PART TWO

Sterile swab

Used for cleaning the skin

70% alcohol or Methanol.

Used for disinfecting the skin

Gloves

Used to protect the phlebotomist from contamination

Disposal bucket

Used for disposing used materials

Sharps box or container

Used for disposing sharp materials

Lancet

Is used for piercing{make a hole} of the skin

Specific materials for venous blood collection

Syringes (2.5ml, 5ml and 10ml) and needles 19G, 21G and 23G)

For drawing blood

Vacuum (needle, holder and tubes)

For drawing blood

Blood containers

For putting blood

Tourniquet

For dilating veins

Purpose of finger prick blood collection

Is to obtain capillary blood which is may be used for haematological examinations, including haemoglobin estimation, total and differential white blood cell counts and blood cell morphology, detection of blood parasites, and sickle-cell screening.

Procedure for Finger Prick

Wear gloves

Clean the puncture area with a cotton wool swab soaked in 70% methanol or an alcohol swab; allow area to dry

Using a sterile lancet, make a rapid puncture using the side of the finger in adults and children sufficiently deep to allow the free flow of blood avoid the tip of the finger

Wipe away the first drop of blood with a piece of dry cotton wool. Use the next few drops and transfer onto clean glass slides or into a capillary tube or pipette.

When sufficient blood has been collected, press the piece of dry cotton wool firmly on the puncture area until the bleeding stops.

Place used lancet in the sharps box or container marked “SHARPS”. Place the materials for wrapping the lancet and the cotton wool in the bucket marked “INCINERATOR”.

Make sure the site is warm to ensure blood flows freely.

Do not squeeze the finger too hard as this will lead to haemodilution from tissue fluid and may give unreliable results.

On cold days, sock the hand (or foot of an infant) in warm water and dry before collecting the sample.

Discard the used materials (sharps and infectious) in appropriate containers

Purpose of venous blood collection

Venous blood is used for all blood examinations, including haematological, parasitological, biochemical and serological tests, and for blood culture. Blood samples are collected into plain tubes or tubes containing anticoagulant, or into blood bottles, as required.

Safety Precautions during Collection of Blood Sample from Patients

Always follow standard safety precautions when drawing blood

Consider every person (patient or staff) as potentially infectious and susceptible to infection

Wash hands before and after taking a sample from each patient

Put on new gloves before collecting blood

If blood is spilled, mop and disinfect area immediately

Keep work area organized, clean, and disinfected

Discard all used items in appropriate containers

Overview of Vein Anatomy (Location of veins)

Superficial Veins of the upper limb

Median Cubital Vein. A superficial vein, most commonly used for venepuncture. It lies over the cubital fossa and serves as an anastomosis between the cephalic and basilic vein

Cephalic veins. Shown in both the forearm and arm, it can be followed where it empties into the axillary vein

Basilic Vein. Seen in the forearm and arm, it dives to join the brachial; best area for venepuncture is antecubital fossa area

Apply tourniquet to increase pressure in the veins and aid in site selection. Ask the patient to make a tight fist, so the veins become more prominent.

The tourniquet should not be left on for longer than ONE minute

Using the index finger, feel for a suitable vein, selecting a sufficiently large vein that does not roll and with a direction that can be felt.

Wearing gloves clean the site with a cotton swab soaked in 70% methanol or an alcohol swab and allow to air dry. Do not retouch the cleaned area.

Screw the needle into the handle

With the thumb of the left hand holding down the skin below the puncture site, insert the needle along the line of the vein with the bevel of the needle facing directly upwards.

Insert needle at a 15 to 30 degree angle using a quick smooth motion.

Push the tube on to the end of the needle which is located in the handle.

When sufficient blood has been collected, release the tourniquet and instruct the patient to open his or her fist. Remove the needle from the vein and press firmly on the venipuncture site with a piece of dry cotton. Remove the tourniquet and instruct the patient to continue pressing on the puncture site with the arm raised until bleeding stops.

Label the tubes{ coz resource of time}.

