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Clinical Chemistry > SPECIMEN COLLECTION & HANDLING > Flashcards

SPECIMEN COLLECTION & HANDLING Flashcards

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1
Q

Conscious Inpatients/ Hospitalized patients

A

Verbally ask their full names including middle names
Verify using ID bracelet which includes:
1. First & Last names
2. Hospital/Unit #
3. Room/ Bed #
4. Physician’s name

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2
Q

Sleeping patients

A

Identified in the same manner as conscious in-patients
Must be awakened before blood collection

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3
Q

Unconscious, Mentally Incompetent Patients

A

Identified by asking the attending nurse or relative
As well as thru ID bracelet

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4
Q

Infants & Children

A

A nurse or relative may identify the patient

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5
Q

Outpatient/ Ambulatory Patient

A

Verbally ask:
1. Full names
2. Address
3. Birth date
Countercheck with Valid ID with photo

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6
Q

3-Way ID to avoid misidentification:

A
  1. Patient’s verbal ID statement
  2. Check ID band
  3. Visual comparison of labeled specimen with patient’s ID before leaving bedside
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7
Q

Average human body contains how many liters of WB

A

5 quartz or 4.73 L

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8
Q

Adult Males have approximately how many liters of WB

A

5 - 6 L

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9
Q

Adult Females have approximately how many liters of WB

A

4 - 5 L

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10
Q

WB is composed of ___ Plasma and ___Cells

A

60%; 40%

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11
Q

Process by which blood is obtained from a pateint’s artery

A

Arterial Puncture

UseL Blood gas analysis & pH measurement

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12
Q

Sites for Arterial Puncture (5)

A
  1. Radial Artery
  2. Brachial Artery
  3. Femoral Artery
  4. Scalp Artery
  5. Umbilical Artery
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13
Q

This test is performed prior to blood collection from radial artery

A

Modified Allen Test

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14
Q

Major Complication of Arterial Ouncture:

A

Thrombosis
Hemorrhage
Possible Infection

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15
Q

Unacceptable Sites:

A

Irritated
Edematous
Near a Wound
Area of an AV shunt or Fistula

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16
Q

Angle for Arterial Puncture:

A

45 - 60 degrees

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17
Q

Blood is obtained from a patient’s vein
Deoxygenated blood with a dark red color

A

Venipuncture

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18
Q

Sites for Venipuncture:

A

Antecubital fossa region
Veins on the wrist & dorsal aspect of hands
Veins on ankle

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19
Q

Antecubital fossa region sites:

A
  1. Median Cubital vein (best site)
  2. Cephalic Vein
  3. Basilic Vein (not chosen unless no other vein is more prominent; near brachial artery)
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20
Q

Order of Draw

A
  1. Yellow
  2. Light Blue
  3. Serum (Red)
  4. Green
  5. Lavender/ Purple
  6. Gray
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21
Q

Anticoagulant based on Order of draw

A
  1. Blood Culture Tubes, Sodium Polyanetholesulfonate (SPS)
  2. Trisodium Citrate
  3. With or Without Clot Activator or Gel Separator
  4. Heparin (Li, Na, NH4)
  5. EDTA
  6. Sodium fluoride & Potassium Oxalate
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22
Q

What tube is used for Lactate Sample collection?

A

Gray tube
Blocks Glycolysis

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23
Q

Tourniquet placement and duration

A

3-4 inches above the site
Never leave tourniquet longer than one minute

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24
Q

Angle of needle on Venipuncture

A

15 to 30 degree angle
Bevel side up*

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25
Q

IV Fluid contamination
Increases

A

Glucose
Chloride
Potassium
Sodium

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26
Q

IV Fluid Contamination
Decreases

A

Urea
Creatinine

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27
Q

As little as __% contamination with 5% dextrose will INCREASE glucose in blood sample by ___mg/dL or more

A

10% contamination;
500 mg/dL

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28
Q

No traces of alcohol should remain on skin because it may cause:

A

Hemolysis & contaminate Glucose testing

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29
Q

For Ethanol Testing, disinfection is:

A

Benzalkonium Chloride solution
Zephiran Chloride (1:750)

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30
Q

Most common form of skin cleansing before drawing blood for culture:

A

70% Alcohol then
Iodophor

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31
Q

Skin disinfectant for blood culture for infants 2 months and older & in patients with iodine sensitivity

A

Clorhexidine Gluconate

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32
Q

Color coding:
1. 20G
2. 21G
3. 22G

A
  1. Yellow
  2. Green
  3. Black
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33
Q

