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8/10/2019 Review on Spx Collection
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11/10/2014
1
Review on:
Specimen Collection, Handling and
Storage with
Quality Assurance and Quality
Control
Q.A. vs. Q.C
Quality Assurance
Over all program or system that ensures that the
final results generated by the laboratory hasachieved and maintained a specified quality.
Quality Control
reliability of laboratory results in terms of accuracyand precision:
Machine
Reagents
techniques
Phases in the Performance of
Laboratory Tests
Pre-analytical Phase
Analytical Phase
Post-analytical phase
Patients Preparation
Fasting
Diet
Exercise
Smoking
Alcohol ingestion
DrugsCircadian rhythm
WHICH OF THE FOLLOWING IS INCREASD AFTER A
STRENOUS ACTIVITY?
1.AST 3. AMMONIA 5. CPK
2. TESTOSTERONE 4. LDH
A. 1,2 AND 3 C. 2, 3 AND 4 E.1,2,3,4 AND 5
B. 2 AND 4 D. 1,3 AND 5
WHICH OF THE FOLLOWING IS INCREASD AFTER A
STRENOUS ACTIVITY?
1.AST 3. AMMONIA 5. CPK
2. TESTOSTERONE 4. LDH
A. 1,2 AND 3 C. 2, 3 AND 4 E.1,2,3,4 AND 5
B. 2 AND 4 D. 1,3 AND 5
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TRAVELLING ACROSS SEVERAL TIME ZONES
AFFECTS CIRCADIAM RHYTHM, HOW MANY
DAYS ARE REQUIRED TO ESTABLISH A STABLE
DIURNAL VARIATION?5 DAYS
Specimen Collection
9
Public Relations and Client Interaction
Phlebotomy Related Vascular Anatomy
Blood specimens
Venipuncture Equipment
Tube Additives
Venipuncture Procedure
Syringe Method
Evacuated Tube System
10
Public Relations
Professionalism
Appearance
Attitude
Integrity and honesty
Compassion
Motivation
Dependability and work ethics
Diplomacy
Ethical conformity
11
Phlebotomy
Related VascularAnatomy
The major veins
for venipuncture
are in the
antecubital fossa
12
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H-pattern MCV
At the center of antecubital fossa
First choice for venipuncture
Cephalic vein Lateral
Second-choice in H-pattern
Often hard to palpate
Obese patients
Basilic vein
Medial of antecubital fossa
Not well anchored,rolls easily
Accidentaly puncture the brachial artery
and the median cutaneous nerve branch
13
M-Pattern Median Vein
Located at the very
center
First choice in M-
pattern
Safe to puncture
Median Cephalic
Median Basilic
14
Types of Blood specimens
Arterial, venous, capillary
55% fluid, 45% blood cells
Whole blood
Plasma
Anticoagulated blood, Clear to slightly hazy, pale yellow
With fibrinogen
Serum
Pale yellow, Separated from cells after clotting
Usually used in blood chem
No fibrinogen
15
Venipuncture Equipment
Tourniquet
Restricts venous blood
flow
Distends the vein,
making them prominent
Not more than 1 minute
16
Venipuncture Equipment
Needles
Sterile, disposable
Sized by length and gauge
(the # that relates to the
needle diameter)
Gauge inversely related to
diameter
If too large= damage the vein
If too small= hemolyze the
rbc
Gauge 21-23
17
Syringe System
18
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Evacuated Tubes
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VENIPUNCTURE TECHNIQUE-ETS
IMPORTANT REMINDERS
21
VENIPUNCTURE
Deoxygenated blood;
Dark red
antecubital fossa, dorsal (hand), Wrist, ankle
Pointers:Tourniquet application
60mmHg pressure
Alcohol must not remain on the skin
15 to 30-degree angle
Drawing of blood with IV line
Order of Draw
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ComplicationsSTEPS IN DOING VENIPUNCTURE
WHAT IS THE MOST
IMPORTANT STEP IN
DRAWING BLOOD?
IDENTIFYING THE IN-PATIENTS
Must be two (2) identifiers
Ask the patients full name
Ask the patients date of birth
STEPS IN DOINGVENIPUNCTURE
IDENTIFYING THE OUT-PATIENTS
Must be at least two (2) identifiers
Ask the patients full name
Ask the patients date of birth
Ask the patients address
STEPS IN DOINGVENIPUNCTURE
NEVER DRAW IF THERE IS A
DISCREPANCY!
