finals emi

• Specimen requirements


  • Lavender- or pink-top EDTA tubes
  • Non additive glass red-top maybe used
• Identification & labeling requirements


  • Patient's full name
  • Patient's hospital ID# or SS#
  • Patient's date of birth
  • Date & time of collection
  • Phlebotomist's initials
  • ID bracelet w. self-carbon adhesive label for specimen
  • Blood ID-band with linear bar-coded BBID #'s
  • Siemens Patient Identification Check-Blood Administration
• 1. Type, Screen, and Cross-Match

  2. Blood Donor Collection

  3. Blood Cultures

  4. Coagulation Specimens

  5. 2-Hour Postprandial Glucose

  6. Glucose Tolerance Test (GTT)

  7. Lactose Tolerance Test

  8. Paternity/Parentage Testing

  9. Therapeutic Drug Monitoring

  10. Toxicology Specimens

  11. Trace Elements

  12. Point-of-Care Testing

  13. Bleeding-Time Test Procedure

  14. Arterial Blood Gases and Chemistry Panels

  15. Arterial Blood Gases and Chemistry Panels

  16. Multiple-Test-Panel Monitoring by POCT

  17. Other Tests Performed by POCT
• Donor eligibility


  • Between ages 17 & 66 years
  • Weight at least 110 lbs
  • Physical exam & medical history required
  • Written permission from donor required
• Lookback program


  • All blood components of unit must be traceable to donor
  • Requires notification to all blood recipients when a donor is shown to be positive for a transmissible disease
• Autologous donation


  Person donates blood for his/her own use (e.g., for elective surgeries)
• Cell salvaging


  • Patient's blood can be salvaged, washed, & reinfused
  • Salvaged blood must be tested for residual free hemoglobin
• Blood Cultures


  • Skin antisepsis: Most important part of collecting
  • Purpose: Destroy skin microorganisms, Prevent misinterpretation of microorganism as pathogenic
• Acceptable antiseptics


  • chlorhexidine gluconate
  • Tincture of iodine or povidine
  • Requires 30- to 60-seconds friction scrub
• Media inoculation methods


  • Direct inoculation
  • Syringe inoculation
• Intermediate collection tube


  • Yellow-top SPS tube is acceptable
  • Use is discouraged because: Final concentration of SPS is increased, Presents another opportunity for contamination, Increased exposure risk to lab staff
• Antimicrobial Neutralization Products


  • Removes or neutralizes antimicrobials/antibiotics from blood
  • Prevents antimicrobials from inhibiting growth of microorganisms
• Coagulation Specimens


  • A "clear" or discard tube is required for coagulation tubes (PT/PTT) drawn with butterfly
  • Sodium citrate tubes must be filled until vacuum is exhausted. If not filled completely they will be rejected. Must be 9:1 ratio of blood to anticoagulant.
  • Never pour 2 partially filled tubes together
  • Cooling on ice during transport may be required
  • When drawing from an indwelling catheter: A draw & discard 10 mL must be drawn by the RN

  
• 1. Hour Postprandial Glucose


  • Glucose in diabetics is significantly increased 2 hrs after meal
  • Excellent screening test for diabetes
• Glucose Tolerance Test (GTT)


  • Used to diagnose problems of carbohydrate metabolism
  • Monitors patient's tolerance to high levels of glucose
  • Hyperglycemia: increased blood glucose level
  • Hypoglycemia: decreased blood glucose level
• Glucose Tolerance Test (GTT) – GTT procedure


  Follow normal ID protocol & explain collection procedure; advise of fasting requirements

  b. Draw fasting specimen & check for glucose

  c. Ask patient to collect fasting urine specimen (if needed)

  d. Give patient determined dose of glucose beverage

  e. Remind patient to finish beverage within 5 min.

  f. Note time patient finishes, start timing, calculate collection times

  g. Give a copy of collection times to patient (not necessary, pt does not leave area)

  h. Collect blood & urine specimens at computed times

  i. Label all specimens with collection times, intervals, patient ID

  j. Deliver or send specimens to lab ASAP
• Lactose Tolerance Test


  • Determines lack of enzyme that converts lactose into glucose/galactose
  • Performed in same manner as 2-hr GTT, only w. lactose
• Paternity/Parentage Testing


  • Excludes possibility of paternity rather than proves it
  • Requires a chain-of-custody protocol & specific ID procedures
  • Mother, child, & alleged father are all tested
  • Blood samples are preferred, but cheek swabs are increasing
  • Blood sample testing includes ABO & Rh typing
• Therapeutic Drug Monitoring


  • Establishes & maintains drug dosage at therapeutic level
  • Such as blood thinners, seizure meds etc
  • Avoids drug toxicity
• Therapeutic Phlebotomy