Gauge of needle is ___related to the size of the needle

A

INVERSELY

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34
Q

Gauge used for venipuncture

A

21G

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35
Q

Gauge used for children

A

23G

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36
Q

Gauge for winged infusion

A

23G or 25G

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37
Q

Gauge most commonly used for small & difficult veins

A

23G

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38
Q

Gauge used for scalp or other tiny veins of premature infants

A

25G

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39
Q

Needle length

Syringe

A

1 - 1.5 inches

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40
Q

Needle length

Butterfly needle

A

1/2 to 3/4 inch

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41
Q

Red top tubes will take __ minutes to completely coagulate blood

A

60 minutes

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42
Q

Clot activators will cause blood to clot within ___

A

30 minutes

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43
Q

Tubes with thrombin particles will clot blood in ____

A

5 minutes

44
Q

Sites to be avoided (Venipuncture)

A
  1. IV lines in both arms
  2. Burned or Scarred areas
  3. Areas w/ Hematoma
  4. Thrombosed vevins
  5. Edematous arms
  6. Partial/Radial Mastectomy on one or both arms
  7. Arms with AV shunt or fistula
  8. Casts on arms
45
Q

Increase in number formed elements in blood

Immediate Local Complication

A

Hemoconcentration

46
Q

Failure of blood to enter the syring/ vacutainer tube

Immediate Local Complication

A
  1. Excessive pull of plunger
  2. Piercing the other pole of the vein
  3. Transfixation of the vein
  4. Incorrect bevel position
  5. Absence of vacuum
47
Q

Transient loss of consciousness due to lack of O2 in brain

Immediate Local Complication

A

Syncope (Fainting)

48
Q

What to do when a patient feels faint?

A

Needle should be removed immediately
Patient’s head should be lowered between the legs
Patient should be instructed to breath deeply

49
Q

Abnormal vascular condition in which thrombus develops within a blood vessel

Late Local Complication

A

Thrombosis

50
Q

Inflammation of a vein often accompanied by a clot, occurs as a result of trauma to the vessel wall

Late Local Complication

A

Thrombophlebitis

51
Q

Late General Complications:

A

Serum Hepatitis
AIDS

52
Q
  1. Using a needle that is too small
  2. Pulling a syringe plunger too fast
  3. Expelling the blood strongly into a tube
  4. Forcing the blood from a syringe into an evacuated tube
  5. Shaking or mixing the tubes vigorously
  6. Performing blood collection before the alcohol has dried at the collection site
A

Causes of Hemolysis or Hemolyzed specimen

53
Q
  1. Vein is fragile or too small for the needle size
  2. Needle penetrates all the way through the vein
  3. Needle is partly inserted into the vein
  4. Needle is removed while the tourniquet is still on
  5. Excessive probing
  6. Pressure is not adequately applied after venipuncture
A

Causes of Hematoma

54
Q

Used to obtain blood from children older than one year old

A

Skin Puncture

55
Q

Length of lancet:

A

1.75 mm

56
Q

Depth of incision:

A

< 2.0 mm in infants & children
< 2.5 mm for adults

57
Q

Preferred sites for Skin puncture:

4

A
  1. Lateral plantar heel surface
  2. Palmar surfaces of the fingers (3rd or 4th)
  3. Plantar surface of the big toe
  4. Earlobes - least used
58
Q

Which finger should not be used

A

thumb and 5th finger

59
Q

Important step to do immediately after skin puncture:

A

Wipe away the first drop of blood with a sterile site

60
Q

Order of filling microcollection tubes

A
  1. EDTA
  2. Other tubes with additives
  3. Non additive tubes
61
Q

Skin puncture is useful in adults with:

A
  1. Extreme Obesity
  2. Severe burns
  3. Thrombotic tendencies
62
Q

Sites not generally used for skin puncture

A
  1. Central arch of an infant’s heel
  2. Fingers of a newborn or infant less than 1 year old
  3. Thumb
  4. Index finger
  5. Fifth finger
  6. Fingers on the side of a mastectomy
63
Q

Used for blood gas analysis in newborn and infants for measuring pH and pCO2, but not pO2

A

Arterialized Capillary Blood

64
Q

Best method for blood gas collection in newborns:

A

Indwelling umbilical artery catheter

65
Q

Eliminates multiple phlebotomies and useful in critical care and surgical situations

A

Central Venous Access Collection

66
Q

Order of Draw from Catheter lines:

A
  1. Draw 3-5 mL then DISCARD
  2. Blood culture
  3. Anticoagulated tubes
  4. Clot tubes
67
Q

All measurements should be performed within ___ after collection

A

45 minutes to 1 hour

68
Q

Centrifugation requirement:

A

3000 RCF for 10 minutes

69
Q

Reasons for rapid separation of blood (after centrifugation)

A
  1. To prevent glycolysis
  2. Certain substances are very unstable (K, P, Glucose)
  3. To prevent shit of electrolytes (False increase of K, and decrease of Na in serum & plasma)
  4. To prevent hemolysis
70
Q

Increased in Hemolysis:

A

KLA6MPITC
K (150x in RBC)
LDH (150x in RBC)
ACD
ALP
Aldolase
ALT
AST
Albumin
Mg
Phosphorus
Iron
Total Protein
Cholesterol

71
Q

Other effects of Hemolysis:

