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Questions and Answers
What should the phlebotomist be careful about in routine handling of blood specimens?
What should be done to chilled specimens during transport to maintain stability?
Specimens should be completely submerged in crushed ice and water slurry during transport and immediately tested or refrigerated if necessary.
The phlebotomist is responsible to follow all appropriate steps required for each test that they are scheduled to perform in __________ handling.
Routine
Match the following light-sensitive specimens with appropriate handling methods:
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Specimens rejected due to improper handling cannot be identified properly.
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What is the purpose of the hydrogen breath test?
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What type of specimen is collected to determine gastrointestinal disorders?
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Hair samples can be used to detect chronic drug abuse.
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What is the most preferred site for arterial puncture? Radial artery is the ______ site.
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Match the following arteries with their risk of hematoma:
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What is the purpose of a Glucose Tolerance Test?
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How is a 24-hour urine collection procedure conducted?
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Amniotic fluid is collected through transabdominal amniocentesis at around 15 weeks of gestation.
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______ is used to diagnose meningitis and other disorders like brain abscess and CNS cancer.
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Match the fluid with the corresponding collection method:
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What is the cause of Hematoma in arterial puncture?
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Thrombus formation in arterial puncture can be prevented by using smaller-gauge needles.
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Bright red blood and pulsation are common signs of accidental __________ puncture.
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Match the donor blood type with its corresponding requirements:
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What infectious diseases are tested for in each unit of donor blood?
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Study Notes
Handling and Processing of Blood Specimens for Laboratory Testing
Routine Handling
- Phlebotomist's roles:
- Perform routine venipuncture
- Prepare specimens for transport to the laboratory
- Adhere to time limits for delivery of specimens
Steps Involved in Processing and Handling
- Patient identification
- Blood collection
- Choice of tubes
- Phlebotomist's responsibilities for each test
Mixing Tubes by Inversion
- Cap color and number of inversions:
- Red (Glass): 0x
- Light Blue: 3-4x
- Red (Plastic), Gold/Tiger Top: 5x
- Light Green, Green, Lavender, Pink, Gray, Tan, Yellow, Orange, Royal Blue: 8x
Transporting Specimens
- Avoid hemolysis, platelet activation, and coagulation
- Transport with stopper to:
- Avoid contact with the content
- Minimize agitation
- Aid clot formation
Special Handling
- Body temperature: transport at near body temperature (37°C) for certain specimens
- Chilled specimens: slow down metabolic process for certain specimens
- Light-sensitive specimens: protect from light to avoid affecting test results
Blood Specimen Processing and Reasons for Specimen Rejection
- Specimen processing:
- Identification
- Logging
- Sorting by department
- Evaluation for specimen suitability
- Reasons for specimen rejection:
- Inadequate identification
- Inadequate volume
- Hemolysis
- Wrong tube for collection
- Outdated tube
- Improper handling/mixing
- Contamination
- Insufficient specimen (QNS)
- Collection time incorrect
- Specimen exposed to light
- Procedure did not follow testing time limits
- Delay or error in processing
Delivery Time Limits and Exceptions
- Delivery time limits:
- Routine blood specimens: 45 minutes
- Centrifugation: 1 hour
- Hematology specimen (EDTA tube): should not be centrifuged
- Time limit exceptions:
- STAT or emergency specimens
- Specific exceptions for certain tests (e.g., blood smear, EDTA specimen for CBC, etc.)
Centrifugation
- Importance of leaving the stopper on the tube before centrifugation
- Balancing tubes in the centrifuge
- Preparation of plasma and serum specimens
Aliquot Preparation
- Definition of aliquot
- Preparation of aliquot for chemical analysis or testing
OSHA Act Requirements
- Required protective equipment for handling specimens
- Includes gloves, gown/coats, and masks
Handling and Processing of Non-Blood Specimens
Urine
- Most analyzed non-body fluid
- Inexpensive to test
- Importance of urine analysis in health monitoring and disease diagnosis
Urine Collection Methods
- Random
- Midstream
- Catheterized
- Suprapubic aspiration
- Pediatric
Urine Tests
- Routine urinalysis
- Urine culture and sensitivity
- Urine cytology studies
- Urine drug testing
- Urine glucose and ketone testing
- Urine pregnancy testing
- Other urine tests (e.g., electrophoresis, heavy metals, myoglobin clearance, etc.)
