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Phlebotomy > Blood Specimen Handling > Flashcards

Blood Specimen Handling Flashcards

1
Q

what are pneumatic tube system?

A

devices to expedite the process of transporting specimens to the laboratory
- moves tubes using vacuum
- could result in hemolysis or agitate the distrurbe the specimen

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2
Q

centrifuge specimen timing

A
  • ideally take specimen to lab in 45 min and centiruge within an hour
  • max time btwn collection and centrifuge is 2 hours
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3
Q

how to transport specimen frmo outpaitnet fiacility

A
  • use courier service to transport specimen from collection facility to hospital lab
  • process specimen at outpatiet facility before being transported to lab
  • place specimen in courier puckup lockboxes
  • policies on how long specimen in box and how to protect form extreme temp
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4
Q

transport specimen to reference lab (special tests)

A
  • lab could have its own courier services
  • if done thorugh something like FedEx must compy with local state and federal laws for speical packaging and biohazard identification
    ● A watertight primary container
    ● An original specimen tube or a plastic screw-cap transfer tube
    ● Absorbent material
    ● A watertight secondary container, such as a ziplocked bag, plastic canister,
    or Styrofoam box
    ● Sturdy outer packaging, such as a fiberboard box or mailing tube, wooden
    box, or rigid plastic container
  • paperwork on secondary container + identifiacation
  • if coolant needed then in secondary container
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5
Q

eho regulates transport of medical specimen

A
  • CDC
  • department of transportation
  • federal aviation adminiatrattion
  • FDA
    = international air transport association
  • international civil aviation organization
  • OSHA
  • transportation safety administration
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6
Q

what information should be tracked about transporting specimen

A
  • how long in courier box/ vehicle
  • enter specific info in EHR using LIS include dat and time of collection, phlebotomist identification code, and other comments
  • scan bar codes on spedicmen for real time tracking
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7
Q

wwhat is cold agglutins

A
  • antibodies that react at cooler temps
  • done for pt suspected by having conditions sch as atypical penumonia
  • react with RBC at temp under body temp (attaches to rbc causing clumping )
  • done in red top tube with additive or lavender top EDTA tube
  • orewarm tubes in a container that is 98.6 F
  • deliver to lab in water bath set to 98.6 (keep at body temp!)
  • do test within 1 hour
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8
Q

ice water test

A

Adrenocorticotropic hormone (ACTH)
Ammonia
Catecholamines
Gastrin
Lactic acid
Parathyroid hormone (PTH)
pH/blood gas

  • cover lab with pastic and place tube in cup with ice and water
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9
Q

protect from light

A

Beta-carotene
Bilirubin, total or direct
Porphyrins
Thioridazine (Mellaril®
)
Vitamin A
Vitamin B6
Vitamin B12

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10
Q

tests to deliver to lab within 2 hour
separate and freeze erum after clotting

A

Acid phosphatase
Prostate-specific antigen (PSA)
Prostatic acid phosphatase

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11
Q

use antispetci other tahn alc

A

blood alcohol

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12
Q

at 98.6 until clotted

A

clot retraction
cold agglutinins

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13
Q

seperate freeze serum after clotting

A

complement C4

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14
Q

tests to clot in refrigerator and separate immediatey and freeze serum

A

Complement, total (50)
Complement, total (100)

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15
Q

what tests do you ahve to label peak or trough

A
  • gentamicin
  • tobramycin
  • vancomycin
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16
Q

label tubes with time intervals

A

glucose tolerance

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17
Q

lab test at room temp

A

Human leukocyte antigen (HLA-B27)

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18
Q

why are some specimen chilled?q

A
  • chlling specimen slows down metabolic process and keeps analyte levels as close as possible to those in the blood stream
  • used for ABG, ammonia, lactic acid
  • plce blood vile in specimen transport tube then in container with crushed ice and water or in outer pcojet of 2 compartment specimen baag with cold pack (specimen cant freeze or hemolysis)
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19
Q

how to care for light sensitive specimen?

