Phlebotomy - Chapter 16

What are the four ways in which samples can be safely transported to the lab?

1) Direct by phlebotomist 2) Pneumatic tube 3) Collection department staff 4) Courier 5) Overnight mail

What are five reasons for specimen rejection?

1) Improper or inadequate identification 2) Hemolysis 3) Incorrect tube 4) Tubes past expiration date 5) Inadequate ratio of blood to additive 6) Insufficient volume 7) Drawing at wrong time 8) Contaminated specimen 9) Improper handling 10) Delivery outside time frame

What are three reasons specimens should be delivered under a time constraint to the lab?

1) Ongoing glycolysis (sugar breakdown) is primary cause of inaccurate results 2) (NEED TO LOOK UP!)

Which of the following is used to identify a patient specimen in the lab 1) Name of the collector of the specimen 2) Accession number 3) Specimen type 4) Name of the person depositing specimen in the lab

2) Accession number

Infant bilirubin is transported 1) On ice 2) In amber-colored microtubes 3) In a heel-warmer packet 4) Without special transport measures

2) In amber-colored microtubes

Once a cap is removed from a blood tube the PH 1) May decrease 2) May increase 3) Will not change 4) Becomes alkaline

2) May increase

Complete blood clotting may take ____ at room temp 1) 10-15 min 2) 20-30 min 3) 30-45 min 4) 1 hour

3) 30-45 min

The major risk of stopper removal is 1) Glycolysis 2) Hemolysis 3) Aerosol 4) Clotting

3) Aerosol

Which of these practices are NOT recommended during specimen transport? 1) Placing a sample in a leak-proof bag 2) Carrying the specimen upright 3) Carrying the specimen at a 45-degree angle 4) Labeling samples from outside the hospital with a biohazard symbol

3) Carrying the specimen at a 45-degree angle

Cold agglutinins and cryofibrinogen samples should be 1) Chilled before collection 2) Transported on ice to the lab 3) Warmed before collection and transported warmed 4) Transported at room temperature

3) Warmed before collection and transported warmed

What is the average time for completing clotting to occur in a red-topped tube when clot activators are used?

30 min

Which of the following specimens would NOT be rejected? 1) A CBC collected in a lithium heparin tube 2) An EDTA tube used for a chemistry test 3) A sodium level collected in a sodium heparin tube 4) A cold agglutinin sample transported in a heel-warmer packet

4) A cold agglutinin sample transported in a heel-warmer packet

Which of the following can be centrifuged immediately after collection? 1) Serum separator tubes 2) Clot tubes 3) Thrombin tubes 4) Sodium citrate tubes

4) Sodium citrate tubes

Why is it important that the centrifuge carry a balanced load?

A centrifuge must carry a balanced load; otherwise, the rotor of the centrifuge may spin out of center, which can damage the centrifuge and cause samples to break.

Aerosol

A microscopic mist of blood that forms as droplets inside the tube

Accession number

A unique identifying number used for cataloging the sample in the lab

What are aliquots?

Aliquots are small portions of a specimen transferred into separate containers for distribution to a variety of lab departments.

How are aliquots prepared?

All tubes into which aliquots are placed should be labeled before filling and then capped before delivery to the appropriate department. Aliquots are removed with any one of several types of disposable pipetting systems.

What is the purpose of an accession number?

An accession number is a unique identifying number used for cataloging a sample in the lab.

What are three analytes that are light sensitive?

Bilirubin, vitamin B12, carotene, folate, urine porphyrin

What is the purpose of chilling a specimen?

Chilling a specimen slows metabolic processes and keeps analytes stable during transport and handling.

CLSI

Clinical and Laboratory Standards Institute

What tests must samples be kept warm?

Cold agglutinins, cryoglobulins, cryofibrinogen

CBC

Complete blood count

What are some disadvantages of the pneumatic tube system?

Disadvantages of pneumatic tube systems include unreliability of the system, speed of delivery, and cost of the alternative.

