lecture in specimen collection, presented by Abdelwahnab Kh. Ibrahim.

1. Specimens collection (1)Specimens collection (1)

3. INTRODUCTION :INTRODUCTION :
 The result of any laboratory
examination is only as good as the
sample received in the laboratory
 The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.
 The result of any laboratory
examination is only as good as the
sample received in the laboratory
 The quality of the work a laboratory
produces is only as good as the
quality of the samples it uses for
testing. The laboratory should ensure
that the samples it receives meet all of
the requirements needed to produce
accurate test results.

4. Sample ManagementSample Management
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5. Sample Management cont,Sample Management cont,
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal
Sample Collection
Sample Labeling and documentation
Sample Transport
Sample Referral
Sample Storage
Sample Disposal

6. Sample Management cont,Sample Management cont,
 Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
 Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.
 Sample collection and preservation will vary,
depending on the test and the type of sample
to be collected. The laboratory must carefully
define a sample collection process for all
tests it performs. The following should be
considered when preparing instructions:
 Patient preparation—Some tests require
that the patient be fasting. There may also
be special timing issues for tests such as
blood glucose, drug levels, and hormone
tests.

7. Sample Management cont,Sample Management cont,
 Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.
 Patient identification—The person
collecting the sample must accurately
identify the patient. This might be
done by questioning the patient, by
questioning an accompanying family
member, or by the use of an
identifying wrist band or other device.

8. Sample Management cont,Sample Management cont,
 Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.
 Type of sample required—Blood
tests might require serum, plasma, or
whole blood. Other tests might
require urine or saliva. Microbiology
testing deals with a variety of sample
types, so specific information as to
what is required for the test is needed.

9. Sample Management cont,Sample Management cont,
 Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.
 Type of container—The container for
the sample is often very important, as it
will affect volume and any needed
additives such as anti-coagulants and
preservatives. If the container does not
control volume, for example as with
Vacutainer® tubes, this will need to be
clearly specified. Some microbiology
samples will require specific transport
media to preserve microorganisms.

10. Sample Management cont,Sample Management cont,
 Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
 Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any important safety precautions
should be explained.
 Sample labeling—All requirements for
labeling of the sample at the time of
collection will need to be explained in
detail in the instructions for collection.
 Special handling—Some samples may
require special handling, such as
immediate refrigeration, protection from
light, or prompt delivery to the laboratory.
Any important safety precautions
should be explained.

11. Sample management entails theSample management entails the
following:following:
• Information needed on requisitions or forms
• Handling urgent requests
• Collection, labeling, preservation and
transport
• Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
• Processing and tracking samples
• Storage, retention, and disposal.
• Information needed on requisitions or forms
• Handling urgent requests
• Collection, labeling, preservation and
transport
• Safety practices (leaking or broken
containers, contaminated forms, other
biohazards)
• Processing and tracking samples
• Storage, retention, and disposal.

12. Collection RequirementsCollection Requirements
 Patient preparation
 Patient identification
 Type of sample
required
 Type of container
needed
 Labeling
 Special handling
 Safety precautions
 Patient preparation
 Patient identification
 Type of sample
required
 Type of container
needed
 Labeling
 Special handling
 Safety precautions

13. Each sample should be labeled with:
 Patient’s name
 Patient’s unique ID
number
Test ordered
Time and date of
collection
 Collector’s initials
Each sample should be labeled with:
 Patient’s name
 Patient’s unique ID
number
Test ordered
Time and date of
collection
 Collector’s initials
Use computer-generated bar codes when possible

14. SAMPLES REJECTION CRITERIASAMPLES REJECTION CRITERIA
 The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
 Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.
 The laboratory should establish rejection
criteria and follow them closely. It is the
responsibility of the laboratory to enforce
its policies on sample rejection so that
patient care is not compromised.
 Management should regularly review the
number of rejected samples and reasons
for rejections, conduct training on sample
collection, and revise written procedures
for sample management as needed.

