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2024 SEM 1 PMLS 2 (LAB) > special collections and POCT > Flashcards

special collections and POCT Flashcards

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1
Q

Tests that require specific and unique collection procedures, not usually performed in the laboratory.

A

special collection tests

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2
Q

What are the key components of special collection preparation?

A

Special instructions
Special preparation
Special equipment
Special handling
Special timing

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3
Q

What are the specimen requirements for blood bank tests?

A

Lavender- or pink-top EDTA tubes
Non-additive glass red-top tubes (depending on facility protocol)

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4
Q

What should you do if unsure about specimen requirements for a test?

A

Always ask the laboratory at the facility where the collection is being performed, as policies may vary.

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5
Q

What are the strict identification and labeling requirements for blood bank specimens?

A

Patient’s full name
Patient’s hospital ID number
Patient’s date of birth
Date and time of collection
Phlebotomist’s initials

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6
Q

Is the patient’s room number part of the identifier for blood bank specimens? Why or why not?

A

No, because patients are frequently transferred between rooms.

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7
Q

what is a special identification system used for blood bank specimens?

A

ID bracelet with self-carbon adhesive label for specimens
Blood ID-band with linear bar-coded BBID numbers

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8
Q

What does the blood type and screen test determine?

A

The patient’s ABO blood type, Rh factor (+ or -), and screens for antibodies.

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9
Q

What is the purpose of a crossmatch test?

A

To determine compatibility between the patient’s blood and the donor’s blood.

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10
Q

What does a phlebotomist compare when collecting a blood bank specimen?

A

The labeled blood bank tube with the patient’s blood bank ID bracelet.

By a unique ID sticker that exactly matches the ID on the tube of blood collected for the crossmatch.

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11
Q

To determine the presence and extent of infection, identify the type of organism responsible, and find the best antibiotic to use.

A

blood culture tests
- it is ordered when a patient has a condition suggesting bloodstream invasion and a fever

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12
Q

Why is blood considered sterile?

A

It is free from microorganisms, as lymph nodes filter microorganisms from the blood.

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13
Q

What is sepsis, and how does it relate to blood cultures?

A

Sepsis is an overwhelming immune response to a bloodstream infection, causing widespread inflammation and damage. Blood cultures help diagnose the causative organism.

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14
Q

What are the special requirements for blood culture collections?

A

2-4 blood culture sets (or 1-2 sets with SPS if resources are limited)
Collected at different sites (e.g., right/left antecubital fossa, right/left hand)

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15
Q

What is the protocol for blood cultures in cases of fever of unknown origin (FUO)?

A

Collect 2-3 blood cultures from different sites.
If fever persists and no positive results, recollect 2 more sets.
Collect before or during a fever spike, or follow laboratory policy if timing is uncertain.

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16
Q

How far apart should blood cultures be drawn?

A

30 to 60 minutes apart, unless the patient is in critical condition or physician instructions differ.

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17
Q

What types of special bottles are used for blood cultures?

A

Yellow: Anaerobic cultures
Grey: Aerobic cultures
Red: Fungal cultures

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18
Q

How does patient age affect blood culture collection?

A

The volume of blood collected depends on the patient’s age.

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19
Q

Why is skin antisepsis the most critical part of blood culture collection?

A

To destroy skin microorganisms, prevent contamination, and avoid misinterpretation of normal flora as the cause of infection.

acceptable:
Chlorhexidine gluconate
Tincture of iodine
Povidone-iodine with 70% ethanol (used when the top two are unavailable)

*30 to 60-second friction scrub in a circular motion. Do not wipe the area twice.

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20
Q

What is the purpose of the initial specimen diversion?

A

To reduce blood culture contamination by diverting 1.5 to 2 mL of the first blood collected, which may contain skin plugs, cells, and microbes.

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21
Q

Why is the next portion of blood collected after initial specimen diversion used for blood cultures?

A

It is less likely to contain contaminants from the skin

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22
Q

What is an intermediate collection tube, and when is it used

A

A yellow-top SPS tube used in place of a blood culture bottle.

however, the use of intermediate collection tubes is discouraged as:
Increases final concentration of SPS.
Increases risk of contamination.
Exposes lab staff to higher risks.