Check to ensure bleeding from the venipuncture site has stopped. Cover the area with a small dressing, if needed.

Place the needle in the sharps box. Place other contaminated materials in the bucket marked “INCINERATION”.

Organise materials and equipment

Applying Tourniquet

Instruct the Patient to Form Fist

Clean Venipuncture Site with Alcohol Using a Circular Motion (after palpating path of vein) and Allow Area to Dry

Assemble Needle and Vacuum Tube Holder

Insert Collection Tube into Holder Until Tube Reaches Needle

Remove Cap from Needle

Use Your Thumb to Draw Skin Tight About 1- 2” Below Venepuncture Site

Insert Needle, Bevel Side Up, Into Vein and Penetrate Vein at a 15 Degree Angle

Push Vacutainer Tube Completely onto Needle. Blood Should Begin to Flow into

Tube and Release Tourniquet

Place Dry Gauze over the Venepuncture Site and Apply Mild Pressure to Pad and Slowly Remove Needle

Apply Mild Pressure Until Bleeding Has Stopped

Label the tube

Waste Disposal of used materials

IMPORTANCE OF STOOL EXAMINATION

Stool examination is used to identify parasites causing several infections and infestations.

The identification of parasites can also assist in the control of local parasitic infections.

For stool examination, a fresh specimen is collected in a clean, dry and leak-proof container.

The specimen should not be contaminated with urine, so be sure to instruct the patient correctly.

The collection of several specimens on alternate days may be required to detect parasites.

Give a patient a specimen collection container and a spatula and instruct collect to collect the stool specimen as follows:

You have been asked to collect a stool specimen for laboratory analysis.

Please wash your hands before beginning the procedure.

DO NOT pass the specimen into the toilet

DO NOT pass the specimen directly into the collection vial.

DO NOT urinate on the specimen or into the collection vial.

DO NOT allow any water to mix with the specimen.

Pass the stool specimen into any clean and dry container such as a bedpan, plastic plate, or newspaper.

Carefully open a specimen collection container o Using the spatula, collect small amounts of stool from areas that are slimy, watery, or bloody and place them into a specimen collection container.

If the stool is hard, collect small amounts from both ends and the middle and place into a specimen collection container.

Fill the specimen collection container with enough specimen (About 1 spoonful or 10ml if it is a liquid specimen.)

Obtain a stool sample (in the container) from a patient.

Adhere to infection prevention and control standards.

Write patient’s name, date, & time of collection on the container

The specimen must be transported as soon as possible to the lab and must be accompanied by a doctors request form.

Stool samples must be examined within one hour after collection.

A macroscopic examination reports the physical appearance of a specimen.

This includes a description of

colour (yellow, brown or black)

consistency (formed, semi formed, watery or rice water)

visible contents (blood, mucus or worms)

Normal Stool: Appears brownish due to the presence of stercobilinogen. Stool from infants appear yellow brown or yellow green.

Colorless Stool: Pale colored stool is due to

The absence of stercobilinogen as a result of obstructive jaundice,

Abnormal fat absorption in the intestine as that occurs during Giardiasis.

Brown/Black Stool: Can be a result of

Iron therapy,

Gastro intestinal bleeding

Hookworm infection.

Normal Stool: Usually well formed.

Unformed, Semi formed/Watery Stool: Indicates

Bacterial infection.

Parasitic infection.

Rice Water Stool: Indicates cholera.

Normal Stool: Usually have no visible abnormal contents.

Blood in Stool: May be due to certain;

Parasites (e.g. Entamoeba histolytica, Schistosoma mansoni) or to

Bacteria (Shigella sp. Enterohemorrhagic Escherichia coli)

colonic or rectal malignancies.

Mucus: Usually due to;

Entamoeba histolytica

Tumor

Dysentery

Bacterial infection.

Worms: Worms or segments of worms may be seen when the following are the causative agents of the infection

Ascaris

Taenia

Enterobius vermicularis.

Saline and Iodine Preparation of Stool (Wet Mount/Wet Preparation/Saline Mount)

Routinely stool specimens are examined using the saline and iodine preparation to detect

Parasites

Cysts

Cells.

