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    Gnhiversity of San Aqustin ILOILO CITY, PHILIPPINES COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS 2 MEDICAL LABORATORY SCIENCE PROGRAM PT RASS PRINCIPLES OF MLS » NEE y © 2021. Printed in Calibri. Cover Design: J.R.D. Fundal, RMT All rights reserved. Copyright applied for. No part of this module may be reproduced, stored in retrieval system or transmitted in any forms or by any means, electronic, mechanical, photocopying or otherwise, without written permission from the authors. The authors have done everything possible to make this module accurate and in accordance with accepted standards. The authors are not responsible for errors or omissions or for consequences (loss, damage, or disruption) from application of the module, and make no warranty, expressed or implied in regard to the contents of the module. Any practice described in this module should be applied by the reader in accordance with accepted standards used in regard to unique circumstances that may apply in each situation. 1]Page PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 ABOUT THE INSTRUCTOR OF MEDICAL LABORATORY SCIENCE PRACTICE 2 MODULE 6 Prepared by: Jura Rose Isabelle Sornillo, RMT Preparation and Handling of Nonblood Specimens for Laboratory Testing 31 Page PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 fell PART 1: OVERVIEW OF DISCUSSION Dear MLS Students, Welcome! SYA. In the laboratory blood is not the only specimen sample that is being =(\ Y= tested for the diagnosis of certain diseases. Testing non-blood specimens provides a supplementary diagnosis with the results from the blood tests, soit is important to collect the samples correctly so to avoid any interferences that may cause conflict of data, and identify the tests being performed on the non-blood specimens. PART 2: LEARNING OUTCOMES At the end of this lesson, the students must be able to, 1. Identify the different nonblood specimens for laboratory testing. 2. Discuss the collection and handling procedures for different nonblood specimens. 3. Collect and process samples for urinalysis. Oo PART 3: DISCUSSION ‘an Nonblood Specimen Labelling and Handling Y Nonblood specimens should be labeled with the same identifying information as blood specimens. Y In addition, since many body fluids are similar in appearance, labeling should include the type and/or source of the specimen. Y The label should be applied to the container, not the lid, so as to avoid misidentification, Y Follow facility protocol. TORY SCIENCE PRACTICE 2 Nonblood Body-Fluid Specimens Urine - most frequently analyzed nonblood body fiuid - readily available, easy to collect, and generally inexpensive to test = its analysis can provide information on many of the body’s major metabolic functions. = Analysis of urine can aid in monitoring wellness, the diagnosis and treatment of urinary tract infections, the detection and monitoring of metabolic disease, and determining the effectiveness or complications of therapy. — Inpatient urine specimen collection is typically handled by nursing personnel. - Outpatient urine specimen collection is often handled by phlebotomists, and should be instructed correctly for the procedures. Figure 6.1 Urine Specimen in sterile containers. Common Urine Tests Routine Urinalysis (UA) = the most commonly requested urine test because it screens for urinary and systemic disorders. = A routine UA typically includes physical, chemical, and microscopic analysis of the urine specimen. 5|Page PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 1. Physical analysis a. macroscopic observation and notation of color, clarity, and odor, b. measurements of volume c. specific gravity or osmolality 2. Chemical analysis a. Can detect bacteria, bilirubin, blood (red blood cells and hemoglobin), glucose, ketones, leukocytes, nitrite, protein, and urobilinogen, and measure pH and specific gravity. b. Commonly performed using a plastic reagent strip (often called a dipstick) that contains pads impregnated with test reagents. c. The strip is dipped into the urine and color reactions that take place on the pads are compared to a color chart, which is usually found on the label of the reagent strip container. 4d. Special timing, which is not the same for all tests, is involved in reading the results, which are reported in the manner indicated on the color chart. Figure 6.2 Parameter Urine Test Strip Bottle 6IPage PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Urine Culture and Sensitivity - Aurine culture and sensitivity (C&S) test may be requested on a patient with symptoms of urinary tract infection (UTI) — involves placing a measured portion of urine on a special nutrient medium that encourages the growth of microorganisms, incubating it for 18 to 24 hours, checking it for growth, and identifying any microorganisms that, grow. — Urine must be collected ina sterile container, following midstream clean- catch procedures to ensure that the specimen is free of contaminating matter from the external genital areas Urine Cytology Studies — Cytology studies are performed to detect cancer, cytomegalovirus, and other viral and inflammatory diseases of the bladder and other structures of the urinary system. — Prepared from urinary sediment or filtrate. — The smear is stained by the Papanicolaou (PAP) method and examined under a microscope for the presence of abnormal cells. — Afresh clean-catch specimen is required for the test. — Ifadelay is unavoidable, the specimen can be preserved by the addition of an equal volume of 50% alcohol. Urine Drug Specimen — is performed to detect illicit use of recreational drugs, use of anabolic steroids to enhance performance in sports, and unwarranted use of prescription drugs. — itis also used to monitor therapeutic drug use in order to minimize withdrawal symptoms and to confirm a diagnosis of drug overdose. = Arandom sample ina chemically clean, covered container is required for the test. 7IPage PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 20 021 = Specimens containing blood cells or having a high or low urine pH or a low specific gravity will yield erroneous results and will require recollection of the specimen. Other Urine Tests - Numerous chemistry tests—including electrophoresis, tests for heavy metals, myoglobin clearance, creatinine clearance, and porphyrins. — Many of these tests require a pooled timed specimen, such as a 24-hour collection 1. Random = Canbe collected at any time. - They are used primarily for routine urinalysis and screening tests. Random refers only to the timing of the specimen and not the method of collection. 2. First Morning Urine/8-Hour Specimen = Also called a first voided, overnight, or early morning specimen) is usually collected immediately upon awakening in the morning after approximately 8 hours of sleep. — This type of specimen normally has a higher specific gravity, which means that it is more concentrated than a random specimen. - Are often requested to confirm results of random specimens and specimens with low specific gravity. 3. Fasting - Typically used for glucose monitoring. = Itdiffers from a first morning specimen in that the specimen is the second specimen voided after a period of fasting. - This helps assure that the specimen will not be affected by food consumed prior to fasting. 4. Timed - Some tests require individual urine specimens collected at specific times. Others require the BlPace PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 91Page collection and pooling of urine throughout a specific time period. Tolerance Test Specimen = Typically require collection of urine at specific times. — The traditional standard glucose tolerance test (GTT) requires individual urine specimens collected serially at specific times that correspond with the timing of blood collection, such as fasting, 1/2-hour, 1 hour, and so on. — Timing of the specimens is important in the interpretation of test results. — For this reason, the specimens must be collected as close to the requested time 2-Hour Postprandial Specimen — Collected 2 hours after a meal and tested for glucose. —_Itis primarily used to monitor the insulin therapy of patients with diabetes mellitus. — The patient is instructed to void shortly before consuming a normal meal and to collect a specimen 2 hours later. — Comparison of results with fasting urine and fasting blood glucose specimens’ results is done. 24- Hour Urine Specimen = Is collected to allow quantitative analysis of a urine analyte. — Best time to begin isin the morning between 6 and 8AM. — Requires a large, clean wide-mouth container capable of holding liters. . Double-voided Specimen — Is one that requires emptying the bladder and then waiting for a specified amount of time before collecting the specimen. — Commonly used to test urine for glucose and ketone. PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORA AY 2020 TORY 202 1 Urine Collection Methods 1. Regular Voided Urine — Aregular voided urine collection requires no special patient preparation and is collected by having the patient void (urinate) into a clean urine container. 2. Midstream Clean-Catch Specimen — is collected ina sterile container and yields a specimen that is suitable for microbial analysis or culture and sensitivity testing — Special cleaning of the genital area is required before the specimen is collected. - Table 6.3 and 6.4 describe the proper procedures for Midstream Clean-Catch 3. Catheterized Specimen — Acatheterized urine specimen is collected from a sterile catheter inserted through the urethra into the bladder. — Catheterized specimens are sometimes collected on babies to obtain a specimen for C&S, on female patients to prevent vaginal contamination of the specimen; - and on bedridden patients when serial specimen collections are needed 4. Suprapubic Aspiration — Involves inserting a needle directly into the urinary bladder and aspirating (withdrawing by suction) the urine directly from the bladder into a sterile syringe — The procedure normally requires the use of local anesthesia and is performed by a physician. — The specimen can also be collected from the catheter by a nurse using a sterile needle and syringe. — Used for samples for microbial analysis or cytology studies. It is sometimes used to obtain uncontaminated samples from infants and young children. 