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23
Q

Collecting specimens directly into blood culture bottles using a butterfly needle and specially designed holder.

A

direct inoculation in blood culture collection

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24
Q

When using direct inoculation, which blood culture bottle is filled first and why?

A

The aerobic bottle, as air from the tubing will not affect it.

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25
How can backflow be avoided during direct inoculation?
Keep the culture bottle lower than the collection site.
26
Transferring blood into culture bottles using a syringe and safety transfer device.
syringe inoculation in blood culture collection
27
When using syringe inoculation, which blood culture bottle is filled first and why?
The anaerobic bottle, to avoid introducing air into the sample. precautions should be taken: Hold the plunger to control blood flow. Avoid pushing the plunger to prevent hemolysis and aerosol formation. Change the needle after contact with the skin.
28
Why is changing the needle after skin contact important in blood culture collection
To avoid transferring contaminants from the skin into the blood culture bottle.
29
How should culture bottles be prepared during the procedure?
Remove the flip-off cap and inspect for defects. Cleanse the bottle stoppers with alcohol while the site is drying. Only use alcohol not iodine
30
What is important to mark on blood culture bottles before collection?
The minimum and maximum fill levels.
31
What is the correct technique for venipuncture during blood culture collection?
Reapply the tourniquet. Perform venipuncture without touching or re-palpating the site. Fill bottles directly and invert several times.
32
How should the patient’s skin be cleaned if iodine was used?
Clean the site to remove residual iodine.
33
What information must be included on the bottle label?
Required patient information. Blood collection site (to help identify localized infections if positive).
34
Why is it important to transport blood culture specimens to the lab quickly?
To ensure the accuracy of results by preventing microbial growth or death.
35
What are Antimicrobial Neutralization Products (ARD/FAN), and what is their purpose?
Products containing resin to remove or neutralize antimicrobials/antibiotics from the blood. Prevents antimicrobials from inhibiting microorganism growth.
36
When should blood collection for culture in ARD tubes be timed?
Right before the next antibiotic dose, when antibiotic levels are at their lowest.
37
Why is pediatric blood culture collection considered difficult?
Due to the smaller blood volume and the need for specialized equipment and techniques.
38
What type of blood culture bottles are used for pediatric collection
Special bottles with different volumes and broth formulations.
39
How is the site cleansed for pediatric blood culture collection?
The site is cleansed twice with 70% isopropyl alcohol or ethanol.
40
What is the maximum blood volume typically collected for pediatric blood cultures?
Up to 4 mL of blood.
41
What methods are used to collect blood for pediatric cultures?
ETS (Evacuated Tube System) or syringe; capillary collection is not used.
42
What are the usual sites for catheter blood culture collection?
One culture set is collected from peripheral blood, and another from the vascular access device (VAD).
43
Why is the first 5 mL of blood from a catheter considered a discard barrel?
It contains the flushing fluid and is not suitable for blood culture testing.
44
Who typically collects blood from a catheter, and why?
Nurses, as they use different antiseptics for VADs and are trained to aspirate clots if necessary.
45
Why is it important to collect two culture sets for catheter blood cultures?
To allow correct interpretation of positive results by comparing peripheral blood and VAD samples.
46
Why is a "clear" or discard tube required for coagulation tests drawn with a butterfly needle?
To account for the tubing and prevent contamination of the sodium citrate tube.
47
What is the required blood-to-anticoagulant ratio in sodium citrate tubes?
9:1 ratio of blood to anticoagulant. - t will be rejected if a sodium citrate is not completely filled
48
Why should two partially filled sodium citrate tubes never be combined?
It compromises the accuracy of the blood-to-anticoagulant ratio.
49
What is the protocol for coagulation factors 5 and 8 if testing is delayed beyond 4 hours?
