Specimen Collection
Name 3 antiseptics used on skin.
70% alcohol
Iodine
Chlorhexidine
When a capillary puncture is performed on an infant or child, which colored tube is collected first?
What 2 type of specimen issues are commonly encountered with this type of blood collection and result in recollection of the specimen?
purple
clotted and hemolyzed specimens are common
What effect does excessive probing with a needle in the patient's arm have on a venipuncture specimen?
It can rupture the RBCs causing hemolysis and release clotting factors that result in a clotted specimen regardless of the presence of anticoagulant in the tube.
Explain the proper collection of a stool specimen for a patient to collect at home for the following tests...
ova and parasite
bacterial culture and sensitivity
C. diff immunassay (unpreserved stool required)
Provide hat, gloves, various colored sample vials, written instructions with pictures, biohazard bag.
Describe how to place hat on toilet, pass the stool in the hat, put on gloves, use scoop on each vial to transfer stool until filled to the line, secure and mix. Place in biohazard bag and store in ice filled cooler. Transport to lab ASAP after collection
This term refers to the time it takes for a specimen to be ordered, collected, transported, processed, analyzed and reported.
The turn around time (TAT)
How do hemolyzed, icteric or lipemic samples interfere with test results
They affect the interpretation of the chemical reactions that occur in the test
This term defines a potentially life-threatening test result that must be communicated to a healthcare provider STAT
A Critical result
If a phleb. collects a venipuncture specimen from an arm slightly above the patient's IV (in the same arm), what affect does it have on the specimen?
It will dilute the specimen with IV fluids
Match the test with the most appropriate urine specimen.
Urine Cortisol (a hormone)
HCG test
Urinalysis with culture if indicated
1. Clean catch midstream urine
2. 24 hour urine
3. Random urine
Urine Cortisol (a hormone) 2. 24 hour urine
HCG test 3. Random urine
Urinalysis with culture if indicated 1. Clean catch midstream urine
What effect would a patient's heparin therapy have on processing the specimen?
It will lengthen clotting time of serum specimens
The phleb. collected blood on an 85 year old woman for PT/PTT and potassium levels. Even though a winged infusion set was used to collect the blood from the patient's fragile veins, the light blue topped tube was underfilled. The green top tube had the required amount of blood. Describe what caused this problem and how the phleb. can avoid it in the future.
The air in the tubing of the winged infusion set compromised the vacuum in the tube which led to a shortage of blood to fill the tube.
Next time, the phleb. should draw a wasted blue tube to account for the air in the tubing. Once blood has entered the waste tube it can be discarded and the actual blue top for testing can be filled.
If blood is to be collected for a timed blood glucose level determination, the patient must fast for ___ to ___ hours. The specimen should be collected in a _____ top tube containing ________ _________as an anticoagulant.
8-12 hours
grey top tube
Sodium oxalate
A phlebotomist must collect a bilirubin on a newborn. What type of tube should be used to collect the sample?
What alternative could the phlebotomist use if they don't have the optimal type of collection tube with them?
Where should the newborn be stuck?
Amber colored microtainer
Red topped microtainer wrapped in foil or coban.
On either side of the heal. Not in the center of the heal and not the fingers
What components are assessed in the physical exam of a urine sample submitted for urinalysis?
Color and transparency
After blood collection, when should plasma be centrifuged?
serum
As soon as possible
When it's clotted
How should each of the following situations be handled by a phlebotomist?
1. patient with a hematoma
2. patient with an IV
3. Non-fasting patient with a 2hour GTT
1. Draw in other arm or below the bruise
2. Draw in other arm, have RN turn off IV and draw a waste tube or draw below the IV
3. Reschedule blood draw and provide clear instructions to patient for adequate fasting
Name a poct used to diagnose and treat anemia.
diabetes?
hemoglobin
glucose
A false negative blood culture is more likely to occur if:
a) the anaerobic blood culture bottle is inoculated with blood and air
b) the indwelling IV catheter is used to obtain the culture specimen
c) the bottle is inoculated with the recommended amount of blood
d) the health care worker palpates the venipuncture site after it has been prepared without first cleaning the gloved finger
a) the anaerobic blood culture bottle is inoculated with blood and air
anaerobic organisms die in the presence of air
Other options are likely to cause accurate or false positive blood cultures
Glucose and ketones in the urine are frequently associated with what disease?
Diabetes mellitus
Place the following specimens in the order of urgency and justify each answer:
Grey top tubes for a glucose tolerance test
Surgical culture and gram stain from heart valves
urine for urinalysis and culture if indicated
CSF for cell count, glucose and protein
CSF first then
surgical culture from heart valve
urinalysis
GTT
State the anticoagulanted tube you would collect for the following tests and the proper order of draw
CBC with differential and peripheral smear
CMP
PT/PTT
ETOH
CBC and peripheral smear= purple EDTA
CMP= green lithium heparin
PT/PTT= blue sodium citrate
ETOH= grey sodium or potassium oxalate
Blue, green, purple, grey
A patient is on Coumadin/Warfarin therapy. What POCT is periodically performed to assess whether the medication is having the desired affects?
PT/INR
Describe 3 pre-analytical errors that would result in compromised test results.
1 involving the specimen collection procedure
1 involving specimen transport
1 involving specimen processing
specimen collection procedure- blood collected in wrong tube, misidentification of pt, tourniq. on too long
specimen transport- specimen transported at wrong temperature or exposed to extreme temperatures
specimen processing- centrifuging too long or too fast, aliquoting to a mislabeled tube
A patient's urine is dark yellow and hazy. There is a strong odor as well. The chemical analysis indicates the presence of a trace amount of blood and protein and a significant amount of leukocytes and nitrate.
Describe the subsequent actions of the MLA.
A microscopic exam should be performed. 10mL of the specimen should be centrifuged for 5 min. The supernatant of the urine should be discarded, leaving the bottom 1 ml of urine. This is mix thoroughly and a drop is placed on a microscope slide for viewing.
Assuming the specimen's microscopic exam confirms the results of the chemical analysis, the specimen should be submitted for urine culture as the presence of leukocytes and nitrate strongly suggest a urinary tract infection.
What is the purpose of a gel or non-gel barrier device in evacuated tubes for blood specimens?
Why is this necessary?
What tests may be affected if gel or a barrier device is not used?
separates the serum/plasma from the clotted RBCs
It prevents cellular components from passing from RBCs to plasma or vis versa
glucose or potassium