m10 special blood collection and point-of-care testing

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Cards (20)

  • Collection priorities

    • Routine samples
    • ASAP samples
    • Stat samples
  • Routine samples

    Tests ordered by the health-care provider to diagnose and monitor a patient's condition, usually collected early in the morning but can be collected throughout the day during scheduled "sweeps"
  • ASAP samples

    Samples to be collected as soon as possible
  • Stat samples

    Samples to be collected, analyzed, and results reported immediately, highest priority, usually ordered from the emergency department or for critically ill patients
  • Tests most critically affected by non-fasting
    • Glucose
    • Cholesterol
    • Triglycerides
    • Lipid profiles
  • Fasting differs from a basal state condition in that the patient must only have refrained from eating and drinking (except water) for 12 hours, whereas in the basal state, the patient also must have refrained from exercise, and drinking water is encouraged to avoid dehydration which can affect laboratory results
  • Reasons for timed samples
    • Measurement of the body's ability to metabolize a particular substance
    • Monitoring changes in a patient's condition
    • Determining blood levels of medications
    • Measuring substances that exhibit diurnal variation
    • Measurement of cardiac markers following acute myocardial infarction
    • Monitoring anticoagulant therapy
    • Glucose Tolerance Tests
  • Currently the WHO have shortened the methods used in OGTT for diabetes mellitus which is the 2-hour OGTT
  • Lactose Tolerance Test

    Evaluates a patient's ability to digest lactose, a milk sugar
  • Patients without mucosal lactase enzyme will not be able to break down lactose from milk and milk products, which may result in gastrointestinal discomfort and diarrhea. Avoiding milk can reduce the symptoms
  • Blood cultures

    One of the most difficult phlebotomy procedures because of the strict aseptic technique required and the need to collect multiple samples in special containers, requested on patients when symptoms of fever and chills indicate a possible infection of the blood by pathogenic microorganisms (septicemia)
  • Timing of sample collection for Blood Culture
    • Stat or timed collections, timing varies from institution to institution or just before the patient's temperature reaches its highest point (spike)
  • Equipment for Blood Culture Sample Collection
    • Requisition form
    • Gloves
    • Tourniquet
    • Chlorhexidine gluconate (or other antiseptic)
    • Alcohol pads
    • Blood culture bottles
    • Syringe
    • Hypodermic needles with safety device
    • Blood transfer device
    • Winged blood collection set and tube holder
    • 2X2 gauze
    • Sharps container
    • Indelible pen
    • Bandage
    • Biohazard bag
  • Procedure for Blood Culture Sample Collection
    1. Obtain and examine the requisition form
    2. Greet the patient and explain the procedure
    3. Use two identifiers to correctly identify the patient
    4. Prepare the patient and verify allergies
    5. Select equipment
    6. Wash hands and don gloves
    7. Apply the tourniquet and locate the venipuncture site
    8. Release tourniquet
    9. Sterilize the site using chlorhexidine gluconate and allow to dry
    10. Assemble equipment while the antiseptic is drying, attach the needle to the syringe
    11. Remove the plastic cap on the collection bottle, confirm the volume of blood required from the label
    12. Clean the top of the bottles with a 70% isopropyl alcohol pad and allow to dry
    13. Reapply the tourniquet and perform the venipuncture (do not palpate the site)
    14. Release the tourniquet, place gauze over the puncture site, remove the needle
    15. Remove the syringe needle with a point-Lok device
    16. Attach safety transfer device
    17. Inoculate the anaerobic blood culture bottle first when using a syringe
    18. Dispense the correct amount of blood into bottles
    19. Mix the blood culture bottles by gentle inversion eight times
    20. Fill other collection tubes after the blood culture tubes
    21. Clean the iodine off the arm with alcohol if necessary
    22. Label the samples appropriately and include the site of collection
    23. Dispose of used equipment and supplies in a biohazard container
    24. Check the venipuncture site for bleeding
    25. Thank the patient, remove gloves, and wash hands
  • Yellow stopper tubes containing acid-citrate-dextrose (ACD)

    Commonly used for DNA paternity testing
  • Urine

    Sample of choice for drug screening because of the ease of collection and because the substance remains in the urine for a longer period of time
  • Point-of-care testing (POCT)

    Any analytical test that is done outside the centralized laboratory and near the site where the patient receives treatment, also called alternate site testing (AST), bedside testing, near-patient testing, remote testing, satellite testing, and rapid diagnostics
  • Dorsal hand vein technique

    Venipuncture technique used for infants and children
  • Equipment for Dorsal Hand Vein Technique
    • Requisition form
    • Gloves
    • Alcohol pads
    • Gauze
    • 23-25 gauge hypodermic needle
    • Microtainers
  • Procedure for Dorsal Hand Vein Technique
    1. Obtain and examine the requisition form
    2. Greet the patient/parent and explain the procedure
    3. Wash hands and put on gloves
    4. Identify the infant/child
    5. Immobilize the patient
    6. Select the vein by encircling the wrist and gently bending it downward, do not use a tourniquet
    7. Cleanse the site with alcohol and allow to air dry
    8. Select a 23-25 gauge hypodermic needle with a clear hub and appropriate Microtainers
    9. Encircle the vein with the thumb underneath and the index and middle finger on top of the wrist and apply pressure with the index finger
    10. Insert the needle with the bevel up into the vein at a 15 degree angle to the skin
    11. Fill microtainers directly from the blood that drips from the hub of the needle, release the finger pressure intermittently to allow the blood to continue to flow
    12. After collection of samples, place gauze over the needle but do not push down, remove the needle and apply pressure for 2-3 mins. or until the bleeding stops, do not apply bandage
    13. Label the tubes
    14. Perform appropriate sample handling
    15. Dispose of used supplies in biohazard containers
    16. Remove gloves and wash hands
    17. Enter blood collection volume in the child's chart or log book
    18. Deliver samples promptly to the laboratory