October 6, 2004

Handling of New Liquid Specimen Traps

The 70 mL Specimen Trap available from the hospital store room (bin # 92401) now comes with a separate, solid cap to prevent leakage during specimen transportation. After collecting the specimen, remove and discard the original cap with attached tubing. Securely attach the solid cap to the container. Once placed into a zippered biohazard bag, the specimen may be transported through the hospital pneumatic tube system to the Medical Laboratories.

New Reports Available in CAS

The Cytogenetics, Flow Cytometry and Molecular Diagnostics Laboratories have begun reporting results in the CoPath system. For cases received in the laboratories on or after September 1, 2004, final results for Cytogenetics studies and the interpretive results for Flow Cytometry and Molecular Diagnostics testing are being reported electronically in the system. Once the results are finalized, a copy is faxed automatically to the requesting physician and the results are electronically transmitted to the CAS system. The results are available under the Surgical Pathology heading. If you experience problems retrieving results, please contact Customer Service at 4-LABS (434-924-5227).

Change in Directorship

Dr. Orieji Illoh, Director of the Immunology (Davis) Laboratory, will be relocating with her family to Texas in early November where she has accepted another academic appointment. Dr. Lloyd Gray will assume the directorship of the laboratory on November 5, 2004. Medical Laboratories and the Department of Pathology wish Dr. Illoh all the best.

Requests for Digoxin Levels

When placing an order for a Digoxin level, please use the “Digibind” comment only if the patient has received a dose of the antidote. Use of the comment when the patient has not received Digibind will delay availability of the results.

Physician (Credentialed Practitioner) Orders for Laboratory Tests

Audits completed by the Hospital Corporate Compliance Office revealed opportunities for improvement regarding physician orders for laboratory tests. Medicare requires a physician’s order for all laboratory tests. The order must include the patient’s name, tests required, date of the order and the physician’s signature.

There is no specific form or format required for the order as long as the essential information is included. Therefore, some examples of how this can be accomplished are by having the physician sign the laboratory request form that includes the patient specific information, by having a physician enter an electronic order, or by having the signed clinic note state the tests being done.

Laboratory Relocation Update

Construction continues at the site for the new building that will house the relocated Core, Microbiology and Molecular Diagnostics Laboratories. The revised schedule suggests the building will be completed in February, 2005 and an internal group is working on a two-week transition plan to ensure continued testing throughout the move.

Discussions are underway with major vendors to select the next generation of chemistry instrumentation for the new site. The latest instruments offer modular automation platforms, allowing for more efficient use of technical staff. Work groups have also been established to address specimen transportation, staff parking and security, telecommunication/IS requirements, and environmental and safety concerns.

For additional information or questions regarding the upcoming relocation please contact Cavell Kopetzky in Medical Laboratories Administration at 434-243-2649 (email: cak3w@virginia.edu).

FDP Assay Now Available as “CONSULT” Only

The Fibrinogen Degradation Product assay (FSP or FDP) is no longer available as an orderable test in the MIS system. Analysis will continue to be performed 24 hours a day but can only be ordered as a consult request. As is now noted in MIS, clinicians must place the order on a consult form. The Clinical Pathology Hemostasis resident on-call is available at 1663 for assistance and please contact the Special Coagulation Laboratory at 4-8007 if you have any questions.

Recommendations for Monitoring Aminoglycoside and Vancomycin Serum Concentrations in Infants and Children

Recommendations for Monitoring:

No monitoring is needed for:

Patients expected to receive less than 5 days of therapy
Patients > 3 months of age with normal renal function and an appropriate clinical response

A trough concentration alone may be evaluated in:

Patients with known or suspected renal dysfunction
Patients receiving vancomycin in addition to another nephrotoxic drug
Patients with an inadequate clinical response
Patients < 3 months of age, including term neonates

Both peak and trough concentrations may be evaluated in:

Preterm neonates
Patients with underlying medical conditions and/or therapies known to affect drug distribution or clearance (e.g. burns, cystic fibrosis, leukemia, ECMO, dialysis)

Recommendations for Time of Sample Draws

Serum concentrations should be obtained after the third dose, unless the patient has unstable renal function and requires earlier intervention.
Aminoglycoside peak concentrations should be obtained 30 minutes after completion of the infusion.
Vancomycin peak concentrations should be obtained 1 hour after completion of the infusion. Note: For adults or those receiving adult doses, vancomycin peak concentrations should be obtained 2 hours after completion of the infusion.
Trough concentrations should be obtained within 30 minutes of the next dose.
Patients receiving extended interval aminoglycosides (e.g. once daily gentamicin or tobramycin in an older child) who require serum concentration monitoring may have a trough concentration drawn and/or random level taken at 4 to 6 hours after a dose.

Ref: Taketomo CK, Hodding JH, Draus DM. Pediatric Dosage Handbook. Hudso, OH: Lexi-Comp., 2003:533-536, 1134-1136.