Post on 07-May-2015
Clinical LaboratoryClinical Laboratory
Antonio Rivas PA-C2009
Antonio Rivas PA-C2009
Clinical or Medical Laboratory
Clinical or Medical Laboratory
Laboratories that perform chemical and microscopic tests on:
bloodother body fluidstissues
Laboratories that perform chemical and microscopic tests on:
bloodother body fluidstissues
Clinical LaboratoriesClinical Laboratories Play a major role in patient care Variety of settings Two types of Clinical.Laboratory
Hospital lab. Non hospital lab.
POLs Reference laboratories(LABCORP/QUEST D.) Government laboratories - federal
Center for Disease control and Prevention(CDC)
Epidemiology labs Laboratory Response Network
Play a major role in patient care Variety of settings Two types of Clinical.Laboratory
Hospital lab. Non hospital lab.
POLs Reference laboratories(LABCORP/QUEST D.) Government laboratories - federal
Center for Disease control and Prevention(CDC)
Epidemiology labs Laboratory Response Network
Government Laboratories- state
Premarital blood testing PKU testing in newborns Fungi,virus, and mycobacteria culture
Government Laboratories- state
Premarital blood testing PKU testing in newborns Fungi,virus, and mycobacteria culture
Regulations of Clinical Laboratory
Regulations of Clinical Laboratory
All laboratories, but research labs.are regulated by Federal and State agencies
CLIA’88- Clinical Laboratory Improvement Amendments of 1988:
Is a revision to the original CLIA of 1967, specifies the minimum performance standards for all Clinical Laboratories
All laboratories, but research labs.are regulated by Federal and State agencies
CLIA’88- Clinical Laboratory Improvement Amendments of 1988:
Is a revision to the original CLIA of 1967, specifies the minimum performance standards for all Clinical Laboratories
Objectives of CLIA’88Objectives of CLIA’88
To ensure quality Laboratory Testing, amendments are continually revised, updated, clarified and refined
CMS:Center for Medicare and Medicaid Services,agency within the Department of Health and Human Services responsible for implementing CLIA’88
To ensure quality Laboratory Testing, amendments are continually revised, updated, clarified and refined
CMS:Center for Medicare and Medicaid Services,agency within the Department of Health and Human Services responsible for implementing CLIA’88
CMSCMS
Any Laboratory performing Lab.tests in humans ,except for research Labs. Must obtain a certificate from CMS (center for medicare-medicaid services) to be allowed to operate
Any Laboratory performing Lab.tests in humans ,except for research Labs. Must obtain a certificate from CMS (center for medicare-medicaid services) to be allowed to operate
Laboratory PersonnelLaboratory Personnel
Director of the Lab.- Pathologist, MD, DO, or hold a doctorate in a related clinical field. Hold certification and have supervisory and clinical laboratory experience
Technical supervisor/Lab.Manager-someone educated in the clinical laboratory sciences who has additional business experience
Director of the Lab.- Pathologist, MD, DO, or hold a doctorate in a related clinical field. Hold certification and have supervisory and clinical laboratory experience
Technical supervisor/Lab.Manager-someone educated in the clinical laboratory sciences who has additional business experience
Laboratory personnelLaboratory personnel
General supervisor for each area
Testing personnel: Medical Technologists(MT/CLS) Medical Lab.Technicians(MLT/CLT) Medical assistants/nursing staff(POLs)
General supervisor for each area
Testing personnel: Medical Technologists(MT/CLS) Medical Lab.Technicians(MLT/CLT) Medical assistants/nursing staff(POLs)
Departments of the Clinical LaboratoryDepartments of the Clinical Laboratory
Clinical Chemistry Hematology Microbiology Blood Bank Supports Services (Phlebotomy/Specimen Processing)
Clinical Chemistry Hematology Microbiology Blood Bank Supports Services (Phlebotomy/Specimen Processing)
Clinical ChemistryClinical Chemistry
Tests perform in serum, plasma, urine and other body fluids such as spinal fluid, or joint fluid
Largest department in the Lab. Toxicology Special chemistry
Tests perform in serum, plasma, urine and other body fluids such as spinal fluid, or joint fluid
Largest department in the Lab. Toxicology Special chemistry
HematologyHematology
Studying of the cellular components of the blood
Quantitative or Qualitative Coagulation Urinalysis Special hematology
Studying of the cellular components of the blood
Quantitative or Qualitative Coagulation Urinalysis Special hematology
Microbiology Microbiology
Culture/identification microorganisms
From sputum, wounds, blood, urine and other body fluids
Inoculated in culture media Organisms are identified and susceptibility test are performed
Bacteriology, virology, serology, parasitology
Culture/identification microorganisms
From sputum, wounds, blood, urine and other body fluids
Inoculated in culture media Organisms are identified and susceptibility test are performed
Bacteriology, virology, serology, parasitology
Blood BankBlood Bank
Also called immunohematology or transfusion services
ABO group and Rh typing Antibody testing Storage of packed cells units Processing of some components like platelets and cryoprecipitate
Also called immunohematology or transfusion services
ABO group and Rh typing Antibody testing Storage of packed cells units Processing of some components like platelets and cryoprecipitate
Support ServicesSupport Services
Phlebotomists Accessioning
Phlebotomists Accessioning
POCTPOCT
Point of care testing brings the laboratory to the patient, also called bed-side testing
Use small simple analyzers Portable instruments Hgb, glucose, electrolytes,and cholesterol
Point of care testing brings the laboratory to the patient, also called bed-side testing
Use small simple analyzers Portable instruments Hgb, glucose, electrolytes,and cholesterol
