pmls

• Special Procedures


  • Blood Bank Specimens
  • Blood Cultures
  • Coagulation Specimens
  • 2-Hour Postprandial Glucose
  • Glucose Tolerance Test
  • Drug Screening
• Blood Bank Specimens


  • Lavender or pink top EDTA tubes
  • Non additive glass red-stoppered tube
  • Require strict patient identification and specimen labeling procedures
  • Special ID bracelet attached to patient's wrist might be used

  
• Type, Screen and Crossmatch

  1. Determines a patient's blood type (ABO) and Rh factor (positive or negative)

  2. A cross-match is performed using the patient's type and screen results to help select a donor unit of blood

  3. The patient's plasma or serum and the donor's RBCs are mixed together to determine compatibility

  4. Incompatible blood can be fatal

  
• Blood Cultures


  1. Alcohol, iodine, alcohol, lower angle of the syringe check the presence of bacteria of the patient

  2. Determine the presence and extent of infection

  3. Indicate the type of organism responsible and the antibiotic to which it is most susceptible

  4. Useful in assessing the effectiveness of antibiotic therapy once treatment is initiated

  5. Two to four blood cultures are necessary to optimize the detection of bacteremia and fungemia

  6. Specimens should be drawn 30 to 60 minutes apart different time different site

  7. If the patient is in critical condition or an antibiotic must be given right away, cultures should be drawn consecutively and immediately from different site

  8. According to ASM, American Society for Microbiology the volume of blood drawn for infants and younger children should be from 1-4 percent of the patient's total blood volume, generally speaking. For adults or people weighing more than 80 pounds, the recommended volumes for blood cultures are 20ml to 30 ml per culture with a minimum of 10 mL per draw

  9. Collected in special bottles containing nutrient broth (referred to as medium) that encourages the growth of microorganisms

  10. Collected in sets of two: aerobic and anaerobic

  
• Skin Antisepsis


  1. Destruction of microorganisms on the skin

  2. 30- to 60-second friction scrub using: tincture of iodine, chlorhexidine gluconate, and a povidone, 70 percent ethyl alcohol combination
• Coagulation Specimens


  1. Draw a "clear" or discard tube prior to collection of a blue-top tube using plain red top tube

  2. A clear tube is required for all other coagulation tests like factor viii

  3. 9:1 ratio of blood to anticoagulant

  4. If the test cannot be performed in a timely manner, the specimen must be centrifuged and the plasma must be transferred to another tube. frozen

  5. Never pour two partially filled tubes together to create a full tube, as the anticoagulant-to-blood ratio will be greatly increased

  6. Discard 5mL of blood if sample must be drawn from indwelling catheters

  7. If heparin has been introduced in the line, it should be flushed with 5mL of saline
• St. Alexius College, Medical Technology Department, City of Koronadal, South Cotabato
• 1. Hour Postprandial Glucose


  • Glucose test on a specimen collected 2 hours after a meal
  • Is an excellent screening test for diabetes and other metabolic problems
  • Used to monitor insulin therapy
• Glucose Tolerance Test


  1. Evaluates the insulin response to a measured dose of glucose by recording glucose levels on specimens collected at specific time intervals

  2. Must eat balanced meals containing approximately 150g of carbohydrates for 3 days before testing

  3. Must fast for at least 12hrs but not more than 16hrs prior to the test

  4. Allowed to drink water during the fast and during the test to avoid dehydration and because urine specimens may be collected as part of the procedure

  5. OGTT PREGNANT WOMEN , GESTATIONAL DIABETES

  6. 50 g- 1,75 g 2hr,100,3hr
• MT 101 LEC, PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2, "SPECIAL COLLECTION AND POINT OF CARE TESTING"
• Prepared by | Carl Jethro G. Dellosa, RMT
• Drug Screening


  • Specimen used: Urine
  • Performed as pre-employment requirement in healthcare organizations, sports associations, and major companies
  • Can detect illicit drugs such as cocaine/crack, opiates/heroin, amphetamines like ecstasy, speed and crystal and tetrahydrocannabinol/pot
• Special Procedures