  • Withdrawal of large volume of blood to treat (500ml)
  • Polycythemia: Body's over production of RBCs
  • Hemochromatosis: Excess iron deposits in tissues
• Toxicology Specimens


  • Toxicology: scientific study of toxins (poisons)
  • Concerned with detection of toxins & treatment of effects
• Forensic blood alcohol (ethanol) specimens


  • Often requested by law enforcement officials
  • Used to determine levels in breath, urine, or blood
  • Specimen collection must follow chain of custody
  • Forensic toxicology is concerned with legal consequences of toxin exposure
• Clinical blood alcohol (ethanol) specimens


  • Normally ordered by physician for treatment purposes
  • Chain of custody not required, but follow standard protocol
  • Required in connection to on-the-job injury, employee insurance programs, & employee drug screening
  • Skin preparation: don't use alcohol-based disinfectant
  • Specimen requirements: gray-top sodium fluoride tube; fill tube until vacuum is exhausted & don't remove stopper
• Drug screening


  • Required by many healthcare organizations, sports associations, & major companies
  • May be random, pre-employment, post-accident
  • May detect a specific drug or screen for up to 30 drugs
  • Typically performed on urine rather than blood
  • Chain of custody is required
• Patient preparation requirements


  • Explain test purpose & procedure
  • Advise patient of his or her legal rights
  • Obtain a witnessed, signed consent form
• Specimen collection requirements


  • Special area for urine collection
  • Proctor present at time of collection
  • Split sample may be required
  • Specimen must be labeled, sealed, & placed in a clocked container

  
• Trace Elements


  • Tests for aluminum, arsenic, copper, lead, iron, & zinc
  • Measured in small amounts
  • Traces of them in glass, plastic, or stopper material can leach into specimen
  • Special trace element–free tubes must be used (royal blue & contain EDTA, heparin, or no additive)
• Point-of-Care Testing


  • Brings lab testing to location of patient
  • Made possible by development of small, portable testing devices
  • Offers convenience to patient & short turnaround time
  • Requires carrying out quality-control & maintenance procedures necessary to ensure that results are accurate
• Quality and Safety in POCT


  • Waived vs. non-waived quality control checks
  • Electronic quality control (EQC) built into POC instruments
  • Specimen collection & handling not checked by EQC
  • Daily external liquid QC for non-instrumented POCT
  • POC instruments become possible fomites for disease
  • Disinfect with 10% bleach
  • Reduce cross-contamination between patients

  
• Coagulation Monitoring by POCT


  • Prothrombin time (PT) & international normalized ratio (INR)
  • Activated partial thromboplastin time (APTT or PTT)
  • Activated clotting time (ACT)
  • Platelet function
• POCT instruments


  • Cascade POC —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 Test Procedure


  ID patient & sanitize hands

  b. Determine patient use of aspirin in past 2 weeks & describe risks

  c. Support patient's arm on steady surface

  d. Select area on inner lateral surface of forearm

  e. Place blood pressure cuff around arm

  f. Clean selected area with alcohol & allow to air-dry

  g. Put on gloves & prepare equipment

  h. Remove puncture device from package, keeping blade sterile

  i. Inflate blood pressure cuff to 40 mm Hg

  j. Remove safety clip & place puncture device on forearm

  k. Depress trigger & start timer; discard in sharps container

  l. Blot blood flow at 30 seconds w. filter paper

  m. Stop timer when blood no longer stains filter paper

  n. Remove blood pressure cuff, clean & bandage arm

  o. Record time to nearest 30 seconds

  p. Dispose of used & contaminated supplies; thank patient

  
• Arterial Blood Gases and Chemistry Panels


  • pH
  • Partial pressure of carbon dioxide
  • Oxygen saturation
  • Partial pressure of oxygen
• Electrolytes measured


  • Sodium
  • Potassium
  • Chloride
  • Bicarbonate ion
  • Ionized calcium
• Multiple-Test-Panel Monitoring by POCT


  • GEM Premier
  • i-STAT
  • NOVA Stat Profile Analyzer
  • ABL 80 Flex
• Other Tests Performed by POCT


  • Cardiac troponin T & I
  • Lipid testing
  • B-type natriuretic peptide
  • C-reactive protein
  • Glucose: Most common
• Blot blood flow at 30 seconds

  1. Blot with filter paper

  2. Stop timer when blood no longer stains filter paper

  3. Remove blood pressure cuff, clean & bandage arm

  4. Record time to nearest 30 seconds

  5. Dispose of used & contaminated supplies; thank patient

  
• Arterial blood gases measured
• Arterial blood gases measured


  • pH
  • Partial pressure of carbon dioxide
  • Oxygen saturation
  • Partial pressure of oxygen
• Electrolytes measured


  • Sodium
  • Potassium
  • Chloride
  • Bicarbonate ion
  • Ionized calcium