3 - body fluid s.pdf

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1. BODY FLUIDS
PERITONIAL FLUID AND JOINT ASPIRATE
PRESENTERS
-NANCY KARANI
-JOSEPH GICHOHI
-SUBE WARIO

2. OBJECTIVES
uIntroduction
uPossible pathogens
uSpecimen collection
uStorage and transport
uAnalysis/lab diagnosis
uAntibiotics (AST)

3. JOINT ASPIRATE
Introduction
Fluid collected in joints
Also called synovial fluid- secreted by cells of the synovial
membrane
It is very viscous- due to polymerization of the hyaluronic acid it
contains
FUNCTION
a)Lubricant
b)Shock absorber
c)Supply nutrients to the cartilage

4. uNormally synovial fluid and other effusions do not contain microbial
organisms/normal flora. (sterile)
uBacteria in this fluid causes inflammation. (septic arthritis)
uInflammation – accumulation of exudates in body cavities or joint.
uArthritis- inflammation of a joint
uSeptic arthritis may also occur from the process of joint aspiration or
secondary to penetrating trauma e.g. animal bite/ nail puncture

5. POSSIBLE PATHOGENS
Gram positive
uS. Aureus
uStrep. Pyogens
uStrep.Pneumoniae
uEnterococci
uActinomycetes
Gram negative
uN. gonorrhoea
uN. meningitidis
uH. influenzae
uBrucella species
uE. coli
uPseudomonas aeruginosa
uProteus
uBacteroides

6. SPECIMEN COLLECTION
uArthrocentesis/ joint aspiration
uIdentify the site of puncture- may be ultrasound or fluoroscopically guided
uDisinfect
uLet it dry
uUse 18-20 gauge needle with a 20ml syringe or a bigger one depending on amount
of fluid needed
uStretch skin over insertion site
uInsert needle

7. Cont
uKnee may be flexed at 15-20 degrees to facilitate entry by opening up
the joint space
uIf bone is encountered, pull the needle back, verify anatomic landmark
and advance needle in a corrected direction
uApply bandage after removal of needle

8. Collection containers
ØDry sterile screw cap or bottle- dispense 2-3ml of fluid to check for clotting
ØScrew cap tube or bottle with 1ml sterile trisodium citrate- Dispense 9ml of
fluid and mix with the anticoagulant.
ØCitrated sample is used for protein conc. estimation, cell numbers and cultures
uEnsure the samples are properly labeled
N/B: Ensure the collection containers are sterile.

11. STORAGE AD TRANSPORT
uThe sample should be delivered into the lab as fast as
possible
uTransport at room temperature

12. ANALYSIS
a)Appearance ( colour and clarity)
-Normal - straw colour and clear and viscous
- bloody –due to hemorrhage
-cloudy – purulent, contains pus
-rice bodies (crystals)- free floating aggregates of tissue.
Indicate rheumatoid arthritis.
b) Check the sample without anticoagulant for clots
c) Gram stain
d) Culture

13. ANALYSIS
•Culture is done when the fluid has elevated PMNs, protein
concentration of more than 30g/l or when its blood stained.
•Normal PMNs is 25%. Infected is >75%.
•Normal protein concentration is <30g/l, infected is > 30g/l

14. ANALYSIS
üCentrifuge the citrated fluid for 20min to sediment microorganisms
üRemove supernatant and resuspend sediment and culture
üDone on CBA- incubate in CO2 up to 48hrs at
37degrees(anaerobically)
üBA and MacConkey aerobically at 37degrees for up to 72hrs. Check
after overnight incubation
•Culture can also be done in aerobic and anaerobic culture bottles.( use
8- 10ml of fluid)

15. ANALYSIS
§Growth pattern of the pathogens used for identification
§Catalase test done on colonies to differentiate staph from strept
uDiluting synovial fluid with saline helps separate cells that tend to
cluster.

16. ANTIBIOTICS

17. PERITONEAL FLUID
Introduction
-
Fluid contained in the peritoneum(peritoneal cavity)
-Also called ascitic fluid
-Functions is to lubricate the surface of tissue that line the abdominal
wall and pelvic cavity.
-It is a clear, straw coloured fluid.
-It does not clot but form a gel which when shaken becomes fluid again

18. uPeritonitis- inflammation of peritoneum leading to accumulation of
peritoneal fluid.
uPeritoneal fluid is sterile
uBacteria and fungi in peritoneal cavity cause peritonitis
uThey may enter by blood, lymph nodes, biliary or gastrointestinal
tracts
uInflammation can be infective or non infective.
infective- due to bacteria
non infective – due to malignancy

20. POSSIBLE PATHOGENS
Gram positive
uEnterococcus species
uStrep. Pneumoniae
uStrep. Pyogenes
uStrep. Agalacitae
uViridans streptococcus
uStaphylococcus aureus
uClostridium perfringens
uM. tuberculosis
Gram negative
uEnterobactericiae
uPseudomonus aeruginosa
uBacteroides

21. COLLECTION
uDone by paracentesis.
uAlso called abdominal tap
uThe point of collection of the sample is identified and marked. Is
ultrasound guided
uDisinfect
uLocal anesthetic may be applied to numb the area
uA needle is inserted into the abdominal cavity
uFluid is drawn using a syringe

22. uAn abdominal tap may be connected to drain excess fluid from the
patient's abdomen to relieve discomfort.
uThis procedure must be performed in a completely sterile setup
uThe fluid obtained from syringe is dispensed as follows:
ü 2-3ml into a dry sterile screw cap tube or bottle
ü9ml into a screw cap tube containing sterile 1ml trisodium citrate
uEnsure you properly label the tubes

23. STORAGE AND TRANSPORT
uThe sample must be in sterile containers
uTransport at room temperature
uAvail the sample to the lab for analysis as fast as possible

24. ANALYSIS
a)Appearance ( colour and clarity)
-Normal - straw colour and clear and viscous
- bloody –due to hemorrhage
-cloudy – purulent, contains pus
b) Check the sample without anticoagulant for clots
c) Smell for gut content or urine
d) SAAG serum ascites albumin gradient
e) Gram stain
f) Culture. Done when sample is blood stained or has > 30g/dl proteins.

25. ANALYSIS
ü Centrifuge the citrated fluid for 20min to sediment microorganisms
üRemove supernatant and resuspend sediment and cultureDone on CBA-
incubate in CO2 up to 48hrs at 37degrees(anaerobically)
üBA and MacConkey aerobically at 37degrees for up to 72hrs. Check after
overnight incubation
§Growth pattern of the pathogens used for identification
§Catalase test done on colonies to differentiate staph from strept

26. ZN(ziehl neelsen) Staining
uMake a smear on a slide using several drops of sediment from the
centrifuged fluid.
uFix the dried smear and stain by the Ziehl-Neelsen technique
u AFB are usually few and therefore a careful search of the smear is
required.
uHelp in detection of M. tuberculosis

27. THE END