TOPIC 1: Introduction to Phlebotomy: The Clinical Laboratory PDF

TOPIC 1: INTRODUCTION TO PHLEBOTOMY: THE CLINICAL LABORATORY PMLS 038 | PRINCIPLES OF MEDICAL LABORATORY SCIENCE __________________________________________________________________________________________ Lymphocytes LESSON 1: THE CLINICAL LABORATORY Monocytes Basophils CLINICAL LABORATORY ORGANIZATIONAL DIVISION Eosinophils ○ Platelets (Plts/ Thrombocytes ) Most common ﬂuid analyzed is Whole blood (a mixture of cells and plasma) 8 HCCBSMUP Whole blood is is the most common ﬂuid analyzed obtained - blood and body fluids - by using a collection tube with an anticoagulant to prevent clotting. ○ tubes with lavender stopper ○ Anticoagulant: Ethylenediaminetetraacetic acid (EDTA) ○ Requires 8-10 times of immediate tube inversion to activate ↳ Figures of 3- CHC - microscopic test rissues SPECIMEN TYPE - Blood is analyzed as whole blood, plasma or serum. ○ Plasma: liquid portion of the blood obtained from a PICSMC sample that has been anticoagulated; contains - with anticoagulant Tube color : ﬁbrinogen. ANATOMICAL AREA microscopic exams Lavender-Hematology ○ Serum: liquid portion of the blood obtained if the pink Blood Bank - sample is allowed to clot; does not contain Responsible for the analysis of surgical specimens, frozen serum without anticoagulant ﬁbrinogen. sections, biopsies, cytological specimens, and autopsies. - Sections: cancer Plain Red-serum ○ Cytology Section PAPsMeIrS > - CellS , , Take note of the ○ Histology Section +issues pathology biopsies > - , , layers ! ○ Cytogenetics chromosome studies DNA RNA > - , , Histopathology sections ! CLINICAL AREA Blood and body fluids ! In the clinical sections, blood, bone marrow, microbiology samples, urine, and other body ﬂuids are analyzed. paitent Laboratory Information System (LIS) department request results , test , Common tests performed in the Hematology Section: - responsible for the laboratory computer operations, ○ Complete blood count (primary analysis maintaining records; and documentation for the performed) compliance with accrediting regulations. Reticulocyte a. Differential - % of different types of Divided into specialized sections: - immature/young RBCs WBCs and evaluates RBCs and platelet 1. Hematology morphology 2. Coagulation b. Hematocrit (Hct) – volume of RBCs 3. Chemistry packed by centrifugation 4. Blood Bank (Immunohematology) c. Hemoglobin (Hgb) – oxygen-carrying 5. Serology (Immunology) capacity of RBCs 6. Microbiology d. MCV – the size of RBCs 7. Urinalysis indices f. I e. MCH – amount of hemoglobin in RBCs MCHC – weight of the Hgb in a red blood *Phlebotomy and Sample processing cell g. Platelet count – no. of platelets in bloof h. Red cell distribution width (RDW) – diff Blood ! HEMATOLOGY SECTION size of RBCs i. White Blood Cell Count(WBC) –no.of Hematology is the study of the formed (cellular) elements of - platelets in blood the blood Other Routine Test ○ Red Blood cells (RBCs/Erythrocytes) Familiarize ○ Body ﬂuid analysis – type of cells ○ White Blood cells (WBCs/Leukocytes) ○ Bone marrow – type of cells in bone marrow Neutrophils lipid +est HDL LDL ↑ , Red Blood Well ① Macronematocrit test asting lipids - - = 15 hours ○ Erythrocyte Sedimentation Rate(ESR) — Fasting samples are preferred. (8-12 hours) Immature RBCs ○ - - Reticulocyte Count – bone marrow production ○ Sickle cell – Screening test for sickle cell anemia ○ Special stains – type of anemia ** Reticulocyte - immature RBCs ** Lipids - 15 hours Common tests performed in the Chemistry Section: RETICULOCYTE ESR ○ Test for electrolytes like Na, K, Cl, CO2 ○ Lipid panel COAGULATION SECTION ○ Total protein ○ Enzyme immunoassays In this area, the overall process of hemostasis is evaluated; ○ Fasting blood sugars same with a. Platelets ○ Blood gas analyses Hematology b. Blood vessels ○ Therapeutic drug monitoring c. Coagulation factors ○ Blood urea nitrogen d. Fibrinolysis ○ Creatinine e. Inhibitors f. Anticoagulant therapy (Heparin and Coumadin) cross match Tube with light blue stopper OF blood a IMMUNOHEMATOLOGY/BLOOD BANK SECTION > inversion - Anticoagulant: Sodium Citrate (3-4 times) Section of the laboratory where blood may be collected, Common tests performed in the Coagulation Section: CST stored, and prepared for transfusion ○ Prothrombin (PT) Units of blood are collected from donors, tested for the Extrinsic Pathway of coagulation cascade presence of bloodborne pathogens (Hepatitis and HIV), and and monitors Coumadin stored for transfusions. ○ Activated partial thromboplastin time (APTT) Blood may also be separated into components