Week 3 Ch 11 and Ch 13

Tissue specimens

Used for biopsy's

Occult blood- guaiac test.

A test for hidden blood in feces.

ACT

Activated clotting time.

Bacteremia

Bacteria in the blood,

Cerebrospinal fluid

Bacterial or viral encephalitis/meningitis/ fungal infections brain abscess, CNS cancer, Multiple sclerosis cell count/glucose protein

Autologous donation

Blood that is donated for one's own use.

Skin antisepsis, the destruction of microorganisms on the skin, is a critical part of the blood culture collection procedure.

Failure to carefully disinfect the venipuncture site can introduce skin-surface bacteria into the blood culture bottles and interfere with interpretation of results. The laboratory must report all microorganisms detected; it is then up to the patient's physician to determine whether the organism is clinically significant or merely a contaminant. If a contaminating organism is misinterpreted as pathogenic, it could result in inappropriate treatment. The best way to overcome this problem is by meticulous aseptic technique during preparation of the skin with the appropriate bactericidal agent.

Peritoneal fluid

Fluid aspirated from the abdominal cavity

Septicemia

Microorganisms or their toxins in the blood.

NP

Nasopharyngeal. A term referring to the nasal cavity and the pharynx

Serous fluid analysis

Pleural fluid specimens test for pleurisy.

Lysis

Rupturing, as in the bursting of red blood cells,

1 hour Glucose (Glucose Challenge)

a 1-hour glucose screening test or gestational glucose screening test • eat balanced meals containing approximately 150 g of carbohydrate for 3 days before the test. • fast for at least 8 hours but not more than 16 hours prior to the• be allowed to drink water during the fast and during the test to avoid dehydration and because urine specimens may be collected as part of the procedure. No other foods or beverages are allowed. • be discouraged from engaging in excessive exercise for 12 hours before the test. • not smoke or chew gum, as these activities stimulate the digestive process and may cause erroneous test results. • receive both verbal and written instructions to ensure compliance. Gloves, alcohol prep pads, ETS holder, tubes and needle, glucose beverage, urine containers (if applicable), bandage, permanent ink pen.

Catheterized

describing a urine specimen collected from a sterile catheter inserted through the urethra into the bladder.

Gestational:

diabetes. To perform the test the patient is given a drink containing 50 g of glucose. A blood glucose specimen is collected 1 hour after the patient finishes the drink. If the glucose result on the specimen is greater than 140 mg/dL, it is suggested that the patient have a follow-up OGTT within 1 week.

Pericardial

fluid tests for pericarditis

Peritoneal

fluids test for fluid build up in the abdomen.(Ascites)

Breath samples tests

for chronic gastritis/lactose tolerance/pulmonary infections.

Ulcers

found in other body fluids

Electrolytes

gastric secretions contains all the electrolytes

Hair Samples

hair samples can be used to detect alcohol and drugs or abuse such as amphetamines opium cocaine

Hyper/hypoglycemia

highly excited, hypoglycemia: Condition in which the level of sugar (glucose) in the blood is low.

Saliva testing-

hormone levels/ alcohol and drug abuse

Semen analysis-

is the sperm containing fluid that is discharged during male ejaculation

Gastric analysis

stomach fluid. A tube is passed through the mouth& throat into the stomach

Throat swabs

tested for strep infections

Amniotic fluid-

tests for genetic disorders. Test for genetic disorders such as downs syndrome incompatibility between a mother and baby gestational age to check pedal

UTI

urinary tract infection

Describe the blood culture procedure:

1. Follow normal identification protocol; explain collection procedure. 2. Identify venipuncture site and release tourniquet. 3. Aseptically select and assemble I. equipment. 4. Perform friction scrub. 5. Allow the site to dry. 6. Remove the flip-off cap and inspect the bottle for visible defects. 7. Cleanse the culture bottle stoppers while the site is drying. 8. Mark the minimum and maximum fill on the culture bottles. 9. Reapply the tourniquet and perform the venipuncture without touching or repalpating the site. 10. Inoculate the medium as required.11. Invert the bottle several times. 12. Clean the patient's skin if applicable 13. Label the specimen containers with required identification information, including the site of blood collection. 14. Dispose of used and contaminated materials. 15. Thank the patient, remove gloves, and sanitize hands. 16. Transport specimens to the lab as quickly as possible.

