1. Chapter 11 Special Collections and POCT

2. OBJECTIVES
Define the key terms and abbreviations listed at the beginning of this chapter.
Explain the principle behind and list any special equipment required and the steps involved for each of the special collection procedures.
Describe patient identification and specimen labeling procedures, and identify the type of specimen required for blood bank tests.
Explain and state the importance of sterile technique in the collection of blood cultures and identify the reasons why a physician might order them.

3. OBJECTIVES
Identify and describe how to properly collect coagulation specimens.
Describe chain of custody procedures and identify the tests that may require them.
State the importance of peak and trough levels in therapeutic drug monitoring.
Define point-of-care testing (POCT), identify and explain the principle behind the tests commonly performed as POCT, and list special equipment required and the steps involved for POCT tests.

4. 82. Explain the importance of collecting Blood Bank Specimens
Safe blood transfusions
Compatability
Strict procedures must be followed when identifying the patient and labeling the specimen

5. Blood Bank Specimens Lavender stopper Specimen requirements
Red stopper
Lavender stopper
Pink top EDTA tube
Labeling requirements
Patient full name
Patient’s ID number
Patient’s date of birth
Date and time of collection
Phlebotomist’s initials
Optional room & bed number

6. Blood Type & Crossmatch Requirements
Type and screen
Most common tests in blood bank
Determines patient’s blood type, ABO, and Rh
Crossmatch
Uses patient’s type & screen results to select donor’s blood
Determines compatibility
Incompatibility can be fatal due to:
Agglutination
Lysis

7. Special Identifications System
Typenex and Securline
Special bracelet that contains a unique ID number
Patient’s ID information written on self-carbon adhesive label
Label peeled from bracelet & placed on specimen tube
Additional ID numbers sent to lab to be attached to unit of blood

8. 83. What is “Autologous” units?
Your own blood

9. 84. What is “FUO”? Also why is this important to a Doctor?
Fever of unknown origin

10. BLOOD CULTURES Blood cultures help determine the:
presence and extent of infection, …
indicate the type of organism responsible, and….
the antibiotic to which it is susceptible

11. 85. What is the difference between “bacteremia and septicemia?
Bacteremia – few bacteria in blood
Septicemia – microbes in blood (toxic), fever,
very serious medical situation

12. 86. What is the difference between” aerobic “and “anaerobic”
Aerobic – with air
Anaerobic – without air

13. Timing for Blood Culture Drawing
Blood cultures are typically ordered immediately before or after anticipated fever spikes when bacteria are likely to be present.
Timely collection is essential.
The best chance for detecting bacteremia exists from ½ hour to 2 ½ hours prior to the next fever peak
Usually two specimens are drawn minutes apart or from two different sites

14. Blood Culture Volume Depending upon the blood culture system,
10 mL is usually the minimum volume.

15. 87. List 3 other types of antiseptic for B/C, also explain why they might be used?
10% povidone or 1-2% tincture of iodine
Benzalkonium chloride
Chlorhexidine gluconate/isopropyl alcohol

16. Skin Antisepsis Most important part of BC collection
Failure to follow sterile technique
Introduces skin surface bacteria
Interferes with interpretation of results
Various cleaning agents used

17. Skin Antisepsis (continued)
First cleanse
Surface dirt and debris removed
70% isopropyl alcohol, 30 sec. scrub
Second cleanse
1% to 2% tincture iodine, 30 sec. scrub
Povidone swabstick, 60 sec.
Scrub concentric circles
Treat gloved finger the same

18. Cleansing Arm for Blood Culture

19. BC Procedure Clean tops of culture bottles with 70% Isopropyl alcohol
Reapply tourniquet
Mark minimum & maximum fill on side of culture bottles
Using special adapter, fill bottle with right amount of blood

20. BC Procedure (continued)
Fill anaerobic bottle first unless collected with butterfly, then use aerobic first (due to air in the line)
Mix each bottle
Clean the iodine from patient’s skin with alcohol

