UNIT IV SPECIAL PROCEDURES

CHAPTER

11
Special Collections and
Point-of-Care Testing

OBJECTIVES
1 Define the key terms and abbreviations at the beginning of this chapter.
Study the
information in 2 Explain the principle behind each special collection procedure, identify the steps
your textbook involved, and list any special supplies or equipment required.
that corresponds
to each objective 3 Describe patient identification and specimen labeling procedures required for blood
to prepare bank tests and identify the types of specimens typically required.
yourself for the
4 Describe sterile technique in blood culture collection, explain why it is important,
activities in this
chapter. and list the reasons why a physician might order blood cultures.

5 List examples of coagulation specimens and describe how to properly collect and
handle them.

6 Describe chain-of-custody procedures and identify the tests that may require them.

7 Explain the importance of timing; identify the role of drug half-life, providing
names of drugs as examples; and describe peak, trough, and therapeutic levels in
therapeutic drug monitoring.

8 Define point-of-care testing (POCT), explain the principle behind the POCT
examples listed in this chapter, and identify any special equipment required.

197

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 198 UNIT IV: SPECIAL PROCEDURES
Kyla M. Artillaga BSMT 1C

Matching
Use choices only once unless otherwise indicated.

MATCHING 11-1: KEY TERMS AND DESCRIPTIONS

Match the key term with the best description.

Key Terms (1–18) Descriptions (1–18)

B ACT
1. _____ A. Abbreviation for ethanol
Q Aerobic B. Activated clotting time
2. _____
C. Antimicrobial removal device
H Anaerobic
3. _____ D. Bacteria in the blood
E. Platelet function test
4. _____
C ARD F. Instrument’s electronic QC check
5. _____
G autologous G. Donating blood for one’s own use.
H. Without air or able to live without oxygen
6. _____
P BAC I. Fastidious antimicrobial neutralization
7. _____
D Bacteremia J. Fever of unknown origin
K. Cardiac hormone produced in response to pressure overload
8. _____
K BNP L. Hormone detected with POCT pregnancy test
9. _____
E BT M. Detailed documentation for forensic specimens collections
N. Ability to be mixed together without unfavorable effects
10. _____
M Chain of custody
O. Test used to diagnose carbohydrate metabolism problems
11. _____
N Compatibility P. Blood alcohol concentration
Q. With air or able to live only in the presence of oxygen
12. _____
R CRP
R. Nonspecific marker for inflammation
13. _____
F EQC
14. _____
A ETOH
15. _____
I FAN
16. _____
J FUO
17. _____
O GTT
18. _____
L HCG

Key Terms (19–37) Descriptions (19–37)

D Hypoglycemia
19. _____ A. After a meal
B. Highest serum drug concentration anticipated
R Hyperkalemia
20. _____
C. The mineral potassium
21. _____
N Hypernatremia D. Decreased blood sugar levels
E. Drug level testing collected at specific times
H iCa2⫹
22. _____
F. Specific heart muscle protein staying elevated up to 14 days
23. _____
G INR G. Standardized form of PT results
H. Ionized form of calcium
C K⫹
24. _____
I. Microorganism and toxins in the blood
P Lactate
25. _____ J. National Institute on Drug Abuse
K. Lowest serum drug concentration expected
26. _____
L Lookback
L. Requires blood unit components to be traceable to the donor
27. _____
O Lysis M. Specific heart muscle protein showing elevation in 3 to 6 hours
N. Increased blood sodium levels
28. _____
J NIDA O. Rupturing, as in the bursting of a red blood cell
29. _____
B Peak level P. Level of this analyte marks severity of metabolic acidosis
30. _____
Q POCT

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 CHAPTER 11: SPECIAL COLLECTIONS AND POINT-OF-CARE TESTING 199

A PP
31. _____ Q. Testing performed at the patient’s side
R. Increased blood potassium
32. _____
I Septicemia
S. Intensive insulin therapy to control glucose levels
33. _____
E TDM
34. _____
S TGC
M TnI
35. _____
36. _____
F TnT
K Trough level
37. _____

MATCHING 11-2: POC TESTS AND INSTRUMENTS USED FOR TESTING

Match the following tests to the POCT instruments (instruments can only be used once).

