is optional.

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Blood banks can use special identification systems such as _____ (self-carbon adhesive for specimen), ______ (linear bar-code), and ________ check-blood administration.

ID bracelet
Blood ID band
Siemens Patient Identification

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______ includes typing the blood for transfusion and screening for infectious diseases. The blood type (ABO) and Rh factor (+ or -) are determined.

Screening

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There are cases when there is a need to conduct a cross-match test to eliminate _______ that may arise between the patient and the donor.

blood related compatibility issues

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✓ _____ is done mainly for the purposes of blood transfusion.
✓ Blood donors should be ____ years of age, with a minimum weight of _____. They must have completed the physical exam and declared their medical history.
✓ The unit of blood can be separated into _____ but these should still be traceable to the donor.

Blood donor collection
18 to 65, 110 lbs
RBCs, plasma and platelets

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✓ There are also cases when there is an autologous donation where the patient donates blood for his use especially for _____.
✓ Another special scenario is _____ where the blood of the patient is salvaged (during surgical procedure), washed and re-infused after testing for residual free hemoglobin.

elective surgeries
cell salvaging

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✓ A _____ is a test that checks the blood for pathogens for patients who have a fever of unknown origin (FUO).
✓ The test determines the presence of ____ in the blood that causes ____ or presence of microorganism and toxins in the blood that causes ______.

blood culture
bacteria, bacteremia, septicemia

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✓ The physician orders this test only if there is a probability of bloodstream invasion.
✓ For optimum results, the collection should have _____ blood culture sets placed in special bottles, one ______ (with air) and one ____ (without air), that were drawn _____ minutes apart.
✓ _____ is crucial in the blood collection procedure because it prevents the contamination by microbial flora in the skin which can be introduced in blood culture bottles and affect the results

blood culture
2-4, aerobic, anaerobic, 30 to 60
Skin antisepsis

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There are three ways to inoculate the medium which are?

(1) directly into the bottle (during collection),
(2) collected in a syringe (after collection), and
(3) through an intermediate collection tube (in the laboratory).

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When using the _____, blood is transferred to the culture bottles after completing the draw using a safety transfer device which is activated as soon as the needle is removed from the site.

syringe method

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_______ is performed in the laboratory rather than the patient’s bedside.

Intermediate Collection Tube

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✓ A physician requests _____ to assess the blood clotting functions especially if the patient has an unexplained bleeding. This test could be prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) which is a close approximation of the hemostatic system.

coagulation tests

The blood specimen in coagulation tests is then collected using a _____ (color) top with ___% citrate tube with the correct (__:__) blood to coagulant ratio.

* light blue * 3.2 * 9:1

This blood test is done to check if the patient is suffering from diabetes and other metabolic problems.

2-hour Postprandrial Glucose

The 2-hour PP test is also used to monitor ______

insulin therapy

The principles of 2-hour PP specimen collection are: 1. A high-carbohydrate diet was introduced _______ earlier. 2. The patient should fast at least _____ hours prior to the test. 3. ______ specimen maybe be collected before the start of the procedure. 4. A special breakfast containing an equivalent of ______ glucose or a glucose beverage will be given on the day of the test. 5. Blood glucose specimen will then be collected __ hours after the meal.

* 2 to 3 (hours?) * 10 * Fasting glucose * 100g * 2

A patient who could be suffering from _______ is subjected to the glucose tolerance test (GTT) which is also called oral glucose tolerance test (OGTT) to evaluate the ability of the body to metabolize glucose by measuring the tolerance level to high glucose level.

carbohydrate metabolism problems

In GGT or OGGT, ______ to a measured dose of glucose is recorded by specimen collection at given intervals.

Insulin response

✔ The GTT length is _______ for gestational diabetes while it is _____ for other evaluations. ✔ The method of collection should also be consistent be it ____ or ______

* 1 hour, 3 hours * venipuncture or skin puncture.

GTT Procedure - Before the procedure the patient must eat balanced meal containing approximately ____ grams of carbohydrates for ____ days and must fast for ___ to ___ hours before the scheduled test. ____ is allowed to avoid dehydration and because urine specimen is also collected as part of the test.

