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PBTSpecial Procedure

ASCP Review for Special Procedures

Blood Bank Specimens - Special Requirements: Require collection of one or more Lavender or Pink Stopper EDTA tubes. In some cases a non-additive glass Red Stopper tube is used.
Blood Bank Specimens - Identification and Labeling Errors: Strict Patient Identification & Specimen Labeling is Required if there are Errors: Incompatible blood product and possibility of a Fatal Transfusion Reaction.
Blood Bank Specimens - Identification and Labeling Requirements 1. ID of Patient Confirmed. 2. MR number on all corresponding blood collections from this Patient. 3. A unique number that only on bracelet of patient and all blood products match and verified.
Blood Bank Specimens - Blood Product Validation initiated by gathering 4 key facts: 1. The clinicians ID (scanned from bar code ID) 2. Patients ID (Scanned from wrist band) 3. Blood Products unique Donor ID bar code 4. Blood Products bar code on Blood Unit
Blood Bank Specimens - Blood Transfussions Patient Identification Check can require a second Nurse validation.
Type, Screen, and Cross-Match - Process: >Most Common Test Performed by Blood Bank >Blood Type(A, AB, B, O) >Screen Rh Factor (+ or, - ) Cross Match is performed by using the type and screen results to select donor unit of blood.
Type, Screen, and Cross-Match - Procedure: Patient's Plasma or Serum and the Donor's RBCs are mixed together to determine compatibility.
Type, Screen, and Cross-Match - Imcompatible A Transfusion of incompatible blood can be Fatal because Agglutination (Clumping) and Lysis (rupturing) of RBCs within Patients Circulatory System.
Blood Bank Specimens - Donor Collection Requires Special Training and Exceptional Venipuncture Skills.
Blood Bank Specimens - Blood Bank Guidelines Agency: American Association of Blood Banks (AABB)- Quality Assurance & Standardization.
Blood Bank Specimens - Blood Bank Regulating Agency: U.S. Food and Drug Administration (FDA) - Regulates the Blood Bank because Blood and Blood Products are considered Pharmaceuticals.
Blood Bank Specimens - Donor Elgibility Ages 17-66 years of age and weigh at least 110 lbs. Minors must have written permission from parents. Over 66 may donate at the discretion of the Blood Bank Physician.
Blood Bank Specimens - Anticoagulant and Preservative: CPD - Citrate-Phospaate-Dextrose or CPDAI which is CPD with Adenine. Used in Blood Bank collected units of Blood for Transfusion purposes.
Citrate-Phosphate-Dextrose CPD or Citrate-Phosphate-Dextrose-Adenine CPDAI Citrate: prevents clotting by Chelating Calcium Phosphate: Stabilizes pH Dextrose: provides energy/food for the cells to keep them alive.
Blood Bank - Lookback Program: All components of the unit of blood must be traceable to the Donor mandated Federally. It requires notification to all recipients if the blood products are positive for Transmissible Disease.
Blood Bank - Autologous Donation Is a process by which a person donates blood for their own use. Minimum time between donation and surgery 72hours. Must have written permission from Physician to make a Autologous Donation.
Blood Cultures - Bacteremia or Septicemia Bacteria in the blood or microorganisms or the their toxins in the blood.
Blood Cultures - Help to determine: The presence and extent of infection as well of indicating the type of organism responsible and the antibiotic to which it is most susceptible.
Blood Cultures - Should be ordered: On the basis of whether the patients has a condition in which bloodstream invasion is possible not solely based on If there is a Fever of Unknown Origin (UFO).
Blood Cultures - Typically ordered when: Immediately before or after anticipated Fever spikes, which is when bacteria is most likely to be present.
Blood Cultures - Collection Timely Collection is essential. Best time to detect Bacteremia 30 minutes to 2 1/2 hours prior to fever spike.
Blood Cultures - Specimen Requirements as cited by the ASM American Society of Microbiology: 2 - 4 cultures for optimal detection of bacteremia and fungemia. Draw 30 - 60 min apart. Each Set own site (only 2 cultures/draw site) Sometimes 2nd site cultures drawn 30 min apart.
Coagulation Specimens - Light Blue Stopper Contain Sodium Citrate for Coagulation must be filled until vacuum is exhaustes to obtain a 9:1 ratio of blood to Anticoagulant.
Coagulation Specimens - If Hemoglobin is High or Low: A Blue Stopper CTAT tube is best. Withe the Sodium Citrate it contains Theophylline, adenosine and dipyridamol to inhibit Thrombocyte activation between Collection and performance of test.
Coagulation Specimens - V & VIII Coagulation Factors: Not Stable should be in ice slurry during transport. If test can not be done in a timely manner then Centrifuge and Freeze Plasma.
