Lab pmls

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Created by
Gwyneth Tomalon

Cards (62)

  • Evacuated Tube System (ETS)

    Most frequently used method for performing venipuncture
  • Evacuated Tube System (ETS)

    • Consists of a double-pointed needle to puncture the stopper of the collection tube, a holder to hold the needle and blood collection tube, and color-coded evacuated tubes
    • Produce the best blood samples for analysis because the blood goes directly from the patient's vein into the appropriate test tube, eliminating the need for the transfer of specimens and minimizing the risk of biohazard exposure
  • Equipment for ETS

    • Multisample needle
    • Tube holder / Adaptor
    • Evacuated tube
    • Cotton (wet and dry)
    • Tourniquet
    • Plaster
    • Marker
  • Multisample needle

    • Attach to a holder that holds the collection tube
    • Has a beveled point at each end designed: one end is for venipuncture and the other end punctures the rubber stopper of the evacuated blood collection tube
    • Has different colors depending on gauge size: Blue: 23-gauge, Black: 22-gauge, Green: 21-gauge
    • Gauge: The number that indicates the diameter of its lumen (also called bore, circular hollow space inside the needle), the higher the gauge, the smaller the lumen, commonly used are 20, 21, and 22
  • Tube holder / Adaptor
    • A plastic sleeve into which the phlebotomist screws the double-pointed needle
    • May be designed to act as a safety shield for the used needle
    • For single use only, must be discarded with the used needle as directed by Occupational Safety and Health Administration (OSHA)
    • Its flared ends aid the phlebotomist during the changing of tubes in multiple-sample situations
    • Ribbed pediatric holder inserts can be inserted into the regular size holder for pediatric tubes
  • Evacuated tube

    • Placed into the large opening at the opposite end of the tube holder
    • Should fit securely in the holder to provide proper puncturing of the rubber stopper and maximum control
    • The first tube can be partially advanced onto the stopper-puncturing needle in the holder when needle is not in vein, a marking near the top of the holder indicates the distance an evacuated tube may be advanced into the stopper-puncturing needle without entering the tube and losing the vacuum
    • When needle is in the vein, fully advanced to the end of the holder, blood will flow into the tube once the needle penetrates the stopper
    • After collecting blood, removed with a slight twist to help disengage them from the needle
    • For multiple blood collections, remove the tube from adaptor without withdrawing the needle and push the succeeding tubes into the adaptor
  • Procedure for ETS

    1. Patient identification
    2. Preparation
    3. Tourniquet application
    4. Palpate the vein
    5. Vein selection
    6. Assemble equipment
    7. Re-apply tourniquet and prepare to draw
    8. Performing the draw
    9. Ending draw - release tourniquet
    10. Mixing and labeling tubes
    11. Inspect area for continued bleeding or swelling
    12. Discard all used materials
    13. Thank the patient
    14. Wash or sanitize hands
  • Correct insertion technique

    • Blood flows freely into needle
  • Bevel on vein upper wall

    Does not allow blood to flow
  • Bevel on vein lower wall

    Does not allow blood to flow
  • Needle inserted too far

    Slowly retract the needle until blood flows into needle
  • Needle partially inserted

    Causes blood leakage into tissue, causes hematoma, advise patient to apply cold compress then hot compress
  • Collapsed vein

    Swelling and no flow, remove the needle and redraw
  • Sources of Error

    • Failure to insert the needle completely into the vein
    • Puncturing the stopper before entering the vein
    • Not anchoring the vein before inserting the needle
    • Bouncing the needle on the skin before guiding it into the vein
    • Not keeping the holder stationary during tube change
  • Rejection of Samples

    • Hemolysis
    • Clotted
    • Insufficient sample (QNS)
    • Wrong tube collected for test ordered
    • Improper storage
    • Improperly labeled
  • Manufacturers of Safety Shields and Blunting Devices
    • Becton, Dickinson, Franklin Lakes, NJ (BD Vacutainer Eclipse blood collection needle)
    • PUNCTUR-GUARD, Gaven Medical LLC, Vernon, CT (Self-blunting needles)
  • Point of Care Testing (POCT)
    Medical testing at the site of patient care
  • Alternate Site Testing (AST)

    Also known as POCT or ancillary, bedside, or near-patient testing
  • First reported: PAPYRUS documents - Egyptian physicians using ants to determine glycosuria in patients suspected of having diabetes mellitus

    1550 B.C
  • POCT initially explored in England
    1950s
  • POCT introduced by Dr. Gerald J. Kost - Applied biosensors for monitoring ionized calcium levels in whole blood

