Transcript ppt chapter 9

PowerPoint ® Presentation to Accompany
Phlebotomy:
A Competency-Based
Approach
Booth and Mundt
9-2
Chapter 9
Blood Specimen Handling
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-3
Upon completion of this chapter, you should
be able to:




Explain methods for transporting and processing blood
specimens for routine and special testing and
reference laboratories.
Describe clerical errors that can occur during
specimen processing.
Recognize criteria for special specimen handling.
List the circumstances that would lead to recollection
or rejection of a patient sample.
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
Specimen Transport Within a
Facility (LO 9.1)
9-4
Pneumatic tube system
 Dumbwaiter
 Automated tracks
 Robotics
 Conveyor belts

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
Specimen Transport Outside a
Facility (LO 9.1)

9-5
Courier service
Specimens placed
in locked box
 May need to be
processed before
transport
 Policy needed for
time and temperature

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
Specimen Transport to Other
Facilities (LO 9.1)

9-6
Reference
laboratories
Courier service
 Shipping

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-7
Packaging Requirements (LO 9.1)
Shipping
Container
Secondary
Container
Primary
Container
McGraw-Hill
Specimen
Documentation
Absorbent
Material
Ice Pack
©2013 by McGraw-Hill Education. All rights reserved.
9-8
Specimen Transit Tracking
(LO 9.1)

Transit information entered in LIS
Manual entry
 Bar code
reader

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-9
Apply Your Knowledge
(LO 9.1)
Name at least two ways in which
specimens are transported to a
laboratory.
Answer: Walking to the lab, pneumatic
tube system, dumbwaiter, courier pickup,
mailing, express service.
GREAT!
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-10
Pre-Examination Errors
(LO 9.2)

Errors that occur before, during, or after
blood collection
Patient identification errors
 Specimen collection errors
 Specimen handling errors

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-11
Apply Your Knowledge
(LO 9.2)
What errors are considered
pre-examination errors?
Answer: Patient identification errors,
specimen collection errors, and specimen
handling errors.
GOOD JOB!
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
Specimens That Require
Warming (LO 9.3)
9-12
Testing for cold
agglutinins
 Must be kept at
37° C

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
Specimens That Require
Chilling (LO 9.3)

9-13
Tests
Arterial blood gases
 Ammonia
 Lactic acid

Transport in crushed
ice and water
 Do not freeze

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-14
Light-Sensitive Specimens (LO 9.3)

Tests
Bilirubin
 Carotene

Use amber tube
 Wrap in foil

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-15
Specimens for Legal Matters
(LO 9.3)
Results may be used in court of law
 Chain-of-custody

Uninterrupted control of authorized
personnel
 If broken, specimen and tests are invalid

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-16
Blood Alcohol Specimens (LO 9.3)
Proceeding without patient permission or
court order = assault and battery
 Requires chain-of-custody procedure
 Do not use alcohol to cleanse site

Alcohol prep pad
 Iodine swab

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-17
Forensic Specimens (LO 9.3)
Usually for legal cases
 Require chain-of-custody procedure
 Check specific guidelines at your facility

Special evidence kits
 Proper training

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-18
Toxicology Specimens (LO 9.3)

Reasons for toxicology specimens
Detect poisons, drugs, or medications
 Detect trace elements


Follow your facility’s protocols
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-19
No-Tourniquet Blood Collection
(LO 9.3)
Required for lactic acid tests
 Tourniquet may be applied briefly to
locate vein
 Remove tourniquet before collection
 Arm must be at rest for 2 minutes before
collection
 Place specimen on ice
 Deliver to laboratory STAT

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-20
Special Coagulation Studies (LO 9.3)

Types of coagulation studies
Factor assay
 Platelet function studies
 Coagulation inhibitor assays

Follow strict order of draw
 Perform procedure quickly
 Invert tubes to mix
 Deliver to laboratory immediately

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-21
Separated Specimens (LO 9.3)

