PRINCIPLES OF MEDICAL LABORATORY platelet activation, coagulation or even

SCIENCE 2 3RD LECTURE EXAMINATION breakage of glass tube

-​ The specimen should be transported with
LESSON 9: HANDLING AND PROCESSING OF stopper to:
BLOOD SPECIMENS FOR LABORATORY 1.​ Avoid contact to the patient
TESTING 2.​ Minimize agitation of the specimen
3.​ Aid clot formation
Steps Involved in Processing and Handling
Different Types of Specimens
-​ 46 to 68% of laboratory errors occur in the Special Handling
pre-analytical phase -​ Special care is needed when handling
-​ The phlebotomist is responsible to follow blood specimen to protect its condition
all appropriate steps required for each test and quality.
that they are scheduled to perform ●​ Body Temperature
●​ Chilled specimen
Pre-analytical Phase ●​ Light-sensitive specimen
-​ Patient Identification
-​ Blood Collection 1. Body Temperature
-​ Choice of Tubes -​ Specimens should be transported below
body temperature to prevent precipitation
or agglutination
Routine Handling -​ WHAT TO DO?
-​ Roles of the phlebotomist in routine ●​ Tubes should be pre-warmed at
handling: 37°C
1.​ Have the knowledge and skills to ●​ Portable heat blocks are used
perform routine venipuncture during transport
2.​ Be careful in mixing tubes and ●​ Heel warmer can withstand a
preparing specimen for transport to temperature slightly higher than
the laboratory 37°C
3.​ Adhere to time limits set for -​ EXAMPLES
delivery of specimen to the ●​ Cold Agglutinin
laboratory ●​ Cryofibrinogen
●​ Cryoglobulins
1. Mixing Tubes by Inversion
2. Chilled Specimen
-​ Chilling shows the metabolic process,
Cap Color Number of
Inversions which could affect the results for some
specimens
Red (Glass) 0x -​ WHAT TO DO?
●​ Specimens should be completely
Light Blue 3-4x
submerged in crushed ice and
Red (plastic; with clot water slurry during transport and
activator) 5x immediately tested or refrigerated
Gold/Tiger Top -​ EXAMPLES:
●​ ACTH
Light green ; Green ;
●​ Acetone
Lavender ; Pink ; Gray 8x
; Tan Yellow ; Orange ; ●​ ACE
Royal Blue ●​ Ammonia
●​ Catecholamines
●​ Free fatty acids
2. Transporting Specimens
●​ Gastrins
-​ Handling specimens for transport should
●​ Glucagon
be done properly to avoid hemolysis,
●​ Homocysteine
 ●​ Lactic acid Delivery Time Limits
●​ PTH -​ Routine blood specimen must be
●​ pH/blood gas delivered in the laboratory within 45
●​ Pyruvate minutes
●​ Renin -​ Centrifugation must be done within 1 hour
-​ Hematology specimen (EDTA tube)
3. Light-Sensitive Specimen should not be centrifuged
-​ Exposure to light can affect the result of a -​ STAT or emergency specimens take
specimen priority over all other specimens in terms
-​ WHAT TO DO? of transportation, processing and testing
●​ Wrap the specimen tube with -​ Exceptions to the time limit
aluminum foil or use light-blocking,
amber-colored container Time Limit Exception
-​ EXAMPLES: 1.​ Blood smear - prepared within 1
●​ Bilirubin hour after the collection
●​ Carotene 2.​ EDTA specimen for CBC -
●​ Red Cell Folate analyzed within 6 hours but is
●​ Vitamin B2 stable 24 hours from collection
●​ Vitamin B6 3.​ EDTA specimen for ESR - tested
●​ Vitamin B12 4 hours (RT) and 12 hours (ref
●​ Vitamin C temp)
●​ Urine Porphyrins 4.​ EDTA specimen for Reticulocyte
●​ Urine Porphobilinogen count - stable for 6 hours (RT) and
-​ Specimen are transported to the 72 hours (ref temp)
laboratory for screening and prioritizing 5.​ Glucose Test drawn from
-​ They are: Sodium fluoride - stable for 24
1.​ Identified hours (RT) but stable for up to 48
2.​ Logged hours (ref temp)
3.​ Sorted by department 6.​ Prothrombin Time (PT) - stable
4.​ Evaluated for specimen suitability for 24 hours
7.​ Activated Partial Prothrombin
Time (APPT) - should be analyzed
Specimen Rejection within 4 hours from collection
1.​ Specimen is not identified
2.​ Inadequate volume Centrifugation
-​ Remember to look on the black -​ Centrifuge - an apparatus that is used to
line when filling the tube separate cells, plasma or serum of blood
3.​ Hemolysis specimens
4.​ Wrong tube for collection -​ Centrifugation - achieved by spinning the
5.​ Tube is outdated blood tubes inside the vessel at a high
6.​ Improper handling/mixing speed that the centrifugal force will cause
7.​ Specimen is contaminated the separation of the specimens
8.​ Specimen is insufficient (QNS) -​ It is important to leave the stopper on the
9.​ Collection time is incorrect tube before centrifugation to avoid
10.​Specimen is exposed to light contamination, evaporation, aerosol
11.​Procedure did not follow testing time formation and pH changes
limits -​ Tubes must be balanced in the centrifuge
12.​There is a delay or error in processing ●​ Plasma specimen - should be
centrifuged immediately
●​ Serum specimen - needs to be
Delivery Time Limits and Exceptions for completely clotted prior to
Delivery and Processing Specimens centrifugation
 -​ Normal clotting: 30 to 60
minutes at Room
Temperature

