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Phlebotomist & Biochemistry
 

Phlebotomist & Biochemistry

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    Phlebotomist & Biochemistry Phlebotomist & Biochemistry Presentation Transcript

      • Phlebotomy and the Biochemistry Dept
      • Felicity Dempsey
      • Senior Medical Scientist
      • Biochemistry Laboratory
      • St James’s Hospital
    • Role of Phlebotomist
      • Inform patient of any test preparation
      • Ensure correct sampling & handling
      • Properly identify the patient
      • Label sample with 2 unique identifiers
      • Adherence Hospital Quality System
      • Adherence Health & Safety Codes
      • Minimise risk management
    • Role of Phlebotomist
      • Knowledge of test requirements (user manual)
      • Universal Blood Precautions (CJD)
      • Ensure quality of sample
      • Ensure patient details stated correctly
      • Avoid haemolysis & microclotting
      • Prioritise STAT samples
      • Prompt dispatch
      • LIS/EPR operation
    • CPA STANDARDS
      • C3standard – The facilities for the patient should provide privacy during reception and sampling
      • C3.1 Waiting/Reception area with disabled access
      • Phlebotomy Area for privacy & recovery
      • Toilet facilities separate to staff
      • C3.2 Notices advising patients of Health & Safety precautions
    • E3 Specimen collection and handling
      • E3.1 Lab management should establish procedures for specimen collection and handling
      • E3.2 Procedures available to service users & those responsible for specimen collection and handling
      • E3.3 Lab periodically reviews its sample volume requirements to ensure that neither insufficient nor excessive amounts are collected.
    • Sampling Procedures
      • Venepuncture
      • Finger prick
      • Heel prick
      • Capillary
    • Sample types
      • Plasma (anticoagulated)
      • Serum (clotted)
      • Whole blood
    • Laboratory Process
      • Preanalytical – Major Advances
      • Primary Sampling, Analysers
      • Analytical – Instrumentation/Analyses
      • Postanalytical – Final result
    • Preanalytical issues
      • Diet
      • Diurnal variations
      • Drug Therapy
      • Pregnancy
      • Dehydration
      • Patient’s current condition
    • Viruses Bacteria Foods Sunlight Stress Drugs Genes Menopause Pregnancy Post-pregnancy Preanalytical                                                                                                                                                     Gender
    • Preanalytical issues
      • Haemolysis
      • Lipaemia
      • Icterus
      • Partially filled tubes
      • Cross contamination
      • Incorrect sample type
      • Incorrect/inadequate labelling/unlabelled
    • Problems with vacuutainers
      • Loss of vacuum
      • Improper storage
      • Incorrect sampling technique
      • Incorrect blood/additive ratio
      • Expired tubes
    • Blood containers
      • Evacuated or syringe
      • Gel separators
      • Viscosity changes on centrifugation
      • Inhibits cell metabolism
      • Change of tube system validated by lab
    •  
    • Additives
      • Liquid, spray dried or powder
      • Anticoagulants
      • Antiglycolytic
      • Clot activators
      • Trace element
    • Order of draw
      • Blood Cultures
      • Citrate
      • Serum
      • Heparin
      • EDTA
      • Oxalate
    • Essential precautions
      • Invert gently to mix
      • Vigorous mixing - haemolysis
      • Cross contamination
      • Never transfer between tubes
    • NCCLS H3-H5, Vol 23, No 23, 8.10.2
    • Anticoagulants
      • Chelates/ precipitates calcium
      • Ca unavailable coagulation process
      • Inhibits thrombin formation
      • Prevents Fibrinogen to Fibrin process
    • Commonly used in Biochemistry
      • Colour coded tubes
      • Lithium Heparin (green/orange)
      • Fluoride Oxalate (grey)
      • Clotted (red)
      • Trace metal (royal blue)
      • System to system variation
    • Test requisition
      • Electronic Patient Register (EPR)
      • Phlebotomy lists
      • Bar coded labels
      • Hospital Forms
      • GP multidisciplinary forms
    • Minimum Acceptance Criteria
      • Form / EPR label
      • Patients Name
      • MRN
      • Hospital /Ward
      • DOB
      • Referring Consultant
      • Date/Time collected (desirable)
      • Clinical Details (noted if not supplied)
    • Transport to Laboratory
      • Pneumatic transport tube system
      • Hospital porter
      • Internal Couriers
      • External Couriers
      • Train
      • Post
    • Considerations for Phlebotomists
