Specimen collection Role of the Nurse

Specimen collection Role of the Nurse

Nurses often assume the responsibility of specimen collection

* Specimens consist
o Urine
o Stool
o Sputum
o Wound drainage
o Blood

What about the client?

* Comfort
* Privacy
* Questions
* Clear, concise directions
o NPO

The Nurse

* Check physician orders
* Keep it Simple directions to client
* Standard precautions
* Label specimen
* Timely
* C&S to lab ASAP or refrigerated
* Documentation

Urine Specimen

* Random
* Clean
* Female ? Menses (make note)
* Tested for:
+ Specific gravity
+ pH
+ Albumin
+ Glucose
+ Microscopic exam

Urine for C&S

* Culture = ? Bacteria growing
* Sensitivity = which antibiotics are effective
* Readings after 24; 48; 72 hrs.

Midstream Urine

Sterile Catheter Specimen

(never from bag)

Why a urine specimen for C&S

* ? Urinary Tract Infection (UTI)
o Frequency
o Urgency
o Dysuria
o Hematuria
o Flank pain
o Fever
o Cloudy, malodorous urine

Obtaining specimen

* Wash hands
* Clean meatus, female front to back
* Start stream, then stop, collect specimen
* Aseptic technique
* Bedpan/mexican hat
* To lab 15-20min post collection

Children

* Pediatric bags ( u Bag)
* Never squeeze diaper

Characteristics of Urine

* Color
* Clarity
* Odor

Specimen Collection

* Random Specimens
o Clean-not sterile
o Ordered for
+ Urinalysis testing
+ Measurement of specific gravity
+ pH
+ Glucose levels

Urine specimen collection

* Midstream Specimen
o Clean voided
o C&S
o 30-60 mls urine
* Sterile Specimen
o Indwelling catheter
o Drainage bag

Urine collection

* Timed urine specimens
o 2-72 hr intervals (24hr most common)
o Begin after urinating
o Note start time on container & requisition
o Collect all urine in timed period

Post Reminder Signs

Indwelling Catheter

* Strict aseptic technique
* Only from Bag if Brand new
* Sampling Port?
* Clamp 30 min. prior
* Wash hands – Glove
* Cleanse port with alcohol swab
* Sterile needle
* To lab 30 min (may refridge 2hrs)

Common Urine Lab Tests

* Routine Urinalysis
o Examine within 2hrs
o 1st voided specimen in AM
o Reagent strip
* Specific Gravity
o Concentration
o 1.010-1.025
* Urine glucose
o Diabetics
o Reagent strips
o Double void

Measuring chemical properties of urine=Urinalysis

* Glucose
* Ketones
* Protein
* Blood- hematuria
* pH
* Specific gravity
* Microscopic examination

Stool Specimen

Analysis of fecal material can detect pathological conditions ie: tumors, hemorrhage, infection

* Tests
o OB
o Pus
o Ova & Parasites

Fecal specimens

* ? Chemical preservatives
* Medical aseptic technique
* To lab on time
* Labelling
* Documentation

Guaiac Test

Colorectal cancer screening test

FOBT

Hemoccult slide test

Fecal Characteristics

* Color
o melena
* Odor
* Consistency
* Frequency
* Amount
* Shape
* Constituents

Guaiac Test

* Single positive test result does not confirm bleeding or colorectal cancer.
* Repeat test 3X
* Meat free, high residue diet

Vaginal or Urethral Discharge Specimens

* Normally thin, nonpurulent, whitish or clear, small in amount
* S&S STD’s, UTI
* Not Delegated
* Assess external genitalia
* If STD record sexual history
* Physician’s order- vaginal/urethral

Blood Specimens

* Lab techs
* ABG’s
* Blood Glucose

Respiratory Tract

* Tests to determine abnormal cells or infection
o Throat cultures
o Sputum specimens
o Skin testing
o Thoracentesis