Coagulation Specimens - Catheter Collection CLSI recommends draw/discard 5mL of blood or 6 x dead space volume of catheter before collection. If Heparin used: Rinse with 5mL Saline, then Discard 5mL of then draw.
2-Hour Postprandial Glucose (2-hourPP) 2 hours after meal Glucose Draw in Grey (Sodium Fluoride) Stopper Tube. In Diabetic patients Glucose levels will be significantly increased.
2-Hour Postprandial Glucose (2-hourPP) - Preparation: 1. Patient on High Carb diet 2-3 days 2. Fast min of 10 hours 3. Fasting Glucose may be collected before start of test.
2-Hour Postprandial Glucose (2-hourPP) - Start of Test: 1. Patient diet 100g glucose 2. Blood Glucose specimen collected 2 hours after meal.
Glucose Tolerance Test (GTT) is use to diagnose problems of carb metabolism. Evaluating the body's ability to metabolize glucose by monitoring tolerance to high levels of glucose without adverse effects.
Glucose Tolerance Test (GTT) - Two Major Disorders involving Glucose Metabolism: 1. Diabetes Mellitus, Hyperglycemia the blood glucose level is increased. 2. Hypoglycemia blood glucose levels are decreased.
Glucose Tolerance Test (GTT) - Evaluates: The Insulin response to a measured dose for glucose by recording glucose levels on specimens collected at specific time intervals.
Glucose Tolerance Test (GTT) - Length: 1 hour for Gestational Diabetes and 3 hours for other glucose metabolism evaluations.
Glucose Tolerance Test (GTT) - Method Consistency If first specimen venipuncture then all taken via venipuncture. If taken via skin puncture then all taken via skin puncture
Glucose Tolerance Test (GTT) - Preparation & Procedure (Time Intevals 30min, 1hr, 2hr...) 1. 150g of carb for 3 days before test. 2. Fast for at least 12 - 16 hours prior to test. Drink plenty of H2O through out. 3. After Fast Drink determined dose of glucose beverage within 5 minutes 4. Collect GTT specimens the for the Time interval.
Lactose Tolerance Test (LTT) - & GTT >It is suggested that a 2-hour GTT be performed the day before the Lactose Tolerance Test. >A 2-hour Lactose Tolerance Test is performed in the same manner as the GTT; however, and equal amount of Lactose is substituted for glucose.
Lactose Tolerance Test (LTT)- Blood Samples Blood Samples for glucose are drawn at the same times used in the previous GTT Test.
Lactose Tolerance Test (LTT) - Mucosal Lactase: If the patient has mucosal lactase, the resulting glucose curve will be similar the GTT curve.
Lactose Tolerance Test (LTT) - No Lactase Enzyme: The patient is then Lactose intolerant, glucose levels will rise only slightly from the fasting level, resulting in a Flat curve.
Paternity / Parenting Testing - Results: exclude the possibility of paternity rather than prove paternity.
Paternity / Parenting Testing - Chain of custody & Specific Id procedures: 1. Blood Sample Testing: ABO and Rh Typing, if not excluded then a Red cell antigen test is performed. 2. Cheek Samples 3. DNA
Paternity / Parenting Testing - Before infant is born: 1. Amniocentesis 2. Chorionic Villus sampling (fetal portion of placenta)
Therapeutic Drug Monitoring (TDM) The testing of drug levels at specific intervals used in management of patients being treated with certain drugs in order to help establish drug dosage.
Therapeutic Drug Monitoring (TDM) - Drug Dosage Management: maintain the dosage at a therapeutic (beneficial level, and avoid drug toxicity.
Therapeutic Drug Monitoring (TDM) - Peal Level (max level)Collection For a drug to be beneficial the peak level must not exceed toxic level - Peak times 30 min after intravenous, 60min after intramuscular, 1-2 hours after oral
Therapeutic Drug Monitoring (TDM) - Trough Level (min level)Collection Must remain within the therapeutic range to help in treatment. Collected usually immediately prior to administration of the next scheduled dose.
Therapeutic Drug Monitoring (TDM) - Timing of Collections Critical with drugs that have a short half life. Timing less critical with drugs having a longer half life.
Therapeutic Phlebotomy Withdrawal of large volumes of blood that as treatment in medical conditions like: Polycythemia & Hemochromatosis
`Therapeutic Phlebotomy - Polycythemia Over production of RBCs - most common reason for performing therapeutic phlebotomy, blood letting.
Therapeutic Phlebotomy - Hemochromatosis Excess Iron deposits in tissues. Periodic removal of single units of blood from the patient gradually depletes iron stores, the body then uses the iron to make new RBCs.
Toxicology Specimens Clinical Toxilogy is concerned with the detection of toxins and treatment for the effects they produce
Toxicology Specimens - Forensic is concerned with the legal consequences of toxin exposure, both intentional and accidental.