5. Pediatric Urine Collection 10|P ae PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 ABORA RY - Aplastic urine collection bag with hypoallergenic skin adhesive is used to collect a urine specimen from an infant or small child who is, not yet potty trained. — The patient’s genital area is cleaned and dried before the bag is taped to the skin. The bag is placed around the vagina of a female and over the penis of a male. A diaper is placed over the collection bag. The patient is checked every — 15 minutes until an adequate specimen is obtained. The bag is then removed, sealed, labeled, and sent to the lab as soon as possible. — A 24-hour specimen can be obtained by using a special collection bag with a tube attached that allows the bag to be emptied periodically. Figure 6.3 Clean Catch Urine Collection Procedure for Women Step Rationale 41. Wash hands theroughly ‘Ade in infection contra and helps avoid contamination of thesite while clearing, 22. Remove the lid ofthe containes, being “The lid and container must remain sterile for accurate ‘eareful not to touch the inside of the interpretation of resus. covert the container Standin a squatting positon over the toilet. Facilitates cleaning ord downward flow of urine Separate the folds of skin around the Allows proper cleaning of the area. Siels ‘5. Clearee the ares on sithe side and Artisentic solution in the wipe removes bacteria {round the opening wth the special from area. Frontto-bck motion cass bectera wipes, using @ fresh wipe for each area away fom the site, land wiping from front to back. Discard used wipes in the trash 6. While keoping the skinfolds separated, Separation of the folds maintars site antcepsi sold inte the tolet fore few secon. \oiding the frat portion of urine into the toilet washes ‘anay the antiseptic ard microbes remaining in the eee 7. Touching only the outside and without Bringing the urine container into the stream without leting i touch the genital area, bring the touching the genital sea helps ensure sterility of urine container into the urine sream until the specimen. An adequate amount of urine is a suffcientamount of urine (30-100 ml) i reded to perform the test, collected. 8. Void the remaining wine into the tozet (Only 30-109 ml of urine isneeded fer the test 9. Cover the specimen withthe lid provided, “The lid and container must remain sterile, and the touching enly the outsidesurfaces of the specimen must be covered to maintain sterlty Id and eortainer. {and protect others frcm exposure to the contents. 10. Clean any urine off the outside of the ‘Aids in infection conto container with an antsepte wipe. Wash hands. ‘Aids i infection contol. Hand specimen to phlebotomist or place Fallow fcilty protocel where instructed if aheady labeled [Page PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Figure 6.4 Clean Catch Urine Collection for Men PURPOSE: To instruct » male in how to properly collect a clean-catch urine specimen EQUIPMENT: Requisition, specimen label, sterile urine container, special sterile antiseptic wipes, and copy of writen instructions Step 41. Wash hands thoroughly. 2. Remove the lid ofthe container, being careful not to touch the inside of the cover or the container. 3 Wash the end of the peris with the special wipe (or soapy water), beginning at the urethral opening and working away from it in ecircular motion (the foreskin of an ‘uncircumeised male must fst be retracted) Repeat the procedure wth a clean wipe. 4, Keeping the foreskin retracted, if applicable, void into the toilet fora few seconds. '5. Touching only the outside and without letting it touch the penis, bring the urine container into the wine stream until a sufficent amount of urine (30-100 mL) is collected, 6. Yoid the remaining urine into the toilet, 7. Cover the specimen with the lid provided, touching only the outside surfaces of the Id ard container {8 Clean any urine spilled on the outside of the container with an antiseptic wipe. ‘wash hands. 10. Hand specimen to phlebotomist or place where instructed if already labeled, [Page Rationale ‘Aids in infection contol and helps avoid contamination of the site while cleaning The lid and container must remain sterile for accurate interpretation of resus, The foreskin must be retracted to alow thorough cleaning of the penis. Antiseptic solution in the wipe removes bacterie from the ares. Wiping aay from the urinary opening carries microbes away from the Keeping the foreskin retracted maintains site antisepsis. Voiding the first portion of urine into the toilet washes away the antiseptic and microbes remaining in the urinzxy opening. ringing the urine container into the stream without touching the peris helps ensure steilty of the specimen, An adequate amount of urine is needed to perform the test (Only 30-100 mL of urine is needed for the test. The lid and container must remain sterile, and the specimen must be covered to maintain sterility specimen must be covered to maintain sterility and protect others from exposure to the contents. Aids in infection conti Aids in infection conti Follow faciliy protocel PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Amniotic Fluid = Clear, almost colorless to pale-yellow fluid that fills the membrane that surrounds and cushions a fetus in the uterus — It is preferably collected after 15 weeks of gestation (pregnancy) and is obtained by a physician through transabdominal amniocentesis. = Amniotic fluid is normally sterile and must be collected in a sterile container. Amniotic Fluid Analysis * Genetic disorders © canbe detected by chromosome studies done on fetal cells removed from the fluid ‘© Specimen must be