POC Tests POCT Instruments

A. CK-MB P Verify Now
1. _____
B. Lactate
2. _____
N Quidel Quick Vue
C. Glycosylated hgb
D. Hemoglobin K Precision XceedPro
3. _____
E. PCO2
4. _____
J StatSpin CritSpin
F. PT
G. TnT 5. _____
M Hemoccult II Sensa
H. BUN
6. _____
G CARDIAC T Rapid Assay
I. BNP
J. Hematocrit 7. _____
O Cholestech LDX
K. ␤-ketone
8. _____
B Triage MeterPro
L. UA
M. Guaiac 9. _____
H GEM Premier 4000
N. HCG
D HemoCue HB 201⫹
10. _____
O. CRP
P. Platelet function C DCA Vantage
11. _____
12. _____
A Triage Cardiac Panel
13. _____
F CoaguChek
14. _____
I i-STAT
15. _____
E ABL80
16. _____
L Clinitek 2001

MATCHING 11-3: SPECIAL TEST COLLECTION, EQUIPMENT, OR PROCEDURE

Match the following tests with the special equipment or procedure involved. (Answers can be used only once.)

Special Test Special Handling, Equipment, or Procedure

1. _____
J 2-hour PP A. Draw in trace element–free tube.
B. Involves intradermal injection of diluted antigen.
2. _____
I Blood alcohol
C. May require a proctor present at the time of collection.
3. _____
H Blood culture D. May require photo identification before collection.
E. Requires serial collection of blood specimens at specific times.
4. _____
F Blood type and screen F. Patient ID procedures are extra strict.
5. _____
L BT G. Requires a 9-to-1 ratio of blood to anticoagulant in the collection tube.

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 200 UNIT IV: SPECIAL PROCEDURES

E GTT
6. _____ H. Skin antisepsis is critical to accurate test results.
I. Special chain of custody protocol required.
7. _____
D Paternity testing
J. Specimen is collected at specific time after eating.
8. _____
K Polycythemia K. Treatment often involves removal of units of blood.
L. Use of a blood pressure cuff is required to perform the test.
9. _____
G PT
B TB test
10. _____
C Urine drug screen
11. _____
A Zinc
12. _____

Labeling Exercises
LABELING EXERCISE 11-1: POC INSTRUMENTS AND TESTS
Label the photo of each of the following POC instruments with the name of the instrument and the test that it is
used to measure. Choose from the following list of tests.

Instrument That Can Measure

Lactate
Hematocrit
Platelet function
ACT
BNP
␤-ketones
HCG
HDL
Creatinine
Blood gases

1. name: PXP Scanning test: R. Ketones

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 CHAPTER 11: SPECIAL COLLECTIONS AND POINT-OF-CARE TESTING 201

2. name: Avoximeter test: Blood Gases

3. name: Statspin Crit Spin test: Hematocrit

4. name: Cascade POC test: ACT

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 210 UNIT IV: SPECIAL PROCEDURES

SKILLS DRILL 11-3: BLOOD CULTURE SPECIMEN COLLECTION

Instructions: Match the rationale with the corresponding step in the procedure.

Procedure Step Rationale

D Identify venipuncture
1. _____ A. Antisepsis does not occur instantly.
site and release tourniquet. B. Notation of site location is necessary because there may be an
isolated infection in that area.
G Aseptically select and
2. _____
C. Ensuring antiseptic technique and sterility of the site is critical
assemble equipment.
to accurate diagnosis.
3. _____
I Perform friction scrub D. The CLSI standard states that the tourniquet should not be left
as prescribed. on longer than 1 minute.
E. Inoculation of the medium can occur directly into the bottle or
4. _____
A Allow site to air-dry. after collection when a syringe is used.
H Cleanse the culture bottle
5. _____ F. Blood culture bottles have vacuum, but it is not always mea-
stoppers while the site sured as in evacuated tubes.
is drying. G. Aseptic technique reduces the risk of false positives due to con-
tamination.
F Mark the minimum and
6. _____
H. The tops of the culture bottles must be free of contaminants
maximum fill on the
when they are inoculated.
culture bottles.
I. Bacteria exist on the skin surface and can be removed
7. _____
C Reapply tourniquet and temporarily.
perform venipuncture
without touching the site.
E Inoculate the media
8. _____
bottles as required.
B Label the specimen
9. _____
containers with
required ID, including
the site of collection.

SKILLS DRILL 11-4: RATIONALE FOR BLEEDING TIME PROCEDURE

1. Why are hands sanitized before touching the patient?

To avoid contamination on the specimen and also avoid infection on the site where it is taken

2. Why must you determine whether the patient has taken aspirin or other salicylate-containing drugs within the
last 2 weeks?

