1. BLOOD CULTURES Ordered for fever of unknown origin (FUO) Bacteremia or Septicemia = Pathogenic bacteria in the blood Sterile blood Careful disinfection of skin and bottles to prevent bacterial cont Skin antiseptics: Povidone-iodine/70%ethy alcohol combo Chlorhexidine gluconate for allergies 30-60 second friction scrub in concentric circles; wait 30 seconds Clean top of bottles with 70% isopropyl alcohol Collect culture sets of 2: Aerobic(vented); Anaerobic(No oxygen)

2. GLUCOSE TESTING Post-prandial (PP) - after eating Glucose levels tested 2 hours after a meal Screening test for diabetes and gestational diabetes

3. GLUCOSE TESTING Glucose Tolerance Test (GTT) Check carbohydrate metabolism problems. Hypoglycemia - Low glucose Hyperglycemia - High glucose Insulin - enzyme produced by pancreas to regulate glucose Diabetic urine = glucose, ketones

4. GLUCOSE TOLERANCE PROCEDURE Patient has 150 g. carbohydrates 3 days prior to test. Fast for at least 8 hour but no more than 16 hours Drink water to prevent dehydrations Procedure: give patient 100gm glucose challenge; Discontinue if patient vomits; Collect fasting, 30 minute, 1, 2, 3 hour blood & urine specimens.

5. THERAPEUTIC DRUG MONITORING (TDM) Manages patient’s drug treatment Peak levels - collected at time of highest serum concentration of the drug (15-30 minutes after administration of drug). Trough levels - collected at time of lowest serum concentration of the drug.

6. Blood Alcohol (ETOH) Blood Alcohol (Ethanol): Prepare site using non-alcohol antiseptic: benzalkonium chloride Collect gray top (fluoride) tube Chain of custody protocol – documentation that specimen accounted for at all times; special forms; Can be summoned to court.

7. Trace Elements Include: aluminum, arsenic, chromium, lead, mercury Collected in royal blue top tube

8. Point of Care Testing Alternate site testing or bedside testing Brings lab testing to patient Testing done on small, portable, handheld devices Considered “waived” testing Do not require same level of quality checks at more complex testing Quality Control done upon receipt of new shipment of test kits or with each new testing personnel Common POC tests Glucose, Hemoglobin, Hematocrit, Lipids, Bilirubin, Occult Blood (Guaiac), Pregnancy

9. NEWBORN SCREENING PKU - phenylketonuria required by law before newborn leaves the hospital Detects presence of genetic or inherited diseases Untreated = brain damage or mental retardation. Procedure: collect onto special filter paper only once; air-dry. 2 collections: Birth & 10-15 days