Separation procedures
Centrifuging
 Aliquoting

For most tests, separation should be
done within 2 hours of collection
 Wear PPE during specimen processing

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-22
Centrifuging Specimens (LO 9.3)
Separates blood cells from liquid
components
 Speed and time depend on
specimen requirement
 Typical speed: 1,000 to 3,000
revolutions per minute

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-23
Centrifuging Specimens (cont.)
(LO 9.3)
Balance the
centrifuge
 Set for the correct
speed
 Close the lid
securely
 Set timer for correct time
 Wear face shield when removing tubes

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-24
Aliquoting Specimens (LO 9.3)

Take great care not to mix up samples
Label transfer tube
 Compare to specimen
tube label

Use pipet to transfer
serum or plasma
 Store properly for
delivery to lab

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-25
Apply Your Knowledge
(LO 9.3)
Which of these centrifuges is balanced
correctly?
Answer: The one on the right.
GREAT!
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-26
Specimen Rejection (LO 9.4)
Recollection may be required if
abnormalities are detected
 Accurate test results depend on
specimens

Errors may go unnoticed
 Questionable results obtained

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-27
Hemolysis (LO 9.4)
Destruction of
red blood cells
 Can result from
improper
collection or
handling

Normal
Specimen
McGraw-Hill
Hemolyzed
Specimen
©2013 by McGraw-Hill Education. All rights reserved.
Clotted Anticoagulated
Specimens (LO 9.4)
9-28
Blood must not be
clotted for some tests
 Blood may clot even in
tubes that have an
anticoagulant
 Often due to collection
issues

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-29
Incomplete Collection (LO 9.4)
May be rejected as
“quantity not sufficient”
(QNS)
 Causes improper
additive-to-blood ratio

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-30
Other Causes for Rejection (LO 9.4)
Incorrect tube collected
 Incorrect order of draw
 Hemoconcentration

Not easily detected
 Results may be questioned if delta check
fails


Contamination by IV fluids
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-31
Other Causes for Rejection (cont.)
(LO 9.4)

Icterus
Dark-yellow to greenish-yellow color
 Caused by bilirubin


Lipemia
Cloudy plasma
 Caused by abnormal amount of fats

Special requirements not followed
 Inadequate or missing documentation

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-32
Apply Your Knowledge
(LO 9.4)
Name two reasons why an incomplete
collection may be rejected.
Answer: The quantity collected may be
insufficient for the test, and the additive-toblood ratio is not correct.
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-33
Chapter 9 Summary
Specimens must be transported to the
laboratory in a timely manner.
 Transport systems include hand delivery,
pneumatic tube system, or automated
transport systems.
 Specimen packaging for transport by
mail or express service must meet local,
state, and federal safety standards.

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-34
Chapter 9 Summary (cont.)
Proper documentation of specimen
collection and transport allows the
specimen to be tracked.
 Pre-examination variables that affect
laboratory results include temperature
control, exposure to light, and special
draw techniques.

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-35
Chapter 9 Summary (cont.)
Specimen handling for legal specimens
must include chain-of-custody
procedures.
 For blood alcohol testing, written patient
consent or a court order is required.
 Forensic specimens are collected as
evidence to help prove or disprove a link
between an individual and objects,
places, or other individuals.

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-36
Chapter 9 Summary (cont.)
Toxicology specimens are collected to
detect poisons, drugs, and medications.
 The phlebotomist may be required to
process specimens, including
centrifugation and aliquoting.
 Specimens may be rejected due to
improper collection techniques or
handling and processing errors.

McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.
9-37
Chapter 9 Summary (cont.)

Reasons for specimen rejection include
hemolysis, clots, hemoconcentration,
contamination, incomplete collection,
incorrect tube or draw order, inadequate
documentation, and failure to follow
special requirements.
McGraw-Hill
©2013 by McGraw-Hill Education. All rights reserved.