including Intrinsic Pathway of coagulation cascade packed cells, platelets, fresh frozen plasma, and and monitors Heparin cryoprecipitate. ○ Thrombin time (TT) Blood transfusions are only done by doctors. Clotting time; if adequate ﬁbrinogen is ↳ together with nurse present Analytical Factors takes the lead ! - Mis just ○ Bleeding time (BT) now quickly blood clots to stop bleeding > - Samples are collected in Evaluates function of platelets ○ plain red (serum) ○ Factor Assays ○ lavender or Detect Factor Deﬁciency [pi + ( ○ pink (plasma) stopper tubes. Serum separator tubes containing gel are not acceptable. Electrolytes sodium CHEMISTRY SECTION Red cap/ potassium chloride Most automated area in the laboratory Study of components in the blood including enzymes, hormones, electrolytes, chemicals and poisons. Tests performed on serum, plasma, urine and other body ﬂuids Performed primarily on serum collected in gels barriers, but may also be collected in tubes with red, green (Heparin), gray, or royal blue (sodium ﬂuoride; for glucose testing) patient may die if incorrect matching of stoppers. Red red glass > - ↓ gray-contain Nac blood type. Patient identiﬁcation is critical in this section. serum > - ↑ ream/yel separator Anti = Potassium oxalate Common tests performed in the Blood Bank Section: PRE-ANALYTICAL FACTORS ○ Group and type — ABO and Rh typing ○ Type and crossmatch — ABO, Rh typing and Factors that may affect the test results: compatibility testing Blood Typing/forward ○ Hemolyzed - specimens that appear red because of typing ○ Antibody Screening the release of hemoglobin from RBCs; ○ Icteric - specimens that are abnormally yellow due ○ ○ Direct Coombs Test Indirect Coombs Test BanS to excess bilirubin ○ Lipemic - specimens that are cloudy because of increased lipids. Antibodies ! SEROLOGY (IMMUNOLOGY) SECTION (3- HIL] The section that performs tests to evaluate the body’s immune response. Hemolyled - rea hemoglobin Detects the presence of antibodies to bacteria, fungi, Eisentric yellow - > pilirubin parasites, viruses, and antibodies produced against body - Lipemic cloudy - lipids substances (autoimmunity). Samples are collected in tubes with red stoppers. scrum most used Common tests performed in the Serology (Immunology) Section: usually use "test cards" ○ Hepatitis B surface antigen - dengue test ○ Hepatitis Panel ○ VDRL and RPR for syphilis ○ Anti-HIV ○ Westernblot conﬁrms HIV ○ HCG — pregnancy ○ Antibody titer MICROBIOLOGY SECTION Identiﬁcation of pathogenic microorganisms, effective antibiotic therapy and infection control in the hospital. ○ Microscopic May be divided into: ○ Bacteriology culture gram staining KOH - , , ○ Mycology lungal sensitivity and culture - ○ Parasitology fungi identification only - ○ Virology -virus identification only Types of specimens: ○ Blood nottake everything ! ○ Sputum - Tuberculosis (TB) LESSON 2: CLINICAL LABORATORY PERSONNEL ○ Wounds ↳ caused by acid fast-bacteria ○ Feces CLINICAL LABORATORY PERSONNEL ○ Urine ○ GI tract ○ Throat swab Doctor LABORATORY DIRECTOR (PATHOLOGIST) ○ Cerebrospinal ﬂuid (CSF) Physician who has completed a 4-5 year pathology residency Common tests performed in the Microbiology Section: Works both in clinical and anatomical pathology ○ Culture and Sensitivity — primary procedure Liaison between the medical staff and lab staff performed ○ Gram stain ○ Blood culture LABORATORY MANAGER (ADMINISTRATOR) ○ Acid-fast bacillus (AFB) culture Medical labora scientist with a master’s degree and 5 or more ○ Fungal culture years of laboratory experience ○ Occult blood Responsible for overall technical and administrative ○ Ova and parasites — performed on stool sample management URINALYSIS SECTION TECHNICAL SUPERVISOR still a meatech ! Detect disorders and infections of the kidneys and detect Medical laboratory scientist with experience and expertise metabolic disorders such as diabetes and liver disease. related to particular laboratory section/s Consists of physical, chemical and microscopic examination Reviews all the lab results; consults the pathologist for of urine. in order ! do not interchange the test > - abnormal results results; scheduling of personnel; Urine samples must not sit at room temperature for longer maintenance of automated machines and provides research than 2 hours and developmental protocols for new test procedures Common tests performed in the Urinalysis Section: ○ Physical examination Color - hydration/denyuration MEDICAL LABORATORY SCIENTIST Volume Clarity A bachelor’s degree in medical technology and 1 year training in accredited laboratory Performs