Aliquot Preparation
-​ Aliquot of specimen refers to a portion of a
sample specimen for chemical analysis or
testing
-​ The preparation is done by transferring a
portion of specimen into one or more
tubes

OSHA Act (RA 110058) Required Protective

Equipment Worn when Processing Specimen
-​ Healthcare institutions should comply with
the appropriate protective equipment set
by the Occupational Safety and Health
Standards Act
-​ Protective equipment includes gloves,
gown/coats and masks
LESSON 10: HANDLING BLOOD SPECIMENS the patient exhibits any
OF NON-BLOOD SPECIMENS FOR therapy-related complications
LABORATORY TESTING -​ Accuracy of urine analysis results
largely depends on several factors:
Non-Blood Specimens ●​ Collection method
-​ Liquid or semiliquid substances produced ●​ Container used
by the body ●​ Transportation and handling of
-​ Found within various organs and body specimen
spaces ●​ Timeliness of the testing

EXAMPLES:
-​ Urine COMMON URINE TESTS
-​ CSF 1. Routine Urinalysis
-​ Amniotic fluid ●​ The frequently ordered urine test that
-​ Synovial fluid screens patient for any urinary or
-​ Serous fluid systematic disorders
-​ Sputum ●​ Covers physical analysis (color, clarity,
-​ Oropharyngeal swab and nasopharyngeal and odor), chemical analysis (pH,
swab specific gravity, glucose, protein, etc.) and
-​ SemenSaliva microscopic analysis (cells, crystals, and
-​ Bone marrow aspirate microorganisms)
-​ Breath samples ●​ Random specimen is acceptable, but
-​ Tissue specimens midstream collection is recommended
-​ Feces/stool & ideal to ensure no contamination by
genital secretions, pubic hair, or bacteria
Labeling surrounding the urinary opening
-​ Name, Date and Time of Collection ●​ Specimen container should be clear & dry
-​ Type and/or Source of the Specimen with tight-fitting lids & chemically cleaned
-​ Label: Pasted on the container, not the lid ●​ Should be transported to the lab
-​ Various handling requirements immediately but could be held at room
-​ All body substances are potentially temperature for 2 hours
infectious ●​ Could be refrigerated if transport will take
-​ Standard precautions must be observed longer prescribed