Quality Assessment System
Quality Assessment System
QA.is incorporated to each department’s procedure manuals and day to day operation
Standardized material are analyzed on each instrument to document precision, and reproducibility
Calibration, maintenance and repair of the instruments is recorded
Participate in proficiency testing programs
QA.is incorporated to each department’s procedure manuals and day to day operation
Standardized material are analyzed on each instrument to document precision, and reproducibility
Calibration, maintenance and repair of the instruments is recorded
Participate in proficiency testing programs
Health care agencies have very specific standards, rules and regulations governing the education and job responsibilities of the laboratory personnel
Lab.professionals are required to complete an authorized program and certification
Lab. Personnel need to observe/protect patient privacy
Health care agencies have very specific standards, rules and regulations governing the education and job responsibilities of the laboratory personnel
Lab.professionals are required to complete an authorized program and certification
Lab. Personnel need to observe/protect patient privacy
safetysafety
Occupational Safety and Health Administration(OSHA) began in 1970 as a legislation and subsequent rules that mandate increased attention to safety in workplaces
The Clinical laboratory has, physical, chemical and biological hazards
Occupational Safety and Health Administration(OSHA) began in 1970 as a legislation and subsequent rules that mandate increased attention to safety in workplaces
The Clinical laboratory has, physical, chemical and biological hazards
PPEPPE
Employees in the clinical lab are required to use personal protective equipment:
Gloves Mask Gowns
Employees in the clinical lab are required to use personal protective equipment:
Gloves Mask Gowns
BiohazardsBiohazards
In 1980 clinical laboratory safety training concentrated in protection from chemical, physical,and contagious diseases such as tuberculosis
The discovery of AIDS, increased in Hepatitis B virus(HBV) and Hepatitis C virus(HCV) brought an emphasis on biological safety
The term Biohazard came into use A Biohazard symbol was adopted that indicates the presence of biological hazard or biohazardous condition
In 1980 clinical laboratory safety training concentrated in protection from chemical, physical,and contagious diseases such as tuberculosis
The discovery of AIDS, increased in Hepatitis B virus(HBV) and Hepatitis C virus(HCV) brought an emphasis on biological safety
The term Biohazard came into use A Biohazard symbol was adopted that indicates the presence of biological hazard or biohazardous condition
Evolution on Biological safety
Evolution on Biological safety
By 1960 infectious patients were placed in ISOLATION rooms
1970-CDC outlined isolation guidelines and listed isolation categories
1985-in response to the increasing AIDS/HIV epidemic CDC adopted Universal Blood and Body fluids precautions, to be applied in all patients regardless of their infectious status
1987- Body substance Isolation, included all body fluid even if not visibly contaminated with blood
By 1960 infectious patients were placed in ISOLATION rooms
1970-CDC outlined isolation guidelines and listed isolation categories
1985-in response to the increasing AIDS/HIV epidemic CDC adopted Universal Blood and Body fluids precautions, to be applied in all patients regardless of their infectious status
1987- Body substance Isolation, included all body fluid even if not visibly contaminated with blood
Evolution on Biological safety
Evolution on Biological safety
1991-OSHA issued “Bloodborne pathogens standard”, not included on previous regulation
1996- CDC implemented “Standard Precautions” that includes a comprehensive set of safety guidelines for Health care workers rendering care to patients, this is the current terminology
To control nosocomial(inst.acquired) infections Transmission-based precautions(additional practices for pathogens that spread by air, droplets, and contact
1991-OSHA issued “Bloodborne pathogens standard”, not included on previous regulation
1996- CDC implemented “Standard Precautions” that includes a comprehensive set of safety guidelines for Health care workers rendering care to patients, this is the current terminology
To control nosocomial(inst.acquired) infections Transmission-based precautions(additional practices for pathogens that spread by air, droplets, and contact
Evolution on Biological safety
Evolution on Biological safety
2001-OSHA revised the BBP(blood borne pathogen) standard to prevent accidental needle-sticks in the workplace
2001-OSHA revised the BBP(blood borne pathogen) standard to prevent accidental needle-sticks in the workplace
Standard PrecautionsStandard Precautions Requires that every patient and every body fluid, body substance, organ, or unfixed tissue be regarded as potentially infectious Hands wash(plain soap)
After touching body fluids and contaminated items, after removing gloves and between patient contact
Wear gloves When touching blood/body fluids/secretions, wear clean gloves when touching mucous membranes and nonintact skin
Wear mask/eye protection/face shield Activities that could generate splashes, spray of blood, body fluids , or secretions
Requires that every patient and every body fluid, body substance, organ, or unfixed tissue be regarded as potentially infectious Hands wash(plain soap)
After touching body fluids and contaminated items, after removing gloves and between patient contact
Wear gloves When touching blood/body fluids/secretions, wear clean gloves when touching mucous membranes and nonintact skin
Wear mask/eye protection/face shield Activities that could generate splashes, spray of blood, body fluids , or secretions
Standard Precautions,cont.