laboratory testing requiring independent judgment Minimal supervision ○ Chemical examination (Memorize ) ! unlicensed MEDICAL LABORATORY TECHNICIAN pH Protein 2-year associate degree from an accredited college medical Glucose laboratory program Ketones Performs laboratory testing by protocol under supervision Blood Bilirubin unlicensed LABORATORY ASSISTANT Urobilinogen Speciﬁc gravity Has a training in phlebotomy, sample receiving and Nitrite processing, quality control and preventive maintenance of Leukocyte esterase instruments, and computer data entry and can perform basic “waived” laboratory testing the smell of perfume can be particularly disturbing to a sick PHLEBOTOMIST person. High school diploma and a phlebotomy training program Hair including facial hair must be clean, neat, and trimmed. Sample collection and processing Long hair must be neatly pulled back. Like jewelry, long hair can become tangled in equipment or pulled by the patient. Long hair hanging near an infectious patient can transport the infection to your next patient. LESSON 3: PHLEBOTOMY AND THE HEALTHCARE Personal hygiene is extremely important because of close FIELD patient contact, and careful attention should be paid to bathing and the use of deodorants and mouthwashes. PHLEBOTOMY Fingernails must be clean and short. Based on the Centers for & the collection of blood samples for laboratory analysis to Disease Control and Prevention (CDC) Handwashing diagnose and monitor medical conditions Guidelines, artiﬁcial nail extenders are not allowed. Phlebotomist is a person trained to obtain blood samples primarily by venipuncture and microtechniques CULTURE DIVERSITY GUIDELINES 1. Approach all patients with a smile and use a friendly tone of DUTIES OF THE PHLEBOTOMIST voice. 1. Correct identiﬁcation and preparation of the patient before 2. Be alert to patient reactions to your approach and direct your sample collection actions to accommodate them. Do not force your style on 2. Collection of the appropriate amount of blood by venipuncture them. or dermal puncture for the speciﬁed tests 3. Do not stereotype a particular culture; not all people of same 3. Selection of the appropriate sample containers for the ethnic culture react in the same manner speciﬁed tests 4. Remember the amount of personal space varies not only 4. Correct labeling of all samples with the required information among people but also among cultures. Certain cultures are 5. Appropriate transportation of samples back to the laboratory not as welcoming to touching as we might expect them to be. in a timely manner Other cultures may reach for you while you are talking. 4 Always be kind ! 6. Effective interaction with patients and hospital personnel 5. Plan to spend additional time explaining procedures and 7. Processing of samples for delivery to the appropriate patient instructions. Be sure instructions are understood by laboratory departments asking the patient to repeat the instructions to you. In some 8. Performance of computer operations and record-keeping cultures nodding is considered a sign of politeness and not pertaining to phlebotomy understanding. 9. Observation of all safety regulations, quality control checks, 6. Above all, show respect for their diversity. and preventive maintenance procedures 10. Attendance at continuing education programs PHLEBOTOMY EDUCATION AND CERTIFICATION Certiﬁcation requirements: PROFESSIONAL AND PERSONAL CHARACTERISTICS FOR ○ Certiﬁcation examinations PHLEBOTOMIST CPC Computer adaptive testing Dependable, cooperative, committed DCS ○ Professional organization membership PAMET PAMET Compassionate, courteous, respectful CUR ↳ MT board passers ord ○ Continuing education PASMETH Integrity, honesty, competence IHf PASMETH Required for licensure ↳ organization of schools Organized, responsible, ﬂexible ORI - not offer MTCOurCes Maintain certiﬁcation Appearance Communication CERTIFICATIONS CULTURE DIVERSITY GUIDELINES a. Verbal b. Listening c. Body language d. Telephone Skills AMT most common in DH APPEARANCE GUIDELINES Clothing and lab coats must be clean and unwrinkled. Clothing worn under the laboratory coat should be conservative and meet institutional requirements. Lab coats must be completely buttoned and completely cover clothing. Shoes must be clean, polished, closed toed, and skid-proof. If jewelry is worn, it must be conservative. Dangling jewelry including earrings can be grabbed by a patient or become tangled in bedside equipment. Many institutions do not permit facial piercings and tattoos; if present, they must be completely covered. Makeup must also be conservatively applied. HEALTH-CARE DELIVERY SYSTEM Perfume and cologne are usually not recommended or must Employment settings: be kept to a minimum. 