PHLEB-LAB-MOD-6-DORAN-MLS1F-1.pdf

Principles of Medical Laboratory Science Practice 2 (Clinical Laboratory Assistance and Phlebotomy) (LAB) Module 6: Preparation and Handling of Nonblood Specimens for Laboratory Testing 2nd Semester l Finals l University of San Agustin l Outline effec...

Principles of Medical Laboratory Science Practice 2 (Clinical Laboratory Assistance and Phlebotomy) (LAB) Module 6: Preparation and Handling of Nonblood Specimens for Laboratory Testing 2nd Semester l Finals l University of San Agustin l Outline effectiveness or complications of  Different non-blood specimens for therapy. laboratory testing  Inpatient urine specimen collection is  Collection and handling procedures typically handled by nursing personnel. for different non-blood specimens  Outpatient urine specimen collection  Collect and Process samples for is often handled by phlebotomists, and Urinalysis. should be instructed correctly for the Nonblood Specimen Labelling and Handling procedures. Common Urine Tests  Nonblood Specimens should be labelled with the same identifying information Routine Urinalysis (UA) as blood specimens.  In addition, since many body fluids are  Most commonly requested urine test similar in appearance, labelling should because it screens for urinary and include the type and/or source of the systemic disorders. specimen.  A routine UA typically includes physical,  The label should be applied to the chemical, and microscopic analysis of container, not the lid, so as to avoid the urine specimen misidentification.  Follow facility protocol. 1. Physical analysis Nonblood Body-Fluid Specimens Urine a. Macroscopic observation and notation of color, clarity, and ordor b. Measurements of volume c. Specific gravity or osmolality 2. Chemicalanalysis a. Can detect bacteria, bilirubin, blood (red blood cells and hemoglobin), glucose, ketones, leukocytes, nitrite, protein, and urobilinogen, and measure pH and specific gravity. b. Commonly performed using a plastic  most frequently analyzed nonblood reagent strip (often called a dipstick) body fluid that contains pads impregnated with test  readily available, easy to collect, and reagents. generally inexpensive to test c. The strip is dipped into the urine and  Its analysis can provide information on color reactions that take place on the many of the body’s major metabolic pads are compared to a color chart, functions. which is usually found on the label of the  Analysis of urine can aid in monitoring reagent strip container. wellness, the diagnosis and treatment d. Special timing, which is not the same of urinary tract infections, the for all test, is involved in reading the detection and monitoring of metabolic results, which are reported in the manner disease, and determining the indicated on the color chart. TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 1 2 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  If a delay is unavoidable, the specimen can be preserved by the addition of an equal volume of 50% alcohol. Urine Drug Specimen  Performed to detect illicit use of recreational drugs, use of anabolic steroids to enhance performance in sports, and unwarranted use of prescription drugs.  It is also used to monitor therapeutic drug use in order to minimize withdrawal symptoms and to confirm a diagnosis of drug overdose. Urine Culture and Sensitivity  A random sample in a chemically clean, covered container is required for  A urine culture and sensitivity (C&S) test the test. may be requested on a patient with  Specimens containing blood cells or symptoms of urinary tract infection having a high or low urine pH or a low (UTI). specific gravity will yield erroneous  Involves placing a measured portion of results and will require recollection of urine on a special nutrient medium that the specimen. encourages the growth of microorganisms, incubating it for 18 to Other Urine Tests 24 hours, checking it for growth, and identifying any microorganisms that  Numerous chemistry tests—including grow. electrophoresis, tests for heavy metals,  Urine must be collected in a sterile myoglobin clearance, creatinine container, following midstream clean- clearance, and porphyrins. catch procedures to ensure that the  Many of these tests require a pooled specimen is free of contaminating timed specimen, such as a 24-hour matter from the external genital areas collection. Urine Cytology Studies Types of Urine Specimens  Cytology studies are performed to 1. Random detect cancer, cytomegalovirus, and other viral and inflammatory diseases of  Can be collected at any time. the bladder and other structures of the  They are used primarily for routine urinary system. urinalysis and screening tests.  Prepared from urinary sediment or  Random refers only to the timing of the filtrate. specimen and not the method of  The smear is stained by the collection. Papanicolaou (PAP) method and examined under a microscope for the presence of abnormal cells.  A fresh clean-catch specimen is required for the test. 2. First Morning Urine/8-HourSpecimen TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 2 3 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  Also called a first voided, overnight, or  Collected 2 hours after a meal and early morning specimen) is usually tested for glucose. collected immediately upon  It is primarily used to monitor the awakening in the morning after insulin therapy of patients with diabetes approximately 8 hours of sleep. mellitus.  