Standard Precautions,cont. Patient care equipment
should be handled to prevent transfer of microorganisms to other patients and environment
Linen Handle,transport,and process in a manner to avoid contamination of clothing and other patients or environment
Occupational health and blood-borne pathogens Prevent injuries when using, handling, cleaning and disposing sharps
NEVER RECAP A USED NEEDLE Do not removed used needle from syringe by hand Disposed used sharps on puncture resistant containers
Patient care equipment should be handled to prevent transfer of microorganisms to other patients and environment
Linen Handle,transport,and process in a manner to avoid contamination of clothing and other patients or environment
Occupational health and blood-borne pathogens Prevent injuries when using, handling, cleaning and disposing sharps
NEVER RECAP A USED NEEDLE Do not removed used needle from syringe by hand Disposed used sharps on puncture resistant containers
Standard Precautions,cont.
Standard Precautions,cont.
Use resuscitation devices as an alternative to mouth to mouth resuscitation
Patient placement Use a private room for patients who can be a source of contamination or patients who are not expected to maintain hygiene or environmental control
Environmental control Follow hospital procedures for routine care and cleaning/desinfection of any soiled device, equipment or environmental surface
Use resuscitation devices as an alternative to mouth to mouth resuscitation
Patient placement Use a private room for patients who can be a source of contamination or patients who are not expected to maintain hygiene or environmental control
Environmental control Follow hospital procedures for routine care and cleaning/desinfection of any soiled device, equipment or environmental surface
General laboratory equipment
General laboratory equipment Centrifuges- spin samples at high
speeds forcing the heavier particles to the bottom of the container,e.g..separating plasma and blood cells Safety tips
Use Standard Precautions/PPE Load must be balanced Tubes must be capped during operation Do not open the centrifuge while rotor is moving
Clean spills immediately with surface disinfectants
Centrifuges- spin samples at high speeds forcing the heavier particles to the bottom of the container,e.g..separating plasma and blood cells Safety tips
Use Standard Precautions/PPE Load must be balanced Tubes must be capped during operation Do not open the centrifuge while rotor is moving
Clean spills immediately with surface disinfectants
General laboratory equipment
General laboratory equipment
Autoclaves- use steam under pressure to sterilize medical/surgical instruments, or contaminated materials before disposal Never open unless the chamber pressure reads zero
Use heat-proof gloves to remove items When sterilizing liquids use loosely capped, heat resistant containers, no more than half full
Use an autoclave tray to prevent liquids from spilling
Autoclaves- use steam under pressure to sterilize medical/surgical instruments, or contaminated materials before disposal Never open unless the chamber pressure reads zero
Use heat-proof gloves to remove items When sterilizing liquids use loosely capped, heat resistant containers, no more than half full
Use an autoclave tray to prevent liquids from spilling
General laboratory equipment
General laboratory equipment Laboratory balances
Used to measure chemicals Use PPE and chemical safety precautions
Be gentle, Balances are delicate equipment
Laboratory balances Used to measure chemicals Use PPE and chemical safety precautions
Be gentle, Balances are delicate equipment
General laboratory equipment
General laboratory equipment
Other equipments Refrigerators Water baths PH meters Incubators Thermometers freezer
Other equipments Refrigerators Water baths PH meters Incubators Thermometers freezer
The MicroscopeThe Microscope Is a delicate and expensive instrument , special care must be taken in its use
Various types of microscopes, two categories based on type of illumination Light microscopes
Bright-field- stained specimens Phase-contrast-unstained cells,urine sediment Epi-fluorescence microscope,specimens treated with fluorescent dyes, syphilis, mycobacteria
Electron microscopes:provides greater magnification in medical research
Is a delicate and expensive instrument , special care must be taken in its use
Various types of microscopes, two categories based on type of illumination Light microscopes
Bright-field- stained specimens Phase-contrast-unstained cells,urine sediment Epi-fluorescence microscope,specimens treated with fluorescent dyes, syphilis, mycobacteria
Electron microscopes:provides greater magnification in medical research
Light microscope images
Light microscope images
A-stained cell seen with bright field microscopeB-phase contrast imageC-epi-fluorescence microscopy,Borrelia burgdorferi
Parts of the Microscope
Parts of the Microscope
Parts of the MicroscopeParts of the Microscope
Oculars: monocular or binocular Objective lenses: attached to the revolving nose piece, at least 3 present: low, high dry, and oil immersion lenses
Light condenser which focuses and directs light to the objectives, iris diaphragm that regulates the amount of light that strikes the object observed
Field diaphragm:help align the light Coarse and fine adjustments:focusing knobs
Stage:support for the object been viewed
Oculars: monocular or binocular Objective lenses: attached to the revolving nose piece, at least 3 present: low, high dry, and oil immersion lenses
Light condenser which focuses and directs light to the objectives, iris diaphragm that regulates the amount of light that strikes the object observed
Field diaphragm:help align the light Coarse and fine adjustments:focusing knobs
Stage:support for the object been viewed
Microscope safetyMicroscope safety Safety
observe electrical safety rules Glass slide handle with care to avoid breaking Unfixed specimens should be treated with standard precautions,disinfect stage after use
QA Scheduled maintenance should be performed and documented
Care and cleaning of lenses Use only lens paper, clean lenses before and after each use
Do not allowed immersion oil to touch the low and high dry lenses
Transporting and storing
Safety observe electrical safety rules Glass slide handle with care to avoid breaking Unfixed specimens should be treated with standard precautions,disinfect stage after use
QA Scheduled maintenance should be performed and documented
Care and cleaning of lenses Use only lens paper, clean lenses before and after each use
Do not allowed immersion oil to touch the low and high dry lenses
Transporting and storing
Transporting the Microscope
Transporting the Microscope
Using the MicroscopeUsing the Microscope Use low power objective to locate and to view large objects
With the coarse adjustment knob bring the objective and the slide as close together as possible
While looking through the oculars, move the coarse adjustment knob to bring the objective and slide apart until the object on the slide comes into focus
Use the fine adj.knob to bring the image into sharp focus
Use low power objective to locate and to view large objects
With the coarse adjustment knob bring the objective and the slide as close together as possible
While looking through the oculars, move the coarse adjustment knob to bring the objective and slide apart until the object on the slide comes into focus
Use the fine adj.knob to bring the image into sharp focus
Using the MicroscopeUsing the Microscope If you need to use the high power(40x), to see cells and sediments, after initial focusing with the low power(20x), rotate the high power into position
Never use the coarse adjustment knob with high power, the distance between the objective and slide is very small and the slide could break.
