Unit 4 Accessiong 1.0.ppt

Accessioning 1.2.1,3.3.1,3.3.2,3.3.3,3.3.4,3.3.5,3.3.6,3.3.7,3.3.9,3.4.1,3.4.2,3.4.3, 3.4.4,5.1.1,5.1.2 1  Objectives Accessioning  Objectives 1. Different Phases of Laboratory Testing:...

Accessioning 1.2.1,3.3.1,3.3.2,3.3.3,3.3.4,3.3.5,3.3.6,3.3.7,3.3.9,3.4.1,3.4.2,3.4.3, 3.4.4,5.1.1,5.1.2 1  Objectives Accessioning  Objectives 1. Different Phases of Laboratory Testing: 1.1 Understand the sequential phases involved in laboratory testing. This includes - Preanalytical phase: Sample collection, transportation, and processing. - Analytical phase: Laboratory analysis of samples. - Postanalytical phase: Result interpretation, reporting, and data management. 2. Information Needed on Requisitions and Labels: 2.1 List the requirements needed to ensure completeness and accuracy of requisition forms and sample labels. 3  Objectives 1. Different Phases of Laboratory Testing: 1.1 Understand the sequential phases involved in laboratory testing. This includes - Preanalytical phase: Sample collection, transportation, and processing. - Analytical phase: Laboratory analysis of samples. - Postanalytical phase: Result interpretation, reporting, and data management. 2. Information Needed on Requisitions and Labels: 2.1 List the requirements needed to ensure completeness and accuracy of requisition forms and sample labels. 4  Objectives 3. Describe the Lab Information System(LIS) 3.1 Describe the main function of the Lab Information System 3.2 List some of the advantages of the Lab Information System. 4. Describe barcodes in the laboratory 4.1 Describe the importance of bar codes. 5. Describe proper transportation of specimens to the laboratory 5.1 Describe how safely transport specimens to the laboratory while maintaining sample integrity. 5  Objectives 6. Describe the Central Processing (Accessioning): 6.1 Describe the different procedures in the central processing department. 7. Describe Time constraints for specimens 7.1 Describe time constraints for different specimens 6  Objectives 8. Describe Aliquoting: 8.1 Describe the process of aliquoting 8.2 Describe what the appropriate volume and number of aliquots needed for testing and storage. 8.3 Describe what patient information and test details is needed for the aliquots 9. Correct temperature Storage: 9.1 Describe the different specimens that need to be stored at different temperatures. 9.2 Describe the temperature reference ranges for different refrigerators and freezers 7 10. Specimens Requiring Special Handling: 10.1 Describe specimens that needs unique handling requirements to prevent degradation or contamination. 10.2 Describe the procedures for specimens that need special handling. 11. Specimens that needed to be transported off site 11.1 Describe the reasons why a specimen needs to transported off site 11.2 Describe the importance the Transportation of Dangerous Goods Act 11.3 Describe the procedure on how the package the specimen properly ( the triple packing method) 11.4 Describe the information needed to be the send out manual 8 12. Describe post analysis storage 12.1 Describe the reasons for post analysis storage 12.2 Describe the procedure for post analysis storage 13. Describe the criteria for rejecting specimens: 13.1 Describe the criteria for rejecting specimens 14. Disposing of laboratory waste. 14.1 List the reasons for deposing of laboratory waste 14.2 Describe the produce to dispose of sharps. 9  Objectives 15 Chain of Custody Forms: 15.1 Describe the reasons for the chain of custody procedure 15.2 Describe the special skin preparation when collection for ETOH 16. Reporting results 16.1 Describe the procedures when reporting critical results 10 Phases of laboratory testing 1. Pre-analytical = what happens before testing. It is now called preexamination phase 2. Analytical = what happens during testing. It is now called examination phase. 3.Post-analytical= What happens after testing. It is now called postexamination phase 11  Possible sources of Preanalytical Errors Before collection Altitude Dehydration of patient Duplicate test orders Exercise Not fasting Incomplete requisition, or wrong test order Medication Patient stress Pregnancy Smoking 12  At time of Collection  Misidentified patient  Not letting the alcohol dry  Expired tubes  Not mixing properly  Faulty technique  Improper vein selection  Incorrect order of draw  Wrong tube  Mislabeled tube  NSQ  Wrong time  Tourniquet left on too long 13  During specimen transport Delay in transportation Agitation of specimen ( hemolysis) Exposure to light Wrong temperature Transport method ( pneumatic tube vs. hand delivery) 14  During specimen processing Contamination ( dust, powder from gloves) Delay in testing Delay in centrifugation Failure to centrifuge at the right speed Failure to separate the cells from fluid Mislabeling aliquot Multiple centrifugation Rimming clots 15  During specimen storage Exposure to light Wrong temperature 16  Why do we make errors ? With all the checks and balances, errors should be a thing of the past. But we still make errors. Why? 1)Tiredness 2)Lack of nutrition, dehydration 3)Stress 4)Overwork – deadlines to meet 17  Why do we make errors ? 