This type of specimen normally has a  The patient is instructed to void higher specific gravity, which means shortly before consuming a normal meal that it is more concentrated than a and to collect a specimen 2 hours later. random specimen.  Comparison of results with fasting urine  Are often requested to confirm results of and fasting blood glucose specimens’ random specimens and specimens with results is done. low specific gravity. c. 24- Hour Urine Specimen 3. Fasting  Is collected to allow quantitative  Typically used for glucose monitoring. analysis of a urine analyte.  It differs from a first morning specimen in  Best time to begin is in the morning that the specimen is the second between 6 and 8 AM. specimen voided after a period of  Requires a large, clean wide-mouth fasting. container capable of holding liters.  This helps assure that the specimen will not be affected by food consumed d. Double-voided Specimen prior to fasting.  Is one that requires emptying the 4. Timed bladder and then waiting for a specified amount of time before collecting the  Some tests require individual urine specimen. specimens collected at specific times.  Commonly used to test urine for  Others require the – collection and glucose and ketone. pooling of urine throughout a specific time period. Urine Collection Methods a. Tolerance Test Specimen 1. Regular Voided Urine  Typically require collection of urine at  A regular voided urine collection requires specific times. no special patient preparation and is  The traditional standard glucose collected by having the patient void tolerance test (GTT) requires individual (urinate) into a clean urine container. urine specimens collected serially at specific times that correspond with the 2. Midstream Clean-Catch Specimen timing of blood collection, such as fasting, 1/2-hour, 1 hour, and so on.  Collected in a sterile container and  Timing of the specimens is important yields a specimen that is suitable for in the interpretation of test results. microbial analysis or culture and  For this reason, the specimens must be sensitivity testing. collected as close to the requested  Special cleaning of the genital area is time required before the specimen is collected. b. 2-Hour Postprandial Specimen 3. Catheterized Specimen TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 3 4 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  A catheterized urine specimen is sealed, labeled, and sent to the lab as collected from a sterile catheter soon as possible. inserted through the urethra into the  A 24-hour specimen can be obtained bladder. by using a special collection bag with a  Catheterized specimens are sometimes tube attached that allows the bag to be collected emptied periodically. o on babies to obtain a specimen for C&S Amniotic Fluid o on female patients to prevent vaginal contamination of the  Clear, almost colorless to pale-yellow specimen; fluid that fills the membrane that o on bedridden patients when surrounds and cushions a fetus in the serial specimen collections are uterus. needed  It is preferably collected after 15 weeks of gestation (pregnancy) and is 4. Suprapubic Aspiration obtained by a physician through transabdominal amniocentesis.  Involves inserting a needle directly  Amniotic fluid is normally sterile and into the urinary bladder and aspirating must be collected in a sterile container. (withdrawing by suction) the urine directly from the bladder into a sterile Amniotic Fluid Analysis syringe  The procedure normally requires the Genetic disorders use of local anesthesia and is performed by a physician.  Can be detected by chromosome  The specimen can also be collected studies done on fetal cells removed from the catheter by a nurse using a from the fluid. sterile needle and syringe.  Specimen must be kept at room  Used for samples for microbial analysis temperature. or cytology studies. It is sometimes used to obtain uncontaminated samples Hemolytic disease from infants and young children.  Can be detected by measuring 5. Pediatric Urine Collection bilirubin levels.  The specimen should be protected from  A plastic urine collection bag with light to prevent breakdown of bilirubin hypoallergenic skin adhesive is used and delivered to the laboratory ASAP. to collect a urine specimen from an infant or small child who is not yet Estimating gestational age potty trained.  The patient’s genital area is cleaned  Amniotic fluid creatinine levels and dried before the bag is taped to the because these levels are related to fetal skin. The bag is placed around the muscle mass. vagina of a female and over the penis of a male. A diaper is placed over the collection bag. The patient is checked every  15 minutes until an adequate specimen is obtained. The bag is then removed, Measuring alpha-fetoprotein (AFP) TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 4 5 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  An antigen normally present in the  Specimens are obtained most often human fetus that is also found in through lumbar puncture (spinal tap) amniotic fluid and maternal serum. by a physician.  