2. Urine Culture and Sensitivity (C&S)

Urine ●​ Requested if the patient has symptoms
-​ Most analyzed among the non-body of a UTI
fluids in the body ●​ Should be midstream clean-catch urine
-​ Inexpensive to test since its collection is collection placed in a sterile container
not tedious and available most of the time ●​ A measured portion of the urine is cultured
-​ Urine analysis: on a special nutrient medium for 18-24
●​ Provides a picture of the many hours.
metabolic functions of the body ●​ The medium will encourage the growth of
●​ Helps in monitoring wellness microbes
●​ Helps in diagnosing and treating ●​ If a microbe is present & identified, a
UTI sensitivity or antibiotic susceptibility test is
●​ Helps in detecting and performed
monitoring the progress of
treatment in metabolic diseases 3. Urine Cytology Studies
●​ Helps in identifying the ●​ Requested by the physician to detect
effectiveness of an administered cancer, cytomegalovirus, and other viral
therapy, as well as checking if and inflammatory diseases in the urinary
system
 ●​ A fresh clean-catch specimen is required 2.​ First morning/8-hour urine specimen -
●​ A smear from the cells of the lining of the collected immediately upon waking up
urinary tract is stained using Papanicolaou from 8 hours of sleep
(PAP) stain & examined for abnormal cells 3.​ Fasting - a second morning or second
●​ Should be examined immediately specimen voided after fasting (glucose
●​ If delays can’t be avoided, specimen must monitoring)
be preserved by adding an equal amount 4.​ Timed - collected at specific times or
of 50% alcohol pooled throughout a specific period
●​ Tolerance test (glucose) - fasting,
4. Urine Drug Testing ½ hour, 1 hour, etc.,
●​ Performed to Detect: ●​ 2-hour postprandial - two hours
-​ Illicit use of recreational drugs after a meal
-​ Use of anabolic steroids to ●​ 24-hour - collection and pooling of
enhance performance in sports all urine that is voided in 24 hours
-​ Unwarranted use of prescription ●​ Double-voided - waiting time is
drugs approximately 30 minutes after
●​ Monitors therapeutic drug use to minimize emptying the bladder
the symptoms associated with the
withdrawal & confirms drug overdose
●​ Random sample is placed in a chemically 24-Hour Urine Collection Procedure
clean container with lid and submitted for 1.​ Empty the bladder upon waking up.
testing 2.​ Affix the label on the container and write
down the time and date of the specimen
5. Urine Glucose and Ketone Testing collection. Start timing.
●​ Performed to screen diabetes and to 3.​ Discard line output at the first hour of
determine the glucose level for patients collection and collect all the urine that has
who are already diabetic been passed for the next 24 hours.
●​ Urine Ketone Level Test - used to 4.​ If instructed, refrigerate the specimen
determine if the patient is suffering from collected all throughout the collection
diabetic ketoacidosis period.
●​ Color changes in the test strip are 5.​ Collect urine prior to bowel movement.
compared to a color chart to interpret the 6.​ Drink fluid as needed to avoid
results of the test dehydration.
7.​ Take one last void at the end of the
6. Urine Pregnancy Testing 24-hour collection period.
●​ Used to confirm pregnancy, which can 8.​ Make sure the container is sealed before
be detected 8 to 10 days after conception placing it in the cooler. Transport the
●​ First morning urine specimen is specimen to the lab at the soonest
preferred since it has the highest possible time.
concentration of HCG