      • Transport on ice
      • Transport frozen
      • Light protected
      • Requires immediate separation
      • Refridgerated centrifuge
      • Inform lab of impending arrival
    • Analytical issues
      • Routine biochemistry (daily)
      • Routine biochemistry (1-3 times weekly)
      • STAT biochemistry
      • Endocrinology
      • POCT
      • Discipline specific specialities
      • Neonatal/Paediatric Biochemistry
    • Routine – Organ Profiling
      • Renal /Liver/Bone/Cardiac profiles
      • ICU profiles – ICU, HDU, BU, Oncology
      • Overlap in some tests
      • Glucose – random, fasting, post prandial
      • Amylase
      • Magnesium
    • Renal profile
      • Urea
      • Creatinine
      • Sodium/Potassium (Na/K)
      • Bicarbonate
    • Bone Profile
      • Calcium (Ca)
      • Inorganic Phosphate (In P)
      • Alkaline Phosphate (ALP)
      • Albumin
    • Liver profile
      • Total Protein/Albumin
      • Total Bilirubin
      • Enzymes – GGT, ALP,
      • Transaminases - AST, ALT
    • Cardiac Profiles/Markers
      • Enzymes
      • LDH, AST, CK
      • Markers
      • CKMBM (mass measurement)
      • Troponin T or I
      • Pro BNP
    • Routine Biochemistry
      • Lipid profiles
      • Therapeutic Drug Monitoring (TDM)
      • anti epileptic, anti asthmatic, lithium, digoxin
      • Diabetes monitoring
      • HbA1c, urinary microalbumen
      • Toxicology
      • Non blood biochemistry
    • Endocrinology
      • Thyroid function tests
      • Infertility testing
      • Adrenal testing
      • Growth & Development
      • DM & Obesity
    •  
    • Specialities
      • Porphyria
      • Haemochromotosis typing
      • Tumour Markers
      • Bone Markers
      • DNA analysis
      • Metabolic disorders
      • Neonatal screening
    • Irish Neonatal Metabolic Screening Programme
      • Phenylketonuria (PKU)
      • Maple Syrup Urine Disease (MSUD)
      • Congenital Hypothyroidism (CHT)
      • Galactosaemia
      • Homocystinuria
    • Guthrie Cards
      • Preanalytical Considerations
      • Adequate sample application
      • Air dry elevated / horizontal
      • No stacking - Cross Contamination
      • Other Contaminants:
      • Powder / Lotions
      • Alcohol wipes
      • Urine, Faeces & Sweat
    • Commonly encountered sample problems
      • Delay in separation (GP)
      • Haemolysis
      • Incorrect sample type
      • Cross contamination
      • Drip arm sample
      • Incorrect patient
      • Lipaemia
      • Icterus
      • Alcohol/Trace Metal Contamination
    • Timing of samples
      • Fasting samples
      • TDM requirements
      • Digoxin - +6 hrs
      • Stimulation tests
    • TDM requirements
      • Efficacy Dose
      • Avoid Toxicity
      • Compliance
      • Lithium – serum required
    • Chain of Custody Protocols
      • Samples unsuitable medico-legal purposes
      • Legal samples
      • Coroner’s requests
      • Industry
      • Work related injury
      • Employee insurance schemes
      • Drug screening
    • Glucose Testing
      • Random
      • Fasting
      • 2hr PP
      • GTT
      • Incorrect Timing - misinterpretation
    • Take home message
      • Reference ranges not consensus
      • Method/ Instrument variation
      • Possible sample type variation
      • Protocols may differ
      • Contact lab if unsure
    • Therapeutic Phlebotomy
      • Haemochromatosis (Fe)
      • Porphyria Cutanea Tarda (Fe)
      • Polycytaemia (RBC)
    • Common aims
      • Know & Comply Hospital/Dept Quality Policy
      • Reduce Turnaround Time (TAT)
      • Inform lab if urgent
      • Efficient transport
      • Efficient Reporting
      • Prioritise wards (ICU/CCU/BU/AE/HDU/Oncology
      • POCT
    • Post analytical
      • Data Review
      • Delta checking
      • Phone urgent results
      • Additional testing
      • Gender based reference ranges
    • Post analytical
      • Electronic reports - Wards Healthlink, Medibridge
      • Computer generated results
      • OPD / Clinic lists
      • Follow up letters/phonecalls
    • Changing face of Pathology
      • Pathology review – just published
      • 3 cold labs (GP work) ??S,W,E
      • 14 hot labs (i.e. 14 A/E)
      • Reduced from 48
      • Country wide/combine hospitals
      • Smaller hospitals – community hospitals
      • Tenders – public/private interests
    • Changing face of Pathology
      • Preanalytical analysers
      • Blood Sciences
      • Combined Biochemistry, Haematology, Immunology analysers
      • Increased POCT
    •  
    •  
    • Why Don’t You……
      • Visit your hospital laboratory
      • Befriend the Lab Staff