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Endocrine Dynamic Function Protocols

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Endocrine Dynamic Function Protocols South Eastern Area Laboratory Services DEPARTMENT OF CLINICAL CHEMISTRY & ENDOCRINOLOGY SEALS Pathology Service Randwick Campus Dynamic Function Protocol DETAILS OF TESTS AVAILABLE AND SPECIMENS REQUIRED Compiled by: Phoebe Stanford Registrar Dept of Clinical Chemistry and Endocrinology SEALS North South Eastern Area Laboratory Services SEALS PATHOLOGY SERVICE RANDWICK CAMPUS TABLE OF CONTENTS PATIENT PREPARATION……………………………………………………….. 4 PROCEDURE FOR USING THE GLUCOMETER…………………………….. 6 PANCREAS DIABETES GLUCOSE TOLERANCE TEST …………………………………………………………………………..7 GESTATIONAL DIABETES SCREENING………………………………………………………………..8 GTT FOR INSULIN RESISTANCE (PCOS)…………………………………………………………….10 MEAL TOLERANCE……………………………………………………………………………………….10 EXTENDED GLUCOSE TOLERANCE TEST……………………………………………………11 ANTERIOR PITUITARY ANTERIOR PITUITARY FUNCTION ITT………………………………………………………………………………………………..12 CUSHING'S DISEASE OVERNIGHT DEXAMETHASONE TEST……………………………………………………15 BILATERAL SIMULTANEOUS INFERIOR PETROSAL SINUS SAMPLING…………….16 ACROMEGALY GROWTH HORMONE SUPPRESSION TEST (OGTT) FOR ACROMEGALY……………26 POSTERIOR PITUITARY DIABETES INSIPIDUS WATER DEPRIVATION TEST………………………………………………………………..27 ADRENAL ADRENAL INSUFFICIENCY SHORT SYNACTHEN TEST…………………………………………………………………..30 SYNACTHEN TEST - CONGENITAL ADRENAL HYERPLASIA………………………….32 HYPERALDOSTERONISM SALINE SUPPRESSION TEST………………………………………………………………..33 LYING/STANDING AND FRUSEMIDE TEST………………………………………………..34 ADRENAL VENOUS SAMPLING……………………………………………………………..36 CHEMAI - Dynamic Function Protocol - 05 Page 2 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services PHAEOCHROMOCYTOMA CLONIDINE SUPPRESSION TEST…………………………………………………………..41 BONE BONE BIOPSY PROTOCOL…………………………………………………………………………..42 APPENDICES APPENDIX 1………………………………………………………………………………………………44 APPENDIX 2……………………………………………………………………………………………..45 APPENDIX 3………………………………………………………………………………………………..46 CHEMAI - Dynamic Function Protocol - 05 Page 3 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services PATIENT PREPARATION All patients must be booked in through the endocrine nurse on extension 24680, or Teresa on extension 24602 and be given the appropriate information regarding their test procedure. Requests for the following dynamic function tests must have the lab request form faxed to Teresa at the Diabetes centre on 9382 4688. Patient details are essential, including patient’ phone number for contacting purposes. 1. Short synacthen test 2. Insulin tolerance test 3. Water deprivation test 4. Saline infusion test All medication on Resuscitation trolley is checked, oxygen and suction equipment is tested. Calibrate glucose meter if required Collect all medication, glucose drink and insulin as required. All patients present to ambulatory care. The registered nurse greets the patient, introduces herself and explains the procedure. Check specimen tubes are correct. Identify patient and check spelling of their name. Check time written on each specimen. Bulk bill with Medicare for Procedure; Additional bloods required separate Medicare form For payment of test follow SEALS Finance payment protocol The patient is assessed by the registered nurse before performing the procedure. The assessment includes: Taking a short medical history Check level of patient anxiety - reassure the patient and position comfortable for procedure Patient’s medication – establish time and dose of last medications. Some tests require morning medication to be omitted. Time of fasting - check that special diet requirements have been followed. Known allergies Weight & Height Blood pressure and pulse Note down on commenced time of 0 minute; time & dosage of medication Time of adverse reaction & noted what action was taken eg. Glucose dose etc. All information is documented on the patients’ continuation notes. CHEMAI - Dynamic Function Protocol - 05 Page 4 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services Choose the appropriate equipment to suit the vein, eg 21 g winged infusion set for cubital fossa, 23 g for smaller veins. A cannula may be inserted if attending nurse / medical officer feels it is appropriate. Three way tap is attached to the end of butterfly/cannula Draw up normal saline in 20 mL syringe for line flushing Attach syringe to 3-way tap. Holder is also attached to 3-way tap for blood collection. At