Centrifuge the sample, separate the plasma, and freeze it.
50
What is the RN's responsibility when drawing from an indwelling catheter for coagulation testing?
Draw and discard the first 5 mL of blood to avoid contamination.
51
Why might coagulation specimens need to be transported on ice?
To preserve the integrity of the sample.
52
What is the purpose of the 2-hour postprandial glucose test?
It screens for diabetes and gestational diabetes mellitus (GDM) by measuring glucose levels 2 hours after a meal.
53
What does the glucose tolerance test (GTT) diagnose?
Problems with carbohydrate metabolism and a patient’s tolerance to high glucose level
54
What are hyperglycemia and hypoglycemia?
Hyperglycemia: Increased blood glucose levels. Hypoglycemia: Decreased blood glucose levels.
55
What are the patient preparation requirements for a GTT?
Eat balanced meals with 150g carbohydrates for 3 days. Fast for at least 8 hours. Drink water during fasting and testing. Avoid smoking, chewing gum, or exercising before the test.
56
When does gestational diabetes typically develop, and is it permanent?
It develops during the 28th week of pregnancy and is usually temporary.
57
What is the normal glucose level after a 50g oral glucose challenge test (OGCT) for gestational diabetes screening?
Less than 140 mg/dL.
58
What glucose loads are used for GTT in gestational diabetes testing?
50-75g of glucose.
59
What are the initial steps in the GTT procedure?
Follow the normal ID protocol and explain the procedure. Confirm fasting requirements (at least 8 hours). Draw fasting blood specimen and process for glucose testing.
60
What should the patient do after the fasting blood specimen is collected?
Collect a fasting urine specimen if required. Drink the determined dose of glucose beverage within 5 minutes.
61
How are blood and urine specimens collected during the GTT?
Note the time the patient finishes the glucose beverage. Start timing and calculate collection intervals. Collect blood and urine specimens at specified times.
62
How should GTT specimens be labeled and handled?
Label all specimens with collection times, intervals, and patient ID. Deliver or send specimens to the lab as soon as possible (SST within 2 hours, no later than 24 hours).
63
What should you do if the patient vomits during the GTT?
Inform the doctor, reschedule, and repeat the procedure.
64
Why are specific time intervals important in the GTT?
To monitor glucose trends and assess the body’s ability to metabolize glucose over time.
65
It measures the average blood glucose levels over the past 2 to 3 months.
HbA1c (glycosylated hemoglobin)
66
How does glucose affect hemoglobin in HbA1c testing?
Excess glucose in the blood binds to hemoglobin.
67
What type of sample is required for HbA1c testing?
EDTA sample; fasting is not required.
68
What is the purpose of the OGCT?
Screening for gestational diabetes mellitus (GDM).
69
How does the OGCT differ from the GTT?
The OGCT uses 50g of glucose, and only fasting and 1-hour blood specimens are collected.
70
what happens if the 1-hour glucose result in the OGCT is greater than 140 mg/dL?
The patient undergoes a full OGTT.
71
What is the purpose of therapeutic drug monitoring (TDM)?
To establish and maintain drug dosage at therapeutic levels, avoiding toxicity and adjusting dosages when combined with other drugs.
72
When is TDM typically used?
For drugs with narrow therapeutic ranges, such as blood thinners and seizure medications.
73
What are the two key levels measured in TDM?
Peak levels: Maximum drug concentration in the blood. Trough levels: Minimum drug concentration, typically measured before the next dose.
74
What is therapeutic phlebotomy, and how much blood is typically withdrawn?
It is the withdrawal of a large volume of blood (usually 500 mL) to treat certain conditions.
75
What conditions are treated with therapeutic phlebotomy?
Polycythemia: Overproduction of red blood cells. Hemochromatosis: Excess iron deposits in tissues.
76
The scientific study of toxins (poisons), focusing on their detection and the treatment of their effects.
toxicology
77
What is the difference between forensic and clinical blood alcohol (ethanol) testing?
Forensic testing: Ordered by law enforcement, involves a chain of custody, and is used for legal purposes. Clinical testing: Ordered by physicians for treatment, does not require a chain of custody but follows standard protocols.
78
What type of disinfectant should be used when collecting blood alcohol specimens?