7. Other Urine Tests Urine Collection Method

●​ Chemistry tests performed using urine that 1.​ Regular voided: The patient voids or
usually need a pool-timed specimen urinates into a clean container.
●​ Include electrophoresis, heavy metals 2.​ Midstream: The patient voids or urinates
(copper and lead), myoglobin clearance, into the toilet first, interrupts the urination
creatinine clearance, and porphyrins for a while, and then restarts into the
container with the last urine flow voided in
the toilet.
Types of Urine Specimens 3.​ Midstream clean-catch: Special cleaning
1.​ Random - collected at any time is performed on the genital area of the
patient before collection.
 4.​ Catheterized: Urine of patient is collected ●​ Performed to check the contents of the
from a sterile catheter inserted through the stomach for abnormal substances and
urethra into the bladder. evaluate the production of acid by
5.​ Suprapubic aspiration: Urine of patient is evaluating the gastric acid concentration.
collected by inserting needle directly into ●​ In basal gastric analysis, a tube is passed
the bladder and aspirating the urine by the through mouth & throat (oropharynx) or
use of a sterile syringe. nose, & throat (nasopharynx) into the
6.​ Pediatric: When the patient is a child who stomach after the patient has done fasting
is not potty trained, urine is collected in a for a specified time period.
plastic bag and checked every 15 minutes ●​ Sample is aspirated to determine acidity
until the required volume is collected. before stimulation.
●​ Gastric stimulant is administered IV after
the specimen collection. A series of
Amniotic Fluid collections will follow with timed intervals.
●​ Clear, colorless to pale-yellow liquid ●​ Placed in sterile containers
contained in the amniotic sac that
surrounds and cushions the fetus during Nasopharyngeal Secretions
pregnancy ●​ Collected and cultured to determine the
●​ Collected by the physician using presence of bacteria that can cause
transabdominal amniocentesis diphtheria, meningitis, pertussis
preferably 15 weeks of gestation (whooping cough), and pneumonia
●​ Guided by the ultrasound machine and ●​ Collection is performed by gently inserting
about 10 ml of fluid is aspirated from the a dacron or sterile cotton-tipped flexible
amniotic sac through the needle inserted wire swab through the nose and into the
in the mother’s abdominal wall into the nasopharynx.
uterus ●​ Swab is rotated and gently removed, then
●​ Done to detect any genetic disorder; placed in a properly labeled sterile
check any problem in fetal devt.; and container containing the transport medium
verify the gestational age. for immediate delivery to the laboratory.
●​ Should be protected from light and
transported immediately to the laboratory. Saliva
●​ Fluid secreted by the glands inside the
Cerebrospinal Fluid (CSF) mouth
●​ Refers to the liquid that surrounds the ●​ Used to check the hormone levels & to
brain and spinal cord. determine alcohol and drug or
●​ Clear, colorless and obtained by the substance abuse
physician using lumbar puncture or ●​ Needs to be frozen to ensure stability
spinal tap prior to delivery to the clinical laboratory
●​ Used to diagnose meningitis and other
disorders such as brain abscess, CNS Semen
cancer, and multiple sclerosis ●​ A thick yellowish-white fluid that contains
●​ Routine tests performed include cell sperm released during the mal ejaculation
counts, chloride, glucose, & total protein ●​ Seminal analysis is done to evaluate the
●​ Collected in 3 special sterile tubes: fertility and assess the effectiveness of
-​ 1st tube - chemistry & sterilization after a vasectomy
immunology test; 2nd tube - procedure
microbiological studies; and 3rd ●​ Also done for forensic or legal reasons
tube - cell counts such as criminal investigations
●​ Should be kept at room temperature and involving sexual assault
sent to the laboratory for immediate ●​ Placed in a sterile container, kept warm, &
analysis protected from light

Gastric Fluid/Gastric Analysis Serous Fluid

 ●​ Found between the membrane that -​ Sweat is collected, weight is
encloses the pleural, pericardial, and recorded, & chloride content is
peritoneal cavities analyzed
●​ Pale-yellow in color, watery and its main ●​ Can also be used to determine illegal
function is to allow the membranes to use of drug by placing patches on the
pass through each other with minimal skin for an extended period of time which
friction is further confirmed by subsequent drug
●​ Effusion or increase in volume indicates testing
inflammation, infection, or decrease in the
serum protein level. Synovial Fluid
●​ Collected by the physician by aspiration & ●​ Viscous fluid that lubricates movable joints
placed in tubes depending on type of test ●​ Tested to determine conditions such as
●​ EDTA tubes - for cell counts & smears arthritis, gout, & other inflammatory
●​ Heparin or Sodium Fluoride tubes - for conditions
chemistry tests ●​ Collected in three tubes
●​ Non-anticoagulant tubes - for -​ EDTA/Heparin: for cell counts, ID
biochemical tests of crystals, smear prep
●​ Heparinized tubes - for blood cultures -​ Sterile: culture and sensitivity
●​ Type of fluid should be indicated on the -​ Non-additive: macroscopic
label as follows: pleural fluid (lungs), appearance, chemistry,
peritoneal fluid (abdominal cavity), & immunology tests, and observing
pericardial fluid (heart) the clot formation

