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Pmls #2 Alkuino Bmls 1b
Pmls #2 Alkuino Bmls 1b
Pmls #2 Alkuino Bmls 1b
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POINT- OF-CARE TESTING
PMLS
The phlebotomist must prioritize his or her workload accordingly to accommodate the various test priorities
In order for Phlebotomist to accommodate the various test priorities he or she must arrange his/her work
loads accordingly. The three different types of sample collection priorities, namely Routine sample, ASAP
samples and STAT samples.
Routine samples, is a test given to monitor and diagnose the patient’s condition. It is usually
collected during scheduled “sweeps” (collection times).
As soon as Possible or ASAP, which the time collection is determined by clinic and hospitals.
STAT samples, is the highest prioritized sample and the result must be released and reported
immediately. It is usually ordered from the emergency department and patient with critical
condition.
It is type of sample that collected from a patient who has had nothing to eat or drink except. The
fasting sample is usually collected from the patient who is refrained from consuming food and drinks for
12 hours, while the basal state is collected from the fasting patient and who is also refrained from exercise.
In addition, the analytes that requires the fasting samples are Glucose, Triglyceride, and lipid profiles.
GTT is usually used for the diagnosis of diabetes mellitus and gestational diabetes. It contained 2 hours
postprandial glucose test where the glucose level of the fasting patient is compared with the glucose level
2 hours after consuming a meal with high content of carbohydrate. The classic GTT requires the patient to
drink a standard glucose load and return for testing on an hourly basis.
Before performing the test, the Patients should be been Fasting for 12 hrs, not more than 16 hrs, should be
AMBULATORY, consume unrestricted diet of 150g Carbohydrate/day for 3 days prior to testing, Patient
should NOT exercise, smoke & drink alcohol prior to testing, and as required, the Glucose load for Adults
is should be 75g while Children receive 1.75g/kg of body weight.
Step 4. Ask the patient to drink the appropriate flavored glucose solution within 5 minutes.
Step 5. Timing for the remaining collection times begins when the patient finishes drinking the glucose
solution.
Step 6. Collect remaining samples at the scheduled times.
The Following are the Glucose Tolerance test scheduled for 3-hour test:
Alcohol
Anticonvulsants
Aspirin
Birth Control Pills
Blood Pressure Medications
Corticosteroids
Diuretics
Estrogen-Replacement Pills
The test used to diagnose lactose intolerance and evaluates patient’s ability to digest lactose. The principle:
Lactose degraded by lactase into glucose and galactose, where the patient consume a standard lactose
solution; performing the same procedure with GTT.
C. Diurnal Variation
Eosinophils
Serum Iron
Glucose
Corticosteroids
The test is performed to ensure patient safety and medication effective ness, the blood levels of
many therapeutic drugs are monitored. The trough levels are instantly collected before the drug is to be
given and it represent the lowest level in the blood, ensuring drug is within therapeutic range. In addition,
the gathering for peak levels varies with the medication and method of administration.
Methotrexate
Theophylline
Various Antibiotics
Phenobarbital
Digoxin
Lithium
V. BLOOD CULTURE
Blood Culture are usually requested on patients with symptoms indicating a possible septicemia
and requires strict aseptic technique. Also, it can be used to diagnose and identify the causative pathogen
and determine most effective treatment.
A. Timing of Collection
It is usually ordered stat or as timed collections. The samples are collected in sets of two drawn 30
or 60 minutes apart, or just before the patient’s temperature reaches its highest point. Hence, the sets are
drawn at the same time from different sites if antibiotics are to be started immediately.
B. Collection Equipment
Blood can be drawn directly into blood culture tubes containing anticoagulant, sodium polyanethol
sulfonate. Antimicrobial removal devices (ARDs) is also present in some blood culture collection system,
which has resin that inactivates antibiotics. Similarly, fastidious antimicrobial neutralization (FAN) blood
collection system uses bottles that contain an activated charcoal that neutralizes the antibiotic.
Cleansing typically begins with vigorous scrubbing of the site for 1 minute using isopropyl alcohol. It
should be from the center of the puncture site progressing outward 3 to 4 inches in concentric circles.
Antiseptics for disinfecting:
2% iodine tincture
povidone-iodine
multiple isopropyl alcohol preps
chlorhexidine gluconate
Sample Collection
In sample collection there are Two samples are routinely collected: one incubated aerobically and
the another anaerobically. In Syringe method, anaerobic bottle inoculated first while in winged blood
collection set, aerobic bottle inoculated first. Overfilling and Underfilling of the bottles cause false result.
There should be at least a 1:10 ratio of blood to media. Adult blood culture bottles usually require
8 to 10 mL for each and pediatric bottles require 1 to 3 mL for each.
C. Procedure
Performing Arterial blood collection is more difficult, uncomfortable and dangerous to patient. The
Arterial blood Collection is not a routine duty of the phlebotomist. Also, it is usually requested for
evaluation of blood gasses, ammonia, and lactic acid.
Blood Gases
The test measures the ability of the lungs to provide oxygen (O2) to the blood and to remove
carbon dioxide (CO2) from the blood and exhale it. It is usually tested using specialized instrumentation
designed to measure the pH, PO2 and PCO2, and to determine HCO3, ctO2 and
O2Sat levels.