5) Some procedures are monotonous 6) Over familiarity 18  Documentation Requisitions – lab tests are requested by means of the lab requisitions form or a computer generated order. Multiple- part requisition forms that serve as both lab requests and report forms are considered a more traditional manual system 19  Information that is needed on a requestion Patient ID ( name, Manitoba Health # and PHIN # , location) Name of Dr. or other legally authorized person ordering the test Tests required Time and date of collection Other pertinent clinical information when appropriate 20  Laboratory Information System( LIS) Since information is the ultimate product of the laboratory and the goal of the laboratory is to provide accurate information in a timely manner.The laboratory information system is now the foundation in all laboratories. 21  Laboratory Information System( LIS) The LIS can routinely ingrate automation, and data handling, provides uniform methodology which lead to increased productivity and process integrity. 22  Laboratory Information System( LIS) The main functions performed by LIS are: Reception and logging of a sample with its associated data Assignment, tracking, and scheduling of the sample’s analytical workload Quality control associated with the sample and any utilized equipment Storage of data acquired from any performed analyses Compilation, inspection, and approval of data for reporting and further analysis 23  Computer System ( LIS) The advantages of using the LIS system: - Faster Turn around time (TAT) - Reduction of clerical errors - Increase efficiency - Flexible delivery options - Cost saving 24 25  Specimen labels Specimens may be labeled manually immediately following the blood draw. This can be time consuming and is prone to errors. Specimens can be labeled with computer generated specimen labels. This is more accurate and efficient. 26 Computer generated labels On the basis of the lab requests, the computer will generate the correct number of labels containing the following information – Patient ID for each tube required – specific tests ordered – Types of tubes required for the tests – Unique specimen # for that patient – Smaller transfer labels for aliquot tubes 27  Barcodes The barcode technology makes sure the correct treatment is administered to the right patient, ultimately reducing errors and ensuring patient safety. 28  Barcodes Information included on barcodes Name and ID # of patient and may include the phlebotomist ID DOB Test codes Specimen accession or log # Expiration dates for inventory of supplies and equipment 29 Computer Generator Labelling Machine 30 Computer Generated Labels 31 Computer Generated Labels 32  The responsibility for the specimen does not end after the sample has been collected. What happens to the specimen after it is collected is very important for maintaining quality control 33  Infectious specimen These may include any human or animal material such as urine, feces, blood, tissue and fluids being shipped for diagnostic or investigative purposes These specimens need a biohazard label or other precautionary label placed on all of the tubes in order to alert fellow workers to a possible hazard 34 Transportation of specimens to the laboratory 35  Transportation to the lab Proper transportation of specimens to the lab is critical for preserving specimen integrity, ensuring accurate test results, supporting patient care decisions, maintaining regulatory compliance, optimizing laboratory operations, and minimizing costs. 