AFP testing is initially performed on The first tube is used for maternal serum, and chemistry and immunology  Abnormal results are confirmed by tests. amniotic fluid AFP testing. The second for microbiology  Abnormal AFP levels may indicate studies problems in fetal development The third for cell counts.  Such as neural tube defects or the  CSF should be kept at room potential for Down’s syndrome. temperature, delivered to the lab stat,  And gestational age of the fetus should and analyzed immediately. be included due to AFP  Levels changes in each week of Gastric fluid gestation.  A gastric analysis examines stomach Fetal lung maturity contents for abnormal substances and measures gastric acid  Can be assessed by measuring the concentration to evaluate stomach amniotic fluid levels of substances acid production. called phospholipids, which act as surfactants to keep the alveoli of the Gastric Fluid Collection lungs inflated.  Results are reported as a lecithin-to- Basal Gastric analysis sphingomyelin (L/S) ratio.  L/S ratio is less than 2 means that fetal  Sample of gastric fluid is aspirated by lungs are likely to be immature. means of a tube passed through the mouth and throat (oropharynx) or nose Cerebrospinal fluid and throat (nasopharynx) into the stomach after a period of fasting.  A clear, colorless liquid that  Tests are done to determine acidity surrounds the brain and spinal cord prior to stimulation. and has many of the same constituents  After Basal Sample is collected, the as blood plasma patient is given a gastric stimulant  Primarily performed for the diagnosis (commonly histamine or pentagastrin) of Meningitis. intravenously and gastric samples are  It is also used to diagnose other collected over timed intervals. disorders such as brain abscess, CNS  The role of the phlebotomist in this cancer, and multiple sclerosis. procedure is to help label specimens  Routine tests include cell counts, and draw blood for serum gastrin chloride, glucose, and total protein determinations. while other tests are performed if indicated. Nasopharyngeal secretions  Are cultured to detect the presence of microorganisms causing diphtheria, meningitis, pertussis, and pneumonia. Cerebrospinal fluid collection Nasopharyngeal secretions collection TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 5 6 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  NP specimens are collected using a  Its volumes increase when sterile Dacron or cotton-tipped inflammation or infection is present or flexible wire swab. when serum protein levels decrease.  Effusion is an increase in fluid 1. The swab is inserted gently into the nose volume. and passed into the nasopharynx. 2. There it is gently rotated, then carefully Types of Serous Fluids removed, placed in a sterile tube containing transport medium, labelled, 1. Pleural fluid - aspirated from the pleural and delivered to the lab. space, or cavity, surrounding the lungs. 2. Peritoneal fluid - aspirated from the Saliva abdominal cavity. 3. Pericardial fluid - aspirated from the  Used to monitor hormone levels and pericardial cavity surrounding the detect alcohol and drug abuse and its heart. early detection of drugs in saliva indicates recent drug use Serous Fluid Collection  Hormone tests are typically frozen to ensure stability and sent to a laboratory  Serous fluids can be aspirated for for testing. testing purposes or when increased amounts are interfering with the normal Semen function of associated organs and a physician performs the procedure.  Semen (seminal fluid) is the sperm- containing thick yellowish-white fluid EDTA tubes are used if cell discharged during male ejaculation. counts or smears are ordered.  It is analyzed to assess fertility or Heparin or sodium fluoride determine the effectiveness of tubes for chemistry tests. sterilization following vasectomy and is Nonanticoagulant tubes are sometimes examined for forensic used for biochemical tests. reasons. Sterile heparinized tubes for cultures. Semen Analysis Collection The type of fluid should be indicated on the specimen label.  Semen specimens are collected in sterile or chemically clean containers Sputum and must be kept warm, protected from light, and delivered to the lab  Mucus or phlegm that is ejected from immediately. the trachea, bronchi, and lungs through deep coughing. Serous Fluid  Sometimes collected in the diagnosis or monitoring of lower respiratory tract  Is the pale-yellow, watery, serum-like infections such as tuberculosis (TB), fluid found between the double- caused by Mycobacterium tuberculosis. layered membranes enclosing the pleural, pericardial, and peritoneal cavities.  It lubricates the membranes and allows Sputum Collection them to slide past one another with minimal friction. TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 6 7 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  First morning specimens are  The forearm is the preferred site, but preferred, as secretions tend to collect the leg or thigh may be used on in the lungs overnight and a larger infants or toddlers. volume of specimen can be produced.  