Sputum Buccal (Cheek) Swabs

●​ Used to diagnose and/or monitor lower ●​ Used to obtain loose cells inside the
respiratory tract infections like cheek for DNA analysis
tuberculosis ●​ Less invasive and painless alternative to
●​ Recommended that collection be done blood collection
first thing in the morning since a larger ●​ Sample is collected by placing the swab
volume has accumulated overnight, & at inside the cheek and gently massages the
least 1 hour after meal to avoid gagging area
●​ Patient should gargle with water & remove ●​ Swab is sent to the lab where the DNA is
dentures (if any), should take 3 or 4 deep extracted from the cells in the swab
breaths, inhale and exhale, cough
forcefully on the last breath, and Bone Marrow
expectorate and expel sputum into the ●​ Examined to identify blood diseases
sterile container. ●​ Physician inserts a large-gauge needle
●​ Procedure is repeated until an adequate into the sternum or iliac crest (hip bone)
amount is collected equivalent to 3 - 5 ml and aspirates 1 - 1.5 ml of specimen
●​ Transported and processed immediately ●​ Hematology technologist makes a special
upon arrival at the laboratory. slides from the first marrow aspiration

Sweat Breath Samples

●​ Used to analyze the chloride content of ●​ C-urea Breath Test (C-UBT)
patients under the age of 20 with -​ Checks for the presence of
symptoms of cystic fibrosis (exocrine Helicobacter pylori, which is a
gland disorder) bacteria that damages the stomach
●​ Sweat Chloride Test lining
-​ Electrical stimulation in the forearm -​ After baseline breath samples
or thigh (iontophoresis) is used to are collected, the patient is
transport the pilocarpine asked to drink a special
(sweat-stimulating drug) into the substance that has synthetic
skin. urea, then asked to breathe into
 a Mylar balloon at specified ●​ Can be used to analyzed for trace and
intervals. heavy metals
-​ Breath specimens are analyzed for ●​ Can also be used to detect chronic drug
carbon-13, which confirms the abuse where hair is the preferred
presence of H. pylori. specimen because it is easy to obtain, and
●​ Hydrogen Breath Test is not easy to alter or tamper
-​ Helps in the detection of
carbohydrate digestion Throat Swabs
problems such as lactose (milk ●​ Mostly collected to aid in streptococcal
sugar) and fructose (fruit sugar) infection detection
-​ Detects bacterial overgrowth in ●​ A special kit contains a sterile
the small intestine and is thought polyester-tipped swab and a covered
as the most accurate tolerance test transport tube
-​ Preparation: ●​ Tube contains the transport medium
❖​ Must not take antibiotics ●​ Note: Collection procedure
two weeks prior to the
scheduled test Tissue Specimen
❖​ Should not eat certain food ●​ Usually collected using biopsy through
for 24 hours before the test which the tissue sample is removed for
& should be fasting on the examination
of the test ●​ Phlebotomist should check the proper
❖​ Smoking and exercise are handling procedure particularly if the
also restricted 30 minutes specimen delivered is not immersed in a
before the test solution
❖​ Baseline breath sample is ●​ For genetic analysis, tissue samples
taken by breathing into a should not be placed in formalin
special bag before the
introduction of a special
drink
❖​ Additional breath samples
are taken every 30 minutes
for three hours and all are
sent to the lab for analysis

Feces
●​ Collected to:
-​ Determine gastrointestinal
disorder
-​ Analyze for the presence of
intestinal ova and parasites
-​ Be cultured then examined for
the presence of pathogenic
bacteria and viruses
-​ Check fat and urobilinogen
content
-​ Test for the presence of occult
blood
●​ Collected in a clean and wide-mouth
container that is sealed and sent to the lab
after collection

