lesson 8

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Cards (74)

  • Special collection procedures

    Non-routine laboratory tests that may not only involve additional preparation and procedure but may require other specimen such as urine or feces. These can be applied for special cases such as blood donation.
  • List of Special Collection Procedures
    • Blood Bank: Blood type & Screen
    • Blood Bank: Cross-match test
    • Blood Culture
    • Coagulation test
    • 2-hour Postprandial glucose
    • Glucose Tolerance Test (GTT) and Oral Glucose Tolerance Test (OGTT)
    • Lactose Tolerance Test
    • Paternity/Parentage Testing
    • Therapeutic Drug Monitoring
    • Therapeutic Phlebotomy
    • Toxicology test
    • Trace elements
  • Blood Bank: Blood type & Screen

    • Determines the blood type and Rh factor
  • Blood Bank: Cross-match test

    • Checks the compatibility of the blood between the donor and the recipient
  • Blood Culture

    • Determines the presence of infection, identifies the type organism involved and measure the extent of infection
  • Coagulation test

    • Evaluates the blood clotting function
    1. hour Postprandial glucose

    • Screening for diabetes and other metabolic disorders
  • Glucose Tolerance Test (GTT) and Oral Glucose Tolerance Test (OGTT)

    • Diagnose problems in carbohydrate metabolism and checks the ability to metabolize glucose thru the tolerance level
  • Lactose Tolerance Test

    • Determine the lack of mucosal lactase which is responsible for conversion of lactose into glucose
  • Paternity/Parentage Testing

    • Verifies the probability that the patient fathered a particular child
  • Therapeutic Drug Monitoring

    • Tests the drug levels at specific interval to establish proper drug dosage and avoid toxicity
  • Therapeutic Phlebotomy

    • Used as treatment to polycythemia and hemochromatosis
  • Toxicology test

    • Checks the presence of toxins in the blood, hair, urine, and other substances
  • Trace elements

    • Checks for presence of aluminum, arsenic, copper, lead, iron, and zinc
  • The following information must be included: 1.Full name including middle initial, 2.Hospital ID Number, 3.Social Security Number for outpatients, 4.Date of Birth, 5.Date & time of collection, 6.Initials of the phlebotomist. Note: Room number and bed number is optional.
  • Blood banks can use special identification systems
    • ID bracelet (self-carbon adhesive for specimen), Blood ID band (linear bar-code), and Siemens Patient Identification check-blood administration
  • Screening includes

    • Typing the blood for transfusion and screening for infectious diseases. The blood type (ABO) and Rh factor (+ or -) are determined.
  • Cross-match test

    • Eliminates blood related compatibility issues that may arise between the patient and the donor
  • Blood donor collection

    • Done mainly for the purposes of blood transfusion
  • Blood donors

    • 17 to 66 years of age, with a minimum weight of 110 lbs. They must have completed the physical exam and declared their medical history.
  • Autologous donation

    • The patient donates blood for his use especially for elective surgeries
  • Cell salvaging

    • The blood of the patient is salvaged (during surgical procedure), washed and re-infused after testing for residual free hemoglobin
  • Blood Culture Collection Procedure
    1. Identify the patient and explain the procedure
    2. Select the venipuncture site and release the tourniquet
    3. Assemble the equipment and follow proper aseptic technique
    4. Perform the friction rub for about 60 seconds
    5. Wait for 30 seconds to allow the site to dry
    6. Open the culture bottle and clean the stopper
    7. Check the fill lines on the bottle
    8. Tourniquet should be reapplied and perform the venipuncture
    9. Inoculate the medium
    10. 10. Mix the blood with the medium
    11. 11. Clean the patient's skin if iodine was used
    12. 12. Observe proper labeling procedures
    13. 13. Discard used and contaminated materials
    14. 14. Thank the patient and decontaminate hands
    15. 15. Transport the specimen promptly to the laboratory
  • Media Inoculation Methods

