Phlebotomy Class 5

What should you tell your patient about testing?

• give instruction card and explain what is says

• verify patient has followed test guidelines

What do fasting specimens require?

collection during “basal state” —> fasting and refraining from strenuous exercise for 10-12 hrs

• lipid panel drawn in SST

What is the opposite of fasting?

“postprandial” —> after a meal

What happens if the patient hasn’t been fasting?

check their requisition form to see which tests require fasting and don’t to determine if they need to come in on a different day

What are some forms of timed samples?

1. to measure blood levels of substances exhibiting diurnal variation

2. to monitor changes in a patients condition

3. to determine levels of medication in the bloodstream (therapeutic drug monitoring)

therapeutic drug monitoring

• observes the blood levels of certain medications to

  • ensure patient safety

  • maintain a therapeutic plasma level.

  • Blood should be drawn to coincide with the trough (lowest chem level) or peak

When are trough levels collected?

15 min before the scheduled pharmaceutical dose

aliquoting

diving a whole sample into parts. Parted into smaller units to have further testing performed; close and exact recording, tracing, and labeling must be adhered to, ensuring the specimens are tracked correctly for the patient

How should you deal with warmed samples?

tubes can be prewarmed in incubator for 30 min at 37°C. Some tests require that the specimen collected be kept at body temperature until the serum is separated from the cells. Collected in prewarmed Red Top Tubes

What are cold agglutinins?

antibodies formed may attach to red blood cells below body temperature. Specimen must be kept warm until the serum is separated from the cells.

What does chilling the samples prevent?

• separation from occuring

What should you do if you need to collect samples protected from light?

• wrap in tape, but be careful with label

  • put label on inside and outside

• if available, transport in amber/ brown-colored bag

What are specimens that require chilling?

What specimens require warming?

What specimens require light protection?

Which specimens are drawn without stasis?

What is the Chain of Custody?

drug testing procedures that must be followed. everyone who has possession of the specimen must be documented. you can be called into court for collection

What is the OOGT procedure?

• 10-12 hr fasting

• first draw, then given glucola (finished within 5 min)

• wait 1hr, then second draw

• wait another hr, then third draw

• wait another hr, then fourth draw

What are the diurnal variation procedures?

blood samples require the same blood test be drawn multiple times throughout the day for comparison

diurnal variation

the daily cyclic variations of chemistry levels for 24 hours

What is a PKU screening test?

• phenylketonuria —> genetic disease that causes mental retardation and brain damage

• ordered for infants within first 72 hours

• dermal puncture from heel

• screening can also be done with urine

What is a ABG test?

• Arterial Blood Gas

• measures oxygen and CO₂ levels in the blood

• also measures blood pH

• sample required from radial artery

• test must be run within 15 min of collection

What tests are performed from arterial samples?

BPH, CO_2, O_2, Bicarb

What is POCT?

Point of Care Testing is testing that is carried out in the presence of the patient using devices onsite so you don’t have to send certain samples to a lab

• can only perform if “waived test”

What are the POCT available in modern clinical testing?

coagulation monitoring, ACT, Prothrombin/ INR, Platelet Func., ABG, glucose, cholesterol

How much blood does average adult body have?

5-7L

How much blood should be drawn for bloodletting?

1-5% in a 24-hour period

What is polycythemia vera?

• too many red blood cells

• blood samples tested for hematocrit

• draw up to 500mL is ordered

• therapeutic donation

• can lead to internal organ issues

What is hemochromatosis?

• too much iron —> stored in major organ tissues (heart, liver, pancreas)

• genetic issue or dietary intake issue

• overuse of supplements, diet in high iron, too many blood transfusions

• 450-500 mL draw, and body will pull stored iron from tissues to use to make new RBC

Where is swab collection performed?

mucous membranes

nasal swab

• COVID-19

• correct insertion depth

• might collect for diagnostic lab work in physicians office

buccal swab

• collects specimens from the mouth

• inside cheek and sublingual (under the tongue)

• DNA test → Chain of Custody and evidence preservation is critical

throat swab

• long swab

• past gag reflex

• prepare for excessive cough or gagging

• might be vomiting

How to collect stool?