* 150 * 3 * 12 to 16 * Drinking water

The steps in the GTT procedure are as follows: 1. Begin with the normal _____. Explain the procedure and advise the patient that only water is allowed during the whole test period. 2. The fasting specimen is drawn and the glucose level is checked and should be over ______ for the test to proceed. 3. The patient should collect a _____ if ordered

* identification protocol * 200 mg/dL * fasting urine specimen

The steps in the GTT procedure are as follows: 4. The patient is given the glucose beverage dose. Adult dose is ___g while children are given __g per kilogram of weight. For gestational diabetes the dose should be between __ to ____g. 5. The beverage should be ingested within _____. 6. Record the time when the ________ then start timing the test which is collected within 30 minutes, 1 hour, 2 hours and so forth.

* 75, 1, 50 to 75 * 5 minutes * drink was finished

The steps in the GTT procedure are as follows: 7. A copy of the _______ is provided to the patient. 8. If applicable the collection time for other specimen such as urine should coincide with the _______. 9. The _____ and the _____ should be written in the label along with patient identification information. 10. Transport the specimen immediately or within ___ hours for accurate results.

* collection time * computed collection time * exact time collected and the time interval * 2

A ___ measures the ability of the body to process lactose and determines if the patient lacks mucosal lactase which is an enzyme that converts lactose into glucose or galactose. Gastrointestinal distress and diarrhea follows after ingestion of milk or food containing lactose for those who lack the lactase enzyme.

lactose tolerance test

The principles for the lactose tolerance testing include: 1. It is recommended that a _____ be administered at least a day before the lactose tolerance test. 2. Equal amount of lactose is substituted to ____ but the test will be performed following the manner of GTT. 3. ______ is drawn at the same time as the previous GTT procedure. 4. The GTT curve and the glucose curve will be similar if the patient has ______. 5. If the patient is lactose intolerant, the result will yield a ______ where glucose levels just slightly rise over the fasting level. 6. Patients with slow gastric emptying, Crohn's disease and cystic fibrosis could show ______ results.

1. 2-hour GTT test 2. glucose 3. Glucose specimen 4. mucosal lactase 5. "flat" curve 6. false-positive

* _______ performed to exclude the possibility of paternity of a particular child * should the result ______ alleged parent further test is performed which include extended red cell antigens, red cell enzymes, serum proteins testing, white cell enzymes, white cells antigen, and human leukocyte antigen (HLA)

* Parentage testing or paternity testing * does not exclude

The most advanced technology to date

DNA paternity testing

Uses genetic fingerprinting or DNA profiling to establish parentage by providing genetic proof

DNA paternity testing

Two other methods used for Parentage/Paternity testing

- polymerase chain reaction (PCR) - restriction fragment length polymorphism (RFLP)

The principles of DNA paternity testing are: 1. All involved parties need to submit a government issued photo identification along with the completed ________. The photos of all tested parties are also taken. 2. The ______ as collected by using a swab that was rubbed inside the cheek and the loose cheek cells adhere to the swab. 3. ________ package are used to hold the specimen during transportation to the laboratory. 4. The test results are ready after _____ which are usually sent via mail.

* Chain of Custody form * Buccal samples * Sealed and tamper-evident * 48 hours

A ______ plays a role in both clinical toxicology (detection of toxins and treatment) and forensic toxicology (legal consequences of toxin exposure) because toxicology test involves collection of blood, hair, urine and other substances from the body for the purpose of determining the presence of toxins which could be in very small amounts.

phlebotomist

______ ✓ Toxicology specimen are ordered by the ______ for legal or forensic purposes. ✓ The most common specimen are ____ and ______ for alcohol. ✓ Others request ______for drug screening, blood specimen for drugs and DNA analysis. ✓ For forensic specimen, there is a need to track the specimen from the time of collection until the time that the results are released using a special protocol called _________.