A. Equipment
It is collected and transported in specially prepared syringes like plastic and glass syringe. Plastic
syringe with freely moving plunger, it must contain 25 gauge and are 5/8 to 11/2 inches long, while the
Glass syringes must be available for use when samples cannot be tested within 30 minutes.
B. Site Selection
The Arterial punctures are considered as a hazardous procedure. Hence, site selection should be performed
and followed properly.
Radial Artery
Brachial Artery
Femoral Artery
Umbilical Artery
Scalp Artery
Foot Artery
Performed if the puncture site is the radial artery and to determine if the ulnar artery id capable of
providing collateral circulation to the hand. It is advisable to choose another site if it lacks of available
circulation to prevent loss of the hand or its function.
C. Procedure
D. Technical Errors
E. Complications
It is used to accumulate units of blood to provide the blood bank a supply of blood and blood
components for transfusions. 1 unit of blood is composed of 405 to 495 mL of blood mixed with 63 mL of
anticoagulant and preservative. The preservatives of the blood are Citrate -Phosphate-Dextrose and Citrate
-Phosphate-Dextrose with Adenine.
The process for accumulating blood from donors is alike to that used for blood sampling; yet,
limited additional measures are required for collection of donated blood. Blood donor collections are
performed following guidelines established by the American Association of Blood Banks (AABB) and the
Food and Drug Administration (FDA) for donor selection and unit collection and processing.
In order to minimize contamination of blood products from the skin flora of the donor’s arm, it is
advisable to measure primarily to ensure patient safety. Safe blood collection ensures that the blood
products are safe for therapeutic use throughout their shelf life.
A. Responsibilities of a Phlebotomist
B. Equipment Requirements
Sterile, closed systems consisting of one or more plastic bags connected to tubing and a
sterile needle
Large-gauge needles
15 to 16 regular gauge, or
17 gauge thin-walled
Tourniquet or blood pressure cuff
C. Procedure
The Blood Bank Procedure:
D. Post-Donation Care
Donor Care
Transfer the blood unit to a proper storage container according to the product and the blood bank
requirements.
Ensure that collected blood samples are stored and delivered to the laboratory with completed
documentation and in a leak-proof, closed container.
E. Adverse Reaction
Hematoma
Dizziness
Fainting
Arterial puncture
Nerve damage
Infection
A. Cold Agglutinins
B. Chilled Samples
Chilling the gathered samples inhibits metabolic processes that continue after blood collection and
can adversely affect laboratory results. For adequate chilling, the sample must be placed in either crushed
ice or a mixture of ice and water, or in a uniform ice block at the bedside. Potassium levels will be falsely
increased if the sample is chilled. Also, prothrombin time (PT) (international normalized ratio [INR])
testing is unacceptable as it may cause activation of Factor VII and alter the results.
C. Light Sensitive Samples
Artificial light or sunlight (ultraviolet) exposure for any length of time may decline the
concentration of various analytes.
Bilirubin
β-carotene
Vitamin A
Vitamin B6
Vitamin B12
Folate
Porphyrins
The test usually requested for medical reasons, legal reasons, or as part of employee drug screening.
It must strictly follow the chain of custody (COC) protocol. Benzalkonium chloride is the disinfectant to
the puncture site for this test. The sample collected is put in gray stopper tubes.
Samples can be collected by dermal puncture and tested by phlebotomists or other health-care
personnel in the patient area. Test results are available quickly and transportation of samples to the
laboratory is avoided. Phlebotomists performing point-of-care testing (POCT) should follow all
manufacturer recommendations.
A. Location
C. Disadvantage
E. Regulatory Requirements
Clinical Laboratory Improvement Act of 1988 (CLIA 88) established standards for all laboratory
testing to ensure accuracy, reliability, and timeliness of patient test results regardless of where the test was
performed.
LEVELS OF COMPLEXITY
Certificate of Waiver Waived Testing
Certificate of Registration Provider-Performed
Certificate for PPMPs Microscopy Procedures
Certificate of Compliance Moderate-Complexity
Certificate of Testing
Accreditation High-Complexity Testing
Waived Testing
• Requires minimal training and education to perform. The erroneous results are likely negligible. It poses
no harm when done incorrectly. Most POC tests are waived.
Provider-Performed Microscopy Procedures
Must only Performed by licensed physicians, dentists, and midlevel practitioners. It is subcategory
of moderate complexity testing. Involves the use of a microscope. Usually There are no QC materials
available
• Wet mounts
• KOH preparations
• Pinworm examinations
• Postcoital direct examinations
• Fern test
• Semen analysis
• Nasal smears for eosinophils
It is also “non-waived testing”. The test is usually performed in larger and more advanced
laboratory settings and majority of POCT is moderate complexity.
E. Types of Analyzer
REFERENCES
• The phlebotomy textbook by Strasinger, 3rd ed.
• Clinical Chemistry: Principles, Techniques, and Correlations by Bishop, 7th ed.
• Tietz Fundamentals of Clinical Chemistry, 6th ed.