Lecture on Analytical Chemistry in BAC testing Part 12

The above is Part Twelve from a lecture given by Attorney Justin J. McShane before the North Carolina Advocates for Justice “Advanced DWI Seminar”. This seminar happened on February 26, 2010. It was organized and hosted by John K. Fanney, Esquire of Fanney & Jackson, P.C. The following is a transcript of this video:

You need to know which vein is there because you have to take a look at the way that it is. If you have an IV going in that’s downstream from your collection site, you are going to have major problems because the lactate is getting in from where your blood draw is.  So you have to do some research. You also have to know intravenous drug users. It doesn’t take a rocket scientist to know that if you see track marks there, don’t do there and try to draw blood from that exact same area. What you are going to do because they are not phlebotomist themselves, they are I guess uncertified phlebotomist themselves. They can introduce things themselves into the general area and confuse the result.

Very important here is something that took me a while to understand and to recognize, how important cleansing is, cleansing of the site. We’ve all had our blood drawn at some point and time in our life and the next time you have your blood drawn I want you to watch the way the person does it. It is not just an infectious diseases thing.  It is getting the right result because of what is called candida albicans. This is what they always do.  They scrub up and down and back and up and down and everything like that. That is completely the wrong way of doing it.  What they should do is called concentric circles, meaning that they take it from the center point and they spiral outwards. The reason why that’s important is good old fashioned common sense. I want you to imagine you have mud on your arm.  You go take your wash cloth and you just scrub it up and down.  You are not cleaning your arm.  But if you sit there and you start in the middle and you just push it away you are cleaning it. It is no different with mud than it is with that organism called candida albicans. You have to be aware of that and you can ask the open ended question, and I hate open ended questions but with a phlebotomist, “How did you cleanse it?” Give them a pad, have them do it in front of a jury.  Nine times out of ten they are going to go like this unless you have cross-examined them before. They are going to go like this.  You just got your defense.

Candida albicans is, let me skip over these because I am going to get to candida albicans.

Hospitals are notoriously septic environments.  People go there to die.  People don’t go there.  It’s not like Howard Hughes and meticulously well kept. No matter what they do with staph infection there are all kinds of issues.  It comes back to candida albicans, which  I am going to talk about here.

Expiration date.  Everything has got an expiration date. You take a look at the box, the box has an expiration date on the outside, the tube has one.  And this is what the magic box looks like again with all its components that are there. I know I have to buzz through it and I apologize.

This is what I wanted to get to, this is a particularly nasty organism, and it’s called candida albicans. It’s yeast.  It’s everywhere.  It’s on everything.  It coats your apple.  It’s basically everywhere and it’s benign, generally benign except for the DUI defendant. For the DUI defendant it is deadly, and the reason why it is deadly is because of what it is. If you remember we were talking about different concentrations of potassium oxalate and sodium fluoride. Three conditions must be present for the formation of alcohol in the tube that is not your client’s fault, but is neo-generation of alcohol, it is called. That means it might be your client’s fault that he is a .04 but if candida albicans happens in here, it can inflate it to above that magic threshold number through no fault of your client’s, but because of things he trusted other people to do things such as cleaning his arm right, such as storing it in the refrigerator the right way, such as having the correct amount of sodium fluoride.

Three conditions must be present, there must be a sufficient and the right type of organisms.  Well I told you folks, candida albicans is everywhere.  You can’t get away from it so we got number one. Number two, appropriate substrate or food.  Okay, what candida albicans eats is glucose. Guess what has glucose?  Blood.  So we have both of those things being present. The third thing is the appropriate temperature for growth. If it is well refrigerated, if there is proper inversion of the tube where these additives are mixed, then you are not going to have a candida albicans defense. Most of the time that I see, the phlebotomist gives it back to the police officer, he puts it back in his car and who the hell knows when he gets it into a refrigerator. Is that refrigerator one that has an alarm on it that is well maintained and well contained and taken a look at as it probably should be?  Of course not. Where does it go and what does he do? It is actually relatively easy to find a lack of proper temperature or it’s not traceable.

Anyone remember Pac-Man?

[music: Pac-Man].

In case you didn’t know what Pac-Man is.

Candida albicans is just like Pac-Man and here is why, you have to think about it this way: Pac-Man is candida albicans, that organism.  The ghosts are glucose. The flashing dots in the corner that energizes Pac-Man is the lack of refrigeration. Just like in the game itself, it’s only when Pac-Man eats the flashing dots that Pac-Man can eat the ghosts.  However instead of killing the ghosts in our version of Pac-Man it emits out ETOH. It eats glucose which is in the blood and it excretes out ethanol or alcohol. It is particularly scary because the most complicated analytical device, meaning the GC or even now what is called a HPLC, which we didn’t talk about here, cannot tell the difference between when this happens or not. It is impossible for the machine to tell what alcohol is there because your client drank it or it happened through this transformation of ethanol that happens because of candida albicans.

This is very scary stuff. Sometimes they use non alcoholic swabs that are there and sometimes they don’t have the providone iodine. They go to betasept, betasept is used in a hospital environment all the time. You have to be really diligent and take a look at it because what can be there is in the active ingredients isopropyl alcohol. If you can’t show me the separating, how can I tell whether or not it is et

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