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South West District
Prepared by:Dr.Harpreet Kaur Pathologist SWD Dated – 18th Nov’2010
The laboratory technician immediately labels the collected sample with the patient’s name. give a firm prick using the lancet. . • Test results are entered into the system and reports are generated at the reporting area of the laboratory.P. S. Do not press the finger to increase or cause the blood flow. Open the syringe pack if using the syringe or lancet for finger prick or prepare the needle and the holder for using vaccutainer for collection.Hold the ring or middle finger firmly from the base of first digit. (Check if patient is fasting or not – for the required investigations). sample type and then the samples are stored in respective laboratory repository. For Finger prick . OPD number. to concentrate the blood flow. / prepare the finger for finger prick. • • • • • • • Check the details on the request form.O.Procedures: GENERAL GUIDELINES: • • • • The treating doctor (consultant /medical officer) of the patient prescribes the investigations to be performed in the patient’s OPD card. Apply spirit using a spirit swab as disinfectant. FOR PHLEBOTOMY/ FINGER PRICK PROCEDURE • Patient should be given basic information about venipuncture / finger prick and must be made comfortable. The laboratory technicians collect the patient’s sample in the designated sample collection area. Prepare all the vaccutainers / syringes / lancet as per test required. He should be in a relaxed position and tell him that he is going to get a small prick. The patients go to the sample collection area / LAB. Prepare the vein and apply the tourniquet DO NOT tie too hard. let the blood flow on its own. Allow it to dry.
to press for 2-4 mins. • Check the patient-if there is no bleeding and ask the patient to leave. Haemogram Peripheral Smear FBS. The used needle must be destroyed in the needle destroyer / or discarded in the appropriate sharps container or the used syringe should be cut and disinfected in 1% sodium hypochlorite and discarded in red colored bag.• For Venepuncture . Lipid Profile. • • • • If using a syringe blood collected should be dispensed in appropriate vaccutainer tubes. Uric Acid (Overnight fasting For 10-12 Grey Sugar Blue PT APTT PREPARATION OF A BLOOD SMEAR: . Never draw blood too hastily. VACUTAINERS FOR BLOOD COLLECTION Red All Biochemistry All Serology Dengue Serology Malaria Serology All Hormones All Markers Fasting Samples: hrs.Touch the point of the needle to the skin and give a prick along the direction of the vein taking precautions avoiding a double puncture. The cotton swab should be discarded in yellow colored bag. let the free flowing blood fill the syringe / vaccutainer till the required amount of blood is collected. First release the tourniquet and then slowly withdraw the needle from the vein. Press the puncture site gently with cotton and ask the pt.) Random samples: All other Lavender All Haematology Hb DLC TLC C. to prevent bleeding.
• Holding a 1 X 3 inch slide in your left hand by the short side. . Place the spreader slide onto the lower slide in front of the blood drop. Do NOT press down. Perform this step quickly. Or a same size drop of blood from the finger prick is to be placed at one end of the slide. utilizing the wooden applicator sticks held in the right hand. Push the spreader slide forward at approximately a 30 degree angle. Grasp a second slide (spreader slide) in the right hand between thumb and forefinger. place a 2-3 mm drop of mixed whole blood about 1/4 inch from the right side of the slide. Allow the blood to spread by capillary action almost to the edges of the lower slide. Using two wooden applicator sticks rim the tube and check for fibrin clots. Remove stopper holding tube away from face. either by inversion or by mechanical rocker. even motion. The weight of the spreader slide should be the only weight applied. using a rapid. Alternate Method: Leave slide on a flat surface. • • • • • Place the slide containing the drop of blood on a flat surface and hold securely. The drop of blood must be spread within seconds or the cell distribution will be uneven. and pull the slide back until it touches the drop.• Mix sample well.