• follow instructions

• hat-shaped lid

• no urine should contaminate

• you can also place plastic wrap across rim

• must be collected in proper containers, refrigerated or in styrofoam

• some might need to be returned in an hr

• do not accept stool they bring in tupperware

What is a stool guaiac test?

• looks for hidden (occult) blood in a stool sample

• most common fecal occult blood test (FOBT)

• guaiac is plant substance that coats the FOBT test cards

What is a fecal fat analysis?

diagnostic test will look for issues of fat malabsorption or excessive fat in the feces

What are sputum specimens?

• mucous membranes that line respiratory tract

• coughed out

• should be done before eating

What are semen specimens?

• collects semen and immediately bring to physician/lab

• needs to stay warm

• condom can’t have spermicide

• no light or extreme temp

• must reach lab within 1-hr

What are urine specimens?

• most common non-blood specimen

• ordered for UTI or kidney infections to evaluate drug effectiveness

• temp should be taken within 4 min of collections

• filled between 12-50 ml

• record medications on req form and chart

• test immediately or cover the container with a lid and keep in fridge

• clean-catch-midstream

• sometimes timed, follow instructions

  • 24-hr, first voided morning urine specimen

How to get urine if patient cannot naturally void urine?

catheterization, suprapubic catheter

What should be on the lab request form?

• patient’s name and DOB

• type of test ordered and ordering physician’s name

• ICD-10-CM code for diagnosis and disease if required

• line where physician may sign

What are the different centrifuges?

• horizontal spinning centrifuge

  • PRP or PRF

• fixed angle centrifuge

icteric (jaundice) specimen

high amount of bilirubin in the blood

• serum and plasma will look green/brownish or dark yellow

lipemic specimen

high amount of lipids

• serum and plasma will appear milky/white

hemolyzed specimen

usually caused by phlebotomist

• serum and plasma are pink/reddish tint

Hematocrit testing and Processing

• blood collected into capillary tube at least 2/3 full

• seal with critoseal

• centrifuge

• place over hematocrit measuring card

Blood Smears for Processing

page 106

Hematology

• section of the lab where the blood’s formed elements are studied by enumerating and classifying the RBC, WBC, and platelets

• the coagulation section is usually part of hematology, but in large labs, separated

• disorders and infections are detected and treatment instituted or monitored

• hemostasis is evaluated

Chemistry

• most extensive and most automated section of the lab

• divided into several processing areas

• electrophoresis, toxicology, immunochemistry

Blood Bank

• whole blood is collected, stored, and prepared for transfusion

  • adherence to patient ID and specimen handling procedures to ensure patient safety

  • might be separated into components including packed cells, platelets, fresh frozen plasma, and cryoprecipitate

Serology

• performs tests to evaluate the patient’s immune response through antibodies

• uses serum to analyze the presence of antibodies to bacteria, virus, fungi, and parasites against body’s substances

Microbiology

• responsible for detecting pathogenic microorganisms in patient samples and for hospital infection control

• microorganisms that cause disease are pathogenic

• primary test performed in this section of the lab is Culture and Sensitivity (C&S)

  • used to detect and identify microorganisms

Urinalysis

• tests the urine to detect metabolic diseases, drug abuse, and disorders and infections of the kidney and urinary tract

  • UA, C&S, Cytology Studies, Drug Screening (req 45ml), pregnancy test (2L)

• physical examination, chemical examination, and microscopic examination

Basal State refers to

nothing by mouth and restraint from strenuous exercise for 8-12 hours

Which 3 specimens are required to be chilled?

Ammonia, ABG, Lactic Acid

What is aliquoting

dividing the specimen into equal parts

Which 4 tests are primarily performed on ABG specimens?

BPH, CO₂, Bicarb, O₂

When should a Phenylketonuria (PKU) be performed?

72 hours

(T/F) Diurnal variation refers to the daily cyclic variations within the body during a 24-hour period/

true

(T/F) POCT procedures are waived tests performed by healthcare staff other than the doctor or RN.

True

(T/F) Polycythemia vera is when a patient is holding too much iron in their system

false

_ is a swab specimen collected sublingually.

Buccal

What are 5 items required to be on a medical order/req?

name and DOB, tests, ICD-10 code, physician’s name, physican’s signature