36  Transportation to the lab By prioritizing the implementation of best practices and adhering to established protocols for specimen transportation, healthcare facilities can safeguard the quality and reliability of laboratory testing 37  Transportation to the lab Transport as soon as possible Agitation and unnecessary shaking should be avoided to prevent damage to the specimen Specimens should be transported in leak proof biohazard containers with lids to prevent accidental spillage Requisitions are to be sent separately from the specimens ( pouch or separate plastic bag) 38 Specimen Delivery Methods Hand delivery – usually in a hospital setting Pneumatic tube systems Vehicles 39 Transportation pouches 40  Pneumatic Tube System This is one of the most common means of transportation from getting specimens from one end of the hospital to the laboratory. Specimens should be packaged correctly in a leak proof container, sealed in a zip – lock bag and the carrier should be fitted with a disposable clear ,plastic liner in case of leakage 41 Pneumatic Tube System 42  Pneumatic Tube System The pneumatic system can affect laboratory test due to red cell damage. These include; - Potassium - Hemoglobin - Acid phosphatase - Lactate dehydrogenase 43  Pneumatic Tube System Some tests that are not affected are; Alkaline phosphatase AST Chloride Glucose Creatinine Urea Uric Acid 44  Blood tubes should be transported with the stopper up, which aids in clot formation of serum tubes and reduces agitation which could cause hemolysis When handling tubes with anticoagulant, it is important to immediately mix by gentle inversion 8 times except for coag tubes that are to be mixed 3 – 4 times. 45  Pneumatic Tube System The pneumatic tube system is not appropriate for specimens that must maintain body temperature. ( cold agglutinins, cryoglobulins). 46 Central processing ( Accessioning) 47  Central processing Efficiently process and document incoming specimens for analysis. 1.Verify specimen integrity and labeling. 2.Assign unique accession numbers. 3.Enter patient and test information into the laboratory information system (LIS). 4.Sorted by department and type of handling required 5.Spun and separated as needed 6.Distributed to various departments 48  Distribution The central processing will deliver specimens to: – Hematology – Clinical chemistry – Blood bank – Microbiology – Immunology/serology – Coagulation – Urinalysis – Send Out Dept 49  Distribution Remember to deliver STATs immediately and be sure to inform the technologist that the stat has been delivered as soon as it arrives in the lab. 50 51 52 Time constraints for specimens 53  Time constraints for specimens Time constraints for specimens refer to the limited window of time within which samples must be collected, transported, and processed to ensure accurate and reliable test results. These constraints vary depending on the type of specimen, the tests to be performed, and the stability of analytes within the sample 54  Time constraints for specimens Some examples of tests that are time sensitive ( 2 hr. limit) - Glucose - Ionized Calcium - LD or LDH - Potassium 55  Time constraints for specimens Hematology specimens ( EDTA) – - blood smears within an hour – CBC within 6 hrs. But is stable at room temperature for 24 hr. – ESR ( EDTA) 4 hr. at room temperature. In the fridge 12 hrs. 56  Time constraints for specimens If the blood is drawn in an SST/PST tube it is stable for 24 hours after centrifugation If stored at 4 degrees, the SST/PST tube is stable for 48 hrs. 57  Time constraints for specimens Because of the variability of stability of analytes, most labs use the two- hour limit as the maximum time limit for separating specimens generally. All specimens should be centrifuged and separated within 2 hours from the time of collection. 58  Time constraints for specimens Once the serum has been removed or separated from the red blood cell, the sample will be stable at room temperature for eight hours, and up to 48 hours at 2-4 degrees. After 48 hours, the serum specimen should be frozen at –20 degrees in an aliquot tube. 59 Centrifugation of specimens Serum specimens should be completed clotted before centrifugation ( 30 – 60 minutes) Make sure that the centrifuge is balanced. The gel barrier after centrifugation is right across the tube. The serum/plasma has no contact with the red blood cells 60  Time constraints for specimens Molecular testing specimens ( RNA testing) should be transported, processed as soon as possible. This is because RNA substances are extremely unstable. If this is not possible it can be stored at 4°C only for 48 hrs. If this is not possible the specimen must be in an aliquot tube and frozen at -80 ° C 61  Time constraints for specimens Urine specimens ( C&S and UA) are very dependent on timelines. This is because urine components change, and cellular elements decompose. Urine specimens ( protected from light) can be tested within 2 hrs. at room temperature. If this is not possible it should be refrigerated Cytology specimens should be examined ASAP - If not possible ethanol should be added to preserve the cells ( Cyto spray) 62  Exceptions STAT ASAP - some anticoagulated tubes such as sodium fluoride tubes for glucose and EDTA tubes, keep blood stable for up to 24 hours at room temperature. 