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2024 SEM 1 PMLS 2 (LAB) > special collections and POCT > Flashcards

special collections and POCT Flashcards

1
Q

Tests that require specific and unique collection procedures, not usually performed in the laboratory.

A

special collection tests

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2
Q

What are the key components of special collection preparation?

A

Special instructions
Special preparation
Special equipment
Special handling
Special timing

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3
Q

What are the specimen requirements for blood bank tests?

A

Lavender- or pink-top EDTA tubes
Non-additive glass red-top tubes (depending on facility protocol)

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4
Q

What should you do if unsure about specimen requirements for a test?

A

Always ask the laboratory at the facility where the collection is being performed, as policies may vary.

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5
Q

What are the strict identification and labeling requirements for blood bank specimens?

A

Patient’s full name
Patient’s hospital ID number
Patient’s date of birth
Date and time of collection
Phlebotomist’s initials

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6
Q

Is the patient’s room number part of the identifier for blood bank specimens? Why or why not?

A

No, because patients are frequently transferred between rooms.

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7
Q

what is a special identification system used for blood bank specimens?

A

ID bracelet with self-carbon adhesive label for specimens
Blood ID-band with linear bar-coded BBID numbers

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8
Q

What does the blood type and screen test determine?

A

The patient’s ABO blood type, Rh factor (+ or -), and screens for antibodies.

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9
Q

What is the purpose of a crossmatch test?

A

To determine compatibility between the patient’s blood and the donor’s blood.

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10
Q

What does a phlebotomist compare when collecting a blood bank specimen?

A

The labeled blood bank tube with the patient’s blood bank ID bracelet.

By a unique ID sticker that exactly matches the ID on the tube of blood collected for the crossmatch.

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11
Q

To determine the presence and extent of infection, identify the type of organism responsible, and find the best antibiotic to use.

A

blood culture tests
- it is ordered when a patient has a condition suggesting bloodstream invasion and a fever

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12
Q

Why is blood considered sterile?

A

It is free from microorganisms, as lymph nodes filter microorganisms from the blood.

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13
Q

What is sepsis, and how does it relate to blood cultures?

A

Sepsis is an overwhelming immune response to a bloodstream infection, causing widespread inflammation and damage. Blood cultures help diagnose the causative organism.

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14
Q

What are the special requirements for blood culture collections?

A

2-4 blood culture sets (or 1-2 sets with SPS if resources are limited)
Collected at different sites (e.g., right/left antecubital fossa, right/left hand)

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15
Q

What is the protocol for blood cultures in cases of fever of unknown origin (FUO)?

A

Collect 2-3 blood cultures from different sites.
If fever persists and no positive results, recollect 2 more sets.
Collect before or during a fever spike, or follow laboratory policy if timing is uncertain.

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16
Q

How far apart should blood cultures be drawn?

A

30 to 60 minutes apart, unless the patient is in critical condition or physician instructions differ.

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17
Q

What types of special bottles are used for blood cultures?

A

Yellow: Anaerobic cultures
Grey: Aerobic cultures
Red: Fungal cultures

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18
Q

How does patient age affect blood culture collection?

A

The volume of blood collected depends on the patient’s age.

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19
Q

Why is skin antisepsis the most critical part of blood culture collection?

A

To destroy skin microorganisms, prevent contamination, and avoid misinterpretation of normal flora as the cause of infection.

acceptable:
Chlorhexidine gluconate
Tincture of iodine
Povidone-iodine with 70% ethanol (used when the top two are unavailable)

*30 to 60-second friction scrub in a circular motion. Do not wipe the area twice.

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20
Q

What is the purpose of the initial specimen diversion?

A

To reduce blood culture contamination by diverting 1.5 to 2 mL of the first blood collected, which may contain skin plugs, cells, and microbes.

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21
Q

Why is the next portion of blood collected after initial specimen diversion used for blood cultures?

A

It is less likely to contain contaminants from the skin

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22
Q

What is an intermediate collection tube, and when is it used

A

A yellow-top SPS tube used in place of a blood culture bottle.

however, the use of intermediate collection tubes is discouraged as:
Increases final concentration of SPS.
Increases risk of contamination.
Exposes lab staff to higher risks.

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23
Q

Collecting specimens directly into blood culture bottles using a butterfly needle and specially designed holder.