Oil immersion lenses(100x) give the highest magnification of the bright field objectives
If you need to use the high power(40x), to see cells and sediments, after initial focusing with the low power(20x), rotate the high power into position
Never use the coarse adjustment knob with high power, the distance between the objective and slide is very small and the slide could break.
Oil immersion lenses(100x) give the highest magnification of the bright field objectives
Using oil immersion lenses
Using oil immersion lenses After initially focusing with the low
power, rotate the objective to the side and place a small drop of immersion oil on the slide
The oil immersion objective is rotated into the drop of oil been careful no other objective touch the oil
use only fine adjustment knob with oil
Condenser should be all the way up Maximum light source Open the iris diaphragm to the maximum
After initially focusing with the low power, rotate the objective to the side and place a small drop of immersion oil on the slide
The oil immersion objective is rotated into the drop of oil been careful no other objective touch the oil
use only fine adjustment knob with oil
Condenser should be all the way up Maximum light source Open the iris diaphragm to the maximum
After using the Microscope
After using the Microscope
Always switch to the low magnification objective
With lens paper clean the oil immersion objective, stage and condenser if oil has become in contact with it
Turn the light source off Unplug the microscope Store in proper location or cover as appropriate
Always switch to the low magnification objective
With lens paper clean the oil immersion objective, stage and condenser if oil has become in contact with it
Turn the light source off Unplug the microscope Store in proper location or cover as appropriate
Calculate Magnification
Calculate Magnification Degree of magnification on the ocular
multiplied by the degree of magnification on the objectives
Example:10x(ocular) x 100x(oil immersion)= 1000x
The object viewed would be magnified 1000 times its original size Resolving power: the ability of a microscope to produce separate images of closely spaced details in the object being viewed
Degree of magnification on the ocular multiplied by the degree of magnification on the objectives
Example:10x(ocular) x 100x(oil immersion)= 1000x
The object viewed would be magnified 1000 times its original size Resolving power: the ability of a microscope to produce separate images of closely spaced details in the object being viewed
Blood collectionBlood collection
Capillary puncture: small amount of blood collected for glucose, K, electrolytes, Hgb, Htc, Plt count, or when a larger sample is difficult to obtain as in newborns
Routine venipuncture: most common method of obtaining blood, a superficial vein is punctured with a hypodermic needle and blood is collected into a syringe or vacuum tube
Capillary puncture: small amount of blood collected for glucose, K, electrolytes, Hgb, Htc, Plt count, or when a larger sample is difficult to obtain as in newborns
Routine venipuncture: most common method of obtaining blood, a superficial vein is punctured with a hypodermic needle and blood is collected into a syringe or vacuum tube
Capillary PunctureCapillary Puncture Safe Quick Small amount of blood Increased use
Point-of-care testing (POCT) Physician Office Laboratories
Safe Quick Small amount of blood Increased use
Point-of-care testing (POCT) Physician Office Laboratories
Capillary Puncture Sites
Capillary Puncture Sites
Fingertip Great toe Heel
Fingertip Great toe Heel
Capillary Puncture Sites
Capillary Puncture Sites
LancetsLancets
Sterile Single-use Different lengths
Sterile Single-use Different lengths
Collection ContainersCollection Containers
ProcedureProcedure
Routine VenipunctureRoutine Venipuncture
Phlebotomy Superficial vein Large sample of blood Skill and experience
Preserve vein integrity
Phlebotomy Superficial vein Large sample of blood Skill and experience
Preserve vein integrity
Venipuncture SuppliesVenipuncture Supplies
Needles Various safety designs 21 ga, 1 inch
Needle holders Phlebotomy tray
Needles Various safety designs 21 ga, 1 inch
Needle holders Phlebotomy tray
Venipuncture SuppliesVenipuncture Supplies
Venipuncture SuppliesVenipuncture Supplies Vacuum tubes and anticoagulants
Sizes Stopper color:
Red: no anticoagulant, to collect serum for blood chemistries and serology tests
Lavender: containing EDTA for hematologycal and blood typing tests(ethylenediaminetetraacetic acid )
Green: contains heparin, for lymphocytes studies and special chemistry
Light blue: sodium citrate for coagulation studies Gray :potasium oxalate, for glucose and legal alcohol
Black: for westergren ESR Draw exact amount
Vacuum tubes and anticoagulants Sizes Stopper color:
Red: no anticoagulant, to collect serum for blood chemistries and serology tests
Lavender: containing EDTA for hematologycal and blood typing tests(ethylenediaminetetraacetic acid )
Green: contains heparin, for lymphocytes studies and special chemistry
Light blue: sodium citrate for coagulation studies Gray :potasium oxalate, for glucose and legal alcohol
Black: for westergren ESR Draw exact amount
Safety PrecautionsSafety Precautions
Observe standard precautions Wear gloves and other PPE Never recap needles Use proper technique