15. The following are examples ofThe following are examples of
samples that should be rejected:samples that should be rejected:
1. Unlabeled sample;
2. Broken or leaking tube/container;
3. Insufficient patient information;
4. Sample label and patient name on
the test request form do not match;
5. Haemolyzed sample (depending on
test requested);
1. Unlabeled sample;
2. Broken or leaking tube/container;
3. Insufficient patient information;
4. Sample label and patient name on
the test request form do not match;
5. Haemolyzed sample (depending on
test requested);

16. The examples of samples thatThe examples of samples that
should be rejected cont,should be rejected cont,
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.
6. Non-fasting samples, for tests that
require fasting;
7. Sample collected in wrong
tube/container; for example, using the
wrong preservative or non-sterile
container;
8. Inadequate volume for the quantity of
preservative;
9. Insufficient quantity for the test
requested;
10. Prolonged transport time, or other
poor handling during transport.

17. Outcomes of Improper CollectionOutcomes of Improper Collection
 Delays in reporting test results
 Unnecessary re-draws/re-tests
 Decreased customer satisfaction
 Increased costs
 Incorrect diagnosis / treatment
 Injury
 Death
 Delays in reporting test results
 Unnecessary re-draws/re-tests
 Decreased customer satisfaction
 Increased costs
 Incorrect diagnosis / treatment
 Injury
 Death

18. TYPES OF SPECIMENS :TYPES OF SPECIMENS :
 Specimens consist
◦ Blood
◦ Urine
◦ Stool
◦ Sputum
◦ Wound drainage
◦ Others
 Specimens consist
◦ Blood
◦ Urine
◦ Stool
◦ Sputum
◦ Wound drainage
◦ Others

19. BLOOD COLLECTIONBLOOD COLLECTION

20.  Veins : Anticubital vein, veins of arm,
dorsum of hands, long saphenous vein,
femoral vein, umbilical and scalp vein.
 Capillaries : Finger tips, lobule of ear, heel
and thumb.
 Arteries : femoral artery .
 Veins : Anticubital vein, veins of arm,
dorsum of hands, long saphenous vein,
femoral vein, umbilical and scalp vein.
 Capillaries : Finger tips, lobule of ear, heel
and thumb.
 Arteries : femoral artery .
 Veins : Anticubital vein, veins of arm,
dorsum of hands, long saphenous vein,
femoral vein, umbilical and scalp vein.
 Capillaries : Finger tips, lobule of ear, heel
and thumb.
 Arteries : femoral artery .
 Veins : Anticubital vein, veins of arm,
dorsum of hands, long saphenous vein,
femoral vein, umbilical and scalp vein.
 Capillaries : Finger tips, lobule of ear, heel
and thumb.
 Arteries : femoral artery .

21. BLOOD COLLECTION TOOLSBLOOD COLLECTION TOOLS

22. BLOOD COLLECTION TUBESBLOOD COLLECTION TUBES

23. 11.. EDTA (Ethylene DiamineEDTA (Ethylene Diamine
TetraTetra--Acetate) liquid:Acetate) liquid:
 Types: Na and K2 EDTA (1.5-0.25mg
/ml)
 Functions by forming Ca salts to
remove Ca.
 Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw - invert 8 times to prevent
clotting and platelet clumping
 Types: Na and K2 EDTA (1.5-0.25mg
/ml)
 Functions by forming Ca salts to
remove Ca.
 Uses: most hematology studies. such
as: CBC, PCR and HbA1c. requires
full draw - invert 8 times to prevent
clotting and platelet clumping

24. 22. Light Blue :. Light Blue :
 Sodium citrate (1:9 ratio).
 Anticoagulant: 32g/l.
 Action: Remove Calcium.
 Uses: Coagulation studies and platelet
function.
 Sodium citrate (1:9 ratio).
 Anticoagulant: 32g/l.
 Action: Remove Calcium.
 Uses: Coagulation studies and platelet
function.