Nose, Throat Specimens

* Upper respiratory/ throat infections
* Should Not be delegated
* Throat swabs
o ac meal or 1 hr pc meal
o Wash hands, glove
o Tilt head backward
o “ah” ( if pharynx not visualized, tongue depressor, anterior 1/3 of tongue)
o Don’t contaminate

Throat cultures

* Oropharynx & tonsillar
* Sterile swab
* Culture determines pathogenic microorganisms
* Sensitivity determines the antibiotics to which the microorganisms are sensitive or resistant

Method for throat culture

* Insert swab into pharyngeal region
* Reddened areas/ exudate
* Gag reflex if client sitting and leaning forward slightly
* Inform client re procedure

Nose culture

* Blow nose, check nostril patency
* Rotate Swab inflamed mucosa or exudate
* Swab must advance into nasopharynx to ensure culture properly obtained

Sputum specimens (3 major types)

Ordered to identify organisms growing in sputum

* C&S
* AFB
o 3 consecutive, early am
* Cytology
o Abnormal lung cancer by cell type
o 3 early am

Sputum collection

* May be delegated
* Cough effectively
* Mucus from bronchus
* Not Saliva
* Record
o Color
o Consistency
o Amount
o Odor
o Document date & time sent to lab.

Sputum collection

* No mouthwash/toothpaste-

viability of microorganisms and alter culture results

Skin testing

* Determines pulmonary diseases
o Bacterial
o Fungal
o Viral

Antigen injected intradermally

Injection site circled

Instructions not to wash site

Reading skin test

* Induration – palpable, elevated, hardened area around site. Edema and inflammation from antigen –antibiotic reaction. Measured in millimeters
* Reddened flat areas are neg.

The elderly freq. display false neg. or false positive TB skin test

If positive TB test

* Complete history risk factors
* Symptoms
o Weight loss
o Night sweats
o Hemoptysis
o Fatigue

Early am sputum for AFB

Chest xray

Thoracentesis

Insert needle through chest wall into pleural space

Aspirate fluid

* Diagnostic
* Therapeutic
* Biopsy

Gastric Secretions

* NG tube

Cultures

* Culturette/swab
* Wet/dry method
* Nose, throat, wound



Review procedure manual & fill in requisitions.

Nursing Functions for Specimen Collection

* Explain procedure, gain client’s participation
* Collect right amt. of specimen at the right time
* Place specimen in correct container
* Label container accurately

(addressograph), plastic bag

Nursing Functions for specimen collection

* Complete lab. Req.
* Place the specimen in the appropriate place for pick up.
* Document/record specimen sent and anything unusual about the appearance of specimen

Blood glucose levels

* Capillary Puncture
* Reduces Venipunctures
* Clients can perform
* Glucometers
* Chemical reagent strip
* Delegated to those instructed in skill if client’s condition stable

Glucose monitoring

* Ordered ac, pc, hs, fasting, before insulin (sliding scale)
* ? Risks for skin puncture
* Assess area of skin
o Sides of fingers, toes, heels
* Client’s ability
* Normal fasting Bld. Sugar

70-120 mg/100ml

Glucose Monitoring

* Wash hands, glove
* Client wash hands, warm water
* Follow instructions on meter
* Massage /milk finger or puncture site
* Antiseptic swab ( allow to dry completely)
* Wipe away first droplet of blood with tissue/cotton ball

Glucose Monitoring

* Dispose of lancet in sharps container
* Wash hands
* Check puncture site
o Can share reading with client
* Record results
* Proceed as indicated by results

The Value of Measurement

3 benefits to measuring progress and results

* Shows where we are now
* Tells if we are heading toward our goal
* Allows us to make improvements along the way

What we measure gets improved. Peter F. Drucker

* Heightens our awareness
* Helps us focus on what we value and where we are going
* Keeps us on track
* Gives info what is happening along the way and enables us to continue or change depending on desired results