Body cavity fluids

1. Pleural fluid -aspirated from pleural space surrounding the heart. 2. Peritoneal fluid- Abdominal cavity. 3. Pericardial fluid- pericardial cavity surrounding the heart.

Hyper/hypokalemia

A low concentration of potassium in the blood.

Hyper/hyponatremia

A low level of sodium in the blood,

O&P- ova and parasites.

A test to detect the presence of an intestinal parasites and their eggs if feces

ETOH

Abbreviation for ethanol or blood alcohol,

Compatibility

Ability to be mixed together with favorable results, as in blood transfusions,

Postprandial (PP)

After a meal.

Where in the body do you find the following fluids?

Amniotic fluid- comes from the amniotic sac that cushions and surrounds a fetus in the uterus

ARD / FAN- ARD

Antimicrobial removal device, FAN-Fastidious antimicrobial neutralization.

Why and when are blood cultures typically ordered?

Blood culture specimens are most commonly collected in special bottles (Fig. 11-6) containing nutrient broth (referred to as medium) that encourages the growth of microorganisms. These specimens are typically collected in sets of two: one aerobic (with air) and one anaerobic (without air).

Cerebrospinal fluid

CDF is the fluid that surrounds anad helps cushion the brain and spinal cord

CSF

Cerebrospinal fluid, clear colorless liquid that circulates within the cavities surrounding the brain and the spinal cord. It has many of the same components as plasma.

Blood alcohol specimen collection (BAC)

Concentration of alcohol in a person's blood used as a measurement of intoxication for legal or medical purposes,

Fertility

Effectiveness of sterilization following a vasectomy Forensic reasons/legal reasons such as sexual crimes

FOBT

Fecal occult blood test

FUO

Fever of unknown origin.

When should urine be collected and why?

First urine voided in the morning because it's the most concentrated.

Pericardial fluid-

Fluid aspirated from the pericardial cavity of the heart

Pleural fluid-

Fluid aspirated from the pleural cavity surrounding the lungs.

GTT

Glucose tolerance test.

HCG

Human chorionic gonadotropin.

Therapeutic Drug Monitoring Importance of timing:

If the patient is in critical condition or an antibiotic must be given right away, the status of the patient will determine the timing of the blood cultures. • When more than one set is ordered for collection at the same time, the second set should be obtained from a separately prepared site on the opposite arm if possible. In some cases, "second-site" blood cultures are more useful when drawn 30 to 60 minutes apart. • If timing is not specified on the requisition, the phlebotomist should follow the laboratory protocol.

List the ways a phlebotomist may be involved in obtaining non-blood specimens.

Involved in obtaining specimens throat swabs collections. Test administration (sweat chloride collections. Give instructions (urine collection). Processing accessioning and preparing the specimen for testing verifying and labeling and transporting to the lab

How should non-blood specimens be labeled?

Labeled immediately following collection from a patient using the same identifying information of a blood specimen. Label should include type and source.

Sputum culture-

Lower respiratory tract infections such as TB

Gastric analysi

Measures gastric acid concentrations to evaluate stomach acid production

Sputum-

Mucus or phlegm ejected from lungs from trachea, bronchi and lungs by deep coughing

Blood Alcohol Specimen Collections (reasons for, skin prep, specimen requirements)

Sometimes physician orders a blood alcohol for medical reasons related to treatment or other clinical purposes. Industrial purposes in connection with on the job injury employee insurance programs. Law enforcement may request a BAC on a person who has been involved in a traffic accident. Skin prep. Clean site. Cannot use 70%Alcohol. Iodine can be used instead.

