phle ch10

fasting draws

8-12 hours

glucose, cholestrol, lipids

phlebs responsibility

prolonged fasting: increase lipids and bilirubin, and lowers glucose

what to document when timed draws

time in which you drew the blood

OGTT

diabetes mellitus - normal level is <140 mg/dL

OGTT (oral)

1. baseline, fasting draw

2. give glucose - 5 mins to drink, test starts after finsih load, wait an hour

3. 1st draw after 1 hr

4. 2nd draw after another 1 hrs

2 hr postprandial glucose (2hr pp glucose) - sample after eating

lactose tolerance test

Ability to digest milk sugar

fasting

lactose load

two-hour specimen draw

diurnal variation

coritcosteroids, hormones, serum iron, glucose, white blodd counts

24 hour fluctuations, some analytes go up and some go down

therapeutic Drug Monitoring (T D M

drugs with toxic effects, lithium or anitbiotics

testing to make sure within range

trough level

TDM
Lowest level: Collected and tested before next dose is given (~30 mins before)

peak level

TDM

highest level: drawn shortly after dose is given at time specified by the medication and pharmacy

30 mins after iv

1 hr after intramuscular

1-2 hr after oral

blood cultures

aseptic technique !!

collection timing: STAT, FOU, before antibiotics

anticoagulant - invert, two sets draw and labeled from what site, aerobic and anaerobic

VADS

special training, first 5mL discard,

coag test: 20 mL discarded

discard first syringe, second syringe blood cultures, third for anticoag (if no blood cultures, coag test in new synringe)

CVCs

indwelling line

picc lines

cold agglutinins

autoantibodies, attack and destoy rbc when below body temp

warmed specimins until the serum can be seperated

plain red - serum, no additives or sst

portable heat blocks, heel warmers

fail to warm: falsly decrease redults

lavendar tube: if need quicker results

light sensitive specimins

bilirubin, diff vitamins and minerals

amber containers or in glove

chilled specimins

ice slurry, ice block

never electrolytes and prothrombin

legal specimins

chain of custody:legal, chronicological documentation - from pt. id to results recorded

w/ witness (typically police)

drug testing

documentation

BALs and drug testing

BALs

chain of custody

medical, legal, or employee

soap and water, filled to capacity!!, typically plice bring own tubes

drug testing

random, urine (stay in urine long, but test within 2 hrs), chain of custody

DNA testing

molecular diagnostic

yellow ACD

geriatric pt

consider physical factors, disease, emotional factors

smaller needle, torniqeut cover, heat veins, apply pressure longer, coban instead

pediatric pt

prepare child and parent,

dermal puncture: baby,

toddler: toys

child: explain procedure

under 2yo: dorsal hand, microcollection

heme

molecule containing iron thats part of hemoglobin, myoglobin and other protiens. essential for oxygen transport and binding in the blood

OGTT load amounts

50 g - initial gestational screenings

75 g - typical for nonpregnant screenings

100 g - diagnosing getational diabetes

children: 75 g /kg body weight, up to a max of 75 grams

STAT test

highest priority test, treatment determined by

when can u not use chlorpoprep

not on 2 month old or less

how much blood can u take pediatrics

1 mL / 5 kg body weight, weighs more than 45 kg = adult

bacteriemia, septecemia, sepsis

bacteriemia: bacteria in circulatory system

septecemia: blood poisoning due to bacteria, fungi, viruses in blood

sepsis: ectreme, dysfunctinal responce to infection, organ dysfunction and widespread inflammation