Specimen collection Role of the Nurse.ppt

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Laboratory specimen: collection, safe transport and biosafety

Successful laboratory investigations

* advance planning
* collection of appropriate and adequate specimens
* labeling and documentation of laboratory specimen
* storage, packaging and transport to appropriate laboratory
* the ability of the laboratory to accurately perform the diagnostic tests
* biosafety and decontamination procedures to reduce the risk of further spread of the disease
* timely communication of results

Specimen collection:
key issues

* Consider differential diagnoses
* Decide on test(s) to be conducted
* Decide on clinical samples to be

collected to conduct these tests
o consultation between microbiologists, clinicians and epidemiologists

Transport medium

* Allows organisms (pathogens and contaminants) to survive
* Non-nutritive - does not allow organisms to proliferate
* For bacteria – i.e., Cary Blair
* For viruses - virus transport media (VTM)

Some tips

* Laboratory investigation should start as early as possible
* Specimens obtained early, preferably prior to antimicrobial treatment likely to yield the infective pathogen
* Before doing anything, explain the procedure to patient and relatives
* When collecting the specimen, avoid contamination
* Take a sufficient quantity of material
* Follow the appropriate precautions for safety

Blood for smears Collection

Capillary blood from finger prick
+ make smear
+ fix with methanol or other fixative

Handling and transport
Transport slides within 24 hours
Do not refrigerate (can alter cell morphology)

Blood for cultures
Collection

Venous blood
+ infants: 0.5 – 2 ml
+ children: 2 – 5 ml
+ adults: 5 – 10 ml

Requires aseptic technique
Collect within 10 minutes of fever
+ if suspect bacterial endocarditis: 3 sets of blood culture

Blood for cultures
Handling and Transport

Collect into bottles with infusion broth
+ change needle to inoculate the broth
Transport upright with cushion
+ prevents hemolysis
Wrap tubes with absorbent cotton
Travel at ambient temperature
Store at 4oC if can’t reach laboratory in 24 hours

Serum Collection
Venous blood in sterile tube
+ let clot for 30 minutes at ambient temperature
+ glass better than plastic
Handling
Place at 4-8°C for clot retraction for at least 1-2 hours
Centrifuge at 1 500 RPM for 5-10 min
+ separates serum from the clot
Transport
4-8oC if transport lasts less than 10 days
Freeze at -20°C if storage for weeks or months before processing and shipment to reference laboratory
Avoid repeated freeze-thaw cycles
+ destroys IgM
To avoid hemolysis: do not freeze unseparated blood

Collection
o Lumbar puncture
o Sterile tubes
o Aseptic conditions
o Trained person

Cerebrospinal fluid (CSF)

CSF
Handling and transportation
Bacteria
+ preferably in trans-isolate medium, pre-warmed to 25-37°C before inoculation
OR
+ transport at ambient temperature (relevant pathogens do not survive at low temperatures)

Viruses
+ transport at 4-8°C (if up to 48hrs or -70°C for longer duration)

Rectal swabs
Advantage
o convenient
o adapted to small children, debilitated patients and other situations where voided stool sample not feasible

Drawbacks
o no macroscopic assessment possible
o less material available
o not recommended for viruses

Stool samples Collection:
Freshly passed stool samples
+ avoid specimens from a bed pan
Use sterile or clean container
+ do not clean with disinfectant
During an outbreak - collect from 10-20 patients

Stool samples for viruses
Timing
o within 48 hours of onset
Sample amount
o 5-10 ml fresh stool from patients (and controls)

Methods
o fresh stool unmixed with urine in clean, dry and sterile container

Storage
o refrigerate at 4°C; do not freeze
o store at -15°C - for Ag detection, polymerase chain reaction (PCR)

Transport
o 4°C (do not freeze); dry ice for (Ag detection and PCR)

Stool samples for bacteria
Timing
o during active phase
Sample amount and size
o fresh sample and two swabs from patients, controls and carriers (if indicated)