1. Hospitals Many persons are allergic to certain fragrances. Remember 2. Physician Ofﬁce Laboratories (POL) the phlebotomist works in close contact with the patient and 3. Health Maintenance Organizations (HMO) 4. Reference laboratories 5. Urgent care centers 6. Nursing homes 7. Home health-care agencies 8. Blood donor centers HOSPITAL PATIENT CARE AREAS CAP (COLLEGE OF Laboratory accreditation and provision of AMERICAN proﬁciency testing. PATHOLOGISTS) He UNses - criticallyl rns JOINT COMMISSION PATIENT SAFETY GOALS Improving the Accuracy of Patient Identiﬁcation Improving the Effectiveness of Communication among Healthcare Givers Reduce the Risk of Healthcare- Associated Infections Encourage Patients Active Involvement in Their Own Case as a Patient Safety Strategy PCRA - excretory system PATIENT’S BILL OF RIGHTS / PATIENT CARE PARTNERSHIP Require the phlebotomist to: LESSON 4: REGULATORY, ETHICAL, AND LEGAL Mis should never ○ Be respectful of their patients diagnose a patient ISSUES ○ Refer patients to their healthcare provider for the doctors are the one who diagnose information on their tests and condition AGENCIES ○ Recognize that a patient can refuse treatment ○ Maintain the conﬁdentiality of patient information ↳ never chike the results ! CLIA ( CLINICAL Requirements for persons performing LABORATORY waived, provider-performed microscopy, ETHICS VERSUS MEDICAL LAW IMPROVEMENT moderate-complexity, and high-complexity AMENDMENTS OF testing. Ethics standards - 1988) ○ are recommended standards of right and wrong Medical law conduct - ○ speciﬁes legally required conduct of health-care providers LEGAL ISSUES RELATED TO MEDICINE — TORT LAW JC (JOINT Accreditation and certiﬁcation of health care A wrongful act committed by one person against another that COMMISSION) organizations. causes harm to the person or his or her property is called a tort. TORT LAW Intentional 1. Assault – a harmful touching/threat without consent -I CLSI (CLINICAL AND Agency that develops written standrand 2. Battery – a harmful touching with consent (actual) LABORATORY and guidelines for sample collection, 3. Defamation – spoken or written words that can STANDARDS handling and processing, and laboratory injure a person.↳ take information : INSTITUTE) testing and reporting. Unintentional 1. Negligence –failure to give reasonable care in a uNI malpractice suit 2. Malpractice –Misconduct or lack of skills that results in injury to the patient LEGAL ISSUES RELATED TO MEDICINE — TORT LAW A wrongful act committed by one person against another that causes harm to the person or his or her property is called a tort. TORT LAW Intentional 1. Assault – a harmful touching/threat without consent 2. Battery – a harmful touching with consent 3. Defamation – spoken or written words that can injure a person. Unintentional 1. Negligence –failure to give reasonable care in a malpractice suit 2. Malpractice –Misconduct or lack of skills that results in injury to the patient SENTINEL EVENT An unexpected occurrence resulting in death or serious physical (such as loss of a limb) or psychological injury. A report including the event, a root cause analysis, and an action plan must be developed for the JC. Phlebotomist can cause a sentinel event by patient misidentiﬁcation and sample mislabeling. Mortal Sin : - Incorrect Labels TOPIC 2: SAFETY AND INFECTION CONTROL PMLS 038 | PRINCIPLES OF MEDICAL LABORATORY SCIENCE __________________________________________________________________________________________ ○ Breaking the chain: Disinfecting the work area kills SAFETY HAZARDS & ACTIONS the infectious agent and eliminates reservoir A health-care setting contains a wide variety of safety 3. Portal of Exit hazards, many capable of producing serious injury or ○ A way of exit of infectious agent to continue the life-threatening disease. chain of infection. Nose, mouth, and mucous. Types of Safety Hazards: ○ Breaking the chain: Disposing of contaminated 1. Biological materials 2. Sharp 3. Chemical 4. Means of Transmission 4. Radioactive ○ Must have a way to reach a susceptible host. 5. Electrical ○ Direct contact: unprotected host touches or touched 6. Fire/Explosives by the reservoir 7. Physical ○ Droplet: the host inhales material from the reservoir such as aerosol droplets ○ Airbone: inhalation of dried aerosol nuclei circulating on air currents or attached to dust particles non-living ○ Vehicle: ingestion of contaminated food or