Hope you are all enjoying your SIP thus far. I am learning quite a lot already and am finding it quite hard to keep all the information I've been given into my brain. =D
So I'm attached to a clinical laboratory of a really pretty hospital> It is a rather small laboratory which is divided into different stations like Haematology, Blood Banking, Chemistry, Cytology, Microbiology, Urinalysis and Order Entry 1 and 2.
For the first 2 weeks, I was stationed to Order Entry 1. This is after I was told to read 3 thick files of safety manuals, spills and fire safety and general policy manuals. This proved to be useful because the manuals explained in general the roles of the staff and even how some of the machines work.
Specimens are send to the lab via a pneumatic system at the Order Entry 1 (O1) station. This cuts the travelling time taken for the nurses or porter to personally send the specimens to the laboratory. Once the specimens reach the lab, the requisition forms are scanned into the LIS in the computer at O1. The forms must contain the following:
- The patient's name and IC number and his demographics
- The location of the patient (ie ward/clinic/others)
- Name of requesting doctor
- Whether it is urgent
- What tests are being ordered
Blue top- Citrated blood, Red top- Plain blood, Lavender top- EDTA blood, Green top- Heparin Blood, Grey top- Fluoride & Gold Top- Gel tube
Blood is not the only samples that are being processed in the lab. There are also blood cultures, stool samples, sputum samples, gastric aspirate and urine samples. Blood tubes are sent to the chemistry, haematology and blood banking station, depending on what tests are ordered. Some urine samples (depending on what test is being ordered) are sent to the chemistry station. Blood cultures, stool samples and sputum are sent to the microbiology station. 24 hours urine are sent to the urinalysis station.
Ocasionally there will be a need to reject certain samples. However, before rejecting a test, a confirmation with the nurse-in-charge of the patient must be made. Afterwhich, the name of the staff informed must be recorded into the LIS so that traceability can be acheived. Here are some of the grounds by which the order must be rejected:
- Specimen sent without requisition form
- Insufficient sample (particularly blood tubes)
- Unlabelled or incorrectly labelled sample
- Broken tubes
- Specimen not sent in ice ( eg iced heparin syringe for Arterial Blood Gases test and iced EDTA tube for renin test)
- Incorrect blood tube sent for order
- Clotted blood
Sharifah
TG01
=)
9 comments:
hey fa! (:
ask you, whats the difference between Order Entry 1 and 2?
Natalie
TG01
hey fah!
what does the fluoride and gel do to the blood samples?
have fun gal!
charmaine
TG01
heyy,
Glad that you're taking pride in your work!
I guess time-stamping is mandatory immediately after sample receipt?
Another thing, you mentioned that "once the specimens reach the lab, the requisition forms are scanned into the LIS in the computer at O1." In my workplace, the test requests have to be individually typed into the LIS, not scanned. So could u explain how scanning of request forms is done?
Last question, other than checking for the appropriate specimens, do you label the tubes for dispatch to their various stations?
Thanks a lot! =)
Kent
TG01
Hey Sharifah,
Just want to ask you, why are some sampels sent in fluoride tubes rather than the normal EDTA tubes?
Because i receive alot of fluoride tubes for glucose tests. Will fluoride affect the glucose result?
Sally
TG02
Hi all!
Natalie:
OE1 mostly handles all the in-house keying of orders while OE2 handles tests that are ordered by other companies (called Corporate Screening) and polyclinics (ie Jurong, Bukit Batok, Chua Chu Kang Polyclinic etc). =)
Charmaine:
The gel tube contains a gel near the bottom of the gel. When centrifuged, the red cells actually penetrate through the gel while the serum does not. The reduces the occurence of the analyzer to accidentally suck up red cells instead of the serum. This separation also eases the med tech's duty to separate the serum into secondary tubes because a dropper need not be used. Cool, right.
The fluoride tube contains Sodium Fluoride. It is used in the glucose fasting test. NaF actually inhibits the glycolysis process by the red cells. This thus gives a more accurate measurement of glucose in the blood as a plain tube may give a falsely low glucose reading. Hope that clears your doubts!
Kent:
Hmm, if I'm not mistaken time-stamping is automatically done as the requisition form is scanned into the LIS.
You see, most requisition forms have a sticker at the top right hand corner which states the patient's name, demographics and a barcode. This barcode is scanned into the computer as an order. I seem to have misled you into thinking that the LIS automatically detects what tests is ordered for a particular patient. The individual tests ordered DO have to be keyed in manually. =P
No, we do not label the tubes. The med techs in the chemistry section labels all the tubes and dispatch them into either haematology, blood banking or urinalysis or of course their own chemistry staion. Cheers!
Sally:
I'm surprised that you mentioned EDTA as the 'normal' tube because at my workplace usually most tests use heparinized or plain blood. Anyway, you may find my answer to Charmaine's questions above useful in clearing your doubts. =D
Hope that answers all your questions. In any case, flood me with more questions! =DD
Hi
If the specimen sent to the lab is found unsuitable and it has to be rejected, what kind of action the lab has to take?
Thx..haha..have fun!
Cheers
~Ye Tun
TG01
Hi Sharifah,
Your experience in the clinical lab sound fun!
However, it will be interesting if you can explain the pneumatic system in greater detail so I'll understand how this system works.
I'm attached to a blood bank lab but I didn't get to see so many different coloured blood tubes! Maybe, I didn`t get to see all these different blood tubes yet, where they maybe situated in the other labs of the blood bank that I'll be posted to at the later part of my attachent.
But at this point of time, I'm curious to know what is the purpose for using differernt blood tubes (as mentioned in your post) besides the EDTA tubes which is to prevent blood from clotting?
Thanks!
Loh Sharon, Tg 01
HEY sharifah!!
how are u ?? hope ur doing great.. anyways.. juz asking out of curiosity, when u recieve samples rite..in the request form they will state the diagnosis, etc. With the diagnosis given issit possible to interpret the results or the test to be done??
Vinodhini
EH OMG! GOT SOME PPLS COMMENT I NVR REPLY!!!!! heh. sorry2, in any case you all come back to read ah, here's my reply:
Ye Tun:
Hmm, I briefly mentioned the procedure in my post but I'll repeat it here. I've got to confirm with a med tech that this sample has to be rejected. Then i have to call the Ward from which the sample came from and ask to speak to the Nurse-in-Charge and present to her the problem. Then, i record the name of the nurse and the time I called her on the requisition form and order a Rejection panel in the LIS where I have to record the Nurse's name and the time that i spoke to her. The sample is either thrwon away or kept as extra if sufficient. =)
Sharon:
You can read more about the Gel and Fluoride tubes in my previous comment. As for Heparin Tube, it also acts as an anti-coagulant. The Plain tube contains no anticoagulant thus the blood inside usually is clotted.
The pnuematic system is wired across the entire hospital. If you have seen the parcel-moving thing on the ceiling in SGH, I guess its kinda similar to that. Except its pipes and the cannister aren't parcels but tubes. Maybe i'll post a picture of the cannister when I get a chance. =) Hope that helps.
Vino:
Heya! Yeah, sometimes we can guess what tests the doctor wants to run. For example, if the patient has a heart condition, tests ordered is usually AST, CK and CKMB (which is the Cardiac Enzyme Panel) and also Troponin T. Cheers!
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