Types of Urine Specimens
- Random
- First morning/8-hour urine specimen
- Fasting
- Timed
- 24-hour urine collection
- Double-voided
Urine Collection Procedure
- Empty bladder upon waking up
- Affix label and write down time and date
- Start timing
- Discard line output at first hour
- Collect all urine for the next 24 hours
- Refrigerate specimen during collection period
- Collect urine prior to bowel movement
- Drink fluids as needed to avoid dehydration
- Take one last void at the end of 24-hour collection period
- Seal the container before transporting to the lab
Other Non-Blood Specimens
- Amniotic fluid
- Cerebrospinal fluid (CSF)
- Gastric fluid/gastric analysis
- Nasopharyngeal secretions
- Saliva
- Semen
- Serous fluid
- Sputum
Note: The above notes are a concise summary of the key points and focus on the most important information.### Sweat
- Used to analyze the chloride content of patients under 20 with symptoms of cystic fibrosis
- Sweat Chloride Test:
- Iontophoresis (electrical stimulation) in the forearm or thigh to stimulate sweat production
- Pilocarpine (sweat-stimulating drug) is used
- Sweat is collected, weighed, and analyzed for chloride content
- Can also be used to detect illegal drug use by placing patches on the skin for an extended period
Pilocarpine Iontophoresis
- Test site is cleaned and dried, then a piece of pre-weighed filter paper is placed over the test site
- Sweat is collected for 30 minutes
- Filter paper is retrieved and weighed to determine the weight of sweat collected
Synovial Fluid
- Viscous fluid that lubricates movable joints
- Tested to determine conditions such as arthritis, gout, and other inflammatory conditions
- Collected in three tubes:
- EDTA/Heparin tube for cell counts, crystal identification, and smear preparation
- Sterile tube for culture and sensitivity
- Non-additive tube for macroscopic appearance, chemistry, immunology tests, and observing clot formation
Arthrocentesis
- A procedure to collect synovial fluid from a joint
Buccal (Cheek) Swabs
- Used to obtain loose cells inside the cheek for DNA analysis
- Less invasive and painless alternative to blood collection
- Sample is collected by placing the swab inside the cheek and gently massaging the area
- Swab is sent to the lab where DNA is extracted from the cells
Bone Marrow
- Examined to identify blood diseases
- Physician inserts a large-gauge needle into the sternum or iliac crest (hip bone) and aspirates 1-1.5 mL of specimen
- Hematology technologist makes special slides from the first marrow aspiration
Breath Samples
- C-Urea Breath Test (C-UBT):
- Checks for the presence of Helicobacter pylori bacteria that damages the stomach lining
- Patient drinks a special substance with synthetic urea, then breathes into a Mylar balloon at specified intervals
- Breath specimens are analyzed for carbon-13, which confirms the presence of H. pylori
- Hydrogen Breath Test:
- Helps detect carbohydrate digestion problems, such as lactose (milk sugar) and fructose (fruit sugar)
- Detects bacterial overgrowth in the small intestine
- Most accurate tolerance test
- Patient must not take antibiotics two weeks prior to the test and should fast on the day of the test
Feces
- Collected to:
- Determine gastrointestinal disorders
- Analyze for the presence of intestinal ova and parasites
- Culture and examine for the presence of pathogenic bacteria and viruses
- Check fat and urobilinogen content
- Test for the presence of occult blood
- Collected in a clean and wide-mouth container, sealed, and sent to the lab
Hair
- Used to analyze for trace and heavy metals
- Used to detect chronic drug abuse
Throat Swabs
- Mostly collected to aid in streptococcal infection detection
- Special kit contains a sterile polyester-tipped swab and a covered transport tube
- Tube contains transport medium
Tissue Specimen
- Usually collected using biopsy through which the tissue sample is removed for examination
- Phlebotomy should check the proper handling procedure, particularly if the specimen delivered is not immersed in a solution
- For genetic analysis, tissue samples should not be placed in formalin
Arterial Puncture
- Used to collect blood specimens for ABG analysis to manage cardiopulmonary disorders and maintain acid-base balance of the body
- Arterial blood is the ideal specimen for respiratory function evaluation due to the consistency of its composition and high oxygen content
- Composition of Arterial Blood:
- Uniform throughout the body
- Tests requiring arterial blood include blood gases (O2 and CO2), lactic acid, and ammonia
Arterial Puncture Equipment
- Collection Kits:
- Syringes: preanticoagulated, plastic, 1-5 mL based on instrumentation and tests
- Needles: 20- to 25-gauge, 5/8 to 1.5 inches
- Anticoagulant:
- Heparin used to coat the plastic syringes, tested within 30 minutes