A
  • cover substance in foil or special container (amber plastic tubes)
  • light can alter some chemical compositions (bilirbuin and carotene)
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20
Q

what to do if too much bilirubin in neonate

A
  • place under UV light
  • turn off uv light when taking bilirubin sample bc will destroy
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21
Q

legality and blood collection

A
  • uninteruppted chain of custody
  • medicolegal specimen such as rape or drug testing
  • make sure to collect specimen from correct pt and guard against tampering
  • fill out chain of custody form and make sure every person who handles sample signs and dates legal document
  • keep in locked container and/or seal tube with tamperproof label or wax
22
Q

why may blood alc testing be required/ procedure

A
  • pt can refuse unless court order (make sure legality is all done)
  • if employer requests bc employee appears intoxicated
  • clean area with green surgical soap or hydrg=ogen peroxide (no alc pads or iodine swabs)
23
Q

testing guidelines for forensic tests

A
  1. Avoid contamination by wearing gloves at all times.
  2. Collect the specimen as soon as possible.
  3. Ensure that the specimen is packed, stored, and transported correctly. In general,
    fluids are refrigerated and other specimens are kept dry and at room temperature.
  4. Label each specimen with the patient’s name and date of birth, the name of the
    person collecting the specimen, the type of specimen, and the date and time of
    the collection.
  5. Make sure the specimen is packed securely and is tamperproof. Only authorized
    people should touch the specimen.
  6. Record all handling of the specimen, most commonly on a chain-of-custody form.
24
Q

what does toxicology test for?

A
  • poisons drugs and medication
  • for trace elements such as aluminim, lead, mercyry and zinc
  • for peak and trough levels of pt medication
  • in chemsitry sexction of lab or reference lab
  • follow your lab protical
  • dont use alc, tourniquet and collect blood for special coagulation testing
25
Q

how to collect blood for lactic acid

A
  • some facilities require to be performed witghout tourniquet
  • could be affected by exercise, vigorous hand pumping, tournqiuet
  • rest arm
    -re move tourniquet
  • no fist or pup hand
  • gray top tube (sodium fluoride) in ice and water transpotr
26
Q

what should special coagulation tests be drawn with

A
  • large bore needle (not smaller than 21 guage)
  • quickly
  • invert each tube
27
Q

what does coagulation factor assays test for and special handling

A

Factors I, II, V, VII, VIII, IX, X, XI, XII, XIII,
von Willebrand Factor

  • May require discard tube
  • Centrifugation, separation, shipped
    frozen to reference lab
28
Q

what are coagulation inhibitor assays for and what are the special handling

A

Anti-thrombin III
Antiphospholipids
Lupus inhibitor
Proteins S and C

  • May require discard tube
  • Centrifugation, separation, shipped
    frozen to reference lab
29
Q

what are platelet functio nstudies and what are the special handling

A

Platelet antibodies
Platelet inhibition
Platelet function assay (PFA),
platelet response (aspirin and/or Plavix®)

  • May require discard tube
  • Centrifugation, separation, shipped
    frozen to reference lab
  • Requires discard tube
  • Immediate delivery to laboratory
30
Q

what to do if collecting from venous access device line

A
  • dlush line with saline
  • raw 10-20 mL of fluid and blood by syringe and discard
  • new syringe for required amt of blood and transfter to blue stopper tubes
31
Q

what are the 2 waus to prcoess pt samples

A
  • centruging (spinning)
  • aliquoting (dividsing or separating specimen into separate containers) (need to do by 2 hours)
32
Q

what happens if speciemn r not centrigued or aloiquoted by 2 hours?

A
  • Potassium and glucose blood tests are most affected. If blood cells
    are left in contact with the serum or plasma, glucose can be decreased and
    potassium can significantly increase. Blood cells use glucose to keep alive and
    nourished, whereas potassium can slowly leak out of red blood cells.
33
Q

differnet types of centrifuges and how do tehy work

A
  • styles include refrigerated, floor models, and tabletop models
  • pseed of rotation (revolutions per minute), radius of rotor head = relative centrifugal forice (RCF) which is expressed in gravity (g)
  • drsigned to spin blood specimen and separate cells from liquid portions
  • SST tubes must be completelty clotted before centrifuge
  • centrigufe at 1000 to 3000 rpm for 15 min
  • balance tubes (can do counter weight with tube with water or saline)
34
Q

what to do when opening a tube with a rubber stopper

A
  • use a pad with absorbent backing to cnotain and prevent aerosols
  • can use pipet to transfer serum or plasma into transfer tube
35
Q

what are erros made before specimen analysis called?

