Diagnostic Laboratory Blood Sample Management - PDF

Diagnostic Laboratory blood sample management Siti Balkis Budin MD, MSc, PhD  Laboratory Sample / Specimen A laboratory specimen is a sample of patient's tissue, fluid, or other material derived from the patient used for laboratory analysis, examinat...

Diagnostic Laboratory blood sample management Siti Balkis Budin MD, MSc, PhD  Laboratory Sample / Specimen A laboratory specimen is a sample of patient's tissue, fluid, or other material derived from the patient used for laboratory analysis, examination or study: 0  The result of any laboratory test is highly depends on proper sample management Loading… 0  Importance Of good speciments management 0  Outcomes of Improper Collection delays in reporting test results Poor specimen quality can affect key quality reporting requirements unnecessary re-draws/re-tests decreased customer satisfaction Loading… Lower patient satisfaction from improper collection technique or repeated specimen collection Repeated phlebotomy cause pain and injury Longer wait times for patient lab test results increased costs due to repeated specimen 0 collections, multiple venipunctures, or unnecessary  treatment Outcomes of Improper Collection incorrect diagnosis / treatment Decreased ability to identify and manage the diseases Inaccurate results and inappropriate treatment High morbidity /death 0  Sample Management Patient identification Sample Collection Phlebotomy technique Test Tube Patient preparation Y Sample Labeling and documentation Sample Transport Sample Referral yellow d acid-citrate exrs et Sample Storage Heparincitrate ? Sample Disposal green sodium acd ble citric oxckte sodium 0 greyhycolyticitor c black  Blood Collection: Color-code Tubes Green-top tubes contain heparin Blue-top tubes contain sodium citrate and citric acid Black-top tubes contain sodium oxalate Yellow-top tubes contain acid-citrate- dextrose (ACD) solution. Grey-top tubes contain a glycolytic inhibitor.  Antocoagulant EDTA is a anticoagulant. It works by calcium chelation and is used clinically in heamatology studies. It is well suited to DNA-based assays. Heparin is an anticoagulant. There are some reports of occasional problems with heparin in PCR assays, studies generally find that there are no major difference in the use of EDTA or heparin Citrate also works by calcium chelation and is used in coagulation studies and blood banking. It is optimal for assays conducted on lymphocytes and DNA.  The Laboratory’s Responsibilities Provide sample collection information Provide appropriate containers and supplies What- When- How Define a good Assess all samples - labeling system pre-examination 0  Test Requisition Lab Requisition form patient ID tests requested time and date of sample collection source of sample, when appropriate clinical data, Loading… where indicated contact information of requesting physician or authorized individual 0  Collection Requirements patient preparation patient identification type of sample required type of container needed labeling special handling safety precautions 0  Provide sample collection information 0  Sample Labeling Each sample should be labeled with: patient’s name patient’s unique ID number test ordered time and date of collection collector’s initials Use computer-generated bar codes when possible 0  Specimens That Require Warming (LO 9.3) Testing for cold agglutinins Must be kept at 37° C ©2013 by McGraw-Hill 9-0 Education. All rights reserved.  Specimens That Require Chilling (LO 9.3) Tests Arterial blood gases Ammonia Lactic acid Transport in crushed ice and water Do not freeze ©2013 by McGraw-Hill 9-0 Education. All rights reserved. Light-Sensitive Specimens (LO 9.3) Tests Bilirubin Carotene Use amber tube Wrap in foil ©2013 by McGraw-Hill 9-0 Education. All rights reserved. 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 ©2013 by McGraw-Hill 9-0 Education. All rights reserved. Blood Alcohol Specimens (LO 9.3) Requires chain-of-custody procedure Do not use alcohol to cleanse site Alcohol prep pad Iodine swab ©2013 by McGraw-Hill 9-0 Education. All rights reserved. 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 ©2013 by McGraw-Hill 9-0 Education. All rights reserved. Toxicology Specimens (LO 9.3) Reasons for toxicology specimens Detect poisons, drugs, or medications Detect trace elements Follow your facility’s protocols ©2013 by McGraw-Hill 9-0 Education. All rights reserved. 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 ©2013 by McGraw-Hill 9-0 Education. All rights reserved.  Labeled samples, completed Spilled urine sample, requisitions a cause for rejection 0  SAMPLES REJECTION CRITERIA Unlabeled sample Broken or leaking tube/container Insufficient patient information Sample label and patient name on the test request form do not match Haemolyzed sample ( depending on the test) Incorrect tube collected Incorrect order of draw 0  SAMPLES REJECTION CRITERIA Non fasting sample if required Sample collected in a wrong tube, wrong preservative, on sterile Inadequate volume for the required preservative Insufficient for the test requested Prolonged transport time Contamination by IV fluids Special requirements not followed Clotted Blood 0  Actions for Rejected Samples inform authorized person request another sample record rejected samples retain rejected sample Loading… based on preset criteria extraordinary circumstances may require testing suboptimal samples 0  Sample Register or Log A register should include: date and time of collection date and time of receipt sample type patient name demographics as required laboratory assigned identification tests to be performed 0  Sample Handling Handle all samples as if infectious Universal Precautions 0  Sample Storage describe samples to be stored determine retention time determine location describe proper conditions establish method of organizing samples 0  Sample Retention set policy for retention monitor stored samples, including freeze/thaw cycles maintain an organized, accessible system establish a schedule to review all stored samples establish tracking procedures 0  Sample Disposal set policy for sample disposal compliance with local and country regulations. disinfection procedures 0  Sample Transport Maintain integrity of sample: temperature preservation of sample special transport containers time limitations Assure safety regulations are met 0  Managing Sample Transport Meet all applicable regulations Train personnel in all transport procedures Assure sample is protected: temperature transport time packaging and preservation 0  Summary provide a laboratory handbook with collection information to all users have a system for tracking samples as they move through the laboratory establish and implement a policy for sample storage and sample disposal maintain sample integrity assure that all transport regulations and requirements are met Always follow universal precautions 0  Key Messages the laboratory must have good samples in order to ensure accuracy and reliability of testing and confidence in results sample management directly affects patient care and outcome 0 0