Transcript HG017-5.10_9. Chapter 9 Lecture

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Fasting Specimens
(NPO)
• A fasting specimen is usually
•
•
collected from a patient in the
morning before the patient has
had breakfast.
General rule is 12 hr. fast
Black coffee, water allowed
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Timed Specimens
•
•
•
•
Certain specimens must be collected at
specific timed intervals.
Drug levels are one example of timed
specimens.
The drug level in the patient must
be maintained within a therapeutic range.
The therapeutic range is the level the drug
is to be maintained at to be effective but
not harm the patient.
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Timed Specimens (cont.)
• A specimen is collected before the IV
•
is started. This is known as the
trough level (pre) specimen.
The specimen collected immediately
after the IV is complete is known as
the peak level (post) specimen.
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Timed Specimens (cont.)
• Another example of timed specimens
are Cortisol Levels.
• Cortisols are usually drawn at exactly
0800 and 1600.
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ASAP Specimens
• ASAP (As Soon As Possible)
•
specimen requests are typically
resulted within 2-4 hours from time
of collection.
Follow your hospital’s protocol
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Stat Specimens
• Stat specimens are specimens that
•
need to be collected immediately
because of the critical state of the
patient.
Usually identified as STAT on tube
and request form. Notify lab when
STAT specimen is returned to lab.
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Special Collection Techniques
• Alcohol
– Blood alcohol testing must be collected
without the use of alcohol to clean the
arm.
– Alternative cleaning: soap and water,
others
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Special Collection
Techniques (cont.)
• Chain of custody
– Also known as forensic specimens
– Form that accompanies the specimen
dictates that each person handling the
specimen must sign the form.
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Special Collection
Techniques (cont.)
• Heavy metals
– Special tubes are used when testing for
heavy metals such as arsenic or lead.
– Tubes usually have a royal blue top with
a variety of additives.
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Glucose Testing
Types of Diabetes
• Three types of diabetes
– Type 1: Deficiency in insulin production.
– Type 2: Most common type of diabetes is
a result of lack of insulin activity.
– Prediabetes: Patient’s blood glucose is
higher than normal, but not high enough to
be classified as diabetes.
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Glucose Testing
• Fasting glucose
• Glucose tolerance test
– Two-hour, two specimens
– Two-hour, three specimens
– Three-hour, four specimens
• Gestational screening
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Glucose Testing (cont.)
• Postprandial glucose test
• Two-hour post glucose drink
• Glucose drink given to the patient will
contain either 50, 75, or 100 grams of
glucose. Amount given to the patient
depends on the test being
administered.
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Blood Culture
• Blood cultures are collected when a
patient is suspected of having a
bacterial infection of the bloodstream
(septicemia).
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Blood Culture (cont.)
•
Cleaning the skin
correctly is the
key to an
accurate and
uncontaminated
blood culture
collection.
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Blood Culture (cont.)
• Before introducing blood into the
•
•
bottle, the top of the bottle must be
wiped off with an alcohol pad, not
with iodine or Betadine.
Both an aerobic bottle and an
anaerobic bottle must be collected.
Blood volume varies by the bottle
manufacturer and age groups.
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Urine Collection
• Urine collection requires specific
instructions to the patient. (The
phlebotomist can be asked to give
proper patient instruction.)
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Common Types of
Urine Specimens
• First morning or after 8 hour
•
•
rest
Random specimen
24-hour collection
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Specific Urine Collections
• Clean-catch midstream (CCMS)
• Catheterized urine collection (RN)
• Chain of custody urine collection
• Urine culture collection
• Infant and children collections
• See Chap. 9 pp 290 - 299
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Problems Associated with
Urine Specimens
•
Delay in testing can cause:
– Deterioration of chemical and cellular
components
– Multiplication of bacteria
– Decrease or increase in analytes
because of bacterial growth in the
specimen
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Precautions to Avoid Problems
with a Delay in Testing
• Refrigerate specimen at 5°C.
• Use a patient kit for a clean collection.
• Special preservative tubes
• Amber containers for 24-hour
•
collections
Chemicals in 24-hour urine containers
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Special Preservative Tubes
• Urine
preservative
tubes and urine
transfer straw.
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24-hour Urine Container
• Container
may contain
hydrochloric
acid or boric
acid in order to
preserve the
specimen.
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Semen Collection
• Semen specimens are used for
•
•
fertility testing of the male or for
postvasectomy testing.
Semen specimens must be kept at
body temperature (37°C) and
transported to testing lab STAT
See Procedure 9.7 and Figure 9.13.
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Stool Specimens
•
Occult blood
specimens are
collected by
the patient
and placed
on a card for
testing.
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Stool Specimens (cont.)
•
•
Ova, parasite,
and stool
cultures are
collected in
special
preservative
containers.
Remember, all
specimens
must be
properly
identified and
labeled!!
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Today’s Phlebotomist
•
•
Proper patient identification is most important
step in any encounter with patient!
Phlebotomists are cross-trained to work in
several patient areas:
inpatient, outpatient, registration,
point-of-care testing
Flexibility and proper training
are keys to success!
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