STEPS IN DOINGVENIPUNCTURE
Identify yourself
Who you are
Where you are from
What you are going to do
STEPS IN DOINGVENIPUNCTURE
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VERIFY fasting states
Have you had anything to eat or drink?
When was the last time you had
anything to eat or drink?
VERIFYdiet restrictions
STEPS IN DOINGVENIPUNCTURE
Check latex sensitivity
Check for allergies
STEPS IN DOINGVENIPUNCTURE
Sanitize hands
Put on gloves
Recommended:
Do not touch the patient without
gloves on.
STEPS IN DOINGVENIPUNCTURE
CLSI statesNEVERcombine
Tubes
Holders
Needles
from different manufacturers
STEPS IN DOINGVENIPUNCTURE
GLASS TUBES are strongly
recommended for medication levels
PLASTIC/GLASS Serum tubes should
NEVERbe used before coagulation
tubes
STEPS IN DOINGVENIPUNCTURE
Tubes MUSTbe:
Durable over its shelf life and during
centrifugation
Plastic syringes should be avoided
STEPS IN DOINGVENIPUNCTURE
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Apply tourniquet:
Used to increase intravascular pressure (single use only)
Helps
Palpating the vein and filling of the tubes
Within 20 seconds, analytes begin to change
Suggested time: 1 min.
Retying a tourniquet, must wait two (2) min.
Tourniquet location???
STEPS IN DOINGVENIPUNCTURE
DO NOT HAVE PATIENT PUMP
HAND! (except when using BP cuffs)
STEPS IN DOINGVENIPUNCTURE
BP cuff
40mmHg
Pump hand one to two times
STEPS IN DOINGVENIPUNCTURE
Do not use the following veins
Underside wrist
Lower extremities
Feet
Ankles
On the side of the mastectomy armSTEPS IN DOINGVENIPUNCTURE
Cleansing venipuncture sites
Concentric motion
Air-dry at least 30s
STEPS IN DOINGVENIPUNCTURE
Difficult veins
If you MUSTre-touch, then you
MUSTre-CLEAN
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Invert tubes immediately
CA5x
Na Citrate3-4x
Heparin8x
EDTA8x
Na Fluoride8x
STEPS IN DOINGVENIPUNCTURE
STEPS IN DOING VENIPUNCTURE
Place gauze over the site. (NO cotton balls!)
Remove needles and dispose immediately A non-additive tube may be drawn before
coagulation tubes when using a multi-draw
needle
No CA or additive tube (except SPS) should be
drawn before coagulation studies
STEPS IN DOING VENIPUNCTURE
Check the venipuncture site (after 3-5 min.)
Bandage for 15 min. to one (1) hr.
Patients should NOTbend the arm up
If bleeding lasts more that one minute, notify
nurse or supervisor
STEPS IN DOING VENIPUNCTURE
Labeling:
Patients last and first name
ID#
Date, time, initials of phlebotomist
Time when TDM samples are collected
SPECIAL HANDLING
Examples of tests that require chilling ofspecimen
Gastrin
Ammonia
Lactic acid
Catecholamines
Pyruvate
PTH
SPECIAL HANDLING
Examples of tests requiring transport of
specimens at 37 deg C.
Cold agglutinins
Cryofibrinogen
Cryoglobulins
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SPECIAL HANDLING
Tests requiring protection from light:
Bilirubin
All Vitamin levels
Beta carotene
Porphyrins
Both from sunlight and artificial light (with UVL)
SPECIAL HANDLING
Serum
Specimens should be clooted beforecentrifugation
30-60 min for complete clotting at 20-25 deg C
NOTE: The use of wooding applicator stick forrimming the sides of the tube is NOTRECOMMENDED!.
Clotting time of sample is prolonged if:
Sample is chilled
Patient is in AC therapy
SPECIAL HANDLING
Plasma
Use the appropriate collection tube
Centrifuge immediately after collection
SPECIAL HANDLING
Criteria for rejection
Under the following conditions, blood specimens
may not be acceptable for testing purposes:
Inappropriate specimen containers
Discrepancies in Patient ID
Inadequate volume of blood
Hemolyzed serum/plasma
Improper storage/transport conditions
FAILURE OF BLOOD TO ENTER THE NEEDLE
ARE CAUSED BY THE FOLLOWING:
Notes on Venipuncture:
Complete Order of
draw
Stop, light red, stay
put, green light, go
Multiple
venipuncture
attempts
Try again below the
first site, other arm,
hand or wrist veins
Ask someone else
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Notes on Venipuncture
Pediatric venipuncture
Superficial veins of the
antecubital fossa, neverdeep, hard-to-find veins.