A

direct inoculation in blood culture collection

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24
Q

When using direct inoculation, which blood culture bottle is filled first and why?

A

The aerobic bottle, as air from the tubing will not affect it.

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25
Q

How can backflow be avoided during direct inoculation?

A

Keep the culture bottle lower than the collection site.

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26
Q

Transferring blood into culture bottles using a syringe and safety transfer device.

A

syringe inoculation in blood culture collection

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27
Q

When using syringe inoculation, which blood culture bottle is filled first and why?

A

The anaerobic bottle, to avoid introducing air into the sample.

precautions should be taken:
Hold the plunger to control blood flow.
Avoid pushing the plunger to prevent hemolysis and aerosol formation.
Change the needle after contact with the skin.

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28
Q

Why is changing the needle after skin contact important in blood culture collection

A

To avoid transferring contaminants from the skin into the blood culture bottle.

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29
Q

How should culture bottles be prepared during the procedure?

A

Remove the flip-off cap and inspect for defects.
Cleanse the bottle stoppers with alcohol while the site is drying.
Only use alcohol not iodine

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30
Q

What is important to mark on blood culture bottles before collection?

A

The minimum and maximum fill levels.

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31
Q

What is the correct technique for venipuncture during blood culture collection?

A

Reapply the tourniquet.
Perform venipuncture without touching or re-palpating the site.
Fill bottles directly and invert several times.

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32
Q

How should the patient’s skin be cleaned if iodine was used?

A

Clean the site to remove residual iodine.

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33
Q

What information must be included on the bottle label?

A

Required patient information.
Blood collection site (to help identify localized infections if positive).

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34
Q

Why is it important to transport blood culture specimens to the lab quickly?

A

To ensure the accuracy of results by preventing microbial growth or death.

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35
Q

What are Antimicrobial Neutralization Products (ARD/FAN), and what is their purpose?

A

Products containing resin to remove or neutralize antimicrobials/antibiotics from the blood.
Prevents antimicrobials from inhibiting microorganism growth.

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36
Q

When should blood collection for culture in ARD tubes be timed?

A

Right before the next antibiotic dose, when antibiotic levels are at their lowest.

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37
Q

Why is pediatric blood culture collection considered difficult?

A

Due to the smaller blood volume and the need for specialized equipment and techniques.

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38
Q

What type of blood culture bottles are used for pediatric collection

A

Special bottles with different volumes and broth formulations.

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39
Q

How is the site cleansed for pediatric blood culture collection?

A

The site is cleansed twice with 70% isopropyl alcohol or ethanol.

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40
Q

What is the maximum blood volume typically collected for pediatric blood cultures?

A

Up to 4 mL of blood.

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41
Q

What methods are used to collect blood for pediatric cultures?

A

ETS (Evacuated Tube System) or syringe; capillary collection is not used.

42
Q

What are the usual sites for catheter blood culture collection?

A

One culture set is collected from peripheral blood, and another from the vascular access device (VAD).

43
Q

Why is the first 5 mL of blood from a catheter considered a discard barrel?

A

It contains the flushing fluid and is not suitable for blood culture testing.

44
Q

Who typically collects blood from a catheter, and why?

A

Nurses, as they use different antiseptics for VADs and are trained to aspirate clots if necessary.

45
Q

Why is it important to collect two culture sets for catheter blood cultures?

A

To allow correct interpretation of positive results by comparing peripheral blood and VAD samples.

46
Q

Why is a “clear” or discard tube required for coagulation tests drawn with a butterfly needle?

A

To account for the tubing and prevent contamination of the sodium citrate tube.

47
Q

What is the required blood-to-anticoagulant ratio in sodium citrate tubes?

A

9:1 ratio of blood to anticoagulant.
- t will be rejected if a sodium citrate is not completely filled

48
Q

Why should two partially filled sodium citrate tubes never be combined?

A

It compromises the accuracy of the blood-to-anticoagulant ratio.

49
Q

What is the protocol for coagulation factors 5 and 8 if testing is delayed beyond 4 hours?

A

Centrifuge the sample, separate the plasma, and freeze it.

50
Q

What is the RN’s responsibility when drawing from an indwelling catheter for coagulation testing?

A

Draw and discard the first 5 mL of blood to avoid contamination.

51
Q

Why might coagulation specimens need to be transported on ice?

A

To preserve the integrity of the sample.