Avoid Hemoconcentration: do not leave tourniquet in place for more than 1-2 minutes
Hemolysis: do not shake tubes, mix by gently inverting a few times
Observe standard precautions Wear gloves and other PPE Never recap needles Use proper technique
Avoid Hemoconcentration: do not leave tourniquet in place for more than 1-2 minutes
Hemolysis: do not shake tubes, mix by gently inverting a few times
Select EquipmentSelect Equipment
Patient PreparationPatient Preparation
Patient I.D. Explain procedure Support patient and arm Be prepared! for any sudden reaction from the patient, or occasional patient who may faint
Patient I.D. Explain procedure Support patient and arm Be prepared! for any sudden reaction from the patient, or occasional patient who may faint
Patient PreparationPatient Preparation
Apply TourniquetApply Tourniquet
•3-4 inches above elbow
•Use quick release tie
Identify Suitable VeinIdentify Suitable Vein Veins commonly used
Median cubital Basilic Cephalic
Palpate vein: carefully inspect both arms to find the better site
Veins commonly used Median cubital Basilic Cephalic
Palpate vein: carefully inspect both arms to find the better site
Perform VenipuncturePerform Venipuncture Alcohol-cleanse site, let air dry, do not touch the site after cleaning
Observe bevel up Anchor vein with thumb 1inch below the puncture site
Enter vein in the same direction of it, in a15-25 degree angle, in a smooth motion
Insert vacuum tube Clot tube first Invert anticoagulant tubes softly 5-7 times
Alcohol-cleanse site, let air dry, do not touch the site after cleaning
Observe bevel up Anchor vein with thumb 1inch below the puncture site
Enter vein in the same direction of it, in a15-25 degree angle, in a smooth motion
Insert vacuum tube Clot tube first Invert anticoagulant tubes softly 5-7 times
Perform VenipuncturePerform Venipuncture
Adverse situationsAdverse situations In case of patient developing a large hematoma while venipuncture procedure is being done, withdraw the needle, apply pressure, and intent the procedure in a different site
In case of failure to obtain the blood, ask the patient permission for a second intent, if he agrees try in a different site
After the second non-productive intent,inform the patient and find another person to draw the specimen
In case of patient developing a large hematoma while venipuncture procedure is being done, withdraw the needle, apply pressure, and intent the procedure in a different site
In case of failure to obtain the blood, ask the patient permission for a second intent, if he agrees try in a different site
After the second non-productive intent,inform the patient and find another person to draw the specimen
Complete ProcedureComplete Procedure
Activate safety feature Immediate disposal Label tubes before leaving the room
Patient care
Activate safety feature Immediate disposal Label tubes before leaving the room
Patient care
Patient care Patient care
The tourniquet is always release before needle is withdraw
Gauze should be applied over the puncture site and pressure maintained for 1-3 minutes or until bleeding stops
Ask patient to keep arm extended Offer a small bandage if necessary
The tourniquet is always release before needle is withdraw
Gauze should be applied over the puncture site and pressure maintained for 1-3 minutes or until bleeding stops
Ask patient to keep arm extended Offer a small bandage if necessary
In Case of AccidentIn Case of Accident
Immediately clean exposed area Flood with water Clean with antiseptic soap
Report immediately to supervisor
Seek medical attention
Immediately clean exposed area Flood with water Clean with antiseptic soap
Report immediately to supervisor
Seek medical attention
Label the samplesLabel the samples Must contain patient information
Name Date of birth
Date and time of collection And initials of the person drawing the blood Tubes should never be prelabeled to avoid using the prelabeled tube in the wrong patient
Make sure the tubes are clean and no blood has contaminated the outer part of the tubes
Place specimen in a biohazard labeled bag and proceed as required by the institution
Must contain patient information Name Date of birth
Date and time of collection And initials of the person drawing the blood Tubes should never be prelabeled to avoid using the prelabeled tube in the wrong patient
Make sure the tubes are clean and no blood has contaminated the outer part of the tubes
Place specimen in a biohazard labeled bag and proceed as required by the institution
Clinician's RoleClinician's Role Era of high technology, clinicians must have an understanding and working knowledge of modalities other than their own area of expertise: includes diagnostic evaluation and diagnostic services
Era of high technology, clinicians must have an understanding and working knowledge of modalities other than their own area of expertise: includes diagnostic evaluation and diagnostic services
Laboratory and diagnostic tests are tools to gain additional information
about the patient
Laboratory and diagnostic tests are tools to gain additional information
about the patient By themselves, tests are not therapeutic
used in conjunction with history and physical examination,tests: may confirm a diagnosis or provide valuable information about a patient's status and
response to therapy that may not be apparent from the history and physical examination alone.