Toxicology Specimens - Forensic Chain of Custody Detailed documentation that tracks the specimen from the collection to time that results are reported. The Specimens must be accounted for at all times. Incomplete doc. could compromise legal actions.
Toxicology Specimens - ETOH Blood Alcohol (Ethanol) Specimens
Toxicology Specimens - BAC Blood Alcohol Concentration Law enforcement agencies order BAC on drunk drivers, or suspected drinkers in car accidents.
Toxicology Specimens - Skin Preparation Do NOT use alcohol wipe for a ETOH. Most commonly used is Povidone-Iodine and Benzalkonium Chloride.
Toxicology Specimens - Specimen Requirements A Glass Grey Stopper Sodium Fluoride Tube w/or without anticoagulant. Exhaust Vacuum and fill tube to top. Glass preferred due to porous nature of plastic tubes.
Toxicology Specimens - Drug Screening Testing is typically performed on Urine rather than blood because it is easy to obtain and a wide variety of drugs or their metabolites can be detected in urine for a longer period of time.
Toxicology Specimens - Drug Screening and Chain of Custody Protocol There are legal implication to drug screening and chain of custody protocol required regardless if the test is being performed for legal reason.
Toxicology Specimens - National Institute of Drug Abuse Patient Preparation Requirements >Explain the test purpose and procedure >Advise the patient of legal rights >Obtain a witnessed, signed consent form
Trace Elements or Metals Aluminum, Arsenic, Copper, Lead, Iron, and Zinc
Trace Elements - Must be collected in special Trace Element free tubes. Typically Royal Blue Stopper and contain EDTA, Heparin or No Additive. Noted on the label and color coded: Lavender for EDTA and Green for Heparin.
Trace Elements - When ordered: It is best to draw it by it's self. using a needle/tube assembly.
Blood Cultures - Specimen Requirements as cited by the ASM American Society of Microbiology: 1%-4% of infant to young children total blood volume to be drawn. Those weighing 80lbs or more 20-30mL per culture with min. 10mL per draw.
Blood Cultures - Specimens Drawn in Sets of 2 1 aerobic & 1 anaerobic. With syringe: Anaerobic bottle 1st then Aerobic 2nd. With Butterfly: Aerobic 1st to pull out air in tubing then Anaerobic 2nd.
Blood Cultures - Collection Procedure using Skin Antisepsis. Skin Antisepsis: the destruction of microorganisms on the skin critical at draw site before drawing for Blood Culture. Concentric Circles 3-4 inches in diam.
Blood Cultures - Skin Antisepsis. 30-60 friction scrub to get the bacteria beneath the deatd skin cells with Chlorhexidine gluconate and providone/70% ethyl alcohol combination.
Blood Cultures - According to the CLSI Clinical Laboratory Standards Institute: Chlorhexidine gluconate is the recommended blood culture site disinfectant for infants 20 months or older and patients with iodine sensitivity.
Blood Cultures - Collection Procedure After Skin Antisepsis: >Remove lid to blood cultures - clean >Mark Min & Max fill on bottles >Apply tourniquet, perform venipuncture >Inoculate the Culture medium >Invert Bottle several times
Blood Cultures - Media Inoculation Methods: >Direct Inoculation - Syringe & Venipuncture - Anaerobic then Aerobic > Butterfly Aerobic - Anaerobic. > Intermediate - Yellow Top SPS Tube
Blood Cultures - Syringe OSHA requires the use of a safety Transfer Device
Blood Cultures - Intermediate Collection Inoculation Method Use of a Yellow Top SPS tube as an intermediate for inoculation Is discouraged
Antimicrobial Neutralization Products patients on Antimicrobial (antibiotic) therapy at time of blood cultures which inhibits the their growth so using FAN or ARD provides a medium that neutralize the antibiotics.
Antimicrobial Neutralization Products - ARD Antimicrobial Removal Device: contains a resin that removes antimicrobial's from the blood.
Antimicrobial Neutralization Products - FAN Fastidious Antimicrobial Neutralization: contain activated charcoal, which neutralizes the antibiotic.
Lactose Tolerance Test (LTT) - False Positives result have been demonstrate in patients with: Small bowel resections, slow gastric emptying, Crohn's disease, and Cystic Fibrosis.
Glucose Tolerance Test (GTT) - In Patients with Normal Glucose levels: Blood Glucose levels speak with in 30 minutes to 1 hour following glucose ingestion. The peak in glucose levels triggers the release of insulin which brings glucose levels back down to fasting levels within 2 hours now glucose spills over into urine.
Toxicology Specimens - National Institute of Drug Abuse Specimen Collection Requirements >A special area for urine collection >A proctor present at collection for verification of specimen coming from patient >Label to establish chain of custody ID >Specimen sealed, locked container for transport. >Doc maintained from Courier to Receiver.
Created by: jlmillington1
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