3) Should not touch any edge of the slide. Dry and observe under oil immersion. SOP FOR STAINING TECHNIQUES Leishman’s Staining Propose: To examine a smear Reagents: Leishman’s Stain Distil Water Specimen: Blood. 5. SOP FOR ESR: . Wash in running tap water. Body fluid etc. 3. Cover the smear with Leishman’s Stain. 7. Add double volume of distilled / buffer water . Wait for 8 – 10 min. thinning out to a smooth rounded feather edge. Make a smear in a clean glass slide and air dry . 6.Characteristics of a Good Smear 1) Thick at one end. Equipment: Glass slides Pipettes Procedure: 1. 2) Should occupy 2/3 of the total slide area. 4. 2. Wait for 2 min. 4) Should be margin free. except for point of application. Interpretation: As per microscopic findings.
At the end of 60 minutes. . If not used immediately. Manual 1. push the pipette down to the bottom of the tube. the numerical results are read in millimeters directly from the imprinted scale on the pipette. The blood should be diluted either at the time of vain puncture (4 vol blood taken directly into 1 vol of sterile sodium citrate anticoagulant. Place the test unit in the ESR rack . 4. 2. paying attention to the following external agents that might alter ESR in the pre—analysis phase. the sample must be stored at 4 C and has to be used within 8 hours after collection. Using continuous force. Sample so prepared must be used immediately. Custom made ESR tubes facilitate both the procedures mentioned.Sample preparation Sample must be drawn from a clean vein puncture over a maximum period of 30s without any excessiye venous stasis. Insert the ESR pipette into the blood collection tube (black top vaccutainer). 3.diluents ) or taken first into a primary anticoagulant (EDTA 1. The blood will automatically rise into the pipette and stop at the zero mark.5mg/ml) followed by dilution in the sterile sodium citrate.
. set out your glucometer. Syphilis card test. Perform the test according to the instructions given on the test kits. GLUCOMETER :• • • First. Malaria. a test strip. Check the code on the strip matches with the glucometer. Typhi rapid. Watch the indicator for placing the blood to the strip.SEROLOGY: Include – HbSAg. HCV. Turn on the glucometer and place a test strip in the machine when the machine is ready. Discard according to BMW guidelines. a lancet and an alcohol swab.
Provide the patient with the container for sample collection. • • • Place the drop of blood on or at the side of the strip.• • Make sure patients hand is dry and wipe the area you've selected with an alcohol swab and wait until the alcohol evaporates. The type of drop of blood is determined by the type of strip you are using (some use a "hanging drop" of blood versus a small drop for strips that draw blood in with a capillary action). dry place. Urine routine and microscopy. Keep your glucometer and test strips in a clean. You may use the alcohol prep pad to blot the site where you drew the blood if it is still bleeding. The glucometer will take a few moments to calculate the blood sugar reading. Pierce the finger tip and obtain a drop of blood. • Sample for Urine R&M is taken and labeled. UPT is performed there only (according to the kit sop) and the patient is asked to wait ten minutes and report is given to the patient then itself after entering the details along with the report in the master register. URINE ROUTINE AND MICROSCOPY . entry made in the master register. SOP FOR URINE ANALYSIS • • • • • Check request is for UPT. Tips: • • Make sure you keep batteries in stock that fit your glucometer. Receive the sample from the patient Label the sample.
Check the machine for reagents. In order to avoid any error the quantity of the reagent should be adequate. HAEMATOLOGY ANALYZERS Majority of the Hematology investigations are performed on 3 part automated analyzer Used for hematology parameters. Inspect that there are no broken tubing and power cord is plugged in the outlet. No dust should enter the instrument. care should be taken to prevent entry of dust. Waste tank should be checked daily. . Follow the instructions given in the instruction manual for cell counters • • • • • • • • Procedure • Specified amount of sample corresponding to the amount of EDTA anticoagulant should be collected from the vein.• • • • • Physical examination is done on the sample Sample is poured in a labeled test tube Using the uristix for sugar and protein or multistix for others chemical test is performed and reported according to kits directions. dirt bacteria etc. Check for the printer paper. Urine is centrifuged at 1500 x rpm for 15 mins. Wet mount is observed under the microscope and reported. Reagent should be left at the room temperature (15 to 30 degree C) for 24 hour before using. Supernatant is discarded in the sample container and a wet mount is prepared form the sediment. After unpacking the reagent. sufficient quantity of the reagent should be present.