  • Blood Bank Specimens
  • Blood Cultures
  • Coagulation Specimens
  • 2-Hour Postprandial Glucose
  • Glucose Tolerance Test
  • Drug Screening
• Patient Preparation Requirements


  1. Explain the test purpose and procedure

  2. Advise the patient of his or her legal rights

  3. Obtain a witnessed, signed consent form
• Blood Bank Specimens


  • Lavender or pink top EDTA tubes
  • Non additive glass red-stoppered tube
  • Require strict patient identification and specimen labeling procedures
  • Special ID bracelet attached to patient's wrist might be used

  
• Specimen Collection Requirements


  1. A special area must be maintained for urine collection

  2. A proctor is required to be present at the time of collection to verify that the specimen came from the correct person

  3. A split sample may be required for confirmation or parallel testing

  4. The specimen must be labeled appropriately to establish a chain of custody

  5. To avoid tampering, a specimen must be sealed and placed in a locked container during transport from the collection site to the testing site. Documentation must be carefully maintained from courier to receiver
• Type, Screen and Crossmatch

  1. Determines a patient's blood type (ABO) and Rh factor (positive or negative)

  2. A cross-match is performed using the patient's type and screen results to help select a donor unit of blood

  3. The patient's plasma or serum and the donor's RBCs are mixed together to determine compatibility

  4. Incompatible blood can be fatal

  
• Point-of-Care Testing


  • Alternate site testing (AST) or ancillary, bedside, or near-patient testing
  • Brings laboratory testing to the location of the patient
  • Benefits: convenience to the patient, short turnaround time, deliver prompt medical attention, expedite patient recovery
  • One of the most common POCT is GLUCOSE testing
• Blood Cultures


  1. Alcohol, iodine, alcohol, lower angle of the syringe check the presence of bacteria of the patient

  2. Determine the presence and extent of infection

  3. Indicate the type of organism responsible and the antibiotic to which it is most susceptible

  4. Useful in assessing the effectiveness of antibiotic therapy once treatment is initiated

  5. Two to four blood cultures are necessary to optimize the detection of bacteremia and fungemia

  6. Specimens should be drawn 30 to 60 minutes apart different time different site

  7. If the patient is in critical condition or an antibiotic must be given right away, cultures should be drawn consecutively and immediately from different site

  8. According to ASM, American Society for Microbiology the volume of blood drawn for infants and younger children should be from 1-4 percent of the patient's total blood volume, generally speaking. For adults or people weighing more than 80 pounds, the recommended volumes for blood cultures are 20ml to 30 ml per culture with a minimum of 10 mL per draw

  9. Collected in special bottles containing nutrient broth (referred to as medium) that encourages the growth of microorganisms

  10. Collected in sets of two: aerobic and anaerobic

  
• Establish a chain of custody


  1. Specimen must be sealed and placed in a locked container during transport from the collection site to the testing site

  2. Documentation must be carefully maintained from courier to receiver
• To avoid tampering, a specimen must be sealed and placed in a locked container during transport from the collection site to the testing site
• Skin Antisepsis


  1. Destruction of microorganisms on the skin

  2. 30- to 60-second friction scrub using: tincture of iodine, chlorhexidine gluconate, and a povidone, 70 percent ethyl alcohol combination
• Documentation must be carefully maintained from courier to receiver
• SPECIMEN COLLECTION REQUIREMENTS
• Coagulation Specimens


  1. Draw a "clear" or discard tube prior to collection of a blue-top tube using plain red top tube

  2. A clear tube is required for all other coagulation tests like factor viii

  3. 9:1 ratio of blood to anticoagulant

  4. If the test cannot be performed in a timely manner, the specimen must be centrifuged and the plasma must be transferred to another tube. frozen

  5. Never pour two partially filled tubes together to create a full tube, as the anticoagulant-to-blood ratio will be greatly increased

