Laboratory Testing

Information Regarding Lab Testing can be found on the Intranet → ↑

Order of Draw For Adults

Prevent Sample Clotting Why • Most tubes contain an additive or clot activator that needs to be mixed with the blood sample. • Tubes with anticoagulants such as EDTA need to be mixed to ensure the specimen does not clot.

Variances in Tube Type Tubes that should not clot Tubes that should clot • Gently invert the blood collection tube and mix additive specimens thoroughly

Quantity Not sufficient (QNS) Prevent Delays in Turn Around Time (TAT) Make Sure ALL Tubes are Properly Filled to the Indicated Marking on the Side of the Tube Samples that are short draws can give erroneous results and require special processing

Examples of QNS Samples

. Examples of Fill Line

Blood: Before and After

Hemolysis Causes Evacuated Tubes Specimen Collection: • An improper choice in the venipuncture site, such as drawing from a distal site to the antecubital region of the arm rather than drawing from an antecubital site, • Prolonged tourniquet time • Cleansing the venipuncture site with alcohol and not allowing the site to dry may cause hemolysis. • An improper venipuncture, indicated by a slow blood flow, may indicate occlusion due to the lumen of the needle being too close to the inner wall of the vein • The use of a small-bore needle, resulting in a large vacuum force applied to the blood • The use of a large bore needle may result in a much faster and more forceful flow of blood through the needle, resulting in hemolysis.

Hemolysis Causes Syringe Draws IV Catheters • Pulling the plunger of a syringe back too far while using a large bore needle, may cause enough pressure for hemolysis to result during collection. • Transferring into a tube by pushing down on the syringe plunger in order to force blood into a tube may cause hemolysis, as well as create a positive pressure in the tube which may cause the stopper to come off. IV Catheters • Several studies have noted that when blood is drawn from a peripheral IV catheter, a higher incidence of hemolysis occurs due to frothing of the blood from a loose connection of the blood collection assemblies.

Hemolysis Corrective Actions • Redraw the specimen. • The most common sites to draw from are the median cubital, basalic, and cephalic veins from the antecubital region of the arm. • The most commonly used sizes are 19 through 23. Avoid using a needle that is too small or too large. • The tourniquet should be released after no more than one minute, and excessive fist clenching should be avoided. • Without touching, allow the venipuncture site to air dry.

Hemolysis Corrective Actions • Avoid drawing the syringe plunger back too forcefully when collecting blood with a needle and syringe. • Avoid pushing the plunger too forcefully when transferring to a tube. • Ensure all blood collection assemblies are fitted securely, to avoid frothing.

Documentation of Critical Low Point of Care Glucose Use for Critical Low ≤ 50 mg/dL Glucose Point of Care in Hypoglycemic Event Response Note Critical results should be repeated on meter and then doctor should be notified. Doctor notification should be documented like the sample (Name of doctor, date, time and result all recorded).

Adhoc Documentation of Critical POC Glucose Results Use for Critical High ≥ 400 mg/dL Glucose Point of Care Use for Critical Low ≤ 50 mg/dL Glucose Point of Care when not under hypoglycemic note Critical results should be repeated on meter and then doctor should be notified Doctor notification should be documented like the sample . (Name of doctor, date, time and result all recorded) This should be done in the adhoc critical value notification note in power chart

Documentation of Critical EPOC Results/ Notification of Doctor Use for Critical EPOC results –flagged with flashing nurse sign on EPOC reader. Critical results need to be communicated to doctor and notification can be recorded in the meter. See screen shot Just hit flashing nurse to get to this screen. If you do not document in the EPOC meter, you need to go to the adhoc critical documentation section of power chart and document there. This is mandatory. Failure to comply will result in the removal of EPOC access. NAME OF DOCTOR SHOULD BE TYPED IN THE NOTIFY BAR(SEE NEXT SCREEN) This will appear in the result section in Cerner.

Documentation of Critical EPOC Results/ Notification of Doctor