By themselves, tests are not therapeutic
used in conjunction with history and physical examination,tests: may confirm a diagnosis or provide valuable information about a patient's status and
response to therapy that may not be apparent from the history and physical examination alone.
selecting tests to use:
selecting tests to use:
Test selections are based on : subjective clinical judgment, national recommendations, and evidence-based health care. Often diagnostic tests or procedures are used as predictors of surgical risk or morbidity and mortality rates because, in some cases, the risk may outweigh the benefit.
Test selections are based on : subjective clinical judgment, national recommendations, and evidence-based health care. Often diagnostic tests or procedures are used as predictors of surgical risk or morbidity and mortality rates because, in some cases, the risk may outweigh the benefit.
selecting tests to use:
selecting tests to use:
1.Basic screening (frequently used with wellness groups and case finding)
2. Establishing (initial) diagnoses
3. Differential diagnosis 4. Evaluating current medical case management and outcomes
5. Evaluating disease severity
1.Basic screening (frequently used with wellness groups and case finding)
2. Establishing (initial) diagnoses
3. Differential diagnosis 4. Evaluating current medical case management and outcomes
5. Evaluating disease severity
6. Monitoring course of illness and response to treatment
7. Group and panel testing 8. Regularly scheduled screening tests as part of ongoing care
9. Testing related to specific events, certain signs and symptoms, or other exceptional situations (eg, infection and inflammation , sexual assault, drug screening, postmortem tests, to name a few)
6. Monitoring course of illness and response to treatment
7. Group and panel testing 8. Regularly scheduled screening tests as part of ongoing care
9. Testing related to specific events, certain signs and symptoms, or other exceptional situations (eg, infection and inflammation , sexual assault, drug screening, postmortem tests, to name a few)
Basic screening (frequently used with wellness groups and
case finding)
Basic screening (frequently used with wellness groups and
case finding)
Cervical Papanicolaou (Pap) test Yearly for all women 18 years of age; more often with high-risk factors (eg, dysplasia, human immunodeficiency virus [HIV], herpes simplex); check for human papillomavirus (HPV), chlamydia, and gonorrhea using DNA
Cervical Papanicolaou (Pap) test Yearly for all women 18 years of age; more often with high-risk factors (eg, dysplasia, human immunodeficiency virus [HIV], herpes simplex); check for human papillomavirus (HPV), chlamydia, and gonorrhea using DNA
Establishing (initial) diagnoses
Establishing (initial) diagnoses
Serum amylase In the presence of abdominal pain, suspect pancreatitis
Thyroid-stimulating hormone (TSH) test Suspicion of hypothyroidism, hyperthyroidism, or thyroid dysfunction in patients 50 years of age
Serum amylase In the presence of abdominal pain, suspect pancreatitis
Thyroid-stimulating hormone (TSH) test Suspicion of hypothyroidism, hyperthyroidism, or thyroid dysfunction in patients 50 years of age
Differential diagnosisDifferential diagnosis
Chlamydia and gonorrhea In sexually active persons with multiple partners; monitor for pelvic inflammatory disease
Chlamydia and gonorrhea In sexually active persons with multiple partners; monitor for pelvic inflammatory disease
Evaluating current medical case management and
outcomes
Evaluating current medical case management and
outcomes Tuberculosis (TB) blood test QuantiFERON Gold TB Blood test to assess TB exposure in risk population
Syphilis serum fluorescent treponemal antibody (FTA) test Positive rapid plasma reagin (RPR) test result
Tuberculosis (TB) blood test QuantiFERON Gold TB Blood test to assess TB exposure in risk population
Syphilis serum fluorescent treponemal antibody (FTA) test Positive rapid plasma reagin (RPR) test result
Grading Guidelines for Scientific Evidence
Grading Guidelines for Scientific Evidence
A. Clear evidence from all appropriately conducted trials Measure plasma glucose through an accredited lab to diagnose or screen for diabetes
B.Supportive evidence from well-conducted studies or registries Draw fasting blood plasma specimens for glucose analysis
A. Clear evidence from all appropriately conducted trials Measure plasma glucose through an accredited lab to diagnose or screen for diabetes
B.Supportive evidence from well-conducted studies or registries Draw fasting blood plasma specimens for glucose analysis
C.No published evidence; or only case, observational, or historical evidence • Self-monitoring of blood glucose may help to achieve better control
E.Expert consensus or clinical experience or Internet polls Measure ketones in urine or blood to monitor and diagnose diabetic ketoacidosis (DKA) (in home or clinic)
C.No published evidence; or only case, observational, or historical evidence • Self-monitoring of blood glucose may help to achieve better control
E.Expert consensus or clinical experience or Internet polls Measure ketones in urine or blood to monitor and diagnose diabetic ketoacidosis (DKA) (in home or clinic)
The diagnostic testing model
The diagnostic testing model incorporates three phases:
pretest, emphasis on appropriate test selection,
obtaining proper consent, proper patient preparation, individualized patient education, emotional support, and effective communication.
