Answering your questions on a microscopic exam with negative urine dipstick, RIA lab staffing, MT retraining programs, and phlebotomy trays. (Tips from the clinical experts).Negative urine dipstick dipstick /dip·stick/ (dip´stik) a strip of cellulose chemically impregnated to render it sensitive to protein, glucose, or other substances in the urine. Q If the urine is normal color and clear, and the urine dipstick tests Urine dipstick test A test using a small, chemically treated strip that is dipped into a urine sample; when testing for protein, an area on the strip changes color depending on the amount of protein (if any) in the urine. Mentioned in: Preeclampsia and Eclampsia (other than glucose elevation) are negative, is a microscopic exam necessary? Diabetics frequently demonstrate yeast infections. Would these be missed, or can we rely on the leukocyte esterase Leukocyte esterase (LE) is a urine test for the presence of white blood cells and other abnormalities associated with infection. White blood cells in the urine usually indicate a urinary tract infection. to be positive in a yeast infection because of increased WBCs? A The key to this question is that the urine is of normal color and clear. It is true that diabetics frequently demonstrate yeast infections. However, if yeast (and white blood cells White blood cells A group of several cell types that occur in the bloodstream and are essential for a properly functioning immune system. Mentioned in: Abscess Incision & Drainage, Bone Marrow Transplantation, Complement Deficiencies ) were present, they would be seen as a lack of clarity in the gross urine specimen. Microscopic examination of the urine sediment should be performed when the color is abnormal, the specimen is not clear, and any reagent strip reagent strip Dipstick, see there tests (except glucose or urobilinogen) are positive. If glucose were the only positive finding, the urine clarity should be observed with special care, so as not to miss a yeast infection. The presence of white cells might result in a positive leukocyte esterase test; however, the test is fairly insensitive. According to the reagent strip manufacturers, the leukocyte esterase test requires 5 to 5 wbc/hpf (Multistix, Bayer Corp. Diagnostics Division, Tarrytown, NY) or 10 to 25 cells/[micro]L (Chemstrip, Roche Diagnostics Corporation, Indianapolis, IN) to show a positive reaction. Yeast itself does not result in a positive test for leukocyte esterase. Therefore, a urine specimen might show a lack of clarity, from the presence of yeasts and white cells, before the LE test is positive. Karen M. Ringsrud MT{ASCP ASCP American Society of Clinical Pathologists. ) Assistant Professor Department of Laboratory Medicine and Pathology University of Minnesota Medical School The University of Minnesota Medical School is the medical school of the University of Minnesota. It is a combination of two campuses situated in Minneapolis and Duluth, Minnesota. Minneapolis, MN RIA (Rich Internet Application) A Web-based application that approaches the speed and elegance of a local application. An RIA may refer to a browser-based application that uses AJAX or another enhanced coding technique. staffing Q I currently supervise a radioimmunoassay (RIA) lab within a nuclear medicine department. Our management asked for "accepted standards" for testing times and test/personnel (FTE FTE Full-Time Equivalent FTE Full-Time Employee FTE Full-Time Equivalency FTE Full Time Employment FTE Foundation for Teaching Economics FTE Full Time Enrollment FTE For the Enterprise (SQL) FTE Fund for Theological Education ) ratios for lab tests in general. Is there an accepted standard for this in the blood testing industry? Apparently such standards exist for imaging (radiology) procedures. A Although there are staffing guidelines for nuclear imaging and radiology procedures, I am not aware of any for RIA testing. I inquired at the Department of Veterans Affairs, the nation's largest healthcare provider. They have none. Even if such standards existed, they would be difficult to interpret and use. This is because most of the straightforward analyses that had formerly been done by RIA have been replaced by automated immunochemical assays, leaving only the complex RIA procedures. Staffing guidelines are difficult to apply to complex procedures. They work best with high-volume, frequently performed tests. Daniel M. Baer, M.D. Professor Emeritus Department of Pathology Oregon Health Sciences University Portland, OR MT retraining re·train tr. & intr.v. re·trained, re·train·ing, re·trains To train or undergo training again. re·train programs Q I am an "old" MT(ASCP) who has been Out of the field for 20 years. I'd like to get back into the field now that my kids are older. Any helpful info you could suggest on the best way to do that? Are there any "refresher" programs for people like me? A The tight labor market labor market A place where labor is exchanged for wages; an LM is defined by geography, education and technical expertise, occupation, licensure or certification requirements, and job experience and reduction in the number of schools of medical technology has made this a good time for inactive medical technologists to sharpen their skills and reenter re·en·ter also re-en·ter v. re·en·tered, re·en·ter·ing, re·en·ters v.tr. 1. To enter or come in to again. 