working solutions. The complete information about specimen collection. The work instructions to run a test are available in the kit inserts supplied along with the kits. calibration. can be taken from the kit inserts. reagents. Sample Analysis: MAINTANENCE Daily:. System shut down. Entire system cleaning. Weekly: 1. 2. Mix the sample sufficiently. Kindly follow instructions provided by the manufacturer. storage and stability. . 1. Do not wipe the probe clean. STANDARD OPERATING PROCEDURES – BIOCHEMISTRY Majority of the biochemistry investigations are performed on semi-automated chemistry analyzer. volume. E-Z cleaning. Set the tube to sample probe position specified and aspirate the sample. All the maintenance schedules are given in the manual of the cell counters. reference ranges. preferably on the mixer. Maintenance of the instrument Daily maintenance • The instrument must be operated under the environmental requirement. Care should be taken while removing the tube cover to prevent blood scatter..• • • • • Tubes up to 80 mm height should be used. analytical sensitivity etc. methodology.
After turning off the lamp . Kindly follow instructions provided by the manufacturer. 1.• After turning on the power or the lamp wait 15 – 20 minutes before starting the test . Laboratory coats are worn at all times in the laboratory. Wash the flow cell after finishing each kind of test. Fill the flow cell with D/w before shutdown.Check Zero drift. Weekly maintenance • • • Calibrate Aspiration volume once a week. DO’S & DON’TS OF LABORATORY ♦All universal precautions to be observed in the Laboratory. . 2.wait about 10 min for the lamp to cool down before turning it on again • • • • • • Make sure the measurement is free of bubbles. Handle the dispose after waste according to acceptable laboratory local state and national standard Empty the waste bottle (in accordance with BMW guidelines) System shut down at the end of the day. All the maintenance schedules are given in the manual of the cell counters. Filter check Monthly maintanence • 2ml – 4ml clean with hypochloride. 3. Gloves to be worn while handling specimens and hands should be washed after removing gloves. Protective gear like mask must be worn while handling potentially infectious specimens.
SAFETY REGULATIONS / INSTRUCTIONS IN LAB • • • • • • • • • • • Follow the manufactures Instructions. 5. Decontaminate all surfaces and reusable devices after use with 1% Sodium Hypochlorite. Avoid mouth pipetting. ♦ All samples to be considered potentially Biohazardous and treated with 1% Sodium Hypochlorite. Glove to be worn while cleaning equipments. Cleaning of reusable slides and tubes after disinfecting in 1% Sodium Hypochlorite. At the end of the day put all the reagents back on the shelf . No equipment to be switched off without prior instructions. Dispose off chemicals only by recommended procedure. Do not touch chemicals with your hands. Wash hands thoroughly after collection. During centrifugation always close the lid. 2. Clean the works station with 1% bleach solution. ♦Proper waste disposal to be done in the specified color coded bags. 3. ♦ Instructions for Housekeeping staff: 1. Only trained Housekeeping staff to handle the Laboratory equipments. Never leave a discarded tubes or infected material unattended or unlabelled. Wear gloves & lab coat while doing the tests. 6. General Instructions Cleaning of the work area . Do not eat / drink in the lab / do not store eatables in the lab.4. ♦Daily maintenance of all instruments to be done. Adequate and consultant water supply should be provided for immediate washing and cleaning.
Equipment Maintenance • • • Equipment maintenance as per the instructions in the manual. Daily cleaning and waste removal from the equipments should be done as per the instruction guidelines. Person doing cleaning should wear gloves. .• • • The work area should be decontaminated and cleaned with 1% sodium hypochlorite solution daily in the morning and as required. All the laboratory equipments should be calibrated once daily before Starts and as per instruction manual. The mops should be washed daily and sun dried.
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