kept at room temperature. * Hemolytic disease © canbe detected by measuring bilirubin levels. © Thespecimen should be protected from light to prevent breakdown of bilirubin and delivered to the laboratory ASAP. + Estimating gestational age © amniotic fluid creatinine levels because these levels are related to fetal muscle mass. * Measuring alpha-fetoprotein (AFP) © an antigen normally present in the human fetus that is also found in amniotic fluid and maternal serum. © AFP testing is initially performed on maternal serum, and abnormal results are confirmed by amniotic fluid AFP testing. © Abnormal AFP levels may indicate problems in fetal development such as neural tube defects or the potential for Down’s syndrome. © And gestational age of the fetus should be included due to AFP levels changes in each week of gestation. 13 |P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 * Fetal lung maturity © canbe assessed by measuring the amniotic fluid levels of substances called phospholipids, which act as surfactants to keep the alveoli of the lungs inflated. Results are reported asa lecithin-to-sphingomyelin (I/S) ratio. U/S ratio is less than 2 means that fetal lungs are likely to be immature. Cerebrospinal fluid - Aclear, colorless liquid that surrounds the brain and spinal cord and has many of the same constituents as blood plasma — Primarily performed for the diagnosis of Meningitis. — Itisalso used to diagnose other disorders such as brain abscess, CNS cancer, and multiple sclerosis. — Routine tests include cell counts, chloride, glucose, and total protein while other tests are performed if indicated. Cerebrospinal fluid collection * Specimens are obtained most often through lumbar puncture (spinal tap) bya physician. * The first tube is used for chemistry and immunology tests. * The second for microbiology studies, and the third for cell counts. * CSF should be kept at room temperature, delivered to the lab stat, and analyzed immediately. Gastric fluid — Agastric analysis examines stomach contents for abnormal substances and measures gastric acid concentration to evaluate stomach acid production. 14|P ae PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 20 021 Gastric Fluid Collection * Basal Gastric analysis. o Sample of gastric fluid is aspirated by means of a tube passed through the mouth and throat (oropharynx) or nose and throat (nasopharynx) into the stomach after a period of fasting. © Tests are done to determine acidity prior to stimulation. © After Basal Sample is collected, the patient is given a gastric stimulant (commonly histamine or pentagastrin) intravenously and gastric samples are collected over timed intervals. © The role of the phlebotomist in this procedure is to help label specimens and draw blood for serum gastrin determinations. Nasopharyngeal secretions - Are cultured to detect the presence of microorganisms causing diphtheria, meningitis, pertussis, and pneumonia. Nasopharyngeal secretions collection * NP specimens are collected using sterile Dacron or cotton-tipped flexible wire swab. 1. The swab is inserted gently into the nose and passed into the nasopharynx. 2. There it is gently rotated, then carefully removed, placed ina sterile tube containing transport medium, labeled, and delivered to the lab. Saliva — Used to monitor hormone levels and detect alcohol and drug abuse and its early detection of drugs in saliva indicates recent drug use — Hormone tests are typically frozen to ensure stability and sent to a laboratory for testing. 15|P ae PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 20 021 Semen — Semen (seminal fluid) is the sperm-containing thick yellowish-white fluid discharged during male ejaculation. — Itis analyzed to assess fertility or determine the effectiveness of sterilization following vasectomy and is sometimes examined for forensic reasons. Semen Analysis Collection * Semen specimens are collected in sterile or chemically clean containers and must be kept warm, protected from light, and delivered to the lab immediately. Serous Fluid — Is the pale-yellow, watery, serum-like fluid found between the double- layered membranes enclosing the pleural, pericardial, and peritoneal cavities. — It lubricates the membranes and allows them to slide past one another with minimal friction. = Its volumes increase when inflammation or infection is present or when serum protein levels decrease. —_ Effusion is an increase in fluid volume. Types of Serous Fluids 1. Pleural fluid - aspirated from the pleural space, or cavity, surrounding the lungs. 2. Peritoneal fluid - aspirated from the abdominal cavity. 3. Pericardial fluid - aspirated from the pericardial cavity surrounding the heart. 16|P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Serous Fluid Collection Serous fluids can be aspirated for testing purposes or when increased amounts are interfering with the normal function of associated organs and a physician performs the procedure. * EDTA tubes are used if cell counts or smears are ordered. * Heparin or sodium fluoride tubes for chemistry tests. * Nonanticoagulant tubes are used for biochemical tests. * Sterile heparinized tubes for cultures. * The type of fluid should be indicated on the specimen label. Sputum — Mucus or phlegm that is ejected from the trachea, bronchi, and lungs through deep coughing. — Sometimes collected in the diagnosis or monitoring of lower respiratory tract infections such as tuberculosis (TB), caused by Mycobacterium tuberculosis. Sputum Collection * First morning specimens are preferred, as secretions tend to collect in the lungs overnight and a larger volume of specimen can be produced. 