63  Exceptions Anything on ice should be processed immediately. Tissue specimens ( this includes joint fluids) should be processed in microbiology immediately. Fluids and surgical specimens always first 64 Aliquot preparation 65  Aliquot preparation Aliquot preparation refers to the process of dividing a larger volume of a specimen into smaller, standardized aliquots for storage, analysis, or distribution. Aliquoting is a common practice in laboratory settings to ensure sample integrity, facilitate efficient testing, and support future testing needs. 66 Aliquot preparation Aliquot: a portion of specimen used for testing Used when: 1.Multiple tests are ordered 2.Tests are performed on different instruments or in different areas Prepared by transferring a portion of specimen into one or more tubes labeled w. same ID info. as specimen tube Each aliquot tube should be covered or capped as soon as it is filled 67  Aliquotting When specimens are removed from the original tube and placed in another tube, they are said to be “ taken off”, “poured off”, “decanted” or “ aliquoted”. Never mix specimens in the same aliquot tube. 68  Aliquoting Each aliquot tube should be capped as soon as it is filled. Serum/plasma aliquot can remain at room temperature no longer than 8 hrs. If the test cannot be competed within 8 hrs., it should be refrigerated ( 2- 8 degrees C). If the test cannot be completed within 48 hr.,It should be frozen ( below – 20 degrees C) 69  Aliquoting Serum / plasma should not be frozen and thawed more than once. Refreezing can cause the analytes to deteriorate. Also do not “ frost – free freezers. They allow samples to partially thaw and refreeze. 70  Fingers aliquoting To estimate the amount of specimen in an aliquot tube: 0.5 ml = little finger 1.0 ml = index finger 2.0 ml = middle and index finger 71  Temperature Considerations 72  Temperatures Temperature considerations in lab specimens are crucial to maintaining the integrity, stability, and quality of biological samples throughout the testing process. Different types of specimens require specific temperature conditions to preserve their characteristics and ensure accurate test results. It is important to know the following temperatures when handling specimens 73  Temperatures Body temperature : 36. 4 – 37.6 C ( average is 37 C) Room temperature : 20 – 30 C ( average 25 C) Refrigerator temperature: 2 – 10 C Frozen temperature: - 20 C( some specimens require – 70 C or lower) 74  Chilling specimens To slow down metabolic processes Also protects thermolabile ( to altered or destroyed by heat) analytes. Specimens that have to be chilled ,should be completely immersed in a slurry of crushed ice 75 Chilling – to slow down metabolic processes 76  Note: high temperatures may cause deterioration of chemical constituents The lower temperature, the greater stability 77 Refrigerated unit for keeping specimens cold Fill lower section with water or crushed ice to chill sample tubes quickly. 78 Specimens that must not be chilled Some specimens are negatively affected by chilling during transport. Most coagulation tests Potassium 79 Specimens to be kept at body temperature ( this is done by keeping tubes in a 37 ° heating block or water bath) e.g. Cold agglutinins Cryofibrinogen Semen Analysis 80 Specimens that require special handling Specimen Storage 81  Specimens that require special handling Specimens that require special handling encompass biological samples with unique characteristics, properties, or storage requirements that necessitate specific protocols to maintain their integrity and stability. 82  Protection from light Bilirubin, vitamin B12,Vit C, carotene, – these samples can be taken in a plain tube and protected from light by wrapping in aluminum foil - amber colored collection containers are available for collecting bilirubin from infants. A decrease of 50% of the bilirubin is lost after 1 hour of light exposure. Urine specimens for porphyrins – are collected in a dark bottle 83 Amber micro container 84 CSF 85 CSF CSF – used to diagnosis meningitis infections and other brain disorders. This specimen is delivered STAT Routine tests performed are; cell counts, chloride, glucose, protein and microbiology. 86  CSF Most tests require a minimum of 1 ml. There are usually 3 – 4 tubes collected. 1st tube – goes to chemistry and immunology on ice 2nd tube – goes to microbiology – no ice 3rd tube – goes to hematology ( cell count and differential) on ice 4th tube– goes to cytology or other special tests. 