Method
o Cary-Blair medium
o For Ag detection/PCR – no transport medium

Storage
o refrigerate at 4°C if testing within 48 hours, -70°C if longer; store at -15°C for Ag detection and PCR

Transport
o 4°C (do not freeze); dry ice for Ag, PCR detection

Stool samples for parasites
Timing
o as soon as possible after onset

Sample amount and size
o at least 3 x 5-10 ml fresh stool from patients and controls

Method
o mix with 10% formalin or polyvinyl chloride, 3 parts stool to 1 part preservative
o unpreserved samples for Ag detection and PCR

Storage
o refrigerate at 4°C; store at -15°C for Ag detection and PCR

Transport
o 4°C (do not freeze); dry ice for antigen detection and PCR

Throat swab (posterior pharyngeal swab)
Hold tongue away with tongue depressor
Locate areas of inflammation and exudate in posterior pharynx, tonsillar region of throat behind uvula
Avoid swabbing soft palate; do not touch tongue
Rub area back and forth with cotton or Dacron swab
WHO/CDS/EPR/ARO/2006.1

Nasopharyngeal swab
Tilt head backwards
Insert flexible fine-shafted polyester swab into nostril and back to nasopharynx
Leave in place a few seconds
Withdraw slowly; rotating motion
WHO/CDS/EPR/ARO/2006.1

Nasopharyngeal aspirate
Tilt head slightly backward
Instill 1-1.5 ml of VTM /sterile normal saline into one nostril
Use aspiration mucus trap
Insert silicon catheter in nostril and aspirate the secretion gently by suction in each nostril
WHO/CDS/EPR/ARO/2006.1

Sputum
Collection
Instruct patient to take a deep breath and cough up sputum directly into a wide-mouth sterile container

o avoid saliva or postnasal discharge
o 1 ml minimum volume

Respiratory samples
Handling and Transport
All respiratory specimens except sputum are transported in appropriate media

o bacteria: Amie’s or Stuart’s transport medium
o viruses: viral transport medium (VTM)
Transport as quickly as possible to the laboratory to reduce overgrowth by oral flora

For transit periods up to 24 hours
o ambient temperature for bacteria
o 4-8°C for viruses

Collection
Biopsy relevant tissues
+ place in formalin for histopathology
+ place in transport medium for microbiological testing
+ place in sterile saline for isolation of viral pathogens

Post-mortem samples
Post-mortem samples
Handling and transportation
Fixed specimens can be transported at ambient temperatures

+ transport specimens in transport media within 24h at ambient temperature
+ transport specimens in sterile saline at 4-8oC within 48h

Specimen Transport
media
Storage condition
Purpose/ Lab investigation
Transport
Pending test
Throat swab
VTM
Isolation
Isolation, serology
Stool
Isolation
Urine
Clotted blood
Whole blood
Virologic Investigations
Specimen
Transport
media
Storage condition
Purpose/ Lab investigation
Transport
Pending test
Throat swab
Amie’s or Stuart’s TM
Isolation Visualization
Bacteriologic Investigations
Water for bacteriology
Preparation
Chlorinated water - add sodium thiosulphate (0.5ml of 10% solution or a small crystal)
Tap/ pump
+ remove attachments
+ wipe, clean and flame outlet
+ allow to flow (at least one minute)

Water course or reservoir - collect from a depth of at least 20 cm
Dug well - do not allow the bottle to touch the sides of the well

Water for bacteriology Collection
At least 200 ml of water sample from the source
In sterile glass bottles OR autoclavable plastic bottles
+ tight screw capped lid
+ securely fitting stoppers/caps
+ an overhanging rim

Handling and transportation
Test the water sample within 3 hours of collection
+ keep at ambient temperature

If delayed:
+ pack sample on ice
+ test refrigerated sample within 24 hours

Food samples
Collect suspect food earliest
Collect aseptically - sterile tools, containers