completion of each timed specimen. Flush line with saline frequently and use flush tube to draw up saline to clear 3 way tap of blood Draw off 2 mLs of blood before each collection and discard, to prevent contamination with saline. Lunch to be ordered and given to patient following the Insulin Tolerance Test Review Date: This section was reviewed by Phoebe Stanford (Chemistry registrar) 2014 CHEMAI - Dynamic Function Protocol - 05 Page 5 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services PROCEDURE FOR USING GLUCOMETER Equipment Supplies to wash and dry patient’s finger Gloves for operator Accu-Chek Performa™ Meter Accu-Chek Performa™ Test Strips with code chip (check expiry date) Lancing Device Gauze swab or cotton wool Method Operator to use gloves Wash and dry patient’s finger Prepare lancet device Insert a test strip into meter in direction of arrows Make sure the code number on display matches the code number on the test strip container When flashing blood drop symbol appears of display, perform finger prick Gently squeeze finger to assist blood flow Touch the drop of blood to the front edge of the yellow window of the test strip When you see “6” flash, you have enough blood Your result will appear on the screen in 5 seconds Dispose of blood soiled articles in blood contaminated waste Dispose of lancet device in sharps container Recommendations 1. Washing patient’s finger ensures there are no contaminates that can interfere with result e.g. fruit juice. 2. Drying patient’s finger ensures that there is no thinning of the blood that will result in a low reading. 3. Using the sides of the finger tips ensures less pain for the patient. 4. Using the depth settings on the Lancing Device can help lessen pain and bruising at puncture site. 5. Using a warm wash on hands can aid blood flow to the fingers. 6. If blood glucose result is questionable perform a quality control test and repeat blood glucose test. QUALITY CONTROL CHECKS For detailed instruction on quality control checks and procedure for performing a blood glucose test refer to POWH Clinical Business rules Manual December 2011, Section 15: Diabetes Blood Glucose Monitoring and Quality Control – Accu-Chek Performa (http://seslhnweb/powh/documents/cpm/Section15/accucheckperforma.pdf) CHEMAI - Dynamic Function Protocol - 05 Page 6 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services GLUCOSE TOLERANCE TEST Indication: Screening for diabetes mellitus Procedure: Patient to attend after an overnight fast. Collect blood at baseline (time 0), and then administer 75g glucose drink over 5-10minutes. Blood is then collected 120 minutes after the glucose load. The patient is required to fast (no food or drink) and remain resting until the final sample is collected. Blood collected: Time Glucose (Sodium fluoride) – 1mL 0 min * 120 min (2 hr) * Interpretation: WHO 2006 Criteria Fasting 0 min glucose 120 min glucose (mmol/L) (mmol/L) Normal < 6.1 <7.8 Increased risk for diabetes 6.1-6.9 7.8-11 (IFG or IGT) Diabetes Mellitus 7.0 11.1 Review Date: Reviewed by Phoebe Stanford (Chemistry registrar) 05.01.2016 CHEMAI - Dynamic Function Protocol - 05 Page 7 of 47 Authorised by: C. White & R. Horvath Released: 05.01.2017 This document becomes uncontrolled when printed or downloaded unless registered by local document control procedures South Eastern Area Laboratory Services PREGNANCY DIABETES SCREENING 2 hrs PREGNANCY DIABETES SCREEN (PDS - 2hrs 75g GTT) Indication: Screening for gestational diabetes/ diabetes in pregnancy Procedure: Patient to attend after overnight fast Collect blood at baseline (time 0), then administer 75g glucose drink. Blood collected 60 and 120 minutes after the glucose load. The patient is required to fast (no food or drink) and remain resting until the final sample is collected. Blood collected: Time Glucose (Sodium fluoride) – 1mL 0 min * 60min (1 hr) * 120 min (2 hr) * Interpretation: Gestational diabetes mellitus should be diagnosed at any time during pregnancy if any of the following criteria are met: (a) Fasting plasma glucose 5.1–6.9 mmol/l (b) 1-h post 75 g oral glucose load >10.0 mmol/l* (c) 2-h post 75 g oral glucose load 8.5–11.0 mmol/l *there are no established criteria for the diagnosis of diabetes based on the 1-h post-load value Diabetes mellitus in pregnancy should be diagnosed by the 2006 WHO criteria for diabetes if any of the following criteria are met: (a) Fasting plasma glucose
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