* Forensics Specimens * law enforcement department * breath and blood * urine * chain of custody

The _______measures drug levels at designated intervals so that the appropriate dosage can be established and maintained for the patient thus avoiding toxicity

Therapeutic drug monitoring (TDM)

_________ begins with prescription of the initial dosage appropriate for the patient's clinical condition. The amount in the bloodstream is expected to rise, eventually reach peak (maximum) which screens drug toxicity, and gradually fall to a trough or minimum level which ensures that the levels within therapeutic range.

Therapeutic drug monitoring (TDM)

✓ The timing of collection is important for ______ (amikacin, gentamicin, and tobramycin) which have short half-lives but it is not critical for phenobarbital and digoxin. ✓ _________ should be given to optimize the clinical outcomes while considering the drug dosage, history of dosage given, the recorded response of the patient and desired outcome.

* aminoglycoside drugs * Appropriate concentrations

_______ is performed by drawing a large volume of blood from the patient about 500 mL as part of the treatment procedure for polycythemia and hemochromatosis

Therapeutic phlebotomy

_____ is the overproduction of red blood cells which is harmful to the patient. A ______ test is used to check the RBC level and removal of blood is done when level exceeds a certain level with the goal of returning the levels to normal range

* Polycythemia * hematocrit

_______ is characterized by excess iron deposits in the tissues which could be due to problems with iron metabolism as a result of multiple blood transfusions or excessive intake of iron.

Hemochromatosis

_______ tests are usually ordered for purposes related to treatment but could also be for industrial or jobrelated purposes such as insurance claims or programs and employee drug screening.

Blood alcohol (ethanol [ETOH])

The law enforcement department orders ______ for individuals involved in traffic-related accidents.

blood alcohol concentration(BAC)

The _______ for treatment purposes do not require the chain of custody to be accomplished but the results of such tests can become evidence in _____. However, BAC for industrial and legal sample should follow the chain-of-custody protocol.

* Blood alcohol (ethanol [ETOH]) * court

✓ The ETOH specimen collection uses _______ and ______. ✓ Avoid using isopropyl alcohol and tincture of iodine as antiseptic because these might affect the results. ✓ Use ______ glass tubes for specimen collection. These tubes could be with anticoagulant but it depends on the need of the required specimen for a specific test. ✓ The tubes are filled until the vacuum is exhausted. The tube stopper should remain in place at all times because ghen ______could evaporate.

* aqueous povidone-iodine and aqueous benzalkonium chloride (BZK) * gray-top sodium fluoride * alcohol

✓ Companies healthcare organizations and sports associations subject their potential employee to _______ as part ot of their pre-employment requirement. ✓ The company or organization could also run a _____________ without prior notice.

* random screening

The specimen used is ____ instead of blood. The chain of custody protocol is strictly implemented since legal implications are involved.

* urine

1. The purpose and procedure should be explained to the patient. 2. The patient should be advised about his legal rights. 3. There should be a witness present when the form is signed.

Patient preparation requirements

Specimen collection requirements 1. A special area should be designated for the purpose of _____ 2. During the collection, a proctor is present to ensure that the _____. 3. Split sample may be used for ________. 4. Proper labeling should be followed to establish a _______ 5. Protect the specimen from ____. After collection it should be sealed in a lock container and sent to the laboratory immediately. Documentation should be handled carefully.

1. urine collection. 2. specimen came from the correct person 3. parallel testing 4. chain of custody. 5. tampering

_______ tests for presence of aluminum, arsenic, copper, lead, iron, and zinc

Trace elements

Trace elements are collected in small amounts and must use special element-free tubes colored ______, since traces of these elements in the glass, plastic or stopper could trickle into the specimen will affect the accuracy of the result.

royal blue

In Trace elements: The type of additive, if any, is indicated in the label. (red - no additive, lavender - EDTA, and green-heparin). To avoid contamination, ________

change the transfer device before filling the tub

any analytical test that is done outside the centralized laboratory and near the site where the patient receives treatment.