1. It isalso best to collect the specimen at least 1 hour after a meal to. minimize the risk that the patient will gag or vomit. 2. The patient must first remove dentures if applicable, then rinse his or her mouth and gargle with water to minimize contamination with mouth flora and saliva. 3. The patient is instructed to take three or four slow, deep breaths, inhaling to full capacity and exhaling fully, then to cough forcefully on the last breath and expectorate (cough up and expel sputum) into a special sterile container. 4, The process is repeated until a sufficient amount of sputum is obtained. Sweat 17|P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 — Analyzed for chloride content in the diagnosis of cystic fibrosis. = Cystic fibrosis is a disorder of the exocrine glands that affects many body systems but primarily the lungs, upper respiratory tract, liver, and pancreas. — Patients with cystic fibrosis have abnormally high levels of chloride in their sweat, which can be measured by the sweat chloride test. — Sweat specimens can also be used to detect illicit drug use. Sweat is collected on patches placed on the skin for extended periods of time and then tested for drugs. Sweat Collection * Test involves transporting a sweat-stimulating drug called pilocarpine into the skin by means of electrical stimulation from electrodes placed on the skin, a process called iontophoresis. * The forearm is the preferred site, but the leg or thigh may be used on infants or toddlers. * Sweat is collected, weighed to determine its volume, and analyzed for chloride content. Synovial fluid - Aclear, pale-yellow, viscous fluid that lubricates and decreases friction in = movable joints that normally occurs in small amounts but increases when inflammation is present. — It can be tested to identify or differentiate arthritis, gout, and other inflammatory conditions. Synovial Fluid Collection * It is typically collected in three tubes: o An EDTA or heparin tube for cell counts, identification of crystals, and smear preparation A sterile tube for culture and sensitivity. Nonadditive tube for macroscopic appearance, chemistry, and immunology tests and to observe clot formation. 18|P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Buccal swabs - Collection of a buccal (cheek) swab is a less invasive, painless alternative to blood collection for obtaining cells for DNA analysis. Swab Collection: * The phlebotomist collects the sample by gently massaging the mouth on the inside of the cheek with a special swab * DNAs ater extracted from cells on the swab. Bone Marrow — Aspirated and examined to detect and identify blood diseases. = Abone marrow biopsy may be performed at the same time. Bone Marrow collection 1. A physician inserts a special large-gauge needle into the bone marrow in the iliac crest (hip bone) or sternum (breastbone). 2. Once the bone marrow is penetrated, a 10-mL or larger syringe is attached to the needle to aspirate 1.0 to 1.5 mL of specimen. A laboratory hematology technologist is typically present and makes special slides rom part of the first marrow aspirated. Additional syringes may be attached to collect marrow for other tests such as chromosome studies or bacterial cultures. 3. Part of the first sample may be placed in an EDTA tube for other laboratory studies; remaining aspirate is sometimes allowed to clot and placed in formalin or another suitable preservative and sent to histology for processing and examination. + Inanalternate method, blood and particles from the EDTA tube are filtered through a special paper. The filtered particles are then folded in the paper and placed in formalin. 4. If a bone marrow biopsy is collected at the same time, the cylindrical core of material obtained is touched lightly to the surface of several 19|P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 clean slides before being placed in a special preservative solution. The slides are air-dried and later fixed with methanol and stained with Wright’s stain in the hematology department. . The biopsy specimen and several slides are sent to the histology department for processing and evaluation. The remaining slides including biopsy touch slides are sent to the hematology department for staining and evaluation under the microscope. Breath Samples — Are collected and analyzed for hydrogen content in one type of lactose tolerance test and to detect the presence of Helicobacter pylori (H. pylori), a type of bacteria that secretes substances that damage the lining of the stomach and causes chronic gastritis, which can lead to peptic ulcer disease. Breath Samples Analysis . C-Urea Breath Test * Acommon test used to detect H. pylori is the C-urea breath test (C- UBT). * This test is based on the fact that H. pylori produces urease, an enzyme that breaks down urea but is not normally present in the stomach. © To perform the test, a baseline breath sample is collected, after which the patient drinks a special substance that contains synthetic urea. The synthetic urea contains a form of carbon called carbon-13. ©. IFH. pylori organisms are present, the urease they produce will break down the synthetic urea and in the process release carbon dioxide (C02) that contain carbon-13. © The CO2 will be absorbed into the bloodstream and exhaled in the patient's breath. The patient breathes into a special Mylar balloon or other collection device at specified intervals. The breath specimens are analyzed for carbon-13 content. If carbon-13 is PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 ory 0-2021 aiyP found in amounts higher than those in the baseline sample, H pylori is present in the stomach. 