A
  1. Interferes with color reactions
  2. Increases bilirubin levels
  3. Inhibits Lipase enzyme
72
Q

Most common interfering conditions:

A

Hemolysis
Icterus
Lipemia

73
Q

Occurs when Serum bilirubin reaches 25.2 mg/L or 430 mmol/L

A

Icteric Sample

74
Q

Occurs when serum triglyceride exceeds 25.2 mg/L or 400 mmol/L

A

Lipemia

75
Q

Lipemia inhibits:

A

Amylase
Urate
Urea
CK
Bilirubin
Total Protein

76
Q

Enzymes affected by low temperature storage prior to testing

A

DECREASES
LDH 4
LDH 5
INCREASES
Alkaline Phosphatase

77
Q

Specimens that require chilling (4C) during transport & storage

A

Ammonia
Blood gases
Catecholamines
Gastrin
Lactic Acid
Renin
PTH
Pyruvate

78
Q

Photosensitive analytes

A

Bilirubin
Beta-Carotene
Folate
Porphyrins
Vitamin A
Vitamin B6

79
Q

Excessive centrifugation may cause:

> 3000 RCF

A

Cell Lysis
Slight Elevation in:
K
LD

80
Q

Insufficient centrifugation may cause:

< 1000 RCF or < 10 minutes

A

Incomplete barrier formation in gel tubes
Cell contamination of the specimen

81
Q

Most common method of collection of CSF

A

Lumbar puncture
between 3rd or 4th lumbar vertebrae
between 4th and 5th lumbar vertebrae

82
Q

Required pressure before collection:

A

Between 90 and 180 mmHg

83
Q

Volume that can be collected:

A

20 mL of CSF

84
Q

CSF Tubes:

A
  1. Tube 1 - Chemistry (Gluc & CHON analysis) or Immuno/Sero
  2. Tube 2 - Microbiology (Culture & Gram stain)
  3. Tube 3 - Hematology (Cell counts)

Tube 3 least likely to be contaminated by bloody tap at collection

85
Q

CSF Tubes:

A
  1. Tube 1 - Chemistry (Gluc & CHON analysis) or Immuno/Sero
  2. Tube 2 - Microbiology (Culture & Gram stain)
  3. Tube 3 - Hematology (Cell counts)

Tube 3 least likely to be contaminated by bloody tap at collection

86
Q

Used to assess the completeness of the specimen:

A

24-hour Urine Creatinine

87
Q

Preferred anticoagulant for Synovial fluid

A

Sodium Heparin

88
Q

Ten Common Errors in Specimen Collection:

A
  1. Misidentification of patient
  2. Mislabeling of specimen
  3. Short draws/ Wrong anticoagulant/ blood ratio
  4. Mixing problems/ clots
  5. Wrong tubes/ Wrong anticoagulant
  6. Hemolysis/ Lipemia
  7. Hemoconcentration
  8. Exposure to light/ extreme temperatures
  9. Improperly timed specimens/ Delayed delivery to laboratory
  10. Processing errors: Incomplete centrifugation, Incorrect log-in, Improper storage
89
Q

Combines with Calcium to form insoluble salt
Interferes with Na, K and most BUN (urease) measurement

A

Oxalate

90
Q

Combines with Calcium in a non-ionized form

A

Citrate

91
Q

Concentration of Citrate

A

3.2% or 3.8%

92
Q

Ratio of anticoagulant to blood

A

1:9

93
Q

Combines with calcium in a process called Chelation

A

Ethylenediamine tetraacetic acid
EDTA

94
Q

Plastic tubes;
Spray-dried

A

di-potassium
K2EDTA

95
Q

Liquid form;
Glass tubes

A

tri-potassium
(K3EDTA)

96
Q

forms weakly dissociated calcium components

A

Fluoride

97
Q

Inhibits glycolysis

A

Sodium Fluoride

98
Q

Acts as anti-thrombin, and antithromboplastin; anti-Factor X; Ideal Universal Anticoagulant

A

Heparin

99
Q

Heparin used for most chemistry tests

A

Lithium Heparin

100
Q

Doing this affects:
1. RBC morphology and lipids in EDTA tubes
2. Binding of elevtrolytes and troponin to heparin in some plasma tubes

A

Underfilling blood collection tubes

101
Q

Tube used for Trace elements, Toxicology and TDM

A

Royal blue

Serum; No Additive

102
Q

Used for Lead test

A

Tan tube

103
Q

Used for ESR-Westergen Method

A

Black tube

4:1 blood to AC (Sodium Citrate)

104
Q

Used for ESR-Westergen Method

A

Black tube

4:1 blood to AC (Sodium Citrate)

105
Q

Specific Gravity of:
1. Serum
2. Gel separator
3. RBC

A
  1. 1.03
  2. 1.04
  3. 1.05

Top: Serum
Bottom: RBC (Formed elements)

Clinical Chemistry (16 decks)

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