52
Q

What is the purpose of the 2-hour postprandial glucose test?

A

It screens for diabetes and gestational diabetes mellitus (GDM) by measuring glucose levels 2 hours after a meal.

53
Q

What does the glucose tolerance test (GTT) diagnose?

A

Problems with carbohydrate metabolism and a patient’s tolerance to high glucose level

54
Q

What are hyperglycemia and hypoglycemia?

A

Hyperglycemia: Increased blood glucose levels.
Hypoglycemia: Decreased blood glucose levels.

55
Q

What are the patient preparation requirements for a GTT?

A

Eat balanced meals with 150g carbohydrates for 3 days.
Fast for at least 8 hours.
Drink water during fasting and testing.
Avoid smoking, chewing gum, or exercising before the test.

56
Q

When does gestational diabetes typically develop, and is it permanent?

A

It develops during the 28th week of pregnancy and is usually temporary.

57
Q

What is the normal glucose level after a 50g oral glucose challenge test (OGCT) for gestational diabetes screening?

A

Less than 140 mg/dL.

58
Q

What glucose loads are used for GTT in gestational diabetes testing?

A

50-75g of glucose.

59
Q

What are the initial steps in the GTT procedure?

A

Follow the normal ID protocol and explain the procedure.
Confirm fasting requirements (at least 8 hours).
Draw fasting blood specimen and process for glucose testing.

60
Q

What should the patient do after the fasting blood specimen is collected?

A

Collect a fasting urine specimen if required.
Drink the determined dose of glucose beverage within 5 minutes.

61
Q

How are blood and urine specimens collected during the GTT?

A

Note the time the patient finishes the glucose beverage.
Start timing and calculate collection intervals.
Collect blood and urine specimens at specified times.

62
Q

How should GTT specimens be labeled and handled?

A

Label all specimens with collection times, intervals, and patient ID.
Deliver or send specimens to the lab as soon as possible (SST within 2 hours, no later than 24 hours).

63
Q

What should you do if the patient vomits during the GTT?

A

Inform the doctor, reschedule, and repeat the procedure.

64
Q

Why are specific time intervals important in the GTT?

A

To monitor glucose trends and assess the body’s ability to metabolize glucose over time.

65
Q

It measures the average blood glucose levels over the past 2 to 3 months.

A

HbA1c (glycosylated hemoglobin)

66
Q

How does glucose affect hemoglobin in HbA1c testing?

A

Excess glucose in the blood binds to hemoglobin.

67
Q

What type of sample is required for HbA1c testing?

A

EDTA sample; fasting is not required.

68
Q

What is the purpose of the OGCT?

A

Screening for gestational diabetes mellitus (GDM).

69
Q

How does the OGCT differ from the GTT?

A

The OGCT uses 50g of glucose, and only fasting and 1-hour blood specimens are collected.

70
Q

what happens if the 1-hour glucose result in the OGCT is greater than 140 mg/dL?

A

The patient undergoes a full OGTT.

71
Q

What is the purpose of therapeutic drug monitoring (TDM)?

A

To establish and maintain drug dosage at therapeutic levels, avoiding toxicity and adjusting dosages when combined with other drugs.

72
Q

When is TDM typically used?

A

For drugs with narrow therapeutic ranges, such as blood thinners and seizure medications.

73
Q

What are the two key levels measured in TDM?

A

Peak levels: Maximum drug concentration in the blood.
Trough levels: Minimum drug concentration, typically measured before the next dose.

74
Q

What is therapeutic phlebotomy, and how much blood is typically withdrawn?

A

It is the withdrawal of a large volume of blood (usually 500 mL) to treat certain conditions.

75
Q

What conditions are treated with therapeutic phlebotomy?

A

Polycythemia: Overproduction of red blood cells.
Hemochromatosis: Excess iron deposits in tissues.

76
Q

The scientific study of toxins (poisons), focusing on their detection and the treatment of their effects.

A

toxicology

77
Q

What is the difference between forensic and clinical blood alcohol (ethanol) testing?

A

Forensic testing: Ordered by law enforcement, involves a chain of custody, and is used for legal purposes.
Clinical testing: Ordered by physicians for treatment, does not require a chain of custody but follows standard protocols.

78
Q

What type of disinfectant should be used when collecting blood alcohol specimens?

A

Non-alcohol-based disinfectants such as benzalkonium chloride or povidone-iodine.