87 CSF 88  CSF If one specimen such as a urine or CSF is needed by 3 departments, it must be processed as follows: – 1st. microbiology – to prevent contamination – 2nd. hematology – for cellular analysis – 3rd. chemistry Do not put on ice. 89 Transportation off site 90  Transportation off site The procedures for transporting specimens off-site involve several key steps to ensure the safe and timely delivery of samples to the testing facility while maintaining sample integrit 91  Specimens transported off site Whenever chemicals or specimens are transported to another location, they become subject to the special rules termed Transportation of Dangerous Goods Regulations based on Bill C-45. The purpose of the TDG act is to promote safety and protect the public. 92 What are dangerous goods? Dangerous goods are defined as articles or substances which are capable of posing a significant risk to health, safety, property or the environment when transported by air or surface. 93  Preparing specimens for shipment Package must be labeled as biohazard The type of tissue, organ, or body fluid is identified clearly Contact person must be included in case of breakage or loss Containers must be leak proof and sturdy to prevent breakage Government act that regulates the Transport of Dangerous Goods – TDG Act 94 Lab personnel must be aware of TDG regulations for 3 reasons: 1. Transport of chemicals needed for the lab. 2. Transport of specimens from one site to another. ( satellite lab to main lab) 3. Disposal of hazardous waste ( chemical and biological) 95 Packaging Diagnostic and Infectious Materials The packaging of diagnostic and infectious specimens should generally follow the triple packaging system. This consists of a primary receptacle, a secondary packaging, rigid outer packaging For liquid specimens, an absorbent material placed between the primary container and the secondary packaging , capable of absorbing the entire contents of the package. Also, ice or dry ice must be place outside the secondary container 96  Shipping Diagnostic and Infectious Materials Ice or dry ice must be placed outside the secondary container or as an overpack. There must be interior support to secure the secondary container if the ice dissipates. 97  Triple Packaging Primary package – blood collection tubes, urine containers or pour off tubes with leak proof lids Secondary package – durable, watertight, leak-proof receptacle to enclose and protect the primary receptacle(s). example : Envelope plastic bag Outer package – durable rigid container example: cooler 98 Primary package 99 Secondary package 100 Outer package 101  Packaging Instructions Place all specimens ( tubes racks, urines, histology, micro swabs/plates etc.) inside the plastic bags with the absorbent. Seal the top of the bags All tubes, urine containers,etc. containing liquids must be placed in an upright position. Reqs are to be placed in a separate plastic pouch 102  Transportation off site ( send outs) A record of send outs is often kept in the central processing This log must be stored as a data file in a computer, or it might be recorded in a book The SOP is available for the MLA to refer to when sending out a specimen 103  Information included in the send out manual Name of patient Lab number What test is being tested What day of the week the test is performed Turnaround time for each test as well as the schedule for testing Where is the test sent 104 Information included in the send out manual What are the regulations for sending a specimen to a different location Special considerations ( freezing, RT, transport media, etc.) Date that the specimen was sent Date that the results are expected Date that the results were recived 105 Post Analysis Storage 106  Post Analysis Storage Post-analysis storage refers to the management and preservation of laboratory specimens and test results after the completion of analysis. Proper post-analysis storage is essential for maintaining sample integrity, ensuring data traceability, and facilitating future reference or reanalysis as needed. 