sample collection & rejection .pptx is used in hospital

Sample analysis

1. Sample Collection and Rejection Criteria Presented by : Shahina Azeez

2. Sample Collection PHLEBOTOMY Phlebotomy is an invasive process of the withdrawal of blood from vein,artery or capillary blood for lab analysis or blood transfusion Phlebotomist : collects blood and other samples Interact with patient and other healthcare professionals. Plays an vital role in any healthcare system

3. What do you keep Professional Confidential - All employees are responsible for maintaining confidentiality of medical information Attitude - Always be polite ,friendly, calm & considerate Appearance - Your personal appearance is the impression you make Safety – of yourself and patients

4. Pre-analytical Procedure: Proper identification of the patient Review the ordered tests, check for any special tests or timed specimens are there to be collected. Select the tubes/ containers accordingly Be familiar with any special conditions associated with the timing of collection or handling of the specimen ( eg ; ice, heparinized specimen, any special containers, testing for drug levels) Selection of needle: Vacutainer method: Use 19 -23 guage vacutainer needle for adults and 25 gauge vacutainer needle for child Syringe method: better for patients with difficult veins so that we can control the suction and adjust the vaccum on the vein accordingly

5. PATIENT IDENTIFICATION THREE (3) IDENTIFIERS:- 1. Name 2. Date of Birth 3. Medical Record Number Confirm with appropriate I.D. Be pleasant and confident. ** Never rely solely on verbal communication ONLY from patient.

6. Selection of Suitable Vein: The superficial veins of the arm are usually chosen for venipuncture, namely basilic, cephalic and median cubital veins in the ante-cubital fossa Place the tourniquet appropriately Palpate the vein Select the ideal site, be careful of tendons Vein repeatedly use or injections and venipuncture will get collapse and it feels cord-like should not be used. Avoid areas od compromised circulation Never draw blood from a limb with arteriovenous fistula or graft, it will damage the graft Not suggestive to draw blood from a site below an intravenous infusion

7. Other SITES for Blood Collection Back of hand, side of wrist and antecubital area. 2. As a last resort, at the discretion of physician/nurse, a phlebotomist may collect from a site ABOVE an I.V. line. Physician / nurse must turn off I.V. for a minimum of five minutes prior to collection . NOTE : Collect a WASTE ( plain RED Top Tube ) tube when collecting under these circumstances.

8. Selection of tubes according to the test Follow Blood Draw Order : When multiple types of tubes are required there is a risk of contaminating a subsequent tube with the additive from the tube just collected. To eliminate this risk, refer to the following ordered list to determine the blood draw order .

9. VENIPUNCTURE

10. Prepare Youself Sanitize your hands Put gloves on Recommended: DO NOT touch patient without gloves on

11. Prepare the patient: Inform patient of abstinence from food and give dietary instructions. Remind the patient that physical activity, e.g. jogging is not allowed. Indicate to patient that smoking, coffee and alcohol should be abstained from. Establish medication intake and dose. Get the doctor’s order and request permission from the patient. Position the Patient Make them comfortable Remove Foreign objects out of mouth like Gum ,Mints, Food ,Thermometer

12. Prepare the site Select venipuncture site carefully Prep / Cleanse skin surface in circular motion with Alcohol / Propanol ) wipes Let area Air Dry Place the tourniquet 3 to 4 inches above the venipuncture site Maximum time for tourniquet on arm: 1 minute

13. Select the appropriate Needle 19 to 23 gauge most commonly used 25 gauge is used primarily with pediatric patients . The short needle length allows the phlebotomist to insert it at a shallow angle that can increase the ease of use Determine appropriate gauge based on amount of blood to be drawn , age of patient , and vein size .

14. Straight needle – vs – The “ Butterfly” Needle type depends on Patients assessment Phlebotomist preference The predominant technique used to draw blood for laboratory testing is a conventional straight needle attached to an evacuated tube system Butterfly wingsets are --When a patient’s veins are small or in poor condition , and when a patient is unable or unwilling to cooperate with the procedure. The elderly , neonates, and pediatric patients frequently fall into these categories.

15. THE VENIPUNCTURE Visually inspect the needle tip before insertion ensures that you are entering bevel up. Do not encourage patients to pump fist . Vigorous fist pumping leads to hemoconcentration Anchor the vein by pulling the skin taut below the site with your thumb. (TRACTION) For normal venous punctures, the best angle is between 20 and 40 degrees depending on the depth of the vein. When using a butterfly the angle is probably less than 15 degree.

16. Filling the tubes: ● Each tube contains a specific amount of additive for a specific volume of blood . Under filling or over filling of tube alters blood to additive ratio which can affect the test results. Mixing of specimens: – INVERT TUBES GENTLY. Blood Culture Tube = 8 to 10 times. Citrate Tube(s) = 4 to 5 times (Blue) SST/ Gel Separator Tube = invert and allow to stand for 10 minutes Serum Tubes 10ml Glass or Plastic ( Red ) = NONE Heparin Tube = 8 -10 times (Green/ Dark Green) EDTA Tube = 8 - 10 times (Purple/ Pink) Fluoride (glucose) Tube = 8 - 10 times (Grey) Begin the above process immediately after drawing. Improper Mixing results in inaccurate reporting due to:-Microclots, platelet clumping, clotted specimens, hemolysis.

