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Laboratory Specimen Collection

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by

Cherry Kris Suarez

on 3 November 2013

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Transcript of Laboratory Specimen Collection

LABORATORY SPECIMEN COLLECTION
Principles of Specimen Collection
1. It is imperative that specimens be collected and handled very carefully if the causative agent for infection is to be identified correctly.
Preparatory Phase
Verify doctor's order
BLOOD
URINE
Assessment
STOOL
Assessment
SPUTUM
Assessment
6. Transport the specimen to the laboratory expeditiously or store properly until transported.
5. Label the container properly with the name of the patient, source of the specimen, date, time collected, and test to be performed.
4. Avoid potential contamination of the specimen by using proper collection instruments and containers.
3. Obtain an adequate amount of the specimen necessary for tests.
2. Specimens should be collected during the acute phase of infection and before the initiation of antibiotic therapy, if possible.
Observe infection control guidelines
Follow strict aseptic technique
Perform hand washing, don PPE
Prepare materials at the bedside
Explain procedure to the patient
Assess
Secure consent
Identify patient correctly
Assessment
Documentation
Procedure
Assess anxiety level and history of complication during venipuncture (nausea, fainting, etc)
Assessment
B
L
O
O
D
VEIN SELECTION:
Select appropriate venipuncture site
Introduce yourself to the patient
Routine Blood Tests
B
L
O
O
D
1. Assemble equipment
12. Perform after-care
11. Evaluate patient's response
10. Prepare samples for transportation
9. Label specimens
8. Draw samples in the correct order
6. Fill the laboratory sample tubes
5. Take blood
4. Disinfect the site
3. Apply the tourniquet
2. Select the site
Blood Culture
Tourniquet
Location
Technique
Rationale
Duration
Keep in mind:
Bevel up
Instruct NOT to bend/fold arm
Apply adequate pressure to stop bleeding
Release tourniquet before withdrawing needle
Use slow steady pressure
using syringe
Order of blood draw
B
L
O
O
D
B
L
O
O
D
1. Assemble the equipment
12. Perform after-care
11. Evaluate patient's response
10. Prepare samples for transportation
9. Label specimens
8. Draw samples in correct order
6. Fill the culture bottles
5. Take blood
4. Disinfect the site
3. Apply the tourniquet
2. Select the site
Disinfecting the site:
Blood volume
Order of draw
Keep in mind:
Documentation
Filling the tube
Blood culture bottles
Flouride/ Oxalate
(grey top)
EDTA
(purple top)
Sodium Heparin
(dark green top)
Sodium Citrate
(light blue top)
Non-additive tube
(red top)
patient's name, MRN, sex, age, unit/ward, date and time
1. Draw an indicator line on the bottle
5. Allow surface to dry before inoculating bottle
4. Leave wipes on bottle top
3. Clean surface with alcohol wipes
2. Remove dust caps
Check expiration date & integrity
1-2 mL in neonates
2-3 mL in infants
3-5 mL in children
8-10 mL adults
Where to inoculate first?
ANAEROBIC
AEROBIC
Label with patient name, MRN, age, sex, nationality, date and time, site of draw, ward/unit
Be careful not to scratch, write over or cover the BARCODE with adhesive tapes
7. Mix by swirling
7. Mix slowly, tip to tip
Blood culture from IV devices
at least 2 sets of culture specimens are required
mix gently by swirling
using a new syringe, collect blood for culture through the hub
collect 3 mL for adults and 0.2 mL for pediatric patients, place in non-additive tube (red top), and DISCARD
1 set from peripheral venipuncture
1 set from the intravascular device
WOUND SWAB
ARTERIAL BLOOD GAS
CAPILLARY BLOOD GLUCOSE
CEREBROSPINAL FLUID (CSF)
Documentation
Procedure
Assessment
U
R
I
N
E
Review diagnostic tests and drugs that interfere with test results and alert other healthcare team members
Assess color and odor of urine
Determine amount of urine required
Determine approximate time when testing should be done
Determine type of specimen required (clean or sterile)
Client's ability to void
Procedure
U
R
I
N
E
1. Position and drape patient, provide privacy
4. Label specimen and send immediately. If specimen is not cultured within 30mins of collection, urine must be refrigerated and cultured within 24hrs.