After the macroscopic examination the stool specimen is prepared as follows

Place a drop of saline near one end of a slide and a drop of iodine near the other end.

Iodine is used to stain the nuclear structure of cysts e.g. that of Entamoeba histolytica (four nuclei) and Entamoeba coli (eight nuclei).

Using a wooden applicator stick, mix a small amount of specimen with the saline and a similar amount with the iodine to make a smooth thin preparation and cover with a cover glass.

Examine the slide systematically, first using the 10X objective with the iris sufficiently closed to give good contrast.

Use 40X objective to examine in greater detail after parasite/cyst/ova is seen.

Report your findings

Urine is formed and excreted by the kidneys.

The production and composition of urine depends on the following;

Glomerular filtration,

Tubular selective reabsorption and

Tubular secretion.

A urine sample is easily collected and will provide useful information about the following;

Metabolism status,

Kidney function and the

Urinary tract state.

A specimen can be examined

Macroscopically

biochemically

microscopically

To detect;

Bleeding

Infection

Glucose

Protein

Cells

Presence of micro-organisms.

For routine examination urine is collected in a clean leak-proof container.

For culture purposes midstream urine is collected in a sterile leak proof container.

Mid-stream urine is the portion of urine that does not contain the first and last portions of the sample.

Provide the patient with a clean container.

Instruct the patient to collect about 20 ml of urine directly into the clean container

Receive the specimen from the patient.

Adhere to infection prevention and control standards.

Secure the lid of the container immediately

Label container with patients name, age and address and send to the laboratory for investigation with a filled in request form to perform the test.

Provide the patient with a clean container

Instruct the patient to collect urine specimen in the following steps:

Wash genital area

Begin to urinate without collecting urine

After a few ml have passed, collect urine in container (10-20 ml if possible)

Finish urinating without collecting

Cover the container with its lid and send it to the clinician

Receive the specimen from the patient.

Adhere to IPC

Label the container with patients name, age and address and send to the laboratory for investigation with a filled in request form.

Tests on urine specimens should be performed within one hour to prevent the specimen from being contaminated due to bacterial growth.

Materials required to prepare for the examination of urine include

Gloves

Biohazard waste containers

Liquid soap

Register and Request forms

Urine specimen container

Centrifuge machine

Test tubes

Slides

Cover slips

Microscope

Pasteur pipettes

Hand towels (preferably single use

MACROSCOPIC EXAMINATION

Is performed by reporting the physical appearance of a specimen.

This report can include features like

Color

Transparency

Smell

Normal urine appears yellow and clear with a characteristic aromatic smell.

Some changes in the physical appearance can indicate a disease.

Specimen of urine with normal sample and other pathological samples

Take different samples of urine in different container

Show the colour of urine comparing with the normal urine

Normal urine is pale yellow (amber colour)

Pathological urine has different

Colour

turbidity

smelly

Appearance of Urine

Possible Cause

Cloudy

Urinary tract infection (UTI)

Red and Cloudy

UTI, Schistosomiasis

Brown and cloudy

Black water fever

Silvery shine or milky

Pus, bacteria or epithelial cells

Black

Certain poison e.g. phenol

Yellow/green/brown

Liver disease, viral hepatitis, jaundice Colour due to presence of bile or urobilinogen

Milky white

Bancroftian Filiraiasis

Transporting the Specimen

Check samples and forms before they leave the phlebotomy area

Before the samples leave the clinic they should be checked for errors:

Are sample tubes labelled correctly?

Are the forms completed correctly?

Is there a form for every sample?

Is there a sample for every form?

Does the information on the form match that of the corresponding sample?

This check is critical because once a sample leaves clinic it may be impossible to correct certain errors

Proper Handling of Specimen

Specimens must be properly handled from point of collection to delivery in the laboratory

Results of laboratory investigations are only as good as the sample received by the laboratory.

Use appropriate collection containers for specific testing needs

Store specimens upright, in racks at the appropriate temperature