25. 33. Dark GREEN :. Dark GREEN :
 Sodium Heparin or Lithium Heparin
anticoagulant.
 Action: inactivate thrombin and
thromboplastin.
 Uses:
- For Lithium level use Na Heparin
anticoagulant
- &for Ammonia level use Na or Lithium
Heparin
 Sodium Heparin or Lithium Heparin
anticoagulant.
 Action: inactivate thrombin and
thromboplastin.
 Uses:
- For Lithium level use Na Heparin
anticoagulant
- &for Ammonia level use Na or Lithium
Heparin

26. 44.. Red (Plain tube):Red (Plain tube):
 No preservative/anticoagulant.
 Uses: usually for blood bank tests, toxicology
and serology

27. 55. SST/ Gold top tube:. SST/ Gold top tube:
 SST (Serum Separator Tube)
 No additives.
 Clotting accelerator and separation gel.
 Uses: Chemistry, Immunology, and
Serology.
 SST (Serum Separator Tube)
 No additives.
 Clotting accelerator and separation gel.
 Uses: Chemistry, Immunology, and
Serology.

28. 66. PST /Light Green. PST /Light Green
 Plasma Separating Tube with
Lithium Heparin
 Uses: Chemestries

29. 77. BLACKTOP:. BLACKTOP:
 Na citrate 1:4.
 Action: Remove calcium.
 Uses:Westergren sedimentation rate
(ESR). Requires full draw .
 Na citrate 1:4.
 Action: Remove calcium.
 Uses:Westergren sedimentation rate
(ESR). Requires full draw .

30. 88. Light grey top. Light grey top
 ADDITIVE : Sodium fluoride and
potassium oxalate .
 Action :Antiglycotic agent preserves
glucose up to 5 days
 USES : Glucoses, requires full draw (may
cause hemolysis if short draw)
 ADDITIVE : Sodium fluoride and
potassium oxalate .
 Action :Antiglycotic agent preserves
glucose up to 5 days
 USES : Glucoses, requires full draw (may
cause hemolysis if short draw)

31. 99. ESR tube. ESR tube
 Additive: 3.8% sodium citrate

33.  For fasting BS- empty stomach with a
preferable fasting of 8-10 hours
 For PPBS- a full meal or 75 gm of glucose
intake
 For lipid profile- a fasting sample of not
less than 12 hours, no fatty foods in
previous meal
 No alcohol before sample collection
 For fasting BS- empty stomach with a
preferable fasting of 8-10 hours
 For PPBS- a full meal or 75 gm of glucose
intake
 For lipid profile- a fasting sample of not
less than 12 hours, no fatty foods in
previous meal
 No alcohol before sample collection
 For fasting BS- empty stomach with a
preferable fasting of 8-10 hours
 For PPBS- a full meal or 75 gm of glucose
intake
 For lipid profile- a fasting sample of not
less than 12 hours, no fatty foods in
previous meal
 No alcohol before sample collection
 For fasting BS- empty stomach with a
preferable fasting of 8-10 hours
 For PPBS- a full meal or 75 gm of glucose
intake
 For lipid profile- a fasting sample of not
less than 12 hours, no fatty foods in
previous meal
 No alcohol before sample collection

34. VENOUS BLOOD cont,VENOUS BLOOD cont,
 Most commonly required ….WHY??
 Because most majority of routine tests
are performed on venous blood.
 Blood can be taken directly from the vein.
 The best site for venous collection is the
deep veins of the ante-cubital fossa.
 Most commonly required ….WHY??
 Because most majority of routine tests
are performed on venous blood.
 Blood can be taken directly from the vein.
 The best site for venous collection is the
deep veins of the ante-cubital fossa.

