Review on Spx Collection

8/10/2019 Review on Spx Collection

1/16

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


2/16

11/10/2014

2

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


3/16

11/10/2014

3

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


Tourniquet

Restricts venous blood

flow

Distends the vein,

making them prominent

Not more than 1 minute

16


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


4/16

11/10/2014

4

19

Evacuated Tubes

20

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


5/16

11/10/2014

5

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


NEVER DRAW IF THERE IS A

DISCREPANCY!


Identify yourself

Who you are

Where you are from

What you are going to do



6/16

11/10/2014

6

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


Check latex sensitivity

Check for allergies


Sanitize hands

Put on gloves

Recommended:

Do not touch the patient without

gloves on.


CLSI statesNEVERcombine

Tubes

Holders

Needles

from different manufacturers


GLASS TUBES are strongly

recommended for medication levels

PLASTIC/GLASS Serum tubes should

NEVERbe used before coagulation

tubes


Tubes MUSTbe:

Durable over its shelf life and during

centrifugation

Plastic syringes should be avoided



7/16

11/10/2014

7

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???


DO NOT HAVE PATIENT PUMP

HAND! (except when using BP cuffs)


BP cuff

40mmHg

Pump hand one to two times


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


Difficult veins

If you MUSTre-touch, then you

MUSTre-CLEAN


8/16

11/10/2014

8

Invert tubes immediately

CA5x

Na Citrate3-4x

Heparin8x

EDTA8x

Na Fluoride8x


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


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


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


9/16

11/10/2014

9

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

54


10/16

11/10/2014

10

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


11/16

11/10/2014

11

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


12/16

11/10/2014

12

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


13/16

11/10/2014

13

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


14/16

11/10/2014

14

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


15/16

11/10/2014

15

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


16/16

11/10/2014



WESTGARD CONTROL RULES

End of Lecture

Review on Spx Collection

Documents

Transcript of Review on Spx Collection