Question

242 Unit IV Special Procedures Case Studies Case Study 12-1: Specimen Handling and Collection Verification he had already been drawn, and refused to be de Chad is the lone phlebotomist on the night shift at a again. Chad remembers the glucose specimen in hospital. Al 03:00 he collects a timed glucose using a mack. He quickly verifies collection of and the St PST per laboratory policy. On return to the laboratory and personally delivers them to the proper labor he attempts to verify collection of the specimen. dements. The chemistry tech refuses to a The LIS is down for scheduled updates but will be the glucose specimen. When the STAT CBC is te back on-line soon. He sets the tube in a rack of extra microclots are detected, and it has to be recollected Tubes collected during ER draws. He intends to verify collection in a few minutes but starts sorting morning draw requisitions and forgets about it. After that QUESTIONS he goes on break and loses track of time reading a newspaper until he is puged by an ER nurse to collect 1. Why do you think the glucose specimen was a STAT CEC. He tries but is unable to collect it, so an rejected for testing? ER tech collects it while starting an IV. It is past time 2. What could Chad have done differently, so the for Chad's shift to be over, so he quickly grabs the specimen would not have been forgotten! tube Labeling it on the way back to the laboratory. The 07:00 shift is already there. One of them has just 3. What do you think caused the microclots in the returned from trying to collect a glucose specimen СВсі because the patient's nurse had called for results and 4. How should Chad have handled the CBC? there was no record of the draw. The patient insisted Case Study 12-2: Specimen Rejection and Centrifuge Operation Melinda, a recent phlebotomy graduate, works with an She quickly grabs the tubes. As she puts them in a experienced phlebotomist in a clinic. Her job involves transport bag, she notices the serum in one SST looks drawing specimens, centrifuging them if required, and gelled. She wonders why but puts it in the bug anywa sending them by courier to an off-site laboratory. Today The courier takes the bag and leaves. The elderly her coworker is ill, and Melinda is by herself. Quite a man's BMP specimen, the difficult draw specimen, few patients arrived shortly after the clinic opened at and the homocysteine specimen are all rejected by the 08:00, but most were easy draws and by 09:15 only laboratory and must be recollected. three are left. The first one, an elderly man, needs a PT and BMP. She draws a light blue top and SST. The QUESTIONS next one needs a liver profile. He is a difficult draw and her first attempt is unsuccessful. On the second 1. Why do you think the centrifuge made the noise? try blood flows slowly, but she is able to collect a few Why did moving tubes fix the problem? milliliters in an SST before it stops. The last patient 2. What do you think the gel-like substance in the needs a homocysteine level. She easily draws the elderly man's BMP specimen was? What may have specimen. The waiting room is empty. She looks at the clock. It is 09:40. The courier arrives in 20 minutes caused it, and would that be why it was rejected and she has not centrifuged any of the specimens. She for testing? quickly loads the centrifuge and turns it on. It makes 3. What do you think was most likely wrong with the a terrible noise, so she turns it off. She moves a few difficult draw specimen tubes around and starts it again. This time it sounds OK and finishes spinning just as the courier arrives. 4. Why do you think the homocysteine specimen was rejected?

Answer 1

12.1 :-

1. The glucose specimen was rejected because the sample for glusoce levels should be centrifuged no later than 25 to 30 minutes after the sample is drawn for adequate results .

2. Chad must have kept it separately in an another track with label in a place in front of his eyes so that it's not missed by him for verification of collection and further processing

3. Due to inappropriate mixing with anticoagulant ,microdots developed in CBC. The blood should be thoroughly mixed with anticoagulant during or immediately after sample collection .Inadequate mixing will result in sample clotting, which may not be visible to the naked eye (microclots).

4. Chad must have mixed the blood sample for CBC with the anticoagulant by slow inversion of sampling tubes .