- Glass syringes used for tests longer than 30 minutes, lubricated, and heparinized by collector
- Tightly fitting cap for syringe Luer tip
Arterial Puncture Sites
- Sites:
- Radial Artery (most preferred site)
- Brachial Artery
- Femoral Artery
- Order of Preference: Radial > Brachial > Femoral
- Gauge of Needle Required: a. Brachial Artery: 18-20 gauge b. Radial Artery: 23-25 gauge### Adverse Events in Blood Donation
- Healthcare personnel must monitor donors for adverse effects during and after blood collection
- Donors should remain seated for a few minutes to ensure they are not suffering from dizziness
Donor Care Post Phlebotomy
- Venipuncture sites should be inspected
- Refreshments should be offered to donors before they leave the area
Donor Blood Processing
- Collected blood units are prepared and placed in proper containers for transport to the processing area
Donated Blood Labeling
- Information on the blood unit label must be double-checked, complete, and accurate
Requirements by Donation Type
Whole Blood Donation
- Donation frequency: 56 days
- Must be in good health and feeling well
- Must be at least 16 years old
- Must weigh at least 110lbs
Power Red Donation
- Donation frequency: Every 112 days, 3 times per year
- Must be in good health and feeling well
- Male donors: at least 17 years old, 5'1" tall, and 130lbs
- Female donors: at least 19 years old, 5'5" tall, and 150lbs
Platelet Donation
- Donation frequency: Every 7 days, up to 24 times per year
- Must be in good health and feeling well
- Must be at least 17 years old
- Must weigh at least 110lbs
Donation Intervals
- Wait at least 8 weeks between whole blood donations
- Wait at least 7 days between platelet donations
- Wait at least 16 weeks between Power Red donations
Who can donate?
- Women with menstruation (if they can)
- People who take vitamins (except those taking antibiotics)
Infectious Disease Tested for on Each Unit of Donor Blood
- Chagas disease (Trypanosoma cruzi)
- HIV 1 and 2
- Hepatitis B (Hepatitis B Virus)
- Hepatitis C (Hepatitis C Virus)
- Syphilis
- West Nile virus (West Nile Virus)
- Human T-cell lymphotropic virus (HTLV)
Minimum Requirements for Venipuncture Blood Donation
- BP monitors
- Scales
- Donor couches
- Chairs
- Beds
- Blood Collection Mixers
- Blood Bag Sealers
- Blood Transportation Boxes
- Blood Bank Refrigerators
- Furniture and equipment must be made of cleanable surfaces, kept clean, and disinfected with sodium hypochlorite bleach solution
- Closed collection system with a sterile blood collection bag containing anticoagulant with attached tube and needle
Donor Collection
- Cleansing
- One-step procedure
- Two-step procedure
- Needle sizes: usually 15-17 G
- Veins of choice: veins of the antecubital fossa
- Fist clenching: speed flow of blood
- Completion of Donation
One-Step Procedure
- Duration: about 1 minute
- Material: 2% chlorhexidine gluconate in 70% isopropyl alcohol
- Procedure:
- Wash the site using firm gentle pressure
- Make sure the whole skin site is covered and in contact with the disinfectant for at least 30 seconds
- Allow the site to dry completely or for at least 30 seconds
Two-Step Procedure
- Duration: about 2 minutes
- Material: 70% isopropyl alcohol and tincture of iodine or chlorhexidine (2%)
- Procedure:
- Follow the steps in the one-step procedure
- Use either tincture of iodine or chlorhexidine (2%)
- Start from the center, then move downward, and outward applying firm but gentle pressure
- Contact should be about 30 seconds
- Then, allow the area to dry completely or for about 30 seconds
Venipuncture
- After confirming that bleeding has stopped, phlebotomist should place a sterile gauze/bandage and instruct the donor to keep it on for 4 hours
Apheresis Blood Donation
- Involves the collection of red cells, platelets, or plasma
- Can be autologous or allogenic
Autologous Blood Donation
- Autologous: involving one individual as both donor and recipient
- Purpose: patients scheduled for surgery donate their own blood for own use to prevent transmission of blood-borne pathogens
- Qualifications:
- Time between donations: as often as 72 hours with doctor's approval
- Hemoglobin level: at least 11.0 g/dL
- Hematocrit: 33%
- Autologous units are only designated to autologous donor
Therapeutic Phlebotomy
- Removal of blood
- Formerly termed as bloodletting
- Used for polycythemia (increased RBCs) and hemochromatosis (increased iron levels)
Patient Instruction
- Collection instructions
- Verbal and written
- Prepared to answer questions
- Collection on site or at home
- Confirm with patients that they have understood the instructions
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Description
This quiz covers the roles of a phlebotomist in routine handling of blood specimens for laboratory testing, including steps involved in processing and handling different types of specimens.