Chain of custody

Special strict protocol for forensic specimens that requires detailed documentation tracking the specimen from the time it is collected until the results are reported,

Blood Bank Specimens:

Specimen requirements:Specimens that have labeling errors of any kind or are unlabeled will not be accepted for testing.

Explain the C & S "clean catch" collection procedure.

Sterile contain, clean genital area side to side and top to bottom the mid void into the toilet then to cup void remaining into toilet.

Explain the difference between timed, spot, random, and 24 hour urine tests.

Timed: Urine specimens collected at specific times (glucose tests)Spot: ? Random: Specimens can be collected at anytime (urinalysis & screening) 24 hour urine tests: Used for quantitative analysis. Early AM collection between 6-8 AM. The same again the next morning

Agglutination

To clump together; as in the antigen-antibody reaction between red blood cells of two different blood types.

Clean catch

method of obtaining a urine sample so that it is free from contaminants from the external genital area.

What does C & S mean? When is one ordered? How long does the test take?

Culture and Sensitivity Symptoms of UTI Incubation 24 to 48 hours

Glucose Tolerance Test procedure

GTT-is used to diagnose problems of carbohydrate metabolism. The major carbohydrate in the blood is glucose, the body's source of energy. The GTT, also called the oral glucose tolerance test (OGTT), evaluates the body's ability to metabolize glucose by monitoring the patient's tolerance to high levels of glucose without adverse effects. The two major types of disorders involving glucose metabolism are those in which the blood glucose level is increased (hyperglycemia), as in diabetes mellitus, and those in which the blood glucose levels are decreased (hypoglycemia)

How would you advise a patient to collect & transport the following stool samples:

O & P Microscopic analysis is used to test for O&P. Special Hemoccult (fecal occult blood)- occult blood is blood that is hidden (can not be seen). Tests for diverticulosis, polypsStool C & S Stool sample should not be contaminated with urine or water. Once collected, it should be taken to the lab within 2 hours in a sealed container not lid

Peak level:

Peak levels screen for drug toxicity and specimens are collected when the highest serum concentration of the drug is anticipated. Peak times are influenced by many factors but typically occur approximately 30 minutes after IV administration, 60 minutes after intramuscular (IM) administration, and 1 to 2 hours after oral intake. Careful coordination of sample col¬ lection with dosing is critical.

Lookback

Program that requires all components of a unit of blood to be traceable back to the donor and that also requires notification to all blood recipients when a donor for a blood product they have received has turned positive for a transmissible disease.

Gastric secretions

Stomach acid tests

What is skin antisepsis and why is it important?

The major difficulty in the interpretation of blood cultures is contamination by normal microbial flora on the skin.

Drug Screening

The practice of testing employees' or athletes' urine or blood to screen for illicit or illegal drugs,

How is the site cleaned for blood culture collection?

To minimize the risk of contamination by skin flora, collection sites require a 30- to 60-second friction scrub to get to the bacteria beneath the dead skin cells on the surface of the arm. Tincture of iodine, chlorhexidine gluconate, and a povidone /70% ethyl alcohol . When using an ampule swab of chlorhexidine gluconate or tincture of iodine, the swab should be placed at the site of needle insertion and moved outward in concentric circles without going over any area more than once. The area covered should be at least 2.5 x 2.5 inches in diameter. Because of the increasing incidence of iodine sensitivities, some healthcare facilities are using chlorhexidine gluconate/isopropyl alcohol antiseptic for blood cultures. They offer a one-step application and are effective with a 30-second scrub.

What added information do most institutions require when labeling non-blood specimens?

Type and source of specimen

Special identification systems (Typenex)

Typenex FlexiBlood form, which accompanies the requisition when blood is being collected for patient crossmatching. This barcode system also has directions for proper overlabeling on specimen tubes, thereby making it possible for BB instrumentation to read the label correctly every time.