21. Antimicrobial Neutralization Products
To be used to remove antimicrobial therapy present in patient’s blood
Neutralization products
ARD (antimicrobial removal device)
Resin
FAN (fastidious antimicrobial neutralization)
Activated charcoal
Deliver to the lab as soon as possible

22. 88. What is the device called, from getting blood from a syringe to tubes or blood culture bottles?
Syringe or Blood transfer device

23. 89. What does 2 hour PP indicate, and why is this important?
2 hours after a meal

24. Postprandial Glucose Testing
Definition
Glucose levels after a meal
2 hour postprandial (pp)
Test procedure
Preparation—high carb diet 3 days prior to the test
Fasting & no smoking
Special breakfast equivalent to 100 g glucose
Collection after 2 hours

25. 90. What does GTT stand for and how does it relate to increased and decrease glucose levels?
Glucose Tolerance Test –
Hyperglycemia – increased glucose levels
Hypoglycemia – decrease glucose levels

26. Glucose Tolerance Test
To check for carbohydrate metabolism problems and evaluate insulin response
Diagnosis for two major types of disorders
Hyperglycemia
Hypoglycemia
Written and verbal instructions should be given to patient

27. Glucose Tolerance Procedure
Preliminary preparation
Fasting specimen collection
Ingestion of glucose
Adults – 75 g glucose
Pregnant adults-- 50g
Children & smaller adults – 1g/kg

28. Glucose Tolerance Procedure (continued
Timing the test
Length specified by physician 3, 5, or 6 hr!
Must be drawn on time
Specimen labeling very important (ID for each
specimen!)
Fasting, ½ , 1, 2, 3, 5, or (6)
Urine Specimen with each collection: Usually urine
chemstrip used for test
Consistent method of collection
No food, drink, or smoking allowed. Water is acceptable

29. 91. What I s “TDM”? And how does it relate to peak and trough level of the blood?
Therapeutic Drug Monitoring

30. Therapeutic Drug Monitoring (TDM)
Used to manage patient drug treatment
Establishes drug dosages
Maintains dosages at beneficial levels
Avoids drug toxicity
Timing in regard to drug dosage
Critical for safe treatment
Must be consistent
Team effort
Pharmacy, nursing & lab
Phlebotomist key player

31. Therapeutic Drug Monitoring (TDM) (continued)
Collection times
Peak collected minutes after administration of drug
Trough collected immediately before administration of the next dose
Critical for short half-life drugs, ie, amikacin
Collection tubes
Gel tubes may affect TDM
Consult manufacturer package inserts

32. TDM Dose-Response Curve
Steady state
Usually after
5 doses of drug

33. 92. Name 2 therapeutic reasons for withdrawing blood
Polycythemia – overproduction of RBC
Hemochromatosis – iron deposits in the tissues.

34. Therapeutic Phlebotomy
Definition
Withdrawal of approx. 500 ml
Used to treat
Polycythemia
Overproduction of RBCs
Monitored regularly
Hemochromatosis
Excess iron deposits in the tissues
Periodic removal causes depletion of excess iron stores

35. 93. What does “ETOH” indicate
93. What does “ETOH” indicate? And what is important to remember about this test?
Blood alcohol level
Don’t use alcohol to clean site

36. Toxicology Specimens Blood alcohol (plasma or serum)
Medical
Forensic
Cleaning solutions
Tube type and rules of handling
Forensic specimens (Urine, plasma, or serum)
EtOH, drug levels, DNA analysis
Chain of custody

37. 94. What does “POCT” stand for
94. What does “POCT” stand for? What are the benefits of testing this way, list several tests
Point of Care Testing - faster results
-BT – Platelet formation
ACT – Activated clotting time
ABG Arterial blood gas
Lytes -Electrolytes
Lipids - Lipids
Gluc - Glucose
HCT - Hematocrit
Hgb - Hemoglobin
Preg (HCG) – Pregnacy test

38. Point-of-Care Testing (POCT)
Reasons for POCT
Convenience to the patient
Short TAT allows for:
Providers to address crucial patient needs
Deliver prompt medical attention
Help expedite patient recovery
Portable, hand-held instruments
Personnel must be trained
QC & maintenance procedures mandatory