water living ○ Vector: parasites such as malaria transmitted by a mosquito bite. ○ Breaking the chain: Hand washing, PPE 5. Portal of entry ○ a means to enter the reservoir. Can be the same as portal of exit. ○ Breaking the chain: Disinfection and sterilization 6. Susceptible Host BIOLOGICAL HAZARDS ○ Patients are ideal susceptible hosts. This includes, Source: Infectious agents (bacteria, fungi, parasites, and ○ Patients, Elderly, Newborns, Healthworkers viruses) ○ Breaking the chain: Immunizations, Isolation, healthy Possible injuries: Infections — multiplication of microorganisms in body tissues Actions/Infection Control — procedures to control and monitor infections occurring within their facilities ○ Handwashing ○ Universal/Standard Precautions ○ Personal Protective Equipment ○ Isolation Procedures CHAIN OF INFECTION ➔ To prevent infection it is necessary to understand the components that make up the chain and the methods by which the chain can be broken down ➔ It requires a continuous link between six components: 1. Infectious Agent ○ consists of bacteria, fungi, parasites, and viruses. HAND HYGIENE ○ Breaking the chain: Early detection and treatment of infectious agents Hand contact represents the number one method of infection transmission. 2. Reservoir location Hand hygiene ○ where the infectious agent can live and possibly ○ includes both hand washing and the use of multiply. Humans, Animals, Insects, Fomites, Body alcohol-based antiseptic cleansers. ↑ used when hands is o ﬂuids Alcohol-based visibly soiled ○ cleansers can be used when hands are not visibly Respirators are individually ﬁtted for the wearer and are donned just contaminated. They are not recommended after prior to entering the room. contact with spore-forming bacteria including Clostridium difﬁcile and Bacillus sp. STANDARD PRECAUTIONS (SP) Standard Precautions (SP) were developed by the CDC by HAND WASHING TECHNIQUE treat all US combining the recommendations of Universal Precautions and infectious 1. Wet hands with warm water. Do not allow parts of body to when there is : Body Substance Isolation procedures. touch the sink. blood and SP assumes that every person in the health-care setting is · other body 2. Apply soap, preferably antimicrobial. Fluids potentially infected or colonized by an organism that could be semene 3. Rub to form a lather, create friction, and loosen debris. - SPUTUM transmitted. SP applies to all blood and body ﬂuids, mucous Thoroughly clean between the ﬁngers and under the membranes, and nonintact skin and stresses hand washing. ﬁngernails for at least 20 seconds; include thumbs and wrists in the cleaning. 4. Rinse hands in a downward position to prevent recontamination of hands and wrists. 5. Obtain paper towel from dispenser. 6. Dry hands with a paper towel. 7. Turn off faucets with a clean paper towel to prevent recontamination. Scrubbing the hands for 20 seconds is approximately the time it will take you to sing the ABCs or 2 rounds of "Happy Birthday." The continual emergence of antibiotic-resistant bacteria will result in modiﬁcations to Standard Precautions. TRANSMISSION-BASED PRECAUTION Hands should always be washed: In addition to the protective barriers provided by PPE, the Before patient contact spread of infection can be controlled by placing highly When gloves are removed infectious or highly susceptible patients in private isolation Before leaving the work area rooms. At any time when they have been knowingly contaminated Before going to designated break areas Before and after using bathroom facilities The order of Donning The order of Dofﬁng A (Putting on) PPE (Taking off) PPE 1. Gown 1. Gloves 2. Mask 2. Gown i BOUFF Ont Cup Y BOUFFIntCOP 3. Googles 3. Face shield 4. Face shield 4. Googles 5. Gloves 5. Mask 6. Respirator Note BIOLOGICAL WASTE DISPOSAL Phlebotomy equipment and supplies contaminated with blood and body ﬂuids must be disposed of in containers clearly marked with the biohazard symbol or red or yellow color coding. Items include: ○ Alcohol pads ○ Gauze ○ Bandages ○ Disposable tourniquets ○ Gloves ○ Masks ○ Gowns ○ Specimens (except urine) Contaminated non disposable equipment, blood spills, and blood and body ﬂuid processing areas must be disinfected. Disinfection Procedure ○ Most commonly used disinfectant: 1:10 dilution of sodium hypochlorite (household bleach). Preparation: Weekly. Storage: In plastic bottles (not glass). Application: Allow bleach to air dry on the contaminated surface before removal. SHARP HAZARDS Source: Needles, Lancets, and broken glass Possible injuries: Cuts, punctures (exposure to