Point-Of-Care Testing (POCT)

______ has been called by different names, such as alternate site testing (AST), bedside, near patient testing, remote testing, satellite testing, and rapid diagnostics

Point-Of-Care Testing (POCT)

_________ ranges from a simple procedure as a dipstick, glucometer which is handheld, and up to automated molecular test using analyzers and imaging systems that are portable. These tests are not only convenient, but it also shortens the turnaround time (TAT).

Point-Of-Care Testing (POCT)

✓ _______ procedures should be followed during the conduct of POCT to maintain the accuracy of the results. ✓ ________ are in place for strict compliance. ✓ Manufacturers have enhanced their instruments to include _____ which can detect specimen related problems. ✓ For non-instrumented tests, _________ checks adherence to use of required techniques and the generated results are accurate. ✓ Several manufacturers recommended disinfecting the instrument using ______ to reduce the risk of cross contamination .

* Quality Control (QC) and maintenance * Quality Control procedures * electronic QCs (EQCs) * daily external liquid QC * 10% bleach

______ and _______ can be evaluated using a Coagulation POCT analyzer

Warfarin and heparin therapy

The common coagulation tests checked in Coagulation Monitory by POC are Prothrombin time (PT) & international normalized ratio (INR), Activated partial thromboplastin time (APTT or PTT), Activated clotting time (ACT), and Platelet function.

(Coagulation Monitoring by) POCT

Listed are the available _____ available: * Cascade POC —ACT, APTT, PT/INR * CoaguChek XS Plus PT/INR * GEM Premier 4000 ACT, APTT, PT/INR * i-STAT —ACT, PT/INR * Verify Now —platelet function

POCT instruments

_________ is a non-instrumented test ordered by the physician to evaluate the capillaries for platelet plug formation which is indicative of disorder in the platelet function or problems in capillary integrity.

Bleeding time (BT) test

This test is also used for pre-surgical screening and detection of problems involving hemostasis. Although platelet function assays (coagulation test) has been mostly ordered in place of BT, it is still requested in some occasion.

Bleeding time

T/F: Execution of the proper technique is important to get an accurate result

True

Many healthcare institutions have supported the use of POCT for ______ (ABGs) and electrolytes in selected settings such as the emergency department, pulmonary unit and neonatal intensive care unit.

arterial blood gases

It has greatly improved the turnaround time for the of test for patients in emergency situations which in turn reduces the time of waiting for the physicin's medical diagnosis and prescription

Arterial blood gasses and electrolytes

______ test measures the level of oxygen, carbon dioxide and acid-base (pH) in the patient's blood which givesthe physician an idea about the status of the function of your lungs, heart and kidneys.

Arterial blood gas

________ methods include potential hydrogen (pH), partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), and oxygen saturation (SO2)

ABGs measured by POCT

____ refers to the concentration of hydrogen ions in a solution. The arterial pH test checks the balance of the acid-base level which shows the metabolic and respiratory status of the patient.

normal range for arterial blood gas?

7.35 to 7.45

The _____ is an indicator on how well air is exchanged between the blood and lungs. The test shows the measure of pressure exerted by dissolved CO2 in the blood plasma in proportion to the PO2 in the alveoli.

* PCO2

_______ is when the PCO2 level increased to an abnormal level while ______ is when it decreases.

Hypoventilation, hyperventilation

* _____ is representative of the pressure exerted by the dissolved O2 and the ability of the lungs to diffuse oxygen through the alveoli which is usually used to measure the effectiveness of an oxygen therapy. A normal person exhibits _____ oxygen saturation

* PO2 * 98%

The _____ in the body mainly aid in moving nutrients in the body and removes wastes in the cells of the body.

electrolytes

The POCT uses ______ to determine the blood level of sodium (Na+), potassium (K+, chloride (Cl-), bicarbonate ion (HCO3), and ionized calcium (iCa2+).

electrolyte panels

Sodium helps keep the ______ of fluids in the body and also plays a role in transmitting nerve impulses. An elevated level of sodium is called _____ while reduced level is known as _______.

* normal balance * Hypernatremia * hyponatremia