35. 11. Forearm vein. Forearm vein

36. If difficult to obtain from the anteIf difficult to obtain from the ante--cubitalcubital fossafossa
we can draw blood from following various site:we can draw blood from following various site:
2. Dorsum of hand vein 3. Femoral vein

37. If difficult to obtain from the anteIf difficult to obtain from the ante--cubitalcubital fossafossa
we can draw blood from following various site:we can draw blood from following various site:
4. Jugular vein 5. Scalp vein

38.  Purpose :
Patient identification
Organization of equipment
Collection of appropriate specimens
 Purpose :
Patient identification
Organization of equipment
Collection of appropriate specimens

39.  Introduce yourself
 Begin communication process
 Look and listen
 Explain purpose of visit
 Informed consent
 Patient has the right to refuse - Patient Bill of
Rights
 Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
 Wake a sleeping patient
 Greet unconscious patients
 Introduce yourself
 Begin communication process
 Look and listen
 Explain purpose of visit
 Informed consent
 Patient has the right to refuse - Patient Bill of
Rights
 Guilty of assault if patient has the perception that
blood collector is ignoring his or her refusal
 Wake a sleeping patient
 Greet unconscious patients

40.  THIS ISTHE MOST IMPORTANT STEP !
 Written protocol
 Hospital inpatients
Outpatients
 THIS ISTHE MOST IMPORTANT STEP !
 Written protocol
 Hospital inpatients
Outpatients

41. PreanalyticalPreanalytical variablesvariables

42. ::Medication affecting lab testsMedication affecting lab tests

43. Patient position :Patient position :
 Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
 Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope
 Site is convenient and supported
Place pillow under arm
Place fist under elbow
Place arm at downward
angle to prevent reflux
 Safety
Patient is sitting or lying down
Remove objects from patient’s mouth
Be alert for syncope

44. SELECT EQUIPMENTS :SELECT EQUIPMENTS :
 Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
 Number and type of tubes
 Extra tubes in case of loss of vacuum
 Place all supplies close to patient
Collection equipment
Antiseptic pads
Gauze
Bandage
Needle disposal system
Examination requisition
form
 Number and type of tubes
 Extra tubes in case of loss of vacuum

45. PHLEBOTOMY PROCEDUREPHLEBOTOMY PROCEDURE
Wash hands Apply gloves

46. Procedure :Procedure :
11.Appropriate syringe and/or needle should be selected..Appropriate syringe and/or needle should be selected.
22. If multiple specimens are to be collected its better to. If multiple specimens are to be collected its better to
use butterfly needle.use butterfly needle.

47. Procedure cont,Procedure cont,
Attach needle to holder Place tube into holder

48. 33.Tourniquet should be applied on.Tourniquet should be applied on
the upper arm.the upper arm.
 Locate tourniquet 3
to 4 inches above
site
 Avoid or cover arms
with skin conditions
 Avoid arms on the
side of a mastectomy
 Do not use a
tourniquet for lactate
test
 Locate tourniquet 3
to 4 inches above
site
 Avoid or cover arms
with skin conditions
 Avoid arms on the
side of a mastectomy
 Do not use a
tourniquet for lactate
test

49. Length Of Application :Length Of Application :
 Maximum time is 1 minute
 Apply for site selection
 Release for 2 minutes
 Reapply
 Release when blood flows
 Prolonged tourniquet application :
Causes hemoconcentration
 Increase in the ratio of certain analytes to
plasma
 Biochemical changes take place in the
trapped blood
 Maximum time is 1 minute
 Apply for site selection
 Release for 2 minutes
 Reapply
 Release when blood flows
 Prolonged tourniquet application :
Causes hemoconcentration
 Increase in the ratio of certain analytes to
plasma
 Biochemical changes take place in the
trapped blood

50. Too tightly applied tourniquet :Too tightly applied tourniquet :
Causes :
 Uncomfortable for patient
 Obstruct blood flow
 No radial pulse
 Appearance of petechiae
Causes :
 Uncomfortable for patient
 Obstruct blood flow
 No radial pulse
 Appearance of petechiae

51. Procedure cont,Procedure cont,
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5.Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse
4. Sterilize puncture area with a
spirit/alcohol swab and allow it to dry.
5.Visualize and palpate the vein.
Feeling is more important than sight
Probe with index finger, thumb has a pulse
Push, don’t stroke
Determine: size, depth, direction
Remember: veins are spongy, tendons are
rigid, arteries have a pulse