Identification and labeling requirements:

Typical Labeling Requirements for Blood Bank Specimens • Patient's full name (including middle initial)• Patient's hospital identification number (or other unique identifier) • Patient's date of birth • Date and time of collection • Phlebotomist's ID number or full name • Room number and bed number (optional)

The most commonly analyzed non-blood fluid is?

Urine

Explain the proper UA "midstream procedure" collection Include how long the specimen is stable at room temperature. Indicate time for both a normal UA and one for C & S.

Void initial urine flow, stop fill container, void the rest into the toilet. Up to 2 hours UA and C &S should be refrigerated

Aerobic

With air.

Anaerobic

Without air.

Drug Screening (reasons for, skin prep, specimen requirements)

Workplace drug screening for pre-employment, prepromotion, postaccident or injury, random screening (without prior notice), reasonable suspicion, and for any other situation that they deem important. Tests may detect a specific drug or screen for up to 30 different drugs, depending upon the circumstance. Testing is typically performed on urine rather than blood because it is easy to obtain and a wide variety of drugs or their metabolites (products of metabolism) can be detected in urine for a longer period of time.

Specimen Requirements-

a glass gray sodium fluoride tube with out an anticoagulant (depending upon the need for serum, plasma, or whole blood in the test procedure) is typically required for specimen collection. Because alcohol is volatile (easily vaporized or evaporated), the tube should be filled until the vacuum is exhausted and the stopper should not be removed. In today's environment, usage of synthetic stimulants, as well as some hallucinogenic drugs continues to increase. The phle- botomist may choose to draw other types of specimens at the same time for testing for these other drugs. The recommendation is light blue (citrate) for the synthetic stimulants and lavender for inhalants and DNA analysis.

UA urinalysis-

a laboratory test that typically includes macroscopic chemical and microscopic analysis of a urine specimen.

Suprapubic-aspiration

a way of obtaining urine specimen by inserting a needle directly into the urinary bladder and aspirating and withdrawing by suction the urine directly into a syringe.

Trough level:

are monitored to ensure that levels of the drug stay within the therapeutic range. Trough- level specimens are easiest to collect because they are collected when the lowest serum concentration of the drug is expected, usually immediately prior to administration of the next scheduled dose.

Nasopharyngeal secretions

are tested for diphtheria influenza, meningitis, pertussis (whooping cough ) and pneumonia

Guaiac test

is an occult blood test guaiac is named the Type of resen impregnated on the ? paper used for the test. Also called guaiac smear test as the stool is smeared on the special paper used.

Serous fluid-

pale yellow, watery fluid found between the double-layered membranes that enclose the pleural, pericardial and peritoneal cavities.

Blood bank tests

require the collection of one or more lavender- or pink-top EDTA tubes. In some cases, a non-additive glass red-stoppered tube is used. Specimens collected for blood bank testing can be rejected if they: • are not labeled exactly as described in the laboratory protocol.• are grossly hemolyzed samples. • contain IV fluid (note if drawn from opposite arm or below IV). • have been collected longer than 72 hours before. CAUTION The BBID band needs to remain on the patient as long as it is still valid, usually 3 days. For example, the day the BB specimen is drawn is day "0" and is good until 23:59 of day "4."

Sweat Chloride

sweat is tested for it's chloride, content. Tests such as cystic fibrosis and long term illicit drug use

Midstream

term applied to urine collection in which specimen is collected in the middle of urination rather than the beginning or the end

Synovial fluid analysis

tests for joint inflammation and swelling, help identify inflammatory and/or non-inflammatory arthritis. Joint diseases, gout

Bone marrow aspiration-

to test for blood diseases as bone marrow is the site of blood cell production also chromosome studies/ bacterial culture

Buccal swab-

used to test DNA, herpes simplex virus HPV and mumps