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Specimen collection and handling

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Symon Nayupe
Symon Nayupe

A brief presentation on specimen collection and handling on some of the routine tests carried out in district hospitals in Malawi.

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SPECIMEN COLLECTION AND HANDLING Symon Fidelis Nayupe BSc Medical Laboratory Sciences [Honors]
OBJECTIVES • Responsibility of specimen collection • How to collect and handle various specimens • Sample rejection
Introduction • Nurses often assume the responsibility of sample collection – wards • Proper sample collection and handling ensures quality and reliable lab results – sample degradation or compromise • Necessary for sample collectors to know and abide by proper sample collection and handling techniques
Specimen collection key issues • Consider differential diagnoses • Decide on test(s) to be conducted • Decide on clinical samples to be collected to conduct these tests • consultation between microbiologist, clinicians and epidemiologist
Specimen collection tubes 1. Ethylenediaminetetra-acetic acid [EDTA] •Purple top/ lavender top •Used for:  routine haematology [FBC] Reticulocyte count Sickle test  Glyco HB, Hb electrophoresis CD 4, thin smear, blood grouping •Not suitable for Calcium and coagulation •Invert several times soon after collection
Specimen collection tubes cont… 2. Red top [No clot activator] •As indicated, has no clot activator – plain •ALL BODY FLUIDS [CSF, Ascitic, Pleural, lymph aspirates etc] must be collected in this tube. •Invert several times soon after collection
Sample collection tubes cont… 3. Red top, with clot activator. •Used for chemistry, crossmatch, serology [VDRL, Hep B and C] •Invert several times after collection
Specimen collection tube cont.. 4. Blood culture bottles • Has bacterial growth medium and activated charcoal • Sample for blood culture is collected directly into BC bottle
Basic sample collection techniques A. Venipuncture • Collection of blood from a vein for various tests that require large volume sample • Requires a tourniquet, needle, syringe, disinfectant, cotton wool, specimen collection tubes. • Procedure commonly done on a vein in the antecubital fossa of the arm. • Can also on a site other than the antecubital fossa where a vein is visible or can be reached. • Blood is drawn with a needle after the site has been thoroughly disinfected, with the bevel of the need facing upwards.
Blood samples – blood for smears Collection Capillary blood from finger prick • make smear • fix with methanol or other fixative Handling and transport Transport slides within 24 hours Do not refrigerate (can alter cell morphology)
Blood samples – blood for cultures Collection Venous blood • infants: 0.5 – 2 ml • children: 2 – 5 ml • adults: 5 – 10 ml Requires aseptic technique Collect within 10 minutes of fever • if suspect bacterial endocarditis: 3 sets of blood culture
Basic sample collection techniques • Urine collection • Wash hands • Clean meatus, female front to back • Start stream, then stop, collect specimen • Aseptic technique • Bedpan/mexican hat • To lab 15-20min post collection • Urine specimens • Random specimens, mid-stream urine, timed urine, sterile urine
Basic sample collection techniques • Stool specimens • Analysis of fecal material can detect pathological conditions ie: tumors, hemorrhage, infection • Tests: OB, ova and parasites, pus • Use a sterile container to collect stool. • Applicator sticks, direct collection, stool sample scoop. • Must reach the lab as soon as possible
Basic sample collection techniques • Vaginal or Urethral Discharge Specimens • Normally thin, nonpurulent, whitish or clear, small in amount • STD’s, UTI • Not Delegated • Assess external genitalia • If STD record sexual history • Physician’s order- vaginal/urethral
CSF • Collection • Lumbar puncture • Sterile tubes • Aseptic conditions • Trained person
CSF • Handling and transportation Bacteria • preferably in trans-isolate medium, pre-warmed to 25-37°C before inoculation OR • transport at ambient temperature (relevant pathogens do not survive at low temperatures) Viruses • transport at 4-8o C (if up to 48hrs or -70o C for longer duration)
Common sample collection techniques – sputum Collection Instruct patient to take a deep breath and cough up sputum directly into a wide-mouth sterile container • avoid saliva or postnasal discharge • 1 ml minimum volume
Rejection of samples • All samples collected in wrong tubes are rejected • All samples untimely brought to the lab are rejected • Unlabeled samples are rejected • Insufficient samples are rejected • Compromised samples [haemolysed etc] are rejected • If a sample is rejected, the one rejecting it must indicate the reason for the rejection of the sample.
References • Lieseke CL, E Ziebig; Essentials of Medical Laboratory Practice, 1st Edi., FA Davis Company, Philadelphia, USA [2012]

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Specimen collection and handling