blood pathogens) Actions: ○ Never recap a needle ○ All sharps must be disposed of in puncture-resistant, leak-proof containers labeled with the biohazard symbol. ○ Needle safety devices must be activated before disposing of the entire blood collection assembly. ○ Sharps containers should not be overﬁlled ○ Sharps containers should be labeled with biohazard labels MATERIAL SAFETY DATA SHEET (MSDS) Red Bin Summary of the hazardous nature of chemicals used in the workplace Must be maintained and updated Must be provided for all products by the manufacturers It speciﬁcally includes: ○ chemical identity BLOODBORNE PATHOGENS properties [ ○ ○ chemical name and common name physical and chemical characteristics Bloodborne pathogens are of particular concern to health-care ○ signs and symptoms of exposure workers because of their exposure to blood and sharp objects such as needles. Of primary concern are: war ○ ○ ○ routes of entry exposure limits carcinogen potential cancerous - ○ Human Immunodeﬁciency Virus (HIV) ○ safe handling procedures ○ ○ Hepatitis B virus (HBV) Hepatitis C virus (HCV) mirigation[ ○ ○ spill cleanup procedures ﬁrst-aid tips (must be available in all cases of emergency) OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS STANDARDS RADIOACTIVE HAZARDS OEBPS It was ﬁrst published by OSHA in 1991 to protect health-care Source: Equipment and radioisotopes (release radiation as it workers from exposure to the blood-borne pathogens. breaks down) 2002 Revision: Updated compliance directive. (patients in the radiology department or from patients receiving ○ Requires immediate disposal of blood holders with radioactive treatments and in the laboratory when procedures using attached needles into sharps containers after radioisotopes are performed) activating the device's safety feature Possible injuries: Radiation exposure Postexposure Prophylaxis Actions: ○ Report any accidental exposure to blood (e.g. ○ Working in area; required to wear exposure devices needlestick, mucous membranes, or nonintact skin) ○ Radioactive Hazard Symbol must be displayed on immediately to a supervisor. the doors of all areas where radioactive material Start a conﬁdential medical examination right away. ispresent. Evaluation of the incident must begin immediately to ensure appropriate postexposure prophylaxis (PEP) is initiated within Exposure to radiation during pregnancy presents a danger to the fetus, 24 hours. and phlebotomists who are pregnant or think they may be should avoid areas with this symbol. ELECTRICAL HAZARDS Source: Ungrounded/Wet equipment; frayed cords Possible injuries: Burns or shock Actions: ○ Report damaged cords or equipment CHEMICAL HAZARDS Source: Preservatives and reagents Possible injuries: Exposure to toxic, carcinogenic, or caustic agents (burns)- Actions: ○ Avoid getting on you body, clothing, or work area (Skin contact - ﬂush with large amounts of water FIRE/EXPLOSIVE HAZARDS ○ Assume all are hazardous ○ Never mix the chemicals Source: Heat source or chemical ○ Material Safety Data Sheet (MSDS) Physical injuries: Burns or dismemberment Actions: Rescue Alarm contain Extinguish ○ RACE - , , , ○ PASS - pull Aim Squeeze sweep , , , ○ Evacuation plans ○ Designated chemicals are stored in safety cabinets or explosion proof refrigerators and are used under vented hoods. PHYSICAL HAZARDS Source: Wet ﬂoors, heavy boxes, patients Possible injuries: Falls, sprains, strains, etc. Precautions: ○ Avoid running in rooms and hallways ○ Be alert for wet ﬂoors ○ Bend the knees when lifting heavy objects or patients ○ Keep long hair tied back and remove dangling jewelry to avoid contact with equipment and patients. ○ Wear comfortable, closed-toe shoes with nonskid soles that provide maximum support TYPES OF FIRES AND FIRE EXTINGUISHERS ○ Maintain a clean, organized work area The National Fire Protection Association (NFPA)classiﬁes ﬁres with regard to the type of burning material and also classiﬁes the type of ﬁre extinguisher that is used to control them. OSHA PATHOGEN REGULATION Occupational Safety and Health Administration (OSHA) UNIVERSAL PRECAUTIONS HAZARDOUS MATERIALS CLASSIFICATION A policy of treating ALL blood, body ﬂuids and OPIM (other potentially infectious materials) as INFECTIOUS. The Standard System for the Identiﬁcation of the Fire Hazards of Materials, NFPA 704, uses a color-coded diamond symbol to inform ﬁreﬁghters of the hazards they may encounter when ENGINEERING AND WORK PRACTICE CONTROL ﬁghting a ﬁre in a particular area. Involve taking physical steps to isolate or remove any possible It features: pathogen hazards from