Fluid Balance Teaching Objectives

1
Trent region Fluid Analysis Audit
Francesca Meakin Clinical Biochemist
Email Francesca.Meakin_at_sfh-tr.nhs.uk
2

• 8 responses to questionnaire on fluid analysis
  
• pleural, ascitic and synovial fluid.
• Mean number of total fluid samples received per
  annum
• from 6 labs 375
• Range 527-123

3
(No Transcript)
4
(No Transcript)
5
Sample type
All labs required a plain tube (if measured) for
the following pleural/ascitic fluid
analytes Total protein, LDH, Albumin, Bilrubin,
Cholesterol, Amylase, Trigs and Tumour
markers. Pleural/ascitic fluid GLUCOSE sample
type Plain 3/7 labs Fluoride Oxalate only
3/7 labs 1 lab ??
6
Pleural Fluid pH
7/8 labs measure pleural fluid pH Sample type
Gas syringe with heparin 1 Plain 6 pH
method Blood gas analyser 2 Blood gas analyser
if sample not clotted or viscous otherwise pH
meter 1 Indicator strips 3 Olympus AU640 1
7
Method Validation
6 labs didnt know or havent had tests for
pleural/ascitic fluid validated. 2 labs have
had the tests for pleural/ascitic fluid validated
by the manufacturer.
8
Do you provide interpretation of pleural/ascitic
fluid results?
1 lab stated for ascitic fluid Cholesterol gt
1.3 and CEA gt 5 ng/ml suggests malignancy.
9
Pleural Fluid
Do you offer tests to differentiate exudates from
transudates e.g. Lights criteria? YES 4 NO
4 2 labs state Lights Criteria 1 lab attaches a
comment to report with Lights Criteria 1 lab
states total protein transudate lt 20 g/L,
exudate gt 20 g/L
10
Ascitic Fluid
Do you offer tests to classify ascites into
portal or non-portal hypertension, e.g.
Serum/ascites albumin gradient (SAAG)? Only 1
lab. Do you offer any other tests to
differentiate exudates from transudates? No labs
11
Do you routinely request a paired serum sample
along with a pleural/ ascitic fluid sample? No
labs
Do you have a policy on how clinicians should
collect pleural/ascitic fluid samples? No labs
12
Do you have a policy on how the laboratory
handles pleural/ascitic fluid samples?
Pleural fluid samples dealt as high risk 2
labs Ascitic fluid samples dealt as high risk 1
labs
13
1 lab sends pleural fluid samples to
microbiology before analysis They spin the
samples and aliquot them into a tube in high
risk cabinet. 1 lab does not analyse samples
that are positive for TB.
14
Are all pleural/ ascitic fluid samples
centrifuged prior to analysis?
15
Do you analyse pleural fluid samples that are
blood stained?
1 lab yes after sample centrifuged 1 lab adds a
comment that sample was blood stained 1 lab does
not measure LDH when sample blood stained
16
Synovial Fluid Analysis
2 labs received synovial fluid Tests offered on
synovial fluid crystals, total protein and
urate.
17
Thank you

• Any questions?