Phlebotomy Part 5 (Non-Blood Specimens)

Non-blood specimen labeling and handling

• proper labeling helps avoid testing delays, which can compromise patient care

• non-blood specimens should be labeled with the same identifying info as blood specimens as well as including the type and/or source of the specimen

How do you label non-blood specimens by hand?

Patient Last Name, First Name, Date of birth, what the sample is, date, time of collection, and your initials

Urine

• most frequently analyzed non-blood body fluid

• type preferred is the first urine voided (passed naturally from the bladder or urinated) in the morning, because it is the most concentrated

What test needs the first urine voided in the morning?

Pregnancy

What specimen is most frequently analyzed?

Urine

Routine Urinalysis (UA)

most commonly requested test because it screens for urinary and systemic disorders

Describe the physical analysis of urinalysis (UA)

Involves macroscopic observation and notation of color, clarity, and odor; measurements of volume and specific gravity (SG) or osmolality (indicates urine concentration)

Describe the chemical analysis of urinalysis (UA)

• Can detect bacteria, bilirubin, blood (RBC and hemoglobin), glucose, ketones, leukocytes, nitrate, protein, and urobilinogen, and measure pH and specific gravity.

• analysis is commonly performed using a plastic reagent strip (often called a dipstick) that contains pads impregnanted with test reagents

If the thermometer on the side of a urinalysis cup is 85 F degrees, what do you do?

• don’t accept the sample because it should be about 98F fresh out of the body

• Have the patient give you another sample while you are in the room

Midstream Urine

• Used to avoid contamination by genital secretions, pubic hair, and bacteria surrounding the urinary opening, this is the ideal procedure for collecting a specimen for routine urinalysis

• tell the patient to start voiding and push the cup into the stream

Routine UA Specimens

• Should be collected in clear, dry, chemically clean containers with tight-fitting lids.

• if a culture and sensitivity (C&S) is also ordered on the specimen, the container should be sterile

Does a Routine UA test container have to be sterile?

No

Does a C&S test container have to be sterile?

Yes

Urine culture and sensitivity (C&S) test

• may be requested on a pt. with symptoms of UTIs

• the culture involves placing a measured portion of urine on a special nutrient medium that encourages the growth of microorganisms, incubating it for 18 to 24 hours, checking it for growth, and identifying any microorganisms that grow

Urine clean catch

• procedures to ensure that the specimen is free of contaminating matter from the external genital areas

• A Betadine (Povidone-Iodine) prep pad is used to swab

For a patient with a penis, how do you do a urine clean catch?

Use a betadine prep pad to swab the tip of a penis TWICE

For a patient with a vagina, how do you do a urine clean catch?

Use a betadine prep pad to swab the vagina THREE times, from front to back

Urine cytology studies

• performed to detect cancer, cytomegalovirus, and other viral and inflammatory diseases of the bladder and other structures of the urinary system

• cells from the lining of the urinary tract are readily shed into the urine

Urine Drug Screening

• performed to detect illicit use of recreational drugs, use of anabolic steroids, and unwarranted use of prescription drugs

• used to monitor therapeutic drug use in order to minimize withdrawal symptoms and to confirm a diagnosis of drug overdose

24 Hour Urine

• collected to allow quantitative analysis of a urine analyte

• collection and pooling of all urine voided in the 24 hour period is critical

• the best time to begin the collection is when the patient first wakes up

• store the urine in the fridge

When do you start collecting a 24 hour urine?

SECOND urine voided in the morning

Regular voided specimen

Requires no special patient preparation and is collected by having the patient void (urinate) into a clean urine container

Pediatric Urine Collection

• a plastic urine collection bag with hypoallergenic skin adhesive is used to collect a urine specimen from an infant or small child who is not yet potty trained

• the patient’s genital area is cleaned and dried before the bag is taped to the skin

Amniotic fluid

• clear, almost colorless to pale-yellow fluid

• preferably collected after 15 weeks of gestation (pregnancy) and is obtained by a physician using a procedure called transabdominal amniocentesis

Cerebrospinal Fluid (CSF)

• clear, colorless liquid that surrounds the brain and spinal cord

• specimens are obtained by a physician (preferably an anesthesiologist), most often through lumbar puncture

• typically diagnoses meningitis B

Saliva

It is increasingly being used to monitor hormone levels and detect alcohol and drug abuse because it can be collected quickly and easily in a noninvasive manner

Semen AKA seminal fluid

It is analyzed to assess fertility or determine the effectiveness of sterilization following vasectomy. It is also sometimes examined for forensic (or legal) reasons

Sputum AKA Phlegm

• it is mucus that is ejected from the trachea, bronchi, and lungs through deep coughing

• they are sometiems collected in the diagnosis or monitoring of lower respiratory tract infections such as tuberculosis (TB)

Sweat

• analyzed for chloride content in the diagnosis of cystic fibrosis, predominantly in children and adolescents under the age of 20

  • Cystic fibrosis is a disorder of the exocrine glands that affects many body systems but primarily the lungs

Bone marrow

• sometimes aspirated and examined to detect and identify blood disease

• a biopsy may be performed at the same time

• to obtain the specimen, a physician inserts a special large-gauge needle into the iliac crest

Feces AKA Stool

• examination of these specimens is helpful in evaluating GI disorders

• can be evaluated for the presence of:

  • intestinal parasites and their eggs (ova and parasites, or O&P),

  • cultured to detect the presence of viruses and pathogenic bacteria (e.g., C. difficile and Salmonella)

  • tested for the presence of occult (hidden) blood using the guaiac test

Hair

Samples are sometimes collected for trace and heavy metal analysis and the detection of drugs of abuse

Throat swabs

Specimens are most often collected to aid in the diagnosis of streptococcal (strep) infections

Tissue Specimens

Typically biopsies (looking for cancer)