Phlebotomy Essentials 5Th Edition

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Blood bank specimens yield information that determines which blood products can be?

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transfused safely into a patient.

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A type and crossmatch is a test that is most likely to result In?

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fatal consequences if the patient is misidentified.

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Blood Bank Specimen Tubes that can be used to collect blood For a type and crossmatch are as follows

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Lavender- or pink-top EDTA tubes
Nonadditive glass red-top maybe used

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Blood Bank Identification & labeling requirements

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Patient's full name
Patient's hospital ID# or SS#
Patient's date of birth
Date & time of collection
Phlebotomist's initials

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Blood Banks Special identification system

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ID bracelet w/ self-carbon adhesive label for specimen
Blood ID-band w/ linear bar-coded BBID #'s
Siemens Patient Identification Check-Blood Administration

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Type, Screen, and Cross-Match Tests that determines a Patient's?

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Blood type (ABO) & RH factor (+ or -) & screen.
Cross-match to determine compatibility between patient & donor.

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A transfusion of incompatible blood can be fatal because of

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Agglutination (clumping) and lysis (rupturing of the RBC's within the patient's circulatory system.

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Lookback program

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All blood components of unit must be traceable to donor.
Requires notification to all blood recipients when a donor is shown to be positive for a transmissible disease.

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Autologous donation and autologous transfusion

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Person donates blood for his/her own use (e.g., for elective surgeries)

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Cell salvaging

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Patient's blood can be salvaged, washed, & reinfused.
Salvaged blood must be tested for residual free hemoglobin.

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It is known that bacteria can enter the body and cause disease. During the disease process, bacteria may also?

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enter the circulatory system,causing bacteremia (bacteria in the blood) septicemia (microorganism or their toxins in the blood.)

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Blood Cultures

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GENERAL
Determine presence & extent of infection.
Identify type of organism responsible & best antibiotic to use.
Should be ordered on basis of patient having a condition in which bloodstream invasion is possible & presence of fever of unknown origin.
SPECIMEN REQUIREMENTS
2-4 blood culture sets.
Drawn 30 to 60 min, apart (unless patient in critical condition).
Collected in special bottles, one aerobic and one anaerobic.
When a butterfly is used, it is perferable to fill the aerobic bottle first because air in the tubing will be drawn into it along with the blood.
Blood cultures are typically ordered immediately before or after Anticipated fever spikes when bacteria are most likely present.
Timely collection is essential.

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Blood Cultures require strict?

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Skin antisepsis. Skin antisepsis is the most critical aspect of blood culture collection.
PURPOSE
Destroy skin microorganisms.
Prevent misinterpretation of microorganism as pathogenic.
ACCEPTABLE ANTISEPTICS
Chlorhexidine gloconate.
Tincture of iodine or povidine.
Requires 30 to 60 second friction scrub.

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A clear or discard tube is required for all coagulation tests except for

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PT or PTT

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Sodium citrate tubes must be filled until?

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vacuum is exhausted

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Never pour 2 partially filled tubes

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Together

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some coagulation specimens require

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Cooling on ice

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When drawing from a indwelling catheter

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draw & discard 5 ml of blood or 6x the dead space vol of chatheter.

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When a vacuum is exhausted in a sodium tube it is a?

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9:1 ratio of blood to anticoagulant.
Specimen that requires this ratio is Prothrombin time.

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2- Hour Postprandial Glucose (2 hours after the patient has had a meal

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Glucose in diabetics is significantly increased 2 hrs after meal.
Excellent screening test for diabetes.

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Glucose Tolerance Test (GTT)

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used to diagnose problems of carbohydrate metabolism.
Monitors patient's tolerance to high levels of glucose.
Hyperglycemia: increased blood glucose level.
Hypoglycemia: decreased blood glucose level.

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GTT procedure

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1. Follow normal ID protocol & explain collection procedure; advise of fasting requirements
2. Draw fasting specimen & check for glucose
3. Ask patient to collect fasting urine specimen (if needed)
4. Give patient determined dose of glucose beverage
5. Remind patient to finish beverage within 5 mins.
6. Note time patient finishes, start timing, calculate collection times.
7. Give a copy of collection times to patient
8. collect blood & urine specimens at computed times
9. Label all specimens w/ collected times, intervals, patient ID.
10. Deliver or send specimens to lab ASAP.

