CC BEDSIDE APPROACH AND ETC. 3.

Edema
-swelling (abnormal accumula<on of fluid in the <ssue
Brief Review may alter blood composi<on)
Types of Blood Specimen 4. Hematoma
1. Venous -swelling or mass of blood that escaped from a vein
2. Capillary during venipuncture, painful, inaccuracy, distal (free
3. Arterial flowing blood)
Pre-analy?cal considera?ons 5. Mastectomy
1. Iden<fy procedural risks -suscep<ble to swelling and infec<on
2. address certain pa<ent condi<ons 6. Vascular access device (VAD)
3. handle pa<ent complica<ons associated with blood -trained personnel, assist by transferring the blood,
collec<on must never perform venipuncture
Order
✓ Bacte-Yellow or sterile media CVA COLLECTION
✓ Hema-coag-Light blue 1. Syringe= thrown/discard
✓ Chemistry- Red, Gold 2. Syringe= blood collec<on
✓ Chem-ionized calcium-Heparin tubes 3. Syringe= NSS
✓ HEMA CBC-EDTA tubes In cri<cal areas>>> ICU
Note: -avoid mul<ple phleb
>Heparin is the an<coagulant of choice for blood gas -discard 5-10 mL (ini<al)
analysis
Order: Blood Culture! An<coagulated blood
HANDLING OF SAMPLES
1.Storage temperature of plasma and serum 4-6°C (for Intravenous line
delays longer than 4 hrs) -best not to draw blood specimens from an arm with an IV
2.Stable at room temperature line, esp above the IV access site (contamina<on affects
>Lactate Dehydrogenase result)
3.Aliquot -the sites adjacent to IV therapy should be avoided
>por<on of a spx -IV fluid: increase glucose, chloride, K, Na, with decrease
4.Tests for which the spx require chilling (4°C) urea and crea<nine
>NH3, Blood Gas, Lactate, PTH -as liele as 10% contamina<on with 5% dextrose will
5. Photosensi<ve analytes increase glucose conc by 500 mg/dL or more
>Bilirubin, CK (ONLY PHOTOSENSITIVE ENZYME), Beta
carotene, Folate 1. Hematoma forma<on- swelling at or near the
venipuncture site, blood leaking the <ssue.
• To produce reliable results, @ which <me should blood Discon<nue procedure and pressure is applied
specimens for lipid studies be drawn? 2. Iatrogenic anemia- frequent bloods or removing
➔ 12-16 hrs large quan<<es at a <me esp infants
• Which of the following is the Friedewald formula by 3. Inadvertent arterial puncture- accidentally s<cking
which low density lipoprotein (LDL) cholesterol can be an artery; ohen result of deep or bling probing or
es<mated? (TC=total, cholesterol,TG=triglycerides, at aeemp<ng to draw from a basilica vein.
PL=Phospholipids) Venipuncture must be con<nued and pressure
➔ LDL Cholesterol= TC-(TG/5+ HDL cholesterol) applied for 5 minutes. Iden<fy specimen as arterial
• What is assayed daily together with the unknown and blood if submieed for tes<ng.
used daily to measure precision? 4. Infec<on of the site- use 70% alcohol to clean the
➔ Pooled serum site.
5. Nerve injury- results from poor site selec<on,
BEDSIDE APPROACH inser<ng the needle to deeply or quickly, pa<ent
Problem sites movement on needle inser<on, excessive or lateral
1. Burns, Scars and Ta]oos needle redirec<on, or blind probing.
-difficult to palpate and draw from, suscep<ble to 6. Reflux-backflow of blood from the tube into the px
infec<on (recent), dye (interference) vein that can occur if blood in the tube is contact
2. Damaged Veins with the needle during a blood draw. (mostly in
-feel hard and cordlike, occluded (obstructed), difficult evacuated tubes). To prevent: px arms must be
to puncture, impaired blood flow
 downward posi<on so the the collec<on tube fills
from the boeon up.
7. Vein damage (mostly venipuncture)- scar buildup
that can result from many venipunctures.
Situa?ons that can trigger Hematoma forma?on
- vein is fragile or too small for the needle size
- the need penetrates all the way through the vein
- needle is only partly inserted into the vein
- excessive or blind probing
- needle is removed while tourniquet is s<ll on
- pressure not adequately applied following
venipuncture
Post-care: Apply cold compress.
Laboratory Automa?ons (Analy<cal stage)
Analy?c process
➔ Pre-analy<c (Sample processing, phleb, order of
draw)
➔ Analy<c Process (Chemical analysis, automa<on,
machines)
➔ Post-analy<c (Data management)
Advantages of automa<on:
✓ Increase the number of tests performed by one
laboratorian in a given period
✓ varia<on
✓ eliminates the poten<al errors
✓ U<lize less small amounts of samples and reagents
(microassays)
Discrete analyzers
- each sample-rgnt mixture has its own rxn vessels,
most versa<le, more efficient, you see color
reac<on in each cuve]e
Con?nuous Flow Analyzer
-sample/rgnts flow thru con<nuous tubing
-allows parallel tes<ng
-carry-over (major source of error)
Centrifugal Analyzer
- uses centrifuga<on
Analyzer pathway (design)
❖ Batch tes?ng
-samples are loaded at the same ?me, single test
is conducted on each sample
-best if you have lots of spx
can’t do on stat test
-cant be run if one is missing
❖ Random access tes?ng
ADDT’L Info:
✓ Posi?ve error
-bubbles
-electric impulses
-aperture senng
✓ excessive cell lysis – only nega<ve error
✓ Major intracellular ca<on-K
✓ Major ca<on in the extracellular fluid- Na
✓ Major anion- Cl
✓ Reagent blank be used in the test to correct
absorbance contributed by one or more reagent
✓ Dilu<on of a sample may be done at the beginning
of the assay to correct prozone reac<on.
Specificity- ability of the test to measure only the
substance of interest
When centrifuging test tubes with serum separator gel, w/
c of the following instruments must be used?
-swinging bucket type of centrifuge
Delta checking- to comparison between px’s most recent
result and previous determined value
LIS Benefits
- reduces <me-consuming paper work
- stores pa<ent data
- stores QC data
- provides immediate access to results
- managerial reports (tests per month, workload
units, TATs)
- reduces the chance of an assay being ran on the
wrong pa<ent when barcode is used.
POCT
-point of care tes<ng
-done on pa<ents bed side.
Pre-analy<cal errors
1. improper px error
2. mislabeled spx
3. incorrect order of draw
4. incorrect pa<ent iden<fica<on
5. wrong specimen container
6. incorrect an<coagulant to blood ra<o
7. improper mixing of samples and addi<ves
8. incorrect specimen preserva<on
9. incorrect used of tubes for blood collec<on
10. mishandles specimen (transport and storage)
11. missed or incorrectly interpreted laboratory
requests
post analy<cal errors
 1. unavailable or delayed laboratory results
2. incomplete laboratory results
3. wrong transcrip<on of data

QUALITY CONTROL
-check stability of machine
-quality of reagents
-check technical operator errors

>QC material should resemble human sample and be

available for a minimum of 1 yr (same lot number)- differet
lot numbers of the same material should have different
concentra<ons w/c requires new es<mates of the mean
and SD

Shih
- abrupt changes in the mean
- 6 or more consecu<ve control values distributed
on one side or either side of the mean but
maintain a constant level
- Major cause: improper calibra<on of instruments

Trend
- 6 consecu<ve control values con<nue to either
increase or decrease (up down)
- Main cause: deteriora<on of rgnts