Non-alcohol-based disinfectants such as benzalkonium chloride or povidone-iodine.
79
what are the specimen requirements for blood alcohol testing?
Use a gray-top sodium fluoride tube. Fill the tube completely until the vacuum is exhausted. Do not remove the stopper.
80
What is the importance of the chain of custody in forensic toxicology?
To ensure the integrity and legal admissibility of the specimen by documenting every person who handles it.
81
Why is drug screening commonly required?
It is required by healthcare organizations, sports associations, and major companies, often for random testing, pre-employment, or post-accident situations.
82
What types of substances can drug screening detect?
Drug screenings may detect specific drugs or screen for up to 30 different substances, typically performed on urine rather than blood.
83
What is the chain of custody in drug screening?
Chain of custody ensures the integrity of the specimen, documenting everyone who handles the sample to maintain its legal admissibility.
84
What are the patient preparation requirements for drug screening?
Explain the test purpose and procedure. Advise the patient of their legal rights. Obtain a witnessed, signed consent form.
85
What are the specimen collection requirements for drug screening?
use a special area for urine collection. A proctor must be present during collection. A split sample may be required. Specimen must be labeled, sealed, and placed in a locked container.
86
What trace elements are commonly tested for?
Aluminum, arsenic, copper, lead, iron, and zinc.
87
Why must special trace element-free tubes be used for testing?
leach from glass, plastic, or stopper material into the specimen, affecting results.
88
What type of tubes are used for trace element testing?
Royal blue tubes, which may contain EDTA, heparin, or no additive.
89
What is the traditional method for testing tuberculosis (TB)?
he skin test is the traditional method for TB testing.
90
detect an individual's immune response to Mycobacterium tuberculosis (M.tb) by measuring INF-gamma release when WBCs are exposed to M-TB antigens.
Interferon-Gamma Release Assays (IGRA)
91
how does the QuantiFERON-TB Gold Plus test work?
1 mL of blood is collected in 4 special tubes at room temperature. The blood is incubated within 16 hours after inversion (10 times). A butterfly needle should be used, with a discard tube collected first to avoid dead air space in the tube.
92
it brings lab testing to the location of the patient, made possible by small, portable testing devices, offering convenience and short turnaround times.
Point-of-Care Testing (POCT)
93
What are the benefits of POCT for patients?
provides convenience and faster results, reducing wait times for diagnostic information.
94
What are the key requirements for POCT to ensure accurate results?
POCT requires carrying out quality control and maintenance procedures, including regular checks for accuracy.
95
What is the difference between waived and non-waived quality control checks in POCT?
Waived tests: Simple tests that have minimal risk for error. Non-waived tests: More complex tests that require stricter quality control checks.
96
it is built into POC instruments to help ensure the accuracy of results, but it does not check specimen collection or handling.
Electronic Quality Control (EQC) in POCT
97
How should POCT instruments be disinfected to prevent cross-contamination?
POCT instruments should be disinfected with a 10% bleach solution to reduce the risk of disease transmission.
98
What coagulation tests are commonly monitored in POCT?
Prothrombin Time (PT) International Normalized Ratio (INR) Activated Partial Thromboplastin Time (APTT or PTT) Activated Clotting Time (ACT) Platelet Function
99
Why are coagulation tests monitored in POCT?
To monitor patients on blood thinners (e.g., warfarin) and ensure proper blood clotting levels.
100
What are some common tests performed in POCT?
Arterial Blood Gas Electrolytes (Na, K, Cl, HCO3, iCa) B-Type Natriuretic Peptide Bilirubin Testing Transcutaneous Testing Cardiac Troponin T and I Complete Blood Count (CBC) C-Reactive Protein (CRP) Glucose Testing HbA1c/Glycohemoglobin Hematocrit Hemoglobin Lactate Lipid/Cholesterol Testing Rapid Syphilis Test
101
Why is glucose testing commonly performed in POCT?
To monitor blood glucose levels, particularly for patients with diabetes or in emergency settings.

2024 SEM 1 PMLS 2 (LAB) (10 decks)

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