1. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.1 This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment & Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non- commercial use only.

3. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Fasting Specimens (NPO) A fasting specimen is usually collected from a patient in the morning before the patient has had breakfast. General rule is 12 hr. fast Black coffee, water allowed

4. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Timed Specimens Certain specimens must be collected at specific timed intervals. Drug levels are one example of timed specimens. The drug level in the patient must be maintained within a therapeutic range. The therapeutic range is the level the drug is to be maintained at to be effective but not harm the patient.

5. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Timed Specimens (cont.) A specimen is collected before the IV is started. This is known as the trough level (pre) specimen. The specimen collected immediately after the IV is complete is known as the peak level (post) specimen.

6. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Timed Specimens (cont.) Another example of timed specimens are Cortisol Levels. Cortisols are usually drawn at exactly 0800 and 1600.

7. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 ASAP Specimens ASAP (As Soon As Possible) specimen requests are typically resulted within 2-4 hours from time of collection. Follow your hospital’s protocol

8. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Stat Specimens Stat specimens are specimens that need to be collected immediately because of the critical state of the patient. Usually identified as STAT on tube and request form. Notify lab when STAT specimen is returned to lab.

9. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Special Collection Techniques Alcohol –Blood alcohol testing must be collected without the use of alcohol to clean the arm. –Alternative cleaning: soap and water, others

10. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Special Collection Techniques (cont.) Chain of custody –Also known as forensic specimens –Form that accompanies the specimen dictates that each person handling the specimen must sign the form.

11. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Special Collection Techniques (cont.) Heavy metals –Special tubes are used when testing for heavy metals such as arsenic or lead. –Tubes usually have a royal blue top with a variety of additives.

12. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Glucose Testing Types of Diabetes Three types of diabetes –Type 1: Deficiency in insulin production. –Type 2: Most common type of diabetes is a result of lack of insulin activity. –Prediabetes: Patient’s blood glucose is higher than normal, but not high enough to be classified as diabetes.

13. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Glucose Testing Fasting glucose Glucose tolerance test –Two-hour, two specimens –Two-hour, three specimens –Three-hour, four specimens Gestational screening

14. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Glucose Testing (cont.) Postprandial glucose test Two-hour post glucose drink Glucose drink given to the patient will contain either 50, 75, or 100 grams of glucose. Amount given to the patient depends on the test being administered.

15. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Blood Culture Blood cultures are collected when a patient is suspected of having a bacterial infection of the bloodstream (septicemia).

16. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Blood Culture (cont.) Cleaning the skin correctly is the key to an accurate and uncontaminated blood culture collection.

17. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Blood Culture (cont.) Before introducing blood into the bottle, the top of the bottle must be wiped off with an alcohol pad, not with iodine or Betadine. Both an aerobic bottle and an anaerobic bottle must be collected. Blood volume varies by the bottle manufacturer and age groups.

18. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Urine Collection Urine collection requires specific instructions to the patient. (The phlebotomist can be asked to give proper patient instruction.)

19. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Common Types of Urine Specimens First morning or after 8 hour rest Random specimen 24-hour collection

20. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.20 Specific Urine Collections Clean-catch midstream (CCMS) Catheterized urine collection (RN) Chain of custody urine collection Urine culture collection Infant and children collections See Chap. 9 pp 290 - 299

21. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.21 Problems Associated with Urine Specimens Delay in testing can cause: –Deterioration of chemical and cellular components –Multiplication of bacteria –Decrease or increase in analytes because of bacterial growth in the specimen

22. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.22 Precautions to Avoid Problems with a Delay in Testing Refrigerate specimen at 5°C. Use a patient kit for a clean collection. Special preservative tubes Amber containers for 24-hour collections Chemicals in 24-hour urine containers

23. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.23 Special Preservative Tubes Urine preservative tubes and urine transfer straw.

24. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.24 24-hour Urine Container Container may contain hydrochloric acid or boric acid in order to preserve the specimen.

25. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.25 Semen Collection Semen specimens are used for fertility testing of the male or for postvasectomy testing. Semen specimens must be kept at body temperature (37°C) and transported to testing lab STAT See Procedure 9.7 and Figure 9.13.

26. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.26 Stool Specimens Occult blood specimens are collected by the patient and placed on a card for testing.

27. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.27 Stool Specimens (cont.) Ova, parasite, and stool cultures are collected in special preservative containers. Remember, all specimens must be properly identified and labeled!!

28. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.28 Today’s Phlebotomist Proper patient identification is most important step in any encounter with patient! Phlebotomists are cross-trained to work in several patient areas: inpatient, outpatient, registration, point-of-care testing Flexibility and proper training are keys to success!