the workplace ○ Blue for health hazard Examples: ○ Red for ﬂammability a. Sharps’ containers ○ Yellow for reactivity b. Biological safety cabinet ○ White for speciﬁc hazard c. Laboratory fume hoods d. Proper hand washing and handwashing facility Numbered according to the level of hazard from 0 (none), 1 (minor), 2 e. Banning of eating, smoking, and drinking inside the (moderate), 3 (severe) to 4 (extreme). lab PERSONAL PROTECTIVE EQUIPMENT (PPE) Gloves must be worn when coming in contact with specimens and other hazardous chemicals and OPIM. Gloves must be replaced every after one patient and where the protective integrity is compromised. Eye and face protection items Protective body clothing (lab gowns, aprons, lab coats, surgical caps and scrubs, shoe covers, and disposable arm sleeves) HOUSEKEEPING TECHNIQUES Must ensure that the workplace is maintained in a clean and sanitary condition Example: “Double-bagging” properly labeled with a warning and instructions for dealing with a leak or spill. TOPIC 3: PREANALYSIS IN THE CLINICAL LABORATORY PMLS 038 | PRINCIPLES OF MEDICAL LABORATORY SCIENCE __________________________________________________________________________________________ LESSON 1: PRE-ANALYSIS COMMON PREANALYTICAL ERRORS TESTING PHASE PHASE ERROR PRE-ANALYTICAL PHASE Clinical need BEFORE 1. Incorrect test ordered Order COLLECTION 2. Inadequate patient preparation (e.g., Collect not fasting, recent heavy Transport meal–-lipemia) or improper timing Receive (e.g., trough drug level drawn too Sort early) -> sin ! Mortal Prepare/centrifuge 3. Misidentiﬁcation of patient Uncap (if needed) Aliquot DURING 1. Wrong container/wrong additive ANALYTIC PHASE Load sample on analyzer COLLECTION 2. Short draws/wrong anticoagulant or Add sample/reagents blood ratio Mix 3. Hemoconcentration from prolonged Incubate tourniquet time Detect 4. Hemolysis due to incorrect technique Reduce data (e.g., forcing blood through needle, Produce result draw via intravenous line Review result Repeat test (if necessary) AFTER 1. Inadequate mixing/clots Release result COLLECTION 2. Mislabeling of specimen Recap tube 3. Improper transport to lab: Exposure POST ANALYTICAL PHASE Postprocessing storage to light/ extreme temperatures or Report result delayed delivery Access result 4. Processing errors: Incomplete Interpret result centrifugation, incorrect log-in, Integrate result improper storage or aliquoting prior Integrate with other clinical info to analysis Clinical action PATIENT-RELATED VARIABLES: PHYSIOLOGY PRE-ANALYSIS DIURNAL VARIATION Latin word "Diurnos" - All the context steps that MUST take place BEFORE a u DEFDAP EXERCISE sample can be analyzed FASTING 32-75% of testing errors happens here DIET Careful attention is necessary in this phase to ensure AGE/GENDER/RACE meaningful results POSTURE Errors = extra work; diagnosis delayed; extra-cost PATIENT-RELATED VARIABLES: PHYSIOLOGY PRE-ANALYTICAL POTENTIAL ERRORS FACTORS Patient-related Improperly ordered tests, variables (diet, sample misidentiﬁcation age, sex, etc.) Improper timing, improper Patient fasting · Preparation Improper Collection & anticoagulant:blood ratio Labeling improper mixing Preservatives & incorrect order of draw Anticoagulants Hemolyzed/lipemic Transport specimens. Processing & Storage PATIENT-RELATED VARIABLES: COLLECTION A patient is combative (i.e. geriatrics and pediatrics) IN VIVO - inside TS A TOBACCO SMOKING TIME OF COLLECTION ALCOHOL & DRUG INGESTION most common tests are the ASAP and the stat IN VITRO laboratory > - LATIN NORD : ○ ASAP = "as soon, as possible" HEMOLYZED STATIM ; ○ Stat = "immediately" and is highest priority ICTERIC Timed specimens are ordered usually to: LIPEMIC ○ monitor changes in a patient's condition HEMODILUTED/CONCENTRATED ○ determine the level of a medication ANTICOAGULANT USE ○ measure how well a substance is metabolized SPECIMEN ACCEPTABILITY FORMATIVE QUESTION: Failure to foltow can result in specimen rejection 1. MedTechs play a HUGE role in diagnosis since they alone Rejected specimen means more cost and more delay can determine and screen specimen acceptability (TRUE) IPSG#1: IDENTIFY PATIENTS CORRECTLY 2. Interpretation of results is part of the analytical phase of testing (FALSE) 3. Diet does not affect analytes (FALSE) REASONS FOR SPECIMEN REJECTION: Hemolysis/lipemia Clots present in an anticoagulated specimen PATIENT PREPARATION Non Fasting specimen when test requires fasting Improper blood collection tube TEST ORDER [TO) Short draws, wrong volume Improper transport conditions (ice for blood gases) - Laboratory tests are usually