2. To record again on a list or ledger. v.intr. the profession. There are several ways a rusty technologist might consider getting refresher training: a formal refresher program at an educational institution; workshops given by a hospital or professional society; a self-study program from an educational institution or an association; and "internship" in a lab. I asked a number of educators about "refresher" training, but got only negative answers. We were unable to find any organization or educational institution that provided this kind of education. Check with your area's school of medical technology. There is an Internet link to many of these, http://www.labexplorer.com/cls_sites.htm. Many national and state medical technology professional societies have periodic meetings at which there are workshops covering a wide range of laboratory topics. You can find out what is available in your area by searching the Internet. Start with the ASCLS ASCLS American Society for Clinical Laboratory Science website http://www.ascls.org. It has links to the state association sites. A number of educational organizations were founded to provide continuing education continuing education: see adult education. continuing education or adult education Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904). to medical technologists in remote areas, who were dependent on the education coming to them. CACMLE, www.cacmle.org, is one such organization. It has self-study programs that are oriented toward the technologist who wants refresher training. Some pathology departments have Internet sites with extensive information. One of the best is the University of Iowa Not to be confused with Iowa State University. The first faculty offered instruction at the University in March 1855 to students in the Old Mechanics Building, situated where Seashore Hall is now. In September 1855, the student body numbered 124, of which, 41 were women. . The medical school there has developed the virtual hospital website (http://www.vh.org/Providers/CME/CLIA/CLIAHP.html) that has an extensive Physicians Office Laboratory (POL) course covering both technical and administrative aspects of operating a POL. Among the chapters are training modules in microbiology, hematology, and urinalysis. There is no charge for the course, but there is a charge for continuing education credit. The University of Michigan's Internet Resources for Pathology and Laboratory Medicine website (http://www.pds.med.wmich.edu/users/amp/path_resources.html) provides links to many other laboratory medicine sites. The University of Washington, Laboratory Medicine Department site (http://www.medtraining.org/mts/product.asp) advertises a series of tutorial CDs that could form the basis of a refresher program. These CDs are expensive and intended to be used by labs or schools r ather than individuals. If a local lab or school owns them, it might be possible to arrange to use them as part of your self-study program. Finally, if there is a shortage of qualified medical technologists in your area, you might be able to arrange to get training at a local lab. Daniel M. Baer, M.D. Professor Emeritus Department of Pathology Oregon Health Sciences University Portland, OR Phlebotomy Phlebotomy Definition Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis. trays Q Are there any rules relating to placing phlebotomy trays on the patient's bed, bedside table, or other room furniture while drawing blood? A This issue is not addressed directly in NCCLS NCCLS National Committee for Clinical Laboratory Standards standards. However, from an infection control standpoint, it is easy to see how phlebotomy trays could carry bacteria from room to room or patient to patient. In keeping with sound infection control procedures, therefore, it is not advisable to bring phlebotomy trays in contact with surfaces to which patients would likely be exposed. These include the patient's bed or other furniture, bedside trays, or night stands. A periodic cleaning of the surfaces of the phlebotomy tray with a solution of 10 percent bleach further protects patients from nosocomial infections Nosocomial infections Infections that were not present before the patient came to a hospital, but were acquired by a patient while in the hospital. Mentioned in: Enterobacterial Infections, Staphylococcal Infections . Dennis Ernst, MT(ASCP) Director The Center for Phlebotomy Education Ramsey, IN Daniel M. Baer is professor emeritus of laboratory medicine at Oregon Health Sciences University in Portland, OR, and a member of MLO's editorial advisory board. Reference Garza D. Becan, McBride K. Phelbotomy Handbook. Fifth Edition. Stamford, CT: Appleton & Lange; 1999. |
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