  • 1. SPECIMEN COLLECTION AND HANDLING Symon Fidelis Nayupe BSc Medical Laboratory Sciences [Honors]
  • 2. OBJECTIVES • Responsibility of specimen collection • How to collect and handle various specimens • Sample rejection
  • 3. Introduction • Nurses often assume the responsibility of sample collection – wards • Proper sample collection and handling ensures quality and reliable lab results – sample degradation or compromise • Necessary for sample collectors to know and abide by proper sample collection and handling techniques
  • 4. Specimen collection key issues • Consider differential diagnoses • Decide on test(s) to be conducted • Decide on clinical samples to be collected to conduct these tests • consultation between microbiologist, clinicians and epidemiologist
  • 5. Specimen collection tubes 1. Ethylenediaminetetra-acetic acid [EDTA] •Purple top/ lavender top •Used for:  routine haematology [FBC] Reticulocyte count Sickle test  Glyco HB, Hb electrophoresis CD 4, thin smear, blood grouping •Not suitable for Calcium and coagulation •Invert several times soon after collection
  • 6. Specimen collection tubes cont… 2. Red top [No clot activator] •As indicated, has no clot activator – plain •ALL BODY FLUIDS [CSF, Ascitic, Pleural, lymph aspirates etc] must be collected in this tube. •Invert several times soon after collection
  • 7. Sample collection tubes cont… 3. Red top, with clot activator. •Used for chemistry, crossmatch, serology [VDRL, Hep B and C] •Invert several times after collection
  • 8. Specimen collection tube cont.. 4. Blood culture bottles • Has bacterial growth medium and activated charcoal • Sample for blood culture is collected directly into BC bottle
  • 9. Basic sample collection techniques A. Venipuncture • Collection of blood from a vein for various tests that require large volume sample • Requires a tourniquet, needle, syringe, disinfectant, cotton wool, specimen collection tubes. • Procedure commonly done on a vein in the antecubital fossa of the arm. • Can also on a site other than the antecubital fossa where a vein is visible or can be reached. • Blood is drawn with a needle after the site has been thoroughly disinfected, with the bevel of the need facing upwards.
  • 10. Blood samples – blood for smears Collection Capillary blood from finger prick • make smear • fix with methanol or other fixative Handling and transport Transport slides within 24 hours Do not refrigerate (can alter cell morphology)
  • 11. Blood samples – blood for cultures Collection Venous blood • infants: 0.5 – 2 ml • children: 2 – 5 ml • adults: 5 – 10 ml Requires aseptic technique Collect within 10 minutes of fever • if suspect bacterial endocarditis: 3 sets of blood culture
  • 12. Basic sample collection techniques • Urine collection • Wash hands • Clean meatus, female front to back • Start stream, then stop, collect specimen • Aseptic technique • Bedpan/mexican hat • To lab 15-20min post collection • Urine specimens • Random specimens, mid-stream urine, timed urine, sterile urine
  • 13. Basic sample collection techniques • Stool specimens • Analysis of fecal material can detect pathological conditions ie: tumors, hemorrhage, infection • Tests: OB, ova and parasites, pus • Use a sterile container to collect stool. • Applicator sticks, direct collection, stool sample scoop. • Must reach the lab as soon as possible
  • 14. Basic sample collection techniques • Vaginal or Urethral Discharge Specimens • Normally thin, nonpurulent, whitish or clear, small in amount • STD’s, UTI • Not Delegated • Assess external genitalia • If STD record sexual history • Physician’s order- vaginal/urethral
  • 15. CSF • Collection • Lumbar puncture • Sterile tubes • Aseptic conditions • Trained person
  • 16. CSF • Handling and transportation Bacteria • preferably in trans-isolate medium, pre-warmed to 25-37°C before inoculation OR • transport at ambient temperature (relevant pathogens do not survive at low temperatures) Viruses • transport at 4-8o C (if up to 48hrs or -70o C for longer duration)
  • 17. Common sample collection techniques – sputum Collection Instruct patient to take a deep breath and cough up sputum directly into a wide-mouth sterile container • avoid saliva or postnasal discharge • 1 ml minimum volume
  • 18. Rejection of samples • All samples collected in wrong tubes are rejected • All samples untimely brought to the lab are rejected • Unlabeled samples are rejected • Insufficient samples are rejected • Compromised samples [haemolysed etc] are rejected • If a sample is rejected, the one rejecting it must indicate the reason for the rejection of the sample.
  • 19. References • Lieseke CL, E Ziebig; Essentials of Medical Laboratory Practice, 1st Edi., FA Davis Company, Philadelphia, USA [2012]