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Lactose Tolerance Test

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Determines lack of enzyme that converts lactose into glucose/galactose.
Performed in the same manner as 2hr GTT, only w/lactose.
Results if lactose intolerant the curve will be abnormal (flat).

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Paternity/Parentage Testing

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Excludes possibility of paternity rather than proves it.
Requires a chain of custody protocol & specific ID procedures.
Mother, child, & alleged father are all tested.
Blood samples are preferred, but cheek swabs are increasing
Blood sample testing includes ABO &RH typing.
Paternity testing is performed to determine the probability that a Specific individual fathered a particular child.

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Therapeutic Drug Monitoring (TDM)

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Establishes & maintains drug dosage at therapeutic level.
Determines a beneficial drug dosage for a patient.
Avoids drug toxicity.
Typically used for drugs w/narrow therapeutic ranges.

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Therapeutic phlebotomy

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Polycythemia
Hemochromatosis

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Toxicology Specimens

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GENERAL
Toxicology: Scientific study of toxins (poisons).
Concerned with detection of toxins & treatment of effects.
FORENSIC BLOOD (ETHANOL) SPECIMENS
Often requested by law enforcement officials.
Used to determine levels in breath, urine, or blood.
Specimen collection must follow chain of custody.
A glass gray-top sodium fluoride tube, with with or without an anticoagulant is typically used for collecting an Ethanol specimen.

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Clinical blood alcohol (ethanol) specimens

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Normally ordered by physician for treatment purposes.
Chain of custody not required, but follow standard protocol.
Required in connection to on the job injury, employee insurance programs, & employee drug screening.
Skin preparation: don't use alcohol based disinfectant.
Specimen requirements: gray top sodium fluoride tube; fill tube until vacuum is exhausted & don't remove stopper.

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Drug screening

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Required by many healthcare organizations, sports associations, & major companies.
May be random.
May detect a specific drug or screen for up to 30 drugs.
Typically performed on urine rather than blood
Chain of custody is required.

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Drug screening (Patient preparation requirements)

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Explain test purpose & procedure.
Advise patient of his or her legal rights.
Obtain a witnessed, signed consent form.

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Drug screening (Specimen collection requirements)

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Special area for urine collection.
Proctor present at time of collection.
Split sample may be required.
Chain of custody is to be followed during the collection process.
Specimen must be labeled, sealed & placed in a locked container during transport.

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Trace Elements

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Test for aluminum, arsenic, copper, lead, iron & zinc.
Measured in small amounts.
Traces of them in glass, plastic, or stopper material can leach into specimen.
Special trace element free tubes must be used (royal blue & contain EDTA, heparin, or no additive).
When a trace element test is ordered, it is best to draw it by itself if using a needle/tube assembly, or syringe may be used.

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Coagulation Monitoring by POCT

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POCT instruments
- Cascade POC - ACT, APPT, PT/INR
- CoaguChek XS Plus - PT/INR
- GEM premier 4000 - ACT, APTT, PT/INR
- i-STAT - ACT, PT/INR
- Verify Now - platelet function
- ACT is the test used to monitor heparin therapy

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Other Tests Performed by POCT

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Cardiac troponin T & I, Lipid Testing, B-type natriuretic peptide, C-reactive protein, Glucose, Glycosylated hemoglobin, Hematocrit, Hemoglobin, Lactate, Occult blood (guaiac), Pregnancy testing, Skin tests, Strep testing, Urinalysis, Arterial blood gases.
-Everyone who performs POCT in a clinical setting must meet the requirements of the CLSI for testing and the guidelines of OSHA for specimen handling.

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POC Analyzers

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All POC glucose analyzers approved for hospital use have the ability to use capillary venous, or arterial samples
Data can be downloaded to a data management program
They require the use of an authorized operator ID number.

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Pregnancy testing

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Purpose: to check for hCG in urine HCG hormone.
PROCEDURE:
1. Identify patient
2. Label the specimen cup with patient ID information.
3. Obtain the patient's urine.
4. Remove test device and place on flat surface.
5. Use the supplied dropper and place required drops in the sample well on cassette.