Solid Food
o cut 100-200 grams from centre with sterile knife
o raw meat or poultry - refrigerate in a sterile plastic jar

Liquids
o shake to mix, use sterile tube
o water used for cooking -- 1-5 liters

Contact surfaces (utensils and/or equipment) for food processing
o moisten swab with sterile 0.1% peptone water or buffered distilled water; put the swab in an enrichment broth

Food samples
* Handling and transportation
o As fast as possible
o Keep perishable food at 2-8 °C
o Cool hot food rapidly - put containers under cold running water
o Pack samples to prevent spillage
o Contact the laboratory regarding method of transport and anticipated time of receipt
o Seek help from environmental/veterinary microbiologist

Labeling specimens
* Patient’s name (or Patient Identifier)
* Unique ID number (Research/Outbreak)
* Specimen type
* Date, time and place of collection
* Name/ initials of collector

Patient’s Name/Identifier Unique ID Number
RRR-0023 001712643003
Date, Time, Place of Collection
Specimen Type
Serum
Collected by:
MDR

Glass slides for microscopy
Label slides individually
o use glass marking pencil
o ensure markings don’t interfere with staining process

Each slide should bear:
o patient name
o unique identification number
o date of collection

Some Tips
* Pre-print labels
* Permanently affix label to the specimen container.
* Glass slides for microscopy labeled individually
* One specimen – one lab request
* Each slide should bear the patient’s name, unique identifier, and date of collection
* Use line listing for multiple patients
* Original documents kept by investigation team


Case investigation form
Epidemiologist sends:
Patient information
o age (or date of birth), sex, complete address

Clinical information
o date of onset of symptoms, clinical and immunization history, risk factors or contact history where relevant, anti-microbial drugs taken prior to specimen collection

Laboratory information
o acute or convalescent specimen
o other specimens from the same patient

Line listing – if large number of patients

Case investigation form
Receiving laboratory records:
Date and time when specimen was received
Name and initials of the person receiving specimen
Record of specimen quality

Criteria for rejecting samples
Mismatch of information on the label and the request
Inappropriate transport temperature
Excessive delay in transportation
Inappropriate transport medium
o specimen received in a fixative
o dry specimen
o sample with questionable relevance

Insufficient quantity
Leakage
Reference

Most of the slides used in this presentation are developed by the Department of Epidemic and Pandemic Alert and Response of the World Health Organization with assistance from:

European Program for Intervention Epidemiology Training
Canadian Field Epidemiology Program
Thailand Ministry of Health
Institut Pasteur

References

* Communicable Disease Toolkit: Iraq Crisis. Guidelines for the collection of specimens for laboratory testing. WHO, 2003
* Guidelines for the collection of clinical specimens during field investigation of outbreaks, WHO, 2000
* The role of laboratories and blood banks in disaster situations, WHO publication, 2001
* Sampling during avian influenza investigations, 2006
* IDSR guidelines for specimen collection, 2003
* Laboratory Needs for Emergency Situations, 2003
* Overview of Laboratory Structure and Operational Needs for the Iraqi Crisis, 2003
* Costing for sampling materials and diagnostic reagents for the Iraq crisis, 2003

Successful laboratory investigations.ppt

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Pre-analytical Laboratory Errors

Pre-analytical Laboratory Errors
By: Tim Guirl MT (ASCP)
Phlebotomy Instructor
North Seattle Community College
Health & Human Services Division

Objectives

* Identify the significant pre-analytical errors that can occur during blood specimen collection and transport
* Explain the various means of pre-analytical error prevention
* List proactive steps to reduce potential pre-analytical errors associated with blood collection and transport

Introduction

* Three phases of laboratory testing: pre-analytical, analytical and post-analytical
* Pre-analytical—specimen collection, transport and processing
* Analytical—testing
* Post-analytical—testing results transmission, interpretation, follow-up, retesting.