3. Collect urine specimen- at least 5ml, do not contaminate with tissue, stool or blood
2. Clean genital area
Urine Tests
U
R
I
N
E
ROUTINE URINE ANALYSIS/CULTURE
time of starting and ending must be recorded accordingly
specimen must be placed in refrigerator/ice or added with preservative during collection; keep away from direct sunlight
24-HOUR URINE
do not soak dipstick too long and blot excess urine to avoid inaccurate results
dipsticks must be discarded on expiry or 6mos after bottle is opened
precise timing is essential.
URINE DIPSTICK
strict sterile technique, early morning urine when possible
Documentation
U
R
I
N
E
amount, color, appearance, and odor of urine
nursing interventions completed as result of test findings
time urine collected and time sent to lab
method of obtaining specimen
results of test, physician notification if appropriate
withdraw first sample at 8AM and discard it
, collect subsequent urine samples in the next 24hrs
Record the date and time of blood sample collection, the name of test, the amount of blood collected and any adverse reaction to the procedure.
Routine tests for inpatients will be received by the lab. between 0730H-1200H
Amount of blood withdrawn must also be recorded in the I & O sheet, the doctor shall be notified for consideration of blood replacement.
Record in the "laboratory specimen tracking form" before transport to the lab
Documentation
Procedure
Assessment
S
T
O
O
L
Assess patient's understanding
Assess the last bowel movement
Dietary history
Procedure
S
T
O
O
L
1. Collect as much stool as possible (2.5cm/ 1 inch long or 1oz).
5. Liquid stool should be examined 30mins from start of collection, not after (trophozites disintegrate fast). If semi-formed stool, should be examined within 60mins after defecation.
4. Transport immediately while still warm especially if for ova and parasites.
2. Collect stool free from tissue, urine and menstrual blood contamination.
Stool Tests
GUIAC/ OCCULT BLOOD TEST
S
T
O
O
L
usually repeated for 3-6 times for accuracy
Others- BLOOD >> do not collect during and until 3 days after menstruation, do not collect if with bleeding hemorrhoid/ blood in urine.
DRUGS- NO aspirin or other NSAID for 7 days prior and during the test, NO vitamin C in excess of 250mg/dl for 72 hours prior to test
DIET- NO red meat (e.g. beef, lamb), processed meats and liver, raw fruits and vegetables (melons, radish, turnips, horseradish) for 72hrs prior to test
Documentation
S
T
O
O
L
Record time of specimen collection and transport to lab
Document amount, color, consistency of stool sent, and any unusual characteristic.
6. Enteric precaution should be observed.
3. Use sterile spatula and specimen container when stool is for culture.
Documentation
Procedure
Assessment
S
P
U
T
U
M
Assess patient's lung sounds, monitor O2 saturation
Assess level of pain and the ability to cough
Procedure
S
P
U
T
U
M
1. Have patient rinse mouth with water only
7. Acid-fast bacilli (AFB) test requires specimen collection on 3 consecutive days.
6. Send immediately
5. Suction secretion when patient is unable to cough (do not flush with NSS unless <1ml is in the container)
4. Collect 1-3ml of sputum in a sterile container
3. Instruct to perform a series of short coughs, inhale deeply, and cough forcefully. Steam inhalation/nebulization can be done prior to facilitate collection.
2. Early morning specimen is preferred
Documentation
S
P
U
T
U
M
Record time and method of specimen collection and transport to lab
Note characteristics of respiration before and after collection and how the patient tolerated the procedure
Record nature and amount of secretions
Note on the lab request form any antibiotics given in the past 24 hours.
Assessment
Documentation
Procedure
Assessment
W
O
U
N
D
Assess the wound and surrounding tissue: color, wound edges, healing process, signs of dehiscence, characteristics of drainage
Assess the surrounding skin color, temperature and edema, ecchymosis, or maceration
Procedure
W
O
U
N
D
5. DON'T: swab non-viable tissue (eschar), swab pooled exudate/wound dressings, apply antiseptic prior to swabbing.
4. Use different swab for different site. Maintain strict sterile technique.
3. Collect fresh pus/exudate. If wound is dry, wet swab with saline.