These interventions are key to achieving the desired outcomes and preventing misunderstandings and errors.
incorporates three phases: pretest,
emphasis on appropriate test selection,
obtaining proper consent, proper patient preparation, individualized patient education, emotional support, and effective communication.
These interventions are key to achieving the desired outcomes and preventing misunderstandings and errors.
Intratest Phase: Elements of Safe, Effective, Informed Care
Posttest Phase: Elements of Safe, Effective, Informed Care
Intratest Phase: Elements of Safe, Effective, Informed Care
Posttest Phase: Elements of Safe, Effective, Informed Care
The clinical value of a test is related toThe clinical value of a test is related to
sensitivity, specificity, and the incidence of the disease in the population tested.
Sensitivity and specificity do not change with different populations of ill and healthy patients
The predictive value of the same test can vary significantly with age, gender, and geographic location.
sensitivity, specificity, and the incidence of the disease in the population tested.
Sensitivity and specificity do not change with different populations of ill and healthy patients
The predictive value of the same test can vary significantly with age, gender, and geographic location.
Specificity refers to the ability of a test to identify correctly those individuals who do not have the disease.
The division formula for specificity is as follows:
Specificity%=persons w/o dis.who test neg./total # of persons w/o dis. X 100
Specificity refers to the ability of a test to identify correctly those individuals who do not have the disease.
The division formula for specificity is as follows:
Specificity%=persons w/o dis.who test neg./total # of persons w/o dis. X 100
Sensitivity refers to the ability of a test to correctly identify those individuals who truly have the disease.
The division formula for sensitivity is as follows:
Sensitivity% = persons with dis.who test positive/ total # persons tested with disease x 100
Sensitivity refers to the ability of a test to correctly identify those individuals who truly have the disease.
The division formula for sensitivity is as follows:
Sensitivity% = persons with dis.who test positive/ total # persons tested with disease x 100
Incidence refers to the number of new cases of a disease, during a specified period of time, in a specified population or community.
Prevalence refers to the number of existing cases of a disease, at a specific period of time, in a given population.
Incidence refers to the number of new cases of a disease, during a specified period of time, in a specified population or community.
Prevalence refers to the number of existing cases of a disease, at a specific period of time, in a given population.
Predictive valuesPredictive values
Predictive values refer to the ability of a screening test result to correctly identify the disease state.
The predictive value of the same test can be very different when applied to people of differing ages, gender, geographic locations, and cultures.
Predictive values refer to the ability of a screening test result to correctly identify the disease state.
The predictive value of the same test can be very different when applied to people of differing ages, gender, geographic locations, and cultures.
test outcome deviationstest outcome deviations
Minimize test outcome deviations following proper test protocols. Make certain the patient and his or her significant others know what is expected of them.
Written instructions are very helpful.
Minimize test outcome deviations following proper test protocols. Make certain the patient and his or her significant others know what is expected of them.
Written instructions are very helpful.
Reasons for deviations may include the
following
Reasons for deviations may include the
following Incorrect specimen collection, handling, storage, or labeling
Wrong preservative or lack of preservative
Delayed specimen deliver
Incorrect specimen collection, handling, storage, or labeling
Wrong preservative or lack of preservative
Delayed specimen deliver
Reasons for deviations may include the
following
Reasons for deviations may include the
following Incorrect or incomplete patient preparation
Hemolyzed blood samples Incomplete sample collection, especially of timed samples
Old or deteriorating specimens
Incorrect or incomplete patient preparation
Hemolyzed blood samples Incomplete sample collection, especially of timed samples
Old or deteriorating specimens
Patient factors that can alter test results may include the following
Patient factors that can alter test results may include the following
Incorrect pretest diet Current drug therapy Type of illness. Dehydration Position or activity at time of specimen collection
Incorrect pretest diet Current drug therapy Type of illness. Dehydration Position or activity at time of specimen collection
Patient factors that can alter test results may include the following
Patient factors that can alter test results may include the following
Postprandial status (ie, time patient last ate)
Time of day Pregnancy Age and Gender
Postprandial status (ie, time patient last ate)
Time of day Pregnancy Age and Gender
Patient factors that can alter test results may include the following
Patient factors that can alter test results may include the following
Level of patient knowledge and understanding of testing process
Stress Nonadherence or noncompliance with instructions and pretest preparation
Undisclosed drug or alcohol use
Level of patient knowledge and understanding of testing process
Stress Nonadherence or noncompliance with instructions and pretest preparation
Undisclosed drug or alcohol use
avoid costly mistakesavoid costly mistakes
Communication errors account for more incorrect results than do technical errors.
Properly identify and label every specimen as soon as it is obtained.
Communication errors account for more incorrect results than do technical errors.
Properly identify and label every specimen as soon as it is obtained.
Educate the patient and family
Educate the patient and family
Educate regarding the testing process and what will be expected
Record the date, time, type of teaching, information given, and person to whom the information was given.
Educate regarding the testing process and what will be expected
Record the date, time, type of teaching, information given, and person to whom the information was given.