Hair
LESSON 11: ARTERIAL BLOOD COLLECTION ➔​ Sample handling
procedures to prevent
Arterial Puncture alteration of test results
-​ Used to collect blood specimen for ABG ➔​ Correct puncture technique
analysis to manage cardiopulmonary
disorders and maintain acid-base balance Personal Performing Arterial Punctures
of the body ●​ Physicians
-​ Arterial blood is the ideal specimen for ●​ Nurses
respiratory function evaluation due to the ●​ Medical Laboratory Scientists
consistency of its composition and high ●​ Respiratory Therapists
oxygen content ●​ Emergency Medical Personnel
●​ Senior Phlebotomists
Composition of Arterial Blood
●​ Uniform throughout the body Sites of Puncture:
●​ Tests requiring arterial blood ➔​ Radial artery - most preferred site
-​ Blood gases (oxygen or carbon ➔​ Femoral artery
dioxide) ➔​ Brachial artery
-​ Lactic acid ●​ Order of Preference:
-​ Ammonia ➔​ Radial>Brachial>Femoral

Arterial Blood Gases (ABGs) Arterial Puncture Site Selection

●​ Components ●​ Arteries used by phlebotomists
-​ pCO₂ -​ Radial artery (artery of choice)
-​ pO₂ ➔​ Ulnar artery can provide
-​ pH collateral circulation
●​ Conditions requiring ABG ➔​ Close to the wrist; easily
measurement accessible
-​ Respiratory diseases ➔​ Pressure can be easily
-​ Metabolic diseases applied
●​ Patients requiring blood gas analysis ➔​ Less chance of hematoma
are often critically ill ➔​ Difficult to locate in patient
with hypovolemia or low
Components Measured cardiac output
-​ Brachial artery
➔​ Deeper, near median
nerve, leis in soft tissue
(not that recommended)
➔​ Lies close to the median
nerve; risk of pain and
nerve damage
➔​ Increased risk of hematoma
formation
-​ Femoral artery
➔​ Large and easily palpated
and punctured
➔​ Sometimes only site where
Personal Performing Arterial Punctures arterial sampling is possible
●​ Qualifications ➔​ Poor collateral circulation
-​ Training about: ➔​ Increased risk of infection
➔​ Complication associated because of location and
with arterial puncture pubic hair
➔​ Precautions taken to
ensure a safe procedure
 ➔​ Risk of dislodging plaque Arterial Puncture Procedure
build-up from inner artery ●​ Phlebotomists and Patient Preparation
walls -​ Examination of a requisition form
●​ STEADY STATE
Why is Radial Artery the arterial puncture site -​ 20 to 30 minutes of receiving
of choice? specified amount of oxygen and
1.​ The ulnar artery can provide collateral have refrained from exercise
circulation to the hand. -​ Best time to collect arterial
2.​ It lies close to the surface of the wrist & samples
easily accessible. -​ Do not collect samples from
3.​ It can be easily compressed against the agitated patients (values can be
wrist ligaments, so that pressure can be altered
applied more effectively on the puncture ●​ Important Notes
site after removal of the needle & there is -​ Before blood is collected from the
less chance of hematoma. radial artery in the wrist, one
should do a modified Allen test to
To be acceptable as a puncture site, an artery determine whether the ulnar artery
must be: can provide collateral circulation to
1.​ Large enough to accept at least a the hand after the radial artery
25-gauge needle. puncture
2.​ Located near the skin surface so that -​ Collateral circulation - alternative
deep puncture is not required. source of blood supply around a
3.​ In an area where injury to surrounding blocked artery or vein
tissues will not be critical. -​ The major complications of arterial
4.​ Located in an area where other arteries puncture include thrombosis,
are present to supply blood in case the hemorrhage, and possible
punctures artery is damaged. infection
-​ Unacceptable sites:
Arterial Puncture Equipment ➢​ Irritated
●​ Collection Kits ➢​ Edematous
