Phlebotomy Essentials 5Th Edition

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Accession number:

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Is used by the laboratory to identify a specimen throughout the testing process. A phlebotomist would select the “department order entry” icon. During this data entry phase an accession number is given to each requested order.

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Logging on:

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Is the process of entering a password and gaining access to a computer

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Middleware:

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Accepts data downloaded from POC instruments.

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LIS:

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Laboratory information system

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Mnemonic:

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Memory-aiding code or abbreviation, as used in LIS, for example.

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Output:

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Processed information generated by computer

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Online:

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Computer is connected to system & is operational

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Password:

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Secret word or phrase used to enter system

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Peripherals:

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All additional equipment attached to CPU

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RAM:

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Random access memory; temporary storage of data in CPU

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Rom:

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Is permanent computer memory that instructs the computer to carry out user-requested operations.

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Barcode:

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Is a series of bars and spaces representing numbers and letter.

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Software:

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Coded instructions required to control hardware in processing of data

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Storage:

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A place for keeping data; outside computer, it is called secondary storage

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Verify:

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To confirm or check for correctness of input

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Elements of the computer "storage"

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RAM: Limited temporary storage in CPU
ROM: Internal hard drive memory in CPU "Permanent Memory"
Secondary storage: Storage outside CPU (External hard drives, USB drives, CD's & DVD's)

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RFID:

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Radio Frequency ID
-Composed of a reader & a tag or label
-Tag is applied to product or person to identify & track using radio waves
-Wireless scanner can track more than one tag at a time
-Used to monitor patients
-is one of the newer technologies. It identifies and tracks specimens, equipment & records

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Preanalytical Phase:

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Includes handling and all the steps that are taken before actual testing of the specimen.
Estimated that 46% to 68% of all laboratory errors occur prior to analysis.

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The steps included in the preanalytical phase are:

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Before collection, at time of collection, during specimen transport, during specimen processing, during specimen storage.

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POSSIBLE SOURCES OF PREANALYTICAL ERROR Before Collection

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• Age of patient • Altitude • Dehydrated patient • Duplicate test orders • Exercise • Gender of patient • Inadequate fast • Incomplete requisition • Medications • Patient stress • Pregnancy • Smoking
• Strenuous exercise • Treatments (e.g., intravenous
medications, radioisotopes) • Wrong test ordered

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POSSIBLE SOURCES OF PREANALYTICAL ERROR At Time of Collection

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• Misidentified patient • Antiseptic not dry
• Expired tube • Failure to invert additive tubes properly • Faulty technique • Improper vein selection • Inadequate volume of blood • Inappropriate use of plasma separator tube (PST) or serum separator tube (SST) • Incorrect collection tube • Incorrect needle position • ncorrect needle size • Mislabeled tube • Mixing tubes too vigorously • Nonsterile site preparation • Patient position • Prolonged tourniquet application • Underfilled tube • Wrong collection time

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POSSIBLE SOURCES OF PREANALYTICAL ERROR During Specimen Transport

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• Agitation-induced hemolysis • Delay in transporting • Exposure to light • Failure to follow temperature requirements • Transport method (e.g., hand vs.
pneumatic tube)

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POSSIBLE SOURCES OF PREANALYTICAL ERROR During Specimen Processing

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• Contamination (e.g., dust or glove powder) • Delay in processing or testing • Delay in fluid separation from cells • Evaporation • Failure to centrifuge specimen according to test requirements • Failure to separate fluid from cells • Incomplete centrifugation • Mislabeled aliquot • Multiple centrifugations • Rimming of clots

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POSSIBLE SOURCES OF PREANALYTICAL ERROR During Specimen Storage

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• Exposure to light
• Temperature change outside defined limits

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Pneumatic tube vs. hand.

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A pneumatic tube is a pressurized air transportation system. Like the tubes used in bank lanes.

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It is important to transport specimens carefully.

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Rough handling and agitation can hemolyze specimens, activate platelets, and affect coagulation tests as well as break tubes.

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Tubes should be transported with stoppers up

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to reduce agitation, aid clot formation in serum tubes. Tubes that are transported with the stopper up has nothing to do with maintaining The suitability of the sample.