Sweat is collected, weighed to determine its volume, and analyzed for 1. It is also best to collect the specimen chloride content. at least 1 hour after a meal to minimize the risk that the patient will gag or vomit. Synovial fluid 2. The patient must first remove dentures if applicable, then rinse his or her mouth  A clear, pale-yellow, viscous fluid that and gargle with water to minimize lubricates and decreases friction in contamination with mouth flora and movable joints that normally occurs in saliva. small amounts but increases when 3. The patient is instructed to take three or inflammation is present. four slow, deep breaths, inhaling to full  It can be tested to identify or capacity and exhaling fully, then to differentiate arthritis, gout, and other cough forcefully on the last breath and inflammatory conditions. expectorate (cough up and expel sputum) into a special sterile container. Synovial Fluid Collection 4. The process is repeated until a sufficient amount of sputum is obtained.  It is typically collected in three tubes: o An EDTA or heparin tube for Sweat cell counts, identification of crystals, and smear  Analyzed for chloride content in the preparation diagnosis of cystic fibrosis. o A sterile tube for culture and  Cystic fibrosis is a disorder of the sensitivity. exocrine glands that affects many o Nonadditive tube for body systems but primarily the lungs, macroscopic appearance, upper respiratory tract, liver, and chemistry, and immunology tests pancreas. and to observe clot formation.  Patients with cystic fibrosis have abnormally high levels of chloride in Buccal swabs their sweat, which can be measured by the sweat chloride test.  Collection of a buccal (cheek) swab is a  Sweat specimens can also be used to less invasive, painless alternative to detect illicit drug use. blood collection for obtaining cells for  Sweat is collected on patches placed DNA analysis. on the skin for extended periods of time and then tested for drugs. Swab Collection: Sweat Collection  The phlebotomist collects the sample by gently massaging the mouth on the  Test involves transporting a sweat- inside of the cheek with a special swab. stimulating drug called pilocarpine into  DNA is later extracted from cells on the skin by means of electrical the swab. stimulation from electrodes placed on the skin, a process called iontophoresis Bone Marrow TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 7 8 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  Aspirated and examined to detect and slides are sent to the hematology identify blood diseases. department for staining and evaluation  A bone marrow biopsy may be under the microscope. performed at the same time. Breath Samples Bone Marrow collection  Are collected and analyzed for 1. A physician inserts a special large-gauge hydrogen content in one type of needle into the bone marrow in the iliac lactose tolerance test and to detect crest (hip bone) or sternum the presence of Helicobacter pylori (breastbone). (H. pylori), a type of bacteria that 2. Once the bone marrow is penetrated, a secretes substances that damage the 10-mL or larger syringe is attached to lining of the stomach and causes chronic the needle to aspirate 1.0 to 1.5 mL of gastritis, which can lead to peptic ulcer specimen. A laboratory hematology disease. technologist is typically present and makes special slides from part of the first Breath Samples Analysis marrow aspirated. Additional syringes may be attached to collect marrow for 1. C-UreaBreathTest other tests such as chromosome studies or bacterial cultures.  A common test used to detect H. pylori is the C-urea breath test (CUBT). 3. Part of the first sample may be placed in  This test is based on the fact that H. an EDTA tube for other laboratory pylori produce urease, an enzyme that studies; remaining aspirate is sometimes breaks down urea but is not normally allowed to clot and placed in formalin or present in the stomach. another suitable preservative and sent to o To perform the test, a baseline histology for processing and breath sample is collected, after examination. which the patient drinks a special a. In an alternate method, blood and substance that contains synthetic particles from the EDTA tube are urea. The synthetic urea contains filtered through a special paper. a form of carbon called carbon- The filtered particles are then 13. folded in the paper and placed in o If H. pylori organisms are formalin. present, the urease they produce will break down the synthetic 4. If a bone marrow biopsy is collected at urea and in the process release the same time, the cylindrical core of carbon dioxide (CO2) that contain material obtained is touched lightly to the carbon-13. surface of several clean slides before o The CO2 will be absorbed into being placed in a special preservative the bloodstream and exhaled in solution. The slides are air-dried and the patient’s breath. The patient later fixed with methanol and stained breathes into a special Mylar with Wright’s stain in the hematology balloon or other collection device department. at specified intervals. The breath specimens are analyzed for 5. The biopsy specimen and several slides carbon-13 content. If carbon-13 is are sent to the histology department for found in amounts higher than processing and evaluation. The those in the baseline sample, H. remaining slides including biopsy touch pylori is present in the stomach. TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 