ordered electronically or in Discrepancies between requisition and specimen label writing Unlabeled or mislabeled specimen Online computer input is the most error-free Contaminated specimen/leaking container Verbal requests are made only in emergency situations and should be documented on a standard form REASONS FOR SPECIMEN REJECTION: PATIENT TEST ORDER LAB INFO SYSTEM (LIS) Do NOT assume any information about the specimen or Patient's name Provides quick access to: patient. Age/Sex List of available tests Do NOT relabel an incorrectly labeled specimen. Date of birth (DOB) Types of specimens Do NOT discard the specimen until the investigation is Date of admission (for required, complete. inpatients) Collection Methods Leave specimen EXACTLY as you receive it; put in the Date of test order Blood collection tubes refrigerator for preservation until errors can be resolve Location Amounts of Notify the ﬂoor, nursing station, doctor's ofﬁce, etc. of the Attending Physician blood/body ﬂuid problem and why it must be corrected for analysis to required continue. Turnaround time Identify problems on specimen requisition with date, time, Costs and your initials. Make the person responsible for specimen collection participate in the solution of problems. Any action taken should be documented on the requisition slip. PATIENT ID AND CONSENT Report all mislabeled specimens to the quality assurance board. MORTAL SIN: In collection, ensure: MISIDENTIFIC ID of the patient ATION Labeling of the specimen PROPER LABELING ALIQUOTING LABELING Patient Patient consent and privacy Misidentification Chain of custody written document - of the Patient’s name Patient’s name procedure to be done. Age and sex Age and Sex TEST HIV Testing Date of Birth Date REQUIRING Drug Testing Date and time of Type of specimen COC Nucleic Acid Test collection chain custody Networking Tests/Send-Out Tests Phlebotomist’s initials of ISSUES Policies should describe What to do when: ARISING IN PX A patient refuses blood collection ID A patient was unable to be drawn A patient is unavailable SPECIMEN COLLECTION OVERVIEW BLOOD (WC, SERUM/PLASMA) Most common specimen Venipuncture is performed using a needle/adapter assembly attached to a syringe/ evacuated glass with a rubber stopper. transferred to the appropriate specimen container PROBLEMATIC SITES Burns, Scars, Tattoos Damaged Veins ○ Sclerosed narden vein - ○ Thrombosed blood clots - Edema Hematoma Mastectomy IV sites Fistula SITUATIONS THAT CAN TRIGGER HEMATOMA FORMATION The vein is fragile or too small for the needle size. The needle penetrates all the way through the vein. The needle is only partly inserted into the vein. Excessive or blind probing is used to locate the vein. TUBES ADDITIVES The needle is removed while the tourniquet is still on. Pressure is not adequately applied following venipuncture. Is placed inside evacuated tubes Contains additives which serve speciﬁc functions Functions optimally only when tube is completely ﬁlled and gently inverted/mixed BLOOD COLLECTION DEVICES TOURNIQUET/VEIN PALPATION Categorized as: ANTICOAGULANTS Prevents blood from clotting · Lavender ECHO · Light Blue EDTA, citrate, heparin, oxalate · Green · Gray - gray ANTIGLYCOLYTIC AGENTS - soliumfinoride ! prevents glycolysis sodium ﬂuoride CLOT ACTIVATORS TSD Speeds up clotting Thrombin, silica particles, diatomite THIXOTROPIC GEL Separates serum/plasma from cells OTHERS ↳ sodium polyethanol sulfonate BLOOD COLLECTION TUBES SPS (anticoagulant, anticomplement) color-coded ARD (antibiotic removal device) pre-determined internal vacuum converted from glass to plastic collection tubes to minimize exposure to biohazards and broken glass EDTA (Ethylenediaminetetraacetic acid) Anticoagulant of choice for hematologic counts and morphology shape of cells > - Mechanism: Chelates/binds calcium NO. OF INVERSIONS: 8-10 times Anticoagulant for: ○ Hematology ○ Cell Morphology Specimen type: Whole blood / Plasma TWO SALTS OF EDTA SODIUM FLUORIDE-OXALATE DIPOTASSIUM (K2EDTA) TRIPOTASSIUM (K3EDTA) generally used for glucose measurements because they contain a antiglycolytic agent which prevents glycolysis for 3 /2 his Spray-dried In glass liquid form days “versene” in plastic is NO. OF INVERSIONS: 8-10 times ! specimen : serum spray- dried – used for hematology, blood sodium Flouricle ↳ antiglycolytic agents donor screening OX CICITe anticoagulant - PINK-TOP (EDTA): ABO grouping, Rh typing, Antibody Hours. If PIUSMU is needed NACEDTA · , Or

TOPIC 1: Introduction to Phlebotomy: The Clinical Laboratory PDF

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