EDTA

Ethylenediaminetetraacetic acid

What is the principle and proper operation of a centrifuge?

Every sample must be balanced by another of equal weight.

In these two exceptions what is the maximum time they may be held?

Glucose - 24 hours at room emp and 48 hours at 2-8C. Whole blood specimens in EDTA for 24 hours at room temp.

What are two exceptions to time constraints?

Glucose samples and whole blood specimens collected in EDTA for CBCs

Why must samples be allowed to clot fully before processing?

Incompletely clotted samples continue to clot after serum separation forming fibrin strands which interfere with testing.

What minimal documentation should be included with each specimen delivered to the laboratory?

Minimum documentation to be included with each specimen should include the patient's name, the patient's hospital number and room number, the specimen type, the date and time of delivery to the drop off area, and the name of the person depositing the specimen.

What is the acceptable time between specimen collection and separation of cells from plasma or serum?

No more than 2 hours should pass between collection of the sample and separation of cells from plasma or serum.

OSHA

Occupational Safety and Health Administration

What are the light-sensitive analytes?

One light sensitive analyte is bilirubin. Other light-sensitive analytes include vitamin B12, carotene, folate, and urine porphyrin

PPE

Personal protective equipment

What safety equipment must be used when processing samples?

Personal protective equipment includes gloves, full-length lab coat (buttoned or snapped with closed cuffs, protective face gear including either goggles or a mask or a chin-length face shield

How do you handle samples that must be chilled?

Place in a slurry of chipped or shaved ice and water.

Why should tubes be transported in an upright position?

Promotes clot formation when there is no additive present, prevents sample contamination caused by prolonged contact with the stopper, reduces the likelihood of aerosol formation during uncapping, since the clot does not form at the top it does not have to be rimmed or detached.

Why is proper handling important? What might happen to a sample that is not properly handled and processed.

Proper handling ensures accuracy of test results and avoids rejection of the specimen. Analytes may change over time with temperature changes or exposure to light.

QNS

Quantity not sufficient

How should routine specimens be transported to the laboratory?

Routine specimens should be transported to the lab within 45 min after being drawn

Pneumatic tube system

Samples are carried in sealed plastic carriers that travel within a network of tubes

How do you protect analytes that are light sensitive?

Samples collected in amber-colored microtubes, wrapped in aluminum foil or an amber/brown biohazard bag, and placed inside a brown envelope or heavy paper bag. Can use amber-colored sealable plastic bags.

Why is the acceptable time between specimen collection and separation of cells from plasma or serum important?

Separating the cells from the plasma prevents alteration of the levels of analytes in the serum or plasma as the cells continue to metabolize.

STAT

Short turnaround time

Aliquots

Small portions of specimen transferred into separate containers for distribution to separate departments

How do you keep samples warm?

Specimens that must be maintained at 37C during transport and handling should be warmed in a heel warmer before and after collection. Some tests require warming of the sample in a 37C incubator before testing.

Centrifuge

Spins sample at a very high speed separating components based upon density

How should stat specimens be transported to the laboratory as opposed to routine specimens?

Stat specimens should be transported to the lab immediately after being drawn

What tests can be affected by glycolysis?

Tests affected by glycolysis include glucose, calcitonin, phosphorous, aldosterone, and a number of enzymes

What is the proper procedure for removing a stopper?

To remove a stopper from a tube, place a 4x4 inch gauze pad over the top and pull the stopper straight up, twisting it if necessary. Do not rock it from side to side or pop it off.

How do you handle light-sensitive analytes?

To transport, the specimen must be protected from light- the tube must be wrapped in aluminum foil or an amber-colored tube must be used.

What is the purpose of maintaining tubes in an upright position during transportation?

Tubes must be transported in an upright position to allow complete clot formation, prevent sample contamination caused by prolonged contact with the stopper, and reduce the formation of aerosol during uncapping.

How should a tube with anticoagulant be inverted?

Tubes with anticoagulant should be inverted gently and completely 5-10 times immediately after the sample is drawn.