Wrap in blanket or ask to
sit on parents lap to
immobilize
Use 23 G (butterfly,
syringe needle)
55
PREANALYTIC CONSIDERATIONS: Venipuncture
Burns, scars, tattoos
Damaged veins-sclerosed (hardened) orthrombosed (clotted)occluded
Edema
Hematoma
Mastectomy
IV lines
56
PREANALYTIC CONSIDERATIONS: Venipuncture
57
Procedural Errors
Hematoma
Iatrogenic anemia (10% ofblood volume)
Inadvertent arterial
puncture
Infection of the site
Nerve injury
58
CAPILLARY PUNCTURE
Indications for skin puncture
No accessible veins
Fragile veins
Thrombotic veins/ those with clot-forming
tendencies
POCT samples
Newborns and infants
59
CAPILLARY PUNCTURE
Lateral plantar heel surface
Lateral plantar surface of big toe
Lateral palmar surface of fingers
Earlobes
Arterialized Capillary Puncture
May be obtained for blood gas analysis
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PUNCTURES SHOULD NOT BE MADE
MORE THAN 2 mmDEEP FOR
INFANTS; FOR ADULTS 2-3 mmDEEP
SPECIMEN HANDLING AND STORAGE
Purposes of rapid separation of blood:
Minimize changes
To prevent continuous metabolism
To prevent electrolytes shift
Prevent hemolysis
Complete clotting: 30-60 minutesPremature separation must be avoided
Separation is done within a maximum of 2 hours
Centrifugation
Unacceptable Specimen SPECIMEN HANDLING AND STORAGE
Factors that affect the integrity of specimen:
Temperature
Evaporation
Exposure to light
Saved samples and pathologic samples
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GIVE THE CAUSES
OF THIS KIND OFSAMPLE.
(specific answer)
SPECIMEN HANDLING AND STORAGE
Temperature: Room temp.
Refrigeration temp. Ice packs
Freezing temp. Solid CO2
Nitrogen gas
Anaerobic condition ABG
Ionized and non-ionized calcium
ACP
ARTERIAL PUNCTURE IS PERFORMED
BY WHOM?
MD AND RT
5 SITES FOR
ARTERIAL
PUNCTURE
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5 SITES FOR
ARTERIALPUNCTURE
Radial artery
Brachial artery Femoral artery
Scalp artery
Umbilical artery
IDENTIFY
WHAT ISWRONG IN
THIS
PICTURE?
BEVELACCIDENTALLYCOMES OUT
NEEDLE ISPULLED OUTBEFORERELEASING
THETOURNIQUET
IDENTIFY THE
ENCIRCLED PART
TUBE HOLDER BASILIC VEIN
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CEPHALIC VEIN
WHAT SHOULD YOU DO IF YOU HAVE
DIFFICULTY LOCATING THE VEINS OF
YOUR PATIENT?
Check the other arm
Enhance the vein prominence
Use an alternative site
QUALITY CONTROL SYSTEM
Detect, reduce and correct deficiencies in the
laboratorys analytical process
Precisionand accuracyof laboratory tests
Objective:
Check reagents
Monitor stability of machine
Monitor personnel errors
Types of Quality Control
Internal QC
precision of laboratory tests
Based on the results of control specimens/patients specimens
External QC
Accuracy of laboratory tests
Proficiency testing
interlaboratoryperformance
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QC materials:
Standards
sample of known quantity
Specific analyte is present
Used to establish units
Controls
Sample of known quantity
Several analytes are present
Statistical Quality Control system
Mean, Mode Median
Standard deviation
Variance
Coefficient of Variation
Stages:
Establish statistical limits
Use these limits to evaluate the quality control data
Taking remedial action when indicated
Types of Variations
RANDOM ERRORS
Present in all measurements
Due to chance
Influenced by personnel and environment
Dispersed data
SYSTEMATIC ERRORS
Control values consistently in one directionTrend or shift data
Levey-Jennings Chart
WESTGARD CONTROL RULES WESTGARD CONTROL RULES
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WESTGARD CONTROL RULES WESTGARD CONTROL RULES
WESTGARD CONTROL RULES WESTGARD CONTROL RULES
WESTGARD CONTROL RULES
End of Lecture