Question

lens and Tests 263 Case Studies A murse delivered phlebotomist se Study 13-1: CSF Specimen Handling ce delivered three vials of CSF to the lab. A comist newly trained in specimen processing cented the specimens from the nurse. The Whatomist had never received CSF specimens before phlebotomist was not sure what to do with them. She wae mely busy and her supervisor was at lunch so she set the vials a set the vials aside, intending to ask her supervisor hat to do with them upon her return from lunch The supervisor got called to an emergency meeting and did not return for several hours. The phlebotomist was husy she completely forgot about the CSF specimens until the physician called for the results on them. When he found out the specimens had not been tested he was furious. The specimens had to be recollected and the phlebotomist almost lost her job. and was not sure what extremely busy and her su QUESTIONS 1. How could this incident have been prevented? 2. Why did the specimens have to be recollected? 3. How is a CSF specimen collected Case Study 13-2: Urine C&S Specimen Collection Luann recently received on-the-job phlebotomy training. Today was the first day she had been allowed woman came out of the rest room, set the specimen on the counter as she had been told and left. Later to work alone. It was a busy day and patients were that day when things quieted down, Luann discovered starting to stack up in the waiting area. One elderly that the patient had placed the antiseptic wipes in the woman needed a blood test and a urine C&S. Luann urine container with the specimen. She was mad that was good at drawing blood and liked doing it. She the woman could be so foolish and also that she would hated to instruct patients in urine collection, however. have to call her and request that the woman return to She drew the blood specimen, quickly bandaged the the lab and submit a new specimen. patient and handed her a labeled urine collection container and several antiseptic wipes. She asked the QUESTIONS patient if she had ever given a urine specimen for a culture before and when the patient said "Yes," she 1. Why would the patient make such a mistake if she showed her where the restroom was, and told her had submitted a urine specimen before? that she should put the specimen on the counter when 2. What should Luann have done that would have she was finished and then she could leave. She then prevented the problem with the specimen? called another patient in for a blood draw. The elderly the tech in the micro laboratory. He was relieved and quickly left the floor. Case Study 13-3: AFB Culture It was Friday morning in the small rural hospital, Gerry, the phlebotomist, had just finished his usual morning draws when the nurse handed him an order for an AFB culture and directed him to the patient who was in isolation. The phlebotomist had not seen this order before and asked the nurse if someone else could do it. The nurse said it needed to be done that morning and because they were short staffed he needed to advise the patient on how to collect the specimen. Before dressing to enter the room, he called his supervisor and was told to bring the request to QUESTIONS 1. What does AFB mean? 2. What disease do they think the patient has? 3. What type of specimen would be collected and how should it be done?

Answer 1

13-1 CSF specimen handling

1.The incident could have been prevented by

• Placing the tube in refrigerator at a temperature of 2° to 8° C
• In case of Lactate dehydrogenase CSF test ,it has to be kept at room temperature of 20° to 26° C
• Trying to contact the senior at least by keeping a reminder
• Placing the sample in view or direct contact could have grossly avoided the situations

2.The specimen cannot be used because of not maintaining or keepind it temperature which could have lead to growth of microorganisms in it

3.The CSF collection procedure is sterile procedure performed by a doctor

After informing patient and relative about the procedure and then getting consent to be done first

Patient is placed on prone  position,draped at back and under strict aseptic procedure and spinal needle is introduced in the lumbar region (L3 _L4 ) after local anaesthesia and the fluid is collected in a sterile tube or container and sent immediately to laboratory for investigation. Usually the report can be available in an hour unless it is a routine test which takes 4 hours

13-2 Urine C&S Specimen collection

1.There are scenarios which could happen like this .In this case it should be because of the patients lack of knowledge, or adequate information given to her ,confusion or forgetfulness

2.This could have been prevented by the phlebotomist giving a proper guidance by explaining the procedure each time to a patient when they undergo any type of test though they have undergone such procedure be for to reduce errors.

13-3

1.AFB stands for acid fast bacilli

2.This test is dine for patient who are suspected to have tuberculosis

3,The sample has to be collected early in the morning

The patient should proper brush is teeth and gargle or rinse well with water

Should take a deep breath and then cough out hardly so that the sputum comes out and which has to be collected in the sterile sputum container and sent for laboratory investigation with proper documentation