Laboratory Medicine Updates - 12/7/2001
University of Virginia Health System
“Quality You Expect, Service You Deserve”
LABORATORY MEDICINE UPDATE
December 7, 2001
CHANGES IN SAMPLE REQUIREMENTS
VAP Testing: Our referral laboratory for VAP testing is changing their requirements to serum as the specimen of choice. Please draw a minimum of 1 full red-top tube or two gold-top serum separator tubes.
Hepatitis B Quantitative DNA: With an expanded range for this analysis (now reporting to 1,700,000,000 copies/mL), our referral laboratory now requires a minimum of 1.5 mL serum. Please draw a full red-top tube or two gold-top Serum Separator Tubes to assure adequate volume.
The Toxicology Laboratory will perform specific methadone screening and confirmation upon request. In order for the laboratory to provide a prompt result, please order METHADONE at the same time as the Urine Drugs of Abuse Screen is ordered. As with all drugs of abuse testing, screen positive results will be confirmed by mass-spectrometry. The charge for methadone screening (with confirmation) is $22.00.
TRANSPORTATION OF LEUKEN TRAP TUBES
Please do not use the Pneumatic Tube System for the transportation of samples to the laboratory when specimens are collected in LEUKEN TRAP tubes. Phone the Resource Support Center at 2-1600 for pickup from the unit or clinic.
Samples sent through the tube system have leaked, contaminating the bag and in some cases the entire system, requiring downtime for contamination.
PROTOCOL FOR PERCUTANEOUSLY DRAWN BLOOD CULTURES
Based on a study conducted at the University of Virginia in 1999-2000 comparing four common antiseptics, a phlebotomy protocol for percutaneously drawn blood cultures has been recently approved by the Infection Control Committee and Medical Policy Council. The study demonstrated that isopropyl alcohol was efficacious and cost effective, and had a lower incidence of cutaneous reactions than other antiseptics. The new policy was implemented on November 1, 2001; a copy of the protocol follows.
PROCEDURE FOR ANTISEPTIC PREPARATION AND BLOOD CULTURES
1. Blood culture bottles, tourniquet, syringe(s), butterfly needles, alcohol pads, gauze pads, and bandage(s) should be obtained from the supply area.
2. Select the site of venipuncture. If the patient is unusually dirty, wash the intended site with soap and water prior to venipuncture.
3. Put on exam glove.
4. Open a packet containing an isopropyl alcohol-saturated pad.
5. Scrub the venipuncture site gently but firmly with the pad beginning in the center and continuing in an outward direction using circular strokes for an area of 2 to 3 inches in diameter.
6. Repeat this procedure twice using two more alcohol pads.
7. Allow the area to dry completely after the third alcohol pad. Even if the area appears to dry sooner, wait at least 1 full minutes before performing venipuncture.
8. Prepare the culture bottles for inoculation and wipe the tops with a sterile alcohol pad.
9. Apply a tourniquet, being careful not to touch the prepped area with gloves or tourniquet.
10. Perform phlebotomy using the needle and syringe (20 mL of blood per set of cultures, i.e., 10 mL per bottle, is recommended for adult patients).
11. Release the tourniquet and withdraw the needle extending the protective sheath into the locked position after withdrawal of the needle. Apply pressure to the site of venipunture and place a bandage over the puncture site.
12. Remove the sheathed safety needle from the syringe. Attach a new needle to the syringes and inoculate the blood culture bottles. Sheath the needle after inoculating the cultures bottles. NOTE: If blood sample is drawn at the time of placement of a new intravascular catheter or at the initiation of hemodialysis through a graft or fistula, prep the skin as described above and draw the sample through the catheter into a syringe. Using aseptic technique, place a sterile needle on the syringes and inoculate the culture bottles.
13. Dispose of the sheathed needle(s) and syringe in the appropriate sharps container.
14. Label blood culture bottles and send samples to the lab using the standard protocol for specimen submittal.