Salicylate can interfere with the interpretation of the test and can prolong the bleeding time

causing for the patient to possible scarring

3. Why select the lateral rather than the medial aspect of the arm for the BT?

Because the medial aspect tends to cause more pain and might cause scarring.

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 CHAPTER 11: SPECIAL COLLECTIONS AND POINT-OF-CARE TESTING 213

SKILLS DRILL 11-6: PREGNANCY TEST PROCEDURE

Instructions: Match the rationale with the corresponding step in the procedure.

Procedure Step Rationale

1. _____
E Identify the patient A. To avoid errors, label the specimen even if it is the only one being
according to facility policy. tested at that time.
B. For correct results, the urine must flow evenly onto the testing surface
A Label the specimen cup
2. _____
of the device.
with the patient’s label.
C. The reaction time must be carefully timed and not read after
3. _____
F Obtain the patient’s 10 minutes.
urine specimen. D. The size of the drops must be exactly as specified and consistent for
results to be accurate.
B Remove the test device from
4. _____
E. Correct ID is vital to patient safety and meaningful test results.
the protective pouch and
F. If the patient will be collecting a urine specimen at your testing site,
place it on a flat surface.
explain how to do so.
D Using the disposable
5. _____ G. A positive result can be read as soon as lines at both the T and C areas
dropper provided, add of the test cassette window appear.
3 drops of sample to the
cassette well.
C Set a timer for the time
6. _____
the kit’s manufacturer
states a negative test
must be read.
7. _____
G Read the cassette
window’s results when
the timer goes off.

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 214 UNIT IV: SPECIAL PROCEDURES

Crossword
1 2
A c t H Y 3P E R K A L E M I4 A
g y t D
5 6
H g c o m p a t a b l e
7 8 9 10
l o c E T O H
11 12
a u t o l o g o u s h g a
13
t l e g u a i a c n
14
N I D A y p i d
15 16
n I T C t y p e n e x h
17 18
A R D e e o e
19 20 21
t o A M I c f f r e e l
22
i n i e E Q C d
23 24 25
o o Q A m c u E P A
26
n r u r i n e s n
27 28 29 30
C c a a s t e n a
31 32 33
L i T n T p o G E M
34 35
i S T A T c a r t r i d g e r
36
A r b n y o
37 38
A c c u C h e k B T
39
t n l N i
40
e s a e r o b i c

ACROSS 37. Type of glucose meter

38. POC test that evaluates platelet function
1. Coagulation test used to monitor heparin therapy 40. BC media bottle used to grow microbes needing air
2. Increased blood potassium
5. Scientific symbol for mercury
DOWN
6. Blood types suitable to mix
8. BAC tests for this type of alcohol 1. Process of clumping together (i.e., ag–ab reaction)
11. Blood donated by people who will use it themselves 2. Pertaining to a low glucose level
13. Another name for occult blood testing 3. Partial thromboplastin time
14. Institute that defines collection requirements for 4. Identification (abbrev.)
urine drug screen 7. Strict protocol for forensic specimens
15. Company that makes Surgicutt tool 9. Tight glycemic index
16. Blood bank identification system 10. Small, portable POCT instruments
17. Type of antimicrobial resin 12. Microorganisms or their toxins in the blood
19. The correct name for a heart attack (abbrev.) 18. Volunteer who gives blood for another person’s use
21. Type of Hgb that is measured in blood plasma 20. Body matter/discharge used to test for occult blood
22. Quality control built into the instrument 24. Name of charcoal antimicrobial resin bottle
(abbrev.) (abbrev.)
23. Processes in place to ensure that testing is done 25. BC media bottle used to grow microbes without air
properly (abbrev.) 26. Urinalysis (abbrev.)
24. Agency that regulates blood products 27. Law that states qualifications for personnel who do
26. Body fluid excreted by kidneys POC testing
30. Approx number of gestational weeks for peak 28. A 9:1 ratio of blood to this anticoagulant is required
levels of HCG 29. Extended test used to diagnose carbohydrate
31. Cardiac protein specific for heart muscle metabolism issues
33. Name of POC chemistry instrument made by IL 32. Groups of commonly ordered tests for POCT
34. Handheld POC chemistry analyzer 36. POCT kidney function test abbrev
35. Small, individual POC testing unit for various analytes 39. One of the electrolytes measured by POC instruments

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