79
Q

what are the specimen requirements for blood alcohol testing?

A

Use a gray-top sodium fluoride tube.
Fill the tube completely until the vacuum is exhausted.
Do not remove the stopper.

80
Q

What is the importance of the chain of custody in forensic toxicology?

A

To ensure the integrity and legal admissibility of the specimen by documenting every person who handles it.

81
Q

Why is drug screening commonly required?

A

It is required by healthcare organizations, sports associations, and major companies, often for random testing, pre-employment, or post-accident situations.

82
Q

What types of substances can drug screening detect?

A

Drug screenings may detect specific drugs or screen for up to 30 different substances, typically performed on urine rather than blood.

83
Q

What is the chain of custody in drug screening?

A

Chain of custody ensures the integrity of the specimen, documenting everyone who handles the sample to maintain its legal admissibility.

84
Q

What are the patient preparation requirements for drug screening?

A

Explain the test purpose and procedure.
Advise the patient of their legal rights.
Obtain a witnessed, signed consent form.

85
Q

What are the specimen collection requirements for drug screening?

A

use a special area for urine collection.
A proctor must be present during collection.
A split sample may be required.
Specimen must be labeled, sealed, and placed in a locked container.

86
Q

What trace elements are commonly tested for?

A

Aluminum, arsenic, copper, lead, iron, and zinc.

87
Q

Why must special trace element-free tubes be used for testing?

A

leach from glass, plastic, or stopper material into the specimen, affecting results.

88
Q

What type of tubes are used for trace element testing?

A

Royal blue tubes, which may contain EDTA, heparin, or no additive.

89
Q

What is the traditional method for testing tuberculosis (TB)?

A

he skin test is the traditional method for TB testing.

90
Q

detect an individual’s immune response to Mycobacterium tuberculosis (M.tb) by measuring INF-gamma release when WBCs are exposed to M-TB antigens.

A

Interferon-Gamma Release Assays (IGRA)

91
Q

how does the QuantiFERON-TB Gold Plus test work?

A

1 mL of blood is collected in 4 special tubes at room temperature.
The blood is incubated within 16 hours after inversion (10 times).
A butterfly needle should be used, with a discard tube collected first to avoid dead air space in the tube.

92
Q

it brings lab testing to the location of the patient, made possible by small, portable testing devices, offering convenience and short turnaround times.

A

Point-of-Care Testing (POCT)

93
Q

What are the benefits of POCT for patients?

A

provides convenience and faster results, reducing wait times for diagnostic information.

94
Q

What are the key requirements for POCT to ensure accurate results?

A

POCT requires carrying out quality control and maintenance procedures, including regular checks for accuracy.

95
Q

What is the difference between waived and non-waived quality control checks in POCT?

A

Waived tests: Simple tests that have minimal risk for error.
Non-waived tests: More complex tests that require stricter quality control checks.

96
Q

it is built into POC instruments to help ensure the accuracy of results, but it does not check specimen collection or handling.

A

Electronic Quality Control (EQC) in POCT

97
Q

How should POCT instruments be disinfected to prevent cross-contamination?

A

POCT instruments should be disinfected with a 10% bleach solution to reduce the risk of disease transmission.

98
Q

What coagulation tests are commonly monitored in POCT?

A

Prothrombin Time (PT)
International Normalized Ratio (INR)
Activated Partial Thromboplastin Time (APTT or PTT)
Activated Clotting Time (ACT)
Platelet Function

99
Q

Why are coagulation tests monitored in POCT?

A

To monitor patients on blood thinners (e.g., warfarin) and ensure proper blood clotting levels.

100
Q

What are some common tests performed in POCT?

A

Arterial Blood Gas
Electrolytes (Na, K, Cl, HCO3, iCa)
B-Type Natriuretic Peptide
Bilirubin Testing
Transcutaneous Testing
Cardiac Troponin T and I
Complete Blood Count (CBC)
C-Reactive Protein (CRP)
Glucose Testing
HbA1c/Glycohemoglobin
Hematocrit
Hemoglobin
Lactate
Lipid/Cholesterol Testing
Rapid Syphilis Test

101
Q

Why is glucose testing commonly performed in POCT?

A

To monitor blood glucose levels, particularly for patients with diabetes or in emergency settings.

2024 SEM 1 PMLS 2 (LAB) (10 decks)

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