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Routine Handling (Mixing tubes by inversion)

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Additive tubes require 3-10 gentle inversions

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Routine Handling (Transporting specimens)

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Stopper should be up, should be in plastic bags w/ biohazzard logo, liquid tight closure & a slip pocket for paperwork.

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Routine handling (Delivery time limits)

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Routine blood specimens should arrive at lab within 45 min. Centrifugation, if required, should occur within 1 hr of arrival.

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The CLSI is the organization that develops standards for

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specimen handling and processing.

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According to CLSI, the maximum time limit for separating serum or plasma from cells is

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2.0 hours from the time of collection.

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Glycolysis by erythrocytes and leukocytes in blood specimens can lower glucose values at a rate of up to

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200 mg/L per hour.

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Time Limit Exceptions

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“STAT”, “ASAP”, or “Med Emerg” are specimens that must be attended to before routine specimens.

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Body Temperature specimens

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-Should be collected in a pre-warmed tube
-Should be transported at or near normal body temp of 37 c
-Use portable heat blocks to maintain temp, during transport

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Chilled specimens (example is ammonia)

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-Should be immersed in a slurry of crushed Ice & water.
-Should be tested immediately or refrigerated

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Light sensitive specimens

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Wrap in aluminum foil or use light blocking amber colored container

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Specimen processing

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Central processing area in large labs.
Here, specimens are: Identified, logged/accessioned and accessioning, Sorted by department & type for processing required, Evaluated for suitability for testing.

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Keep at 37 degrees Celsius

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Cold agglutinin, Cryofibrinogen, Cryoglobulins

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Chill in Crushed Ice Slurry

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Adrenocorticotropic hormone (ACTH), Acetone,
Angiotensin-converting enzyme (ACE), Ammonia, Catecholamines, Free fatty acids, Gastrin, Glucagon, Homocysteine, Lactic acid, Parathyroid hormone (PTH), pH/blood gas (if indicated), Pyruvate, Renin

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Protect from Light

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Bilirubin, Carotene, Red cell folate, Serum folate, Vitamin B2, Vitamin B6, Vitamin B12, Vitamin C, Urine porphyrins, Urine porphobilinogen

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(Specimen Suitability) Specimens are rejected for:

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Hemolysis, Insufficient amount of specimen, clotting, inadequate, inaccurate, or missing specimen ID, Wrong or outdated tube, Improper handling, wrong collection time, Exposure to light , Delay in testing, Delay or error in processing, QNS: (Quanity not sufficient, Less volume than is needed for test.)

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Examples of specimen rejection criteria

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Inadequate, inaccurate, or missing specimen identification. A specimen would most likely be accepted for testing despite the specimen did not have the phlebotomist initials.

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Centrifuge:

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A machine that spins blood tubes at high rpm. Centrifugal force separates cells & plasma or serum.

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Tubes awaiting centrifugation

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Stoppers should remain on to prevent inaccurate results, evaporation & contamination.

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Centrifuge operation

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Tubes must be balanced (equal size tubes w/ equal volumes of specimen must be placed opposite one another)
A specimen should never be centrifuged more than once.

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Centrifuging plasma specimens

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Specimens for tests performed on plasma that are collected in tubes containing anticoagulants may be centrifuged without delay.

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STAT chemistry tests such as calcium are typically collected in a?

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green top heparin tube to save time, because plasma specimens can be centrifuged right away as opposed to serum specimens that must clot first.

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Centrifuging Serum Specimens

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Specimens for tests performed on serum must be completely clotted before they are centrifuged.

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3 circumstances likely to result in delayed clotting include:

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Patient has an elevated white blood cell count, patient is taking an anticoagulant medication, and the specimen is chilled soon after being collected. Chilling a specimen slows down metabolic process and protects analytes.

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Aliquot preparation

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Aliquot: A portion of specimen used for testing.
-Used when: Multiple tests are ordered, Tests are performed on different instruments or in different areas.
-Prepared by transferring a portion of specimen into one or more tubes labeled w/ same ID info, as specimen tube.
-Each aliquot tube should be covered or capped as soon as it is filled.
-the tube stopper should be removed behind a splash shield. Pouring the serum or plasma into aliquot tube is NOT recommended because it increases the possibility of Aerosol or splashing.