    Early 1980s
  • POCT

    Defined as "testing at or near the site of patient care"
  • Advantages of POCT

    • Convenience (ease of use and mobility)
    • Decreased Turn Around Time (TAT)
    • No need for transport
    • Increased interaction between health care personnel and patient
    • Faster delivery of results
    • Decrease manpower needs
  • Disadvantages of POCT

    • Potential Billing issues
    • More expensive
    • Maintenance of QC is challenging
    • Documentation Challenges
    • Diluted competency due to large number of operators
  • Where POCT can be used
    • Primary Care
    • Secondary and Tertiary Care (Emergency department, Admission unit, ambulatory diagnostic and treatment center, operating room, intensive care unit (ICU), ward, outpatient clinic)
    • Home, Community Pharmacy, health centers, Workplace Clinic, Physician's office or community clinic, Diagnostic and treatment Center, paramedical support vehicle (ambulance, helicopter, aircraft)
  • Who can perform POCT
    • Non-laboratory personnel (nurses, surgery technician, therapists, others)
    • Clinical Laboratory Improvement Amendments of 1988 (CLIA88) addressing issues like poor documentation and poor-quality results
  • CLIA License and Regulations
    • Moderate Complexity Test: 75 % of 12,000 test methods requires automation
    • High Complexity Tests: require much operator skills and decision making
    • Waived Test: (simple test)
    • Fourth category (It involves a microscope)
  • POCT Checklist

    • Quality Management
    • Specimen handling
    • Reagents
    • Instruments and equipment
    • Personnel
    • Quality Control and Calibration
    • Safety
  • ASSURED criteria

    • Affordable: for those at risk of infection
    • Sensitive: minimal false negatives
    • Specific: minimal false positives
    • User friendly: minimal steps to carry out test
    • Rapid and robust: short turnaround time (TAT) and no need for refrigerated storage
    • Equipment free: no complex equipment
    • Delivered: to end users
  • Types of POCT Controls
    • External Controls - used to verify test systems that use urine or blood specimens
    • Electronic controls - mechanical or electrical calibration
    • Internal Controls - procedural controls ensure things perform as planned
  • Common POCT errors to avoid
    • Patient Identification
    • Proper Specimen Collection
    • Proper storage of testing supplies
    • Quality Control
    • Specimen application
    • Result Interpretation
    • Documentation of Results
  • Examples of Tests Involving POCT
    • Fecal Occult Blood Test
    • Pregnancy test /HCG
    • Cardiac marker - troponin
    • Urinalysis
    • Occult blood
    • Glucose
    • Rapid Strep Test
  • POCT Instruments for Coagulation Monitoring
    • Cascade POCT - ACT, APTT, PT/INR
    • CoaguChek XS Plus- PT/INR
    • GEM Premier 4000 -ACT,APTT,PT/ INR
    • I- STAT - ACT, PT/INR
    • Verify Now -Platelet Function
  • Bleeding Time

    Assessment of primary hemostasis, normal range 2-7 minutes
  • Arterial Blood Gases Measured by POCT
    • pH
    • Partial pressure of carbon dioxide
    • Oxygen Saturation
    • Partial pressure of oxygen
  • Chemistry Panel Tested by POCT
    • Sodium
    • Potassium
    • Chloride
    • Bicarbonate ion
    • Ionized Calcium
  • Examples of POCT Instruments with Multiple Test Panels
    • GEM PREMIER
    • I-STAT
    • Nova stat profile analyzer
    • ABL 80 Flex
  • Reference Values
    • Total Cholesterol: -200 mg/dL
    • LDL Cholesterol: -100 mg/dL
    • HDL Cholesterol:>40 mg/dL for men, >50 mg/dL for women
    • Triglycerides: -150 mg/dL
    • Adult women Hemoglobin: 12-14 g/dL
    • Adult men Hemoglobin: 14-17 g/dL
    • Urine Specific Gravity: 1.001-1.030
    • Urine pH: 5-6
    • Urine Leukocytes: 4500-11000 /microliter
    • Urine Nitrate: 0-0.001
    • Urine Protein: Negative
    • Urine Glucose: 70-99mg/dL Normal, <70 hypoglycemic, >99 hyperglycemic
  • Congenital Hypothyroidism (CH)

    Inborn error or iodine deficiency, prevalence of 1-4000 affected, most common with Hispanic and Native American
  • Thyroid hormones

    • Crucial for normal growth and development of the brain and intellectual function, maturation of fontal lungs and bones, and proper sexual maturation