Phlebotomy Errors

* Phlebotomy is a highly complex skill requiring expert knowledge, dexterity and critical judgment
* It is estimated that one billion venipunctures are performed annually in the U.S.
* Phlebotomy errors may cause harm to patients or result in needlestick injury to the phlebotomist

Pre-analytical errors

* Pre- and post-analytical errors are estimated to constitute 90% of errors
* Errors at any stage of the collection, testing and reporting process can potentially lead to a serious patient misdiagnosis
* Errors during the collection process are not inevitable and can be prevented with a diligent application of quality control, continuing education and effective collection systems

Types of Collection Errors

* Patient Identification
* Phlebotomy Technique
* Test Collection Procedures
* Specimen Transport
* Specimen Processing

Patient Identification Errors

* Errors in correctly identifying the patient are indefensible
* Reasons for patient identification errors
o Proper positive patient identification procedures not followed
+ Patient identification from identification bracelet (inpatients)
+ Patient identification by asking patients to state or spell their full name (inpatients/outpatients)
+ Patient identification by staff or family member if patient unable to identify him/herself

Patient Identification Errors

o Specimen tubes unlabeled
+ Requisition or collection tube labels not affixed to tubes
# Requisition or collection tube labels in bag containing collection tubes
# Requisition or collection tube labels rubber-banded to tubes
# Collection tube labels not affixed to all tubes
# Specimen collection tubes labeled insufficiently with at minimum patient’s full name, date/time of collection, phlebotomist’s initials

Patient Identification Errors

* Collection tubes labeled with the wrong patient
o Wrong computerized labels affixed to collection tubes at bedside
o Collection tubes not labeled at the time of collection
o Collection tubes incorrectly labeled by someone other than the phlebotomist who collects the specimen

Patient Complications

* Some patient variables that affect blood specimens
o Diet
+ Fasting
o Exercise
o Obesity
o Allergies to alcohol or iodine used to clean venipuncture site
+ Use alternative cleanser such as chlorhexidine

Phlebotomy Technique Errors

* Phlebotomy technique is important
o Ensures test result validity
o Minimizes trauma to patient
o Minimizes potential for phlebotomist injury
o Reduces recollections
* Vein selection essential for successful venipuncture
o Three veins in antecubital fossa in order of selection (1) median cubital (2) cephalic (3) basilic

Phlebotomy Technique Errors

* Site Selection
o Avoid sites with IV
+ Use alternative arm or draw below IV to avoid contamination/dilution from IV
+ Document arm if IV
o Mastectomy—avoid site due to lymphostasis
+ Infection risk/alteration in body fluids and blood analytes
o Edematous areas —avoid due to accumulation of body fluids
+ Possible contamination/dilution of specimen

Phlebotomy Technique Errors

o Venous Access Difficulties
+ Obstructed, hardened, scarred veins
+ Veins difficult to locate
+ Use of Alternative sites
# Top of hand/Side of wrist
# Areas to avoid
o Vein Collapse
+ Use of appropriate needle size
+ Smaller evacuated collection tube

Phlebotomy Technique Errors

* Tourniquet Application
o Tourniquet tied too close to the venipuncture site can cause hematoma
o Veins may not become prominent if tourniquet is tied too high (more than 3 to 4 inches above venipuncture site)
o Tourniquet left on longer than one minute can result in hemoconcentration, affecting some test results
+ Tourniquet should be released as soon as needle is in the lumen of the vein and blood flow established

Phlebotomy Technique Errors

* Cleansing of venipuncture site
o Thorough cleaning with alcohol
o Allow alcohol to dry completely to avoid stinging sensation upon needle entry and hemolysis of sample
o Samples such as blood cultures should be collected using iodine to cleanse site to ensure sterility of sample
+ Recollection rate for blood cultures ranges due to contamination is as high as 50% in hospitals with increased costs, patient overtreatment