-​ Syringes: preanticogulated, plastic ➢​ Near a wound or in area of
-​ Type: hypodermic an arteriovenous (AV)
-​ Size: 1 to 5 mL based on shunt or fistula
instrumentation and tests -​ The amount of anticoagulant
-​ Needles: 20- to 25-gauge, ⅝ to 1.5 should be 0.05 mL liquid heparin
inches (1000 IU/mL) for each milliliter of
●​ Anticoagulant blood. Using too much heparin is
-​ Heparin used to coat the plastic probably the most common
syringes to be tested within 30 pre-analytic error in blood gas
minutes measurement
-​ Glass syringes are used for tests ➔​ Irritated
longer than 30 minutes, lubricated, ➔​ Edematous
and heparinized by the collector. ➔​ Near a wound or in area of
●​ Tightly fitting cap for syringe Luer tip an arteriovenous (AV)
shunt or fistula
Additional Supplies ●​ Modified Allen Test
●​ Crushed ice slurry for longer than -​ Purpose: determine ulnar artery
30-minute specimens collateral circulation
●​ Maintains sample integrity -​ Performed prior to arterial puncture
●​ Povidone-iodine, chlorhexidine for site -​ Procedure
cleaning ❖​ Positions patient’s wrist and
●​ Alcohol pads to remove iodine if needed makes fist
●​ Gauze and pressure dressings
 ❖​ Compress radial and ulnar -​ Samples that can be analyzed
arteries within 30 minutes should be
❖​ Patient opens fist - palm collected in plastic syringes and
should blanch not placed in ice.
❖​ Release pressure from -​ When lactate (lactic acid) is
ulnar artery requested; samples are placed on
❖​ Observe color of patient’s ice immediately.
palm -​ Before - place all samples in ice
❖​ Positive test results = color -​ Research studies - if analyzed
returns to palm within 30 minutes results are not
❖​ Negative test results = affected
palm remains blanched -​ Samples that cannot be analyzed
●​ Preparing the Site within 30 mins. Must be collected
-​ Aseptic cleansing procedure in a glass syringe and are placed
➔​ Higher risk of infection in ice.
using an artery
➔​ Use Arterial Puncture Complications
povidone-iodine/chlorhexidi
ne gluconate (air dry)
-​ Injection of local anesthetic may be
administered
●​ Lidocaine
➔​ Just under the skin,
or surrounding
tissue
●​ Wait for anesthetic effect, 2
to 5 minutes (effect begins
to wear off in 15 to 20
minutes)
●​ Performing the Puncture
-​ Relocating the artery: cleaned
finger Accidental Arterial Puncture
-​ Positioning of fingers: ●​ Bright red blood
non-dominant directly over site ●​ Pulsation
-​ Puncture: ●​ Application of direct pressure
❖​ Depth: 5 to 10 mm ●​ Arterial puncture procedure
❖​ Angle: 30 to 45 degrees, ●​ Documented on requisition form
hold syringe like dart ●​ Some test results may be different from
-​ Recommended Angles: venous blood
❖​ For radial artery - 30 to 45 ●​ DO NOT PERFORM ARTERIAL
degrees PUNCTURE JUST BECAUSE YOU ARE
❖​ For brachial artery - 45 to UNSUCCESSFUL WITH
60 degrees VENIPUNCTURE.
-​ Appearance of blood in the syringe
-​ Removal of needle Sampling Errors
-​ Application of direct pressure by ●​ Air bubbles were not expelled from the
the PHLEBOTOMIST: firm for at sample
least 5 minutes (AC therapy > 5 ●​ Processing exceeded optimal time
mins) ●​ Sample was not mixed properly or
-​ Check for pulse: Radial artery immediately
●​ Syringe was used improperly
Sample Handling ●​ Venous blood was obtained by mistake
●​ CLSI GUIDELINES ●​ Improper anticoagulant was used
 ●​ Incorrect volume of heparin was used

Criteria for Rejection of ABG Specimen

●​ Air bubbles are found in the specimen
●​ The specimen has clotted
●​ The specimen has hemolyzed
●​ The submitted specimen did not comply
with the proper labeling requirement for
the specimen as notation temperature
●​ The specimen did not meet the required
volume or ONS
●​ It took so much time for the specimen to
reach the laboratory
●​ The wrong type of syringe was used