8 9 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab)  For those given lactose or fructose, 2. Hydrogen Breath Test increased hydrogen levels in the breath samples respectively indicate increased  The hydrogen breath test helps identify lactose or fructose in the intestinal tract, problems with the digestion of most likely as a result of metabolism. carbohydrates such as lactose (milk o For those given lactulose, if sugar) and fructose (fruit sugar) and is bacterial overgrowth is present, thought to be the most accurate increased hydrogen levels lactose tolerance test. appear twice; the first time when the lactulose reaches bacteria in  It can also be used to detect bacterial the small intestine and the overgrowth in the small intestine. second time when it reaches bacteria in the colon.  The principle behind the test is that hydrogen gas is produced when intestinal bacteria ferment Feces (Stool) carbohydrates such as lactose, fructose, or lactulose (used to detect  Examination of fecal specimens (feces or bacterial overgrowth). stool) is helpful in the evaluation of gastrointestinal disorders.  Some of the hydrogen is absorbed into  Stool specimens can be evaluated for the bloodstream and transported to the the following: lungs, where it is exhaled during normal o the presence of intestinal breathing. parasites and their eggs o To prepare for the test, the patient must not have taken Stool Collection antibiotics for at least 2 weeks before the test and must avoid  Stool specimens are normally collected certain foods for 24 hours prior to in clean, dry, wide-mouthed the test. containers that should be sealed and o The patient must be fasting on sent to the laboratory immediately after the day of the test and is asked collection. to refrain from vigorous exercise  For ova and parasite collection, special and smoking for 30 minutes prior containers with preservatives to and during the test.  Preserved specimens can usually be o On the day of the test, a baseline kept at room temperature. Large gallon breath sample is take by having containers, similar to paint cans, are the patient exhale into a special used for 24-, 48-, and 72-hour stool bag or device. Then the patient is collections for fecal fat and urobilinogen; given a drink that, depending on these specimens must normally be the type of test, contains a refrigerated throughout the collection measured amount of lactose, period. fructose, or lactulose. Additional o Hematest and Hemoccult breath samples are collected at Special test cards are used to regular intervals, typically, every stool specimens for fecal occult 30 minutes for up to 3 hours, blood testing (FOBT). depending on the amount of o The patient is usually instructed hydrogen detected in the to follow a meat-free diet for 3 samples. days prior to the test. TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 9 10 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab) o Patients are then instructed to Tissue Specimens collect separate specimens for 3 successive days.  Tissue specimens from biopsies may also be sent to the laboratory for Hair processing.  (A biopsy is the removal of a tissue  Are sometimes collected for trace and sample for examination.) Most tissue heavy metal analysis and the detection specimens arrive at the laboratory in of drugs of abuse. formalin or another suitable solution and  Easy to obtain and cannot easily be need only be accessioned and sent to altered or tampered with. the proper department. However, with  Hair shows evidence of chronic drug more biopsies being performed in use rather than recent use. outpatient situations, a phlebotomist in  Despite of its rise in usage, there is a specimen processing may encounter lack of standardization. specimens that have not yet been put into the proper solution. It is important for Throat Swabs the phlebotomist to check the procedure manual  Throat swab specimens are most often  To determine the proper handling for any collected to aid in the diagnosis of unfamiliar specimen. (For example, streptococcal (strep) infections. tissues for genetic analysis should not be  Nursing staff usually collect throat put in formalin.) Improper handling can culture specimens on inpatients. ruin a specimen from a – procedure that  Phlebotomists commonly collect throat is, in all probability, expensive, culture specimens on outpatients. uncomfortable for the patient, and not easily repeated. Throat swab collection  A throat culture is typically collected using a special kit containing a sterile polyester-tipped swab in a covered transport tube containing transport medium.  Throat swabs for rapid strep tests are collected in a similar manner. TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 10 Principles of Medical Laboratory Science Practice 2 (Clinical Laboratory Assistance and Phlebotomy) (LAB) Module 6: Preparation and Handling of Nonblood Specimens for Laboratory Testing 2nd Semester l Finals l University of San Agustin l TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 11 12 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab) TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 12 13 PMLS 2: Clinical Laboratory Assistance and Phlebotomy (Lab) TRANSCRIBED BY: ALYSSANDRA FRANCINE S. DORAN | USA MLS 1-F | Page 13