    • Directly into the bottle (during collection)
    • Collected in a syringe (after collection)
    • Through an intermediate collection tube (in the laboratory)
  • Coagulation Specimen Collection and Handling
    • Draw a "clear" tube with 1-2 mL which is discarded prior to collection
    • Collect the blood specimen using a light blue top with 3.2% citrate tube with the correct (9:1) blood to coagulant ratio
    • Invert the tubes gently 3 to 4 times immediately after collection
    • Coagulation sample is collected second when an evacuated tube system is used
    • For draws using indwelling catheter, the line should be flushed with 5 mL of saline
    • The concentration of the sodium citrate should be adjusted for patients with above 55% hematocritt values
    • The collected specimen should be transported to the laboratory immediately or centrifuged and the plasma frozen if unable to reach the lab within four hours
    1. hour Postprandrial Glucose Procedure

    1. A high-carbohydrate diet was introduced 2 to 3 earlier
    2. The patient should fast at least 10 hours prior to the test
    3. Fasting glucose specimen maybe be collected before the start of the procedure
    4. A special breakfast containing an equivalent of 100g glucose or a glucose beverage will be given on the day of the test
    5. Blood glucose specimen will then be collected 2 hours after the meal
  • Glucose Tolerance Test (GTT) Procedure
    1. Begin with the normal identification protocol and explain the procedure
    2. The fasting specimen is drawn and the glucose level is checked
    3. The patient should collect a fasting urine specimen if ordered
    4. The patient is given the glucose beverage dose
    5. Record the time when the drink was finished then start timing the test
    6. A copy of the collection time is provided to the patient
    7. If applicable the collection time for other specimen such as urine should coincide with the computed collection time
    8. The exact time collected and the time interval should be written in the label
    9. Transport the specimen immediately or within 2 hours
  • Lactose Tolerance Test

    • It is recommended that a 2-hour GTT test be administered at least a day before
    • Equal amount of lactose is substituted to glucose but the test will be performed following the manner of GTT
    • Glucose specimen is drawn at the same time as the previous GTT procedure
    • The GTT curve and the glucose curve will be similar if the patient has mucosal lactase
    • If the patient is lactose intolerant, the result will yield a "flat" curve
    • Patients with slow gastric emptying, Crohn's disease and cystic fibrosis could show false-positive results
  • Paternity/Parentage Testing

    • All involved parties need to submit a government issued photo identification along with the completed Chain of Custody form
    • The Buccal samples as collected by using a swab that was rubbed inside the cheek
    • Sealed and tamper-evident package are used to hold the specimen during transportation to the laboratory
    • The test results are ready after 48 hours which are usually sent via mail
  • Chain of Custody Procedures in Drug Testing
    • Toxicology Specimens: A phlebotomist 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.
  • RFLP

    Restriction Fragment Length Polymorphism
  • Principles of DNA paternity testing
    1. All involved parties need to submit a government issued photo identification along with the completed Chain of Custody form
    2. The Buccal samples as collected by using a swab that was rubbed inside the cheek and the loose cheek cells adhere to the swab
    3. Sealed and tamper-evident package are used to hold the specimen during transportation to the laboratory
    4. The test results are ready after 48 hours which are usually sent via mail
  • Chain of Custody

    Special protocol to track the specimen from the time of collection until the time that the results are released
  • Toxicology Specimens

    • Collected for the purpose of determining the presence of toxins which could be in very small amounts
  • Toxicology Specimens

    • Blood
    • Hair
    • Urine
    • Other substances from the body
  • Forensics Specimens

    Toxicology specimen ordered by the law enforcement department for legal or forensic purposes
  • Forensics Specimens

    • Breath
    • Blood for alcohol
    • Urine 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 chain of custody
  • Figure 8.4 shows a Drug Testing Consent Form from the Department of Health
  • Figure 8.5 shows a Custody or Control Form from the Department of Health