  6. Discard 5mL of blood if sample must be drawn from indwelling catheters

  7. If heparin has been introduced in the line, it should be flushed with 5mL of saline

  
• Point-of-care testing (POCT)


  • Alternate site testing (AST) or ancillary, bedside, or near-patient testing
  • Brings laboratory testing to the location of the patient
• Benefits of POCT


  • Convenience to the patient
  • Short turnaround time
  • Deliver prompt medical attention
  • Expedite patient recovery
• 1. Hour Postprandial Glucose


  • Glucose test on a specimen collected 2 hours after a meal
  • Is an excellent screening test for diabetes and other metabolic problems
  • Used to monitor insulin therapy
• POCT glucose testing


  • One of the most common POCT
  • POCT glucose analyzers/meters are small, portable, and relatively inexpensive
  • 2 types of meters are made: individual's personal use and use in healthcare settings
• Glucose Tolerance Test


  1. Evaluates the insulin response to a measured dose of glucose by recording glucose levels on specimens collected at specific time intervals

  2. Must eat balanced meals containing approximately 150g of carbohydrates for 3 days before testing

  3. Must fast for at least 12hrs but not more than 16hrs prior to the test

  4. Allowed to drink water during the fast and during the test to avoid dehydration and because urine specimens may be collected as part of the procedure

  5. OGTT PREGNANT WOMEN , GESTATIONAL DIABETES

  6. 50 g- 1,75 g 2hr,100,3hr
• POCT glucose analyzers/meters


  • ACCU-CHEK Inform
  • HemoCue Glucose 201 DM
  • Precision Xceed Pro
  • SureStep Flex30
• Drug Screening


  • Specimen used: Urine
  • Performed as pre-employment requirement in healthcare organizations, sports associations, and major companies
  • Can detect illicit drugs such as cocaine/crack, opiates/heroin, amphetamines like ecstasy, speed and crystal and tetrahydrocannabinol/pot
• POCT glucose testing


  • Use of special reagent test strips
  • Strips must be protected from excessive heat and moisture
  • Whole-blood specimens obtained by routine skin puncture
• Patient Preparation Requirements


  1. Explain the test purpose and procedure

  2. Advise the patient of his or her legal rights

  3. Obtain a witnessed, signed consent form
• Coagulation monitoring by POCT

  • Warfarin and heparin therapy can be evaluated using a coagulation POCT analyzer
  • Common coagulation tests checked are prothrombin time (PT), International normalized ratio (INR), activated partial thromboplastin time (APTT or PTT), Activated Clotting Time (ACT), and Platelet function
• Trace elements testing by POCT

  • Check for the presence of aluminum, arsenic, copper, lead, iron, and zinc
  • Specimens are collected in small amounts and must use special-free tubes colored ROYAL BLUE
  • To avoid contamination, change the transfer device before the filling the tube
• Specimen Collection Requirements


  1. A special area must be maintained for urine collection

  2. A proctor is required to be present at the time of collection to verify that the specimen came from the correct person

  3. A split sample may be required for confirmation or parallel testing

  4. The specimen must be labeled appropriately to establish a chain of custody

  5. To avoid tampering, a specimen must be sealed and placed in a locked container during transport from the collection site to the testing site. Documentation must be carefully maintained from courier to receiver

  
• Bleeding time


  • Non-instrumented test ordered by the physician to evaluate the capillaries for platelet plug formation, which indicative of disorder in the platelet function or problems in capillary integrity
  • Used for pre-surgical screening and detection of problems involving hemostasis
• Arterial blood gases and electrolytes by POCT

  More expensive than the traditional pre-analytic procedures performed in a typical laboratory but they have greatly improved the turnaround time of the tests for patients in emergency situations
• Point-of-Care Testing (POCT)


  • Alternate site testing (AST) or ancillary, bedside, or near-patient testing
  • Brings laboratory testing to the location of the patient
  • Benefits: convenience to the patient, short turnaround time, deliver prompt medical attention, expedite patient recovery
  • One of the most common POCT is glucose testing