Educate the patient and family
Educate the patient and family
Giving sensory and objective information that relates to what the patient will likely physically feel and the equipment that will be used is important so that patients can envision a realistic representation of what will occur.
Giving sensory and objective information that relates to what the patient will likely physically feel and the equipment that will be used is important so that patients can envision a realistic representation of what will occur.
Educate the patient and family
Educate the patient and family
Avoid technical and medical jargon
and adapt information to the patient's level of understanding.
Slang terms may be necessary to get a point across.
Avoid technical and medical jargon
and adapt information to the patient's level of understanding.
Slang terms may be necessary to get a point across.
Educate the patient and family
Educate the patient and family
Encourage questions and verbalization of feelings, fears, and concerns
Do not dismiss, minimize, or invalidate the patient's anxiety
Develop listening skills, and be aware of nonverbal signals (ie, body language)
Encourage questions and verbalization of feelings, fears, and concerns
Do not dismiss, minimize, or invalidate the patient's anxiety
Develop listening skills, and be aware of nonverbal signals (ie, body language)
Educate the patient and family
Educate the patient and family
Above all, be nonjudgmental. Emphasize that there is usually a waiting period (ie, turn-around time) before test results are relayed back to the clinicians and nursing unit.
Offer listening, presence, and support during this time of great concern and anxiety
Above all, be nonjudgmental. Emphasize that there is usually a waiting period (ie, turn-around time) before test results are relayed back to the clinicians and nursing unit.
Offer listening, presence, and support during this time of great concern and anxiety
Educate the patient and family
Educate the patient and family
Because of factors such as anxiety, language barriers, and physical or emotional impairments, the patient may not fully understand and assimilate instructions and explanations
Because of factors such as anxiety, language barriers, and physical or emotional impairments, the patient may not fully understand and assimilate instructions and explanations
Educate the patient and family
Educate the patient and family
To validate the patient's understanding of what is presented, ask the patient to repeat instructions given to evaluate assimilation and understanding of presented information.
To validate the patient's understanding of what is presented, ask the patient to repeat instructions given to evaluate assimilation and understanding of presented information.
normal or reference values
normal or reference values
Normal values are those that fall within 2 standard deviations (ie, random variation) of the mean value for the normal population.
Normal ranges can vary to some degree from laboratory to laboratory. Frequently, this is because of the particular type of equipment used
Normal values are those that fall within 2 standard deviations (ie, random variation) of the mean value for the normal population.
Normal ranges can vary to some degree from laboratory to laboratory. Frequently, this is because of the particular type of equipment used
normal or reference values
normal or reference values
The reported reference range for a test can vary according to the laboratory used, the method employed, the population tested, and methods of specimen collection and preservation.
The reported reference range for a test can vary according to the laboratory used, the method employed, the population tested, and methods of specimen collection and preservation.
normal or reference values
normal or reference values
Interpretation of laboratory results must always be in the context of the patient's state of being.
Circumstances such as hydration, nutrition, fasting state, mental status, or compliance with test protocols are only a few of the situations that can influence test outcomes.
Interpretation of laboratory results must always be in the context of the patient's state of being.
Circumstances such as hydration, nutrition, fasting state, mental status, or compliance with test protocols are only a few of the situations that can influence test outcomes.
clinical laboratory data values
clinical laboratory data values
may be reported in conventional units, SI units(Systéme International (SI) units), or both
The SI system uses seven dimensionally independent units of measurement to provide logical and consistent measurements
may be reported in conventional units, SI units(Systéme International (SI) units), or both
The SI system uses seven dimensionally independent units of measurement to provide logical and consistent measurements
clinical laboratory data values
clinical laboratory data values
SI concentrations are written as amount per volume (moles or millimoles per liter)
rather than as mass per volume (grams, milligrams, or milliequivalents per deciliter, 100 milliliters, or liter)
SI concentrations are written as amount per volume (moles or millimoles per liter)
rather than as mass per volume (grams, milligrams, or milliequivalents per deciliter, 100 milliliters, or liter)
Numerical values may differ between systems or may be the same.
For example, chloride is the same in both systems: 95 to 105 mEq/L (conventional)
and 95 to 105 mmol/L (SI).
Numerical values may differ between systems or may be the same.
For example, chloride is the same in both systems: 95 to 105 mEq/L (conventional)
and 95 to 105 mmol/L (SI).
Recognize margins of error
Recognize margins of error
possibility exists that some tests will be abnormal owing purely to chance
because a significant margin of error arises from the arbitrary setting of limits.
Moreover, if a laboratory test is considered normal up to the 95th percentile, then 5 times out of 100, the test will show an abnormality even though a patient is not ill
possibility exists that some tests will be abnormal owing purely to chance
because a significant margin of error arises from the arbitrary setting of limits.
Moreover, if a laboratory test is considered normal up to the 95th percentile, then 5 times out of 100, the test will show an abnormality even though a patient is not ill
Cultural SensitivityCultural Sensitivity
Many cultures have diverse beliefs about diagnostic testing that requires blood sampling
Preserving the cultural well-being of any individual or group promotes compliance with testing and easier recovery from routine as well as more invasive and complex procedures
Many cultures have diverse beliefs about diagnostic testing that requires blood sampling
Preserving the cultural well-being of any individual or group promotes compliance with testing and easier recovery from routine as well as more invasive and complex procedures
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