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Sampling body fluids Flashcards

1
Q

A history of pathology based on the 5 senses

A
  • Sight – Injury, infections, swellings, gangrene
  • Touch – Fevers, chills, sensitive areas
  • Hearing – Respiratory distress
  • Smell – Gangrene, infection, ketones
  • Taste – Diabetes mellitus
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2
Q

Ancient Greeks- 4 humous

A

17th Century

• William Harvey – Human Circulation

18th Century

• Improved knowledge of anatomy

19th Century

• Florence Nightingale and Joseph Lister

Discovery that blood values of many parameters reflected physiological state of patient

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3
Q

Sample pathway

A
  • Pre-analytical

Collecting, labelling, transport

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3
Q

Sample pathway

A
  • Pre-analytical

Collecting, labelling, transport

  • Analytical

Diagnostic testing

  • Post-analytical

Result reporting, sample storage

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4
Q

What are the common sites for phlebotomy?

A
  • Median Cubital Vein
  • Cephalic Vein
  • Back of Hand
  • Finger prick
  • Heel prick
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5
Q

Describe phlebotomy

A

More than just collecting blood

  • Variety of diagnostic tests and analytes measured
  • Range of sample collection tubes
  • Different sample collecting requirements o Sent on ice? o Protected from light?
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6
Q

What do you need for phlebotomy?

A
  • Vacuum filled tubes
  • Adapter
  • Gloves
  • Tourniquet
  • Alcohol wipes
  • Adhesive tape
  • Gauze
  • Sharps bin
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7
Q

Correct sampling

A
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8
Q

Incorrect sampling

A
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8
Q

Incorrect sampling

A
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9
Q

Medical biochemistry test per day (by sample type)

A
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10
Q

Sample collection:

Patient identification

A
  • Full name and DOB
  • Confirm ID
  • ID bracelet
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11
Q

Sample collection: Request form

A
  • Filled in correctly
  • Appropriate tests requested
  • Select required tubes
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12
Q

Sample collection:

Select site for venepuncture

A
  • Bruising? Scar tissue?
  • Clean skin
  • All consumables ready?
  • Need to re-bleed?
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13
Q

Sample collection: Label tubes

A
  • Clinic or patient bedside
  • Matching identifiers
  • Collected all required samples?
  • Date and time of collection
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14
Q

Sample collection:

Transport samples

A
  • Invert tube (not shake)
  • Urgent?
  • Do not delay!
    Packaged correctly
15
Q

Sample collection:

Minimum identifiers

A
  • Full name
  • DOB
  • NHS number
16
Q

What is the difference between plasma and serum

A

Plasma

  • Cell-free liquid component of blood
  • Treated with anticoagulants
  • Centrifuged

Serum

  • Cell-free liquid component of blood after coagulation
  • Lacks clotting factors such as fibrinogen
  • Centruged after coagulation
17
Q

Yellow top tube

A
  • Serum Separator Tube (SST)
  • Inert gel than is denser than serum but less dense than erythrocytes
  • Coated with spray coated silica particles
  • Most commonly used tube for routine biochemistry e.g. U&E’s, CRP, liver function, creatinine, lipid profile, bone profile
  • Invert 5-6 times
18
Q

Problems with the yellow top

A

Problems:

  • Incomplete barrier formation
  • Sampling probe is damaged
  • Gel interferes with some drug/endocrine tests
19
Q

Red top tube

A

None/Coated with silica particles

  • Serum obtained following centrifugation
  • Used for the measurement of blood where a yellow top is inappropriate
20
Q

How many types of green top tubes are there?

21
Q

Light green tip tube

A

Gel

  • Anticoagulant: Lithium heparin
  • Blood does not clot - Plasma
  • Invert 8-10 times
22
Q

Dark green tube

A
  • No gel - requires plasma separation following centrifugation
  • Ammonia, insulin, aluminium
23
Purple top tube
Anticoagulant: K-EDTA • Whole blood * HbA1c – Measure of glycaemic control for diabetics (reflects control of diabetes) * Cyclosporin and Tacrolimus (anti-rejection drugs) * Venous carboxyhaemoglobin * Invert 8-10 times
23
Purple top tube
Anticoagulant: K-EDTA • Whole blood * HbA1c – Measure of glycaemic control for diabetics (reflects control of diabetes) * Cyclosporin and Tacrolimus (anti-rejection drugs) * Venous carboxyhaemoglobin * Invert 8-10 times
24
Light grey top
Anticoagulant: Potassium Oxalate * Sodium Fluoride: Inhibits glycolysis (5 days) and alcohol dehydrogenase * Glucose * Lactate * Invert 8-10 times
25
Dark blue top
Purified glass (no contaminating trace metals) * Copper * Zinc * Mercury * Selenium
26
Why is the order of draw important?
Risk of carryover
27
True or False: SST must be taken before K-EDTA tube
TRUE ## Footnote * K-EDTA chelates calcium * Increases potassium * Artificial hypocalcaemia * Hyperkalaemia
28
Interference: Samples require visual inspection prior to analysis HILREF
Haemolysed samples * Shaking or expelling blood through a needle * ↑ potassium, phosphate, AST, LDH and Mg2+ * Colorimetric assay interference Icteric samples * Bilirubin peak absorbance at 460nm * Enzyme activity assays Lipaemic samples • Interfere with most assays
29
Haemolysed Sample Audit
* Prevents tests being performed, misleading results can be reported * Laboratory data for 7 days: • A&E: 24% * Inpatients: 2.9%
30
Haemolysed Sample Audit: In A&E
* Non-standard techniques * Range of staff * Drawing blood through fine lines or needles e.g. 20 G cannula and syringing blood into tubes with the needle still on * Wrong order of draw
31
Improvements
Use of standard techniques * Improved training for junior doctors * Teach order of draw * Use of vacutainers * Additional studies regarding the use of fine gauge cannulas and haemolysis
32
Sample acceptance criteria:
Sample acceptance criteria * Minimum number of matching identifiers? * Correct sample tubes for tests requested? * Adequate sample volume? * What to do if samples are not received correctly * How are rejected samples reported?
33
Urines
1. 24 hour urine * Urinary electrolytes * Creatinine * Copper * Albumin * Cortisol * Protein 2. Random urine * Bence Jones Proteins * Osmolality * Albumin:Creatinine
34
Sweat
* Collected non-invasively * Determine chloride concentration * Diagnostic for cystic fibrosis * CFTR mutation screen

Medical Biochemistry (10 decks)

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