2. Using sterile cotton-tipped swab, collect in the wound bed and margin
1. Clean wound with saline to remove slough, necrotic tissue, dried exudate and dressing residue
Documentation
W
O
U
N
D
Label specimen with specific anatomic site and wound type (surgical, traumatic, etc)
Document procedure, wound assessment findings, and patient's reaction.
Assessment
Documentation
Procedure
Assessment
A
B
G
Perform Allen's test
Check that the patient was not suctioned in the last 15mins
Assess vital signs, use of oxygen (amount used)
Procedure
A
B
G
1. Stabilize the patient's wrist
8. Send immediately
7. If on oxygen, wait 15 mins after initiation; if nebulization given, wait for 20mins before collecting
6. Continue to monitor VS and check extremity for signs of circulatory impairment, assess for bleeding at site
5. Check syringe for air, expel if present. Place cover for syringe and gently rotate to mix heparin. Place in a cup/bag with ice.
4. Apply pressure for 5mins (10-15mins if on anticoagulant), apply pressure dressing when bleeding stops
3. Sample can be withdrawn from arterial line
2. Hold the needle 45-60degree angle at the site of maximal impulse, collect 0.5-1ml blood in a heparinized syringe
Documentation
A
B
G
document results of Allen's test (positive if normal results)
also note if breathing in room air
if patient is on mech vent, note the FiO2 and tidal volume
document in the notes the patient's recent Hgb level, pulse oximetry reading, RR, and respiratory effort, arterial puncture site, amount of time pressure applied to site to control bleeding
record on the form: patient's temperature, oxygen flow rate and delivering method, date and collection time the sample was drawn
Assessment
Documentation
Procedure
Assessment
Documentation
Procedure
Assessment
C
B
G
Assess the history of DM
Check for fasting if for FBS
Assess medications taken such as corticosteroids
Procedure
C
B
G
1. Check the code of strip against code in glucometer
5. Other sites: earlobe, heel (for infants)
4. Wipe away first drop of blood
3. Puncture lateral aspect of finger, make sure it is not cold and clammy
Documentation
C
B
G
Document the results on the chart, report abnormal findings.
Assessment
C
S
F
Assess ICP
Baseline neurologic status (mobility of extremities, sensations, etc)
Assess ability to follow instructions and maintain knee-chest position
C
S
F
C
S
F
Procedure
1. Position in knee-chest position/ sitting with head flexed to chest; bladder should be empty
>>if there is ICP, no more than 2 mL is withdrawn d/t risk of brain stem shift
7.
2-3mL CSF is collected in 3 tubes
(for chemistry and serology, microbiology, and hematology)
6. Instruct to breathe quietly and not to talk
5. Assist patient in slowly straightening of legs after puncture
4. Pressure can be measured (both opening and closing) with a manometer
3. Spinal puncture is done in L3-L4-L5 interspace
2. Assist in skin prep, strict sterile technique is followed
C
S
F
POST LUMBAR TAP
Apply pressure with sterile dressing, check for CSF leakage
Label the specimen and send immediately
Complications: changes in neurologic status (assess LOC, irritability, numbness/tingling of extremity), paralysis, hematoma, meningitis
SPINAL HEADACHE: ensure hydration (to prevent and relieve headache); administer analgesia
POSITION: remain flat for
2 hours
(4-8 hours) to prevent CSF leakage >> headache
Documentation
INFORMED CONSENT!
Document the date, time, physician's name, color, characteristics, amount of fluid collected, pressure reading, and number of specimens sent
Record patient's response to procedure, neurologic status, presence of complications post procedure
Blood tubes
Vacutainer holder and needle
What if there is few blood drawn?
via pediatric collection bag
via mid-stream collection
via catheter
Avoid...
Do not draw blood from a limb with IV line unless diagnosing infection related to the intravascular device
Labeling blood specimen
Transporting specimens
Blood Culture Bottles
betadine
alcohol
Needle Gauge
Neonate
Pedia, Elderly, Small Vein
Adult
(blood donation)
23
22
21
16-18
2. Clean the finger with alcohol
Cherry Kris Suarez
Nurse Tutor
All procedures must be done by
QUALIFIED NURSES

Swabs must be sent immediately and not later than 4 hours
NOTIFY LAB
Full transcript