2. Hydrogen Breath Test The hydrogen breath test helps identify problems with the digestion of carbohydrates such as lactose (milk sugar) and fructose (fruit sugar) and is thought to be the most accurate lactose tolerance test. It can also be used to detect bacterial overgrowth in the small intestine. The principle behind the test is that hydrogen gas is produced when intestinal bacteria ferment carbohydrates such as lactose, fructose, or lactulose (used to detect bacterial overgrowth). Some of the hydrogen is absorbed into the bloodstream and transported to the lungs, where it is exhaled during normal breathing. © To prepare for the test, the patient must not have taken antibiotics for at least 2 weeks before the test and must avoid certain foods for 24 hours prior to the test. © The patient must be fasting on the day of the test and is asked to refrain from vigorous exercise and smoking for 30 minutes prior to and during the test. © Onthe day of the test, a baseline breath sample is taken by having the patient exhale into a special bag or device. Then the patientis given a drink that, depending on the type of test, contains a measured amount of lactose, fructose, or lactulose. Additional breath samples are collected at regular intervals, typically, every v30 minutes for up to 3 hours, depending on the mount of hydrogen detected in the samples. For those given lactose or fructose, increased hydrogen levels in the breath samples respectively indicate increased lactose or fructose in the intestinal tract, most likely as a result of metabolism. © For those given lactulose, if bacterial overgrowth is present, increased hydrogen levels appear twice; the first time when the lactulose reaches bacteria in the small intestine and the second time when it reaches bacteria in the colon. PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORA Ay 2020 TORY 2021 Feces (Stool) — Examination of fecal specimens (feces or stool) is helpful in the evaluation of gastrointestinal disorders. = Stool specimens can be evaluated for the following: © the presence of intestinal parasites and their eggs checked for fat and urobilinogen content © cultured to detect the presence of pathogenic bacteria and viruses ©. tested for the presence of occult (hidden) blood using the guaiac test. Stool Collection * Stool specimens are normally collected in clean, dry, wide-mouthed containers that should be sealed and sent to the laboratory immediately after collection. * For ova and parasite collection, special containers with preservatives * Preserved specimens can usually be kept at room temperature. Large gallon containers, similar to paint cans, are used for 24-, 48-, and 72-hour stool collections for fecal fat and urobilinogen; these specimens must normally be refrigerated throughout the collection period. — Hematest and Hemoccult Special test cards are used to stool specimens for fecal occult blood testing (FOBT). — The patient is usually instructed to follow a meat-free diet for 3 days prior to the test. — Patients are then instructed to collect separate specimens for 3 successive days. IP ae PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 20 021 Hair — Are sometimes collected for trace and heavy metal analysis and the detection of drugs of abuse. — Easy to obtain and cannot easily be altered or tampered with. — Hair shows evidence of chronic drug use rather than recent use. — Despite of its rise in usage, there is @ lack of standardization. Throat Swabs - Throat swab specimens are most often collected to aid in the diagnosis of streptococcal (strep) infections. — Nursing staff usually collect throat culture specimens on inpatients. - Phlebotomists commonly collect throat culture specimens on outpatients. Throat swab collection * A throat culture is typically collected using a special kit containing a sterile polyester-tipped swab in a covered transport tube containing transport medium. * Throat swabs for rapid strep tests are collected ina similar manner. 23|P PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2 LABORATORY AY 2020-2021 Figure 6.5 Throat Culture Specimen Collection PURPOSE: To provide instruction in how to properly collect a throat culture specimen EQUIPMENT: Requisition, specimen label, sterile container with swab and tr Step 4. Wash hands and put on gloves. The phlebotomist may wish to wear a mask ‘and goggles. Folow facility protoco, 2. Open container and remove swab inan aseptic manner. 3. Stand back orto the side of the patient. 4. Instruct the patient totit back the head tend open the meuth wide. '5. Direct ight onto the back of the throat Using a small flashlight or other light source. Depress the tongue with 2 tongue

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