Phlebotomy Technique Errors

* Correct collection system
o Evacuated tube system (Vacutainer) for large veins in antecubital fossa
o Syringe for small, fragile veins or veins outside antecubital fossa
* Venous access
o Needle entry should be at 15 to 30 degrees depending on depth of vein
o Needle entry should be in same direction as vein, centered over vein
o Anchor vein to prevent movement during needle entry and to reduce pain to patient

Test Collection Errors

* Order of Draw
o Order of draw affects the quality of the sample and can lead to erroneous test results due to contamination with the additive from the previous blood collection tube
* Hemolysis
o Blood collected insufficient to amount of additive in tube,
o Traumatic venipuncture
o Blood collected from area with hematoma
o Vigorous shaking of tubes after collection
o Milking the site when collecting capillary samples and blood collected using a small diameter needle.

Test Collection Errors

* Timing of Collection
o Timed Draws
o Therapeutic Drug Monitoring
+ Peak and trough collection times
o Basal State Collections
+ Fasting requirements—no food or liquid except water
o Specimens affected by time of day, for example, cortisol

Test Collection Errors

* Improper collection tube drawn for test ordered
* Collection tube not completely filled
o Example—light blue top tube for Coagulation Studies. Incomplete filling results in specimen dilution and erroneous Prothrombin and aPTT test results.

Test Collection Errors

* Capillary Collections—finger stick or heel stick
o Appropriate site
+ Heel stick—sides of the bottom surface of the heel
+ Finger stick—third or fourth fingers, perpendicular to fingerprint lines on fleshy pads on finger surface
o Warming—Warm before collection to increase capillary blood flow near skin surface
o Cleaning—cleanse site with alcohol and allow to air dry

Capillary Collections

o Massaging site to increase blood flow
+ Milking site can cause hemolysis or tissue fluid contamination
+ Finger sticks—roll fingers toward fingertip at 1st finger joint several times
+ Heel sticks—gently squeeze infant’s heel before performing puncture.
o Perform puncture while firmly squeezing finger or heel
o Wipe away first two drops of blood
+ Ensure that full blood drop wells up each time

Capillary Collections

o Avoid touching capillary collection tube or micro collection tube to skin or scraping skin surface
+ Contaminates puncture site
+ Blood may become hemolyzed
o Mixing micro collection tubes with additive frequently to avoid micro clots
o Collecting tubes with additives first
o Protecting tubes for bilirubin from light

Blood Specimen Transport Errors

* Transport of blood specimens in the proper manner after collection ensures the quality of the sample
* Timing
o Some specimens must be transported immediately after collection, for example Arterial Blood Gases.
o Specimens for serum or plasma chemistry testing should be centrifuged and separated within two hours

Transport Errors

* Temperature
o Specimens must be transported at the appropriate temperature for the required test
+ On ice—ABGs, Ammonia
+ Warmed --98.6 degrees (37 C), cryoglobulins
+ Avoid temperature extremes if transported from via vehicle from other collection site
* Transport Container
o Some samples need to be protected from light, for example, bilirubin
o Transport in leak-proof plastic bags in lockable rigid containers

Error Prevention

* Phlebotomy Education
o Phlebotomists should have completed a standard academic course in phlebotomy and undergo thorough on-the-job training under the supervision of a senior phlebotomist
* Continuing Education
o Phlebotomists should participate in regular educational competency assessments (written and observational)
o Professional Licensure
* Phlebotomy Staffing
o Adequate staffing to maintain collection standards
* Technology
o Use of barcode scanners for patient identification

Questions and Discussion

* How are pre-analytical errors prevented in your laboratory?
* What technology do you use to prevent human error?
* What systems does your hospital use to prevent errors by non-laboratory staff collecting blood?
* What pro-active improvements would reduce the number of pre-analytical errors?

Pre-analytical Laboratory Errors.ppt

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