107  Post Analysis Storage Anticoagulated venous specimens should be stored at 2 – 8° C if they will not be tested within 4 hours. Serum specimens should be separated from whole blood before being refrigerated. Specimens should be capped to minimize evaporation and contamination 108  Post Analysis Storage Serum / plasma aliquots can remain at room temperature for no longer than 8 hr. If the assays can be tested within 48 hrs., then the aliquots should be refrigerated( 2 -8 degrees C) If assays are not completed with 48 hr., the aliquots should be frozen at – 20 or below degrees C. Check SOP for guidelines 109  Post Analysis Storage EDTA tubes are stored at RT for 24 hours and discarded. Frozen specimens unacceptable. Sodium Fluoride/Potassium Oxalate tubes are stored at RT for 24 hours 110 Rejecting specimens 111  Rejecting specimens NSQ A clotted additive tube or fibrin clots Hemolysis ( will affect coag, K, LH,ALT, AST, Glucose and fluids for cell analysis) Lipemia may affect certain tests Specimens such as bilirubin that is not protected from light Specimens collected in a wrong tube Unlabelled tubes are never accepted 112  Not at body temperature ( cold aggluntins) Chilling requirement not met ( lactic acid, ammonia) Contaminated specimen Delay in processing Wrong time. Wrong tube. Wrong order 113 Disposal of waste 114  Disposal of waste 1.Dispose of laboratory waste in a safe and environmentally responsible manner. 1.Segregate waste into appropriate categories (e.g., biohazardous, chemical, sharps). 2.Use designated waste containers and follow disposal protocols. 3.Adhere to local regulations and guidelines. 115  Disposal of Waste Chemical – always check with a superviser, TDG and/or SDS manuals Specimens – shall be treated in a manner that destroys pathogenic micro- organisms. ( autoclave) 116  Disposal of Waste Human anatomical waste – must be incinerated or buried in a cemetery or destroyed in a crematorium Microbiological waste – must be incinerated, autoclaved or otherwise treated in a manner that destroys pathogens 117  Sharps Disposal Sharps are disposed of in puncture resistant containers and shall be -incinerated - autoclaved - otherwise treated in manner that renders them unusable and destroys pathogenic microorganisms. 118 Chain of Custody Forms 119  Chain Of Custody Forms Chain of Custody (CoC) refers to the documented process of establishing and maintaining control over the handling, storage, and disposition of specimens, samples, or evidence from the time of collection to final disposition. The CoC ensures the integrity, security, and traceability of materials and information throughout their lifecycle, particularly in forensic, legal, or regulated environments where accurate documentation and accountability are critical. 120  Chain Of Custody Forms This is a form that follows the specimen from collection through to the final report. It has the signature of everyone who has comes into contact with this specimen. 121  Chain Of Custody Forms It is needed for blood alcohol testing and urine drug testing if these are being tested for legal purposes It can also be used for paternity testing. Chain of custody is provided for drug testing of athletes, 122  Collection of ETOH ETOH ( Ethanol alcohol ) There are medical reasons for collecting ETOH or there are legal reasons. 123  Collection of ETOH Proper Identification of the patient and proper consent. When you have decided on a vein , clean the site with benzalkonium chloride ( or soap and water). Do not use isopropyl alcohol Collect a red or green stopper tube ( without gel) Handout from Shared Health about Legal collection of ETOH 124 Reporting Results 125  Reporting Results Reporting results in a laboratory setting involves the communication of test findings and interpretations to healthcare providers or other authorized individuals for clinical decision-making. Effective result reporting ensures accurate, timely, and clear transmission of information to support patient care 126  Reporting Results Today results , in an automated lab, are generated by the LIS and then an electric results are issued to the patient chart. Sometimes a test has a result that are significant abnormal. 127  Reporting Results These results are called critical ( panic )levels. These results usually indicate life – threatening a situation. And action must be taken immediately. Refer to your SOP for critical values 128  Reporting Results Procedure 1)The critical test result will be communicated directly to the physician/ designate. Verbal communication 2)The person receiving the report will be informed that the result is “ critical” 3)The person taking the results will be asked to repeat the information back so that there is no doubt that the results have been reported accurately 129  Reporting Results 4) Document the verbal communication on a log ( manual or electronic) - Identification of the patient - Identification of the sender - Identification of the receiver - Critical result reported - Date and time of communication 130 Summary 131  Summary of specimen processing Attention to detail is required by the lab assistant when transporting, processing, and distributing clinical lab specimens for testing. Orders from physicians must be followed as to the urgency of testing ( STAT, ASAP, or routine) 132