52. Having difficulty locating a vein ?Having difficulty locating a vein ?
 Check both arms
 Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminator device
 Check both arms
 Listen to patient’s suggestions of
previously successful areas
Enhancement of the vein :
Massage the arm upward from the wrist
Briefly hang the arm down
Apply heat
Transilluminator device

53. 6. Don’t enter the vein directly and vertically.
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
 Bevel up
 15-to-30 degree angle
 Resistance lessens when the needle enters
the vein
Procedure cont,Procedure cont,
6. Don’t enter the vein directly and vertically.
Why?
Because there is more chance of puncturing
the other side of the venous wall by this
way.
Insert the needle :
 Bevel up
 15-to-30 degree angle
 Resistance lessens when the needle enters
the vein

54. Procedure cont,Procedure cont,
Hold vein in place Insert needle

55. VENIPUNCTUREVENIPUNCTURE

56. Procedure cont,Procedure cont,
7. Draw blood according to required tests.
8.Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10.Apply a piece of band or medi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.
7. Draw blood according to required tests.
8.Withdraw the needle. Loosen the
tourniquet.
9. Press down on the gauze, applying
adequate pressure.
10.Apply a piece of band or medi-plast.
11. Dispose of contaminated material in
designated container.
12. Put blood into a suitable container.

57. TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)
1. IF AN INCOMPLETE
COLLECTION OR NO BLOOD IS
OBTAINED:
Change the position of the needle. Move it
forward (it may not be in the lumen)

58.  Or move it backward (it may have
penetrated too far).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:

59. Adjust the angle (the bevel may be against
the vein wall).
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:

60. Loosen the tourniquet.
Try another tube.There may be no
vacuum in the one being used.
Re-anchor the vein.Veins sometimes roll
away from the point of the needle and
puncture site.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
Loosen the tourniquet.
Try another tube.There may be no
vacuum in the one being used.
Re-anchor the vein.Veins sometimes roll
away from the point of the needle and
puncture site.

61. 2. IF BLOOD STOPS FLOWING INTO
THETUBE:
 The vein may have collapsed; resecure the
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
 The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
2. IF BLOOD STOPS FLOWING INTO
THETUBE:
 The vein may have collapsed; resecure the
tourniquet to increase venous filling. If this is
not successful, remove the needle, take care
of the puncture site, and redraw.
 The needle may have pulled out of the vein
when switching tubes. Hold equipment firmly
and place fingers against patient's arm, using
the flange for leverage when withdrawing
and inserting tubes.

62. 3. PROBLEMS OTHERTHAN AN
INCOMPLETE COLLECTION:
 A hematoma forms under the skin
adjacent to the puncture site - release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:
3. PROBLEMS OTHERTHAN AN
INCOMPLETE COLLECTION:
 A hematoma forms under the skin
adjacent to the puncture site - release the
tourniquet immediately and withdraw the
needle. Apply firm pressure.

63.  The blood is bright red (arterial) rather
than venous.Apply firm pressure for more
than 5 minutes.
TROUBLESHOOTING GUIDELINES:TROUBLESHOOTING GUIDELINES:

64.  To draw only a small amount of blood in a
microtube or strip for blood sugar and
bleeding time tests.
 For infants and young children.
 To draw only a small amount of blood in a
microtube or strip for blood sugar and
bleeding time tests.
 For infants and young children.

65. Capillaries structure :Capillaries structure :

66. Blood can be obtained from:Blood can be obtained from:

67. Blood can be obtained from:Blood can be obtained from:
1. Heel pulp 2. Finger pulp

68. 33. Ear lobule. Ear lobule

69. How to collect capillary blood?How to collect capillary blood?
 Select the least used
finger.
 Cleanse the site with
alcohol swab.
 Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.
 Select the least used
finger.
 Cleanse the site with
alcohol swab.
 Puncture across the
grain of the skin, then
transfer blood to a
strip or small
container.