A
  • prexam error
36
Q

what is hemolysis and what are common causes

A
  • hemolysis (destruction of RBCs)
  • gives plasma/ serum reddish color (can interfere with lab tests(
  • could cause erroneous errors for substances found in rbcs such as potassium and calcium
  • causes include not allowiing alc to dry, continuing to draw blood during hematoma formation, forcefuilly squeezing during dermal puncture, vigorously mixing collection tube, forcing blood while using a syringe transfer procuedre by pushing on plunger
  • rough handling of specimen during transport
  • freezing and thawing or heating specimen in transport
37
Q

what can cause anticoagulated specime nt to clot

A
  • incorrect order of draw (clot activator before light blue top)
  • failre to mix tube
  • delay in transfer specimen from syringe tp tube
  • difficulty blood draws
  • use pf expired tube
38
Q

what is an incomoplete draw

A
  • QNS (quantity not sufficient)
  • contains minimum amount but rehjected bc improper additive-to-blood ratio which will prpduice erroneus results (abn chem values, coagulation test, blood counts)
  • coudl be caused by loss of vacuum during venipuncutre or shipping, failure to purge air out of butterfly needl tubing w/ discard tube, use of expired tubes, removing tube beofre fill level is reched, vein collapse, dermal puncture becomes clotted
39
Q

how could incorrect tube be collected

A

The procedure manual was not consulted or information was
misinterpreted.
● The tube was delivered to the wrong laboratory section (a switch
occurred).
● The wrong tube was collected by mistake.
● The requisition was misinterpreted.

40
Q

what is hemoconcentration/ contamination

A
  • hemoconcentration by proolonged tourniquey apoplication
  • contamination by iv (if blood collected above IV)
  • hard to detect (may not pass delta check - comparision of results with previous results for same test)
41
Q

what is icterus

A
  • icteric plasma and serum appear dark yellow to greenish yellow because of increased biliruibn
  • may iterfere with chem tests such as creatinine
42
Q

what is lipemia

A
  • ap amt of fats in blood
  • can make plasma or serum appear cloudy
  • can interfere with lab tests such as hemoglobin
43
Q

documentation related specimen rejection

A

● An unlabeled specimen

● A mislabeled specimen (labeled with another patient’s identifi-
cation information)

● A specimen with two labels containing different patient
information
● Missing documentation for a chain-of-custody specimen
● Labels placed on the wrong tubes for the same patient (for
example, a CBC label on a chemistry tube and vice versa,
which can usually be resolved without re-collecting the
specimen)
● A special labeling procedure that was not followed

44
Q

how does diurnal/circadian variations affect blood components?

A

melatonin is affected by light (increase in dark)
renin and tsh max in predawn
peak cortisol at 8 am
in mon aldosterone,m bilirbuin, cortisol, hemogpobin, insulin, iron, potassium, testosterone, and rbc r highest
- eosinophils, creatinine, glucose, GH, trigylcerides and phospates r normally lowest in morning

45
Q

tsh, cortisol and iron can vary by ___% based on morning and late afternonn

A

50

46
Q

changing position can change blood how?

A
  • decreases plasma volume in adult up to 10% if going from supine to upright sitting/ standing which increases concentrations of aldosterone, bilirubin, blooc cells, calcium, cholestoerl, iron, protein and renin
  • potassium increase within 30 min of standing
  • lying to standing causes 15% increase i ntotal cholestoerl and HDL (1-12% higher triglyceride)
  • plasma aldosterone and renin can double within an hour of changing position (stay in recumbent for at least 30 min before specimen collection)
  • RBC if standing higher
47
Q

what is postural pseudoanemia

A
  • decrease in heatocrit values bc increase in plasm
48
Q

pregnancy and blood

A
  • increase in body fluid = diluting = lower rbc count
49
Q

smoking and blood

A
  • increased cholesterol, cortisol, glucose, GH, triguycerades, and WBC counts
  • lower Ig
50
Q
A

Phlebotomy (17 decks)

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