17. Thinks to be done Post-collection Once the needle is removed, press down the guaze applying adequate pressure to avoid formation of hematoma. Mix and label all appropriate tubes at the patient bedside itself. Label must be permanently attached and contain: ● Full name (first and last) ● MR (medical record) Number ● DOB (date of birth) ● Date/ Time specimen was collection ● Blood collector’s Initials

18. Discard Collection Unit, Syringe Needle, or Transfer Device appropriately Dispose the Contaminated Materials Thank Patient, Remove Gloves, and Sanitize Hands Transport Specimen to the Lab

19. Deliver specimens promptly to the laboratory If necessary, protect from light, transport with icepack (for ammonia) Avoid extreme fluctuations of temperature. Transport serum and plasma tubes in an upright position as far as possible. Avoid spillages Copyright © 2016 Wolters Kluwer • All Rights Reserved

20. VENIPUNCTURE: EIGHT COMPONENTS FOR A SUCCESSFUL VENIPUNCTURE: ► Proper Patient Identification ► Proper Site Selection ► Proper Site Preparation ► Tourniquet Placement / Timing ► Needle Selection ► Tubes/ Order of Draw ► Labeling Specimens ► Handling of Specimens

21. Determining site of draw on infants – newborn to 1 year Collection of blood from Neonates Heel stick ONLY  if neonate under 20 pounds Arm draw  : arm draw can be performed if need but  use caution when using tourniquet to avoid injury and or nerve damage to site. Do not obtain the blood from a finger on an infant under 1 year of age No more than 2 attempts should be made , call the physician if you are unsuccessful at obtaining the specimen. Label all tubes at chair in presence of parents

22. Other type of specimen collection: Newborn card Urine collection: Random or 24hours collection Stool Collection Swab collection Blood culture collection Special testing eg: cortisol salivary collection, Growth hormone, GGT, urea breath testing etc Note: It is the responsibility of the clinic or physician to educate patients about special requirement and timing of medications and sample collection for some special tests with special procedures, as same physicians should describe the procedure on the patient request forms as well. In case for any enquires, Laboratory is available 24*7 at your service.

23. Blood collection From Arterial Line ARTERIAL LINE : is a preferable line for blood collection when the patient is having both Arterial line and CVC line . When obtaining blood from arterial line system, by vacutainer or syringe methods, consider these points : Clean the site with alcohol swab and wait for it to dry (Don`t wipe with gauze) Screw the knop anticlockwise to withdraw the saline mixed blood Turn the stop cock valve Off to the flush solution to avoid introduce of saline into the sample. If using vacutainer ……connect vacutainer and take the desired blood as per the order If using syringe>>>>> After you transfer the blood from the syringe to the tube , if still you have blood in the syringe , Discard it and don’t return it back to the patient.

24. Blood collection From CVC Line When collecting blood from CVC line, the most suitable lumen; DISTAL LUMEN. A patient receiving multiple infusions and inotropes through CVC line , the correct way of collecting blood sample is : TO STOP ALL INFUSIONS EXCEPT INOTROPES AND VASOACTIVE PROCEDURE: Select distal lumen …….Flush the CVC line first….. Aspirate 5cc blood for discarding …. Collect the sample with help of 10cc syringe TRANSFER THE SAMPLE IMMEDIATELY TO THE TUBE . By slow pause through the side of the blood sampling tube Flush the system……. If remaining blood available in syringe discard it . If No sufficient back flow from the line……………………transfer the sample collection to Phlebotomist collection .

25. SPECIMEN COLLECTION Alcohol Alcohol damages cell walls; thereby withdrawing blood without completely allowing the site cleaned with alcohol affects the cell walls. Syringe Syringes have no anticoagulant in them. When blood is drawn from a vein or a line, coagulation begins almost immediately. Pressure Obtaining blood from a line/ port and ejecting blood into a collection tube forcefully can damage cells and cause hemolysis. Tube Filling Under-filling of tubes containing anticoagulants result in a higher than recommended concentration of the additive which promotes hemolysis. Filling Order Additives carryover from one tube to the next thereby a sequential order must be followed to avoid contamination of chemistry samples that may affect electrolyte results.   SPECIMEN HANDLING Improper Mixing of Tubes The tubes must be inverted several times to make sure the anticoagulant is properly mixed with the blood components to stop the entire clotting mechanism. Pneumatic Tube Systems Rapid transport of blood samples in pneumatic tube systems may cause blood cell breakdown and may affect blood results brought about by the sudden acceleration/ decelerations, changes in air pressures, movement of blood samples in the test tube and vibrations.     Common Causes of Errors in Blood Sampling:

26. Sample Rejection Criteria Unlabeled Sample – minimum two identifiers compulsory Mislabeled Sample – Eg: Wrong identifiers, different sample source in request and container. Late Submission of the sample – Eg: Home collection, Holding the sample of approvals,etc Insufficient volume/ Sample integrity – Blood to anticoagulant ratio., hemolyzed sample , lipemic sample Improper collection/preservation – Leaking container Hematology – clotted samples Patient not fasting for fasting glucose Exposed to extreme temperature unless specified in the test Stool samples in pampers, Cultures swabs not in transport media

27. Proper Handling of Irretrievable samples: Incase of a critical specimen such as irretrievable sample, specimen acquired through invasive procedure eg: surgical tissue or CSF or body fluids, doctor or the sister should be called to the laboratory to proper identify and label the specimen and will be accepted by laboratory staff responsible . What happens incase if the recollection sample is also hemolyzed or is lipemic? If the specimen is grossly hemolyzed or lipemic a recollection specimen will be requested. If the recollection specimen is also grossly hemolyzed or is lipemic, it will be processed and a comment will be added.

28. Procedure for rejecting Evaluate sample for acceptability Document the reason for rejection Notify the submitter or the authorized person immediately through phone/mail Maintain the records for recollection/ rejection

29. THANK YOU………….