SPECIMEN JOHNY KUTTY JOSEPH

COLLECTION
 DEFINITION
 In medicine, sampling is gathering of matter from the body to aid in the process of a medical
diagnosis and/or evaluation of an indication for treatment, further medical tests or other
procedures.
 Specimen collection defined as the collection of the specimen for the purposes of diagnosis,
treatment and recovery.
 It is the procedure of obtaining the required amount of fluid / tissue for laboratory examination.
 Specimen collection is a common component of routine checkups for your health. It goes hand-
in-hand with lab tests, allowing medical professionals to obtain tissue or fluids to look for
any changes in your health. In addition, they help physicians diagnose medical conditions, plan
treatments, and monitor diseases.
 Adequate patient preparation, specimen collection, and specimen handling are essential
prerequisites for accurate test results. The accuracy of test results is dependent on the integrity of
specimens.
 PURPOSE
 confirm clinical diagnosis
 Monitor therapeutic level of drugs
 Monitor progress of a patient
 Plan interventions
 Laboratory tests contribute vital information about a patient's health.
 Correct diagnostic and therapeutic decisions rely, in part, on the accuracy
of test results.
 PRINCIPLES
 Sufficient amount in an appropriate contact be collected.
 The specimen should be collected without contamination.
 One should use a sterile container if the specimen is for bacterialogical
examination.
 The specimen must be sent to the lab accompanied by appropriate
requisition forms and clearly labelled with details such as age, sex, IP/NO ,
type of specimen, date and time of collection, signature of who ordered the
specimen.
 If a specimen is being is being send away from the hospital the label should
have: name and address of hospital.
 The specimen should be sent to the lab immediately after collection.
 PRINCIPLES
 Any specimen kept in the ward for inspection by the in-charge or doctor
should be covered to avoid contamination.
 After collecting the specimen write the report on the cardex to avoid repetition
or failure to collect.
 Always explain to the patient before removing any specimen in order to gain
cooperation.
 If possible, collect the specimen in the acute phase of the infection and before
antibiotics are administered.
 Select the correct anatomic site for collection of the specimen.
 Collect the specimen using the proper technique and supplies with minimal
contamination from normal biota (normal flora).
 PRINCIPLES
 Collect the appropriate quantity of specimen.
 Package the specimen in a container or transport medium designed to maintain
the viability of the organisms and avoid hazards that result from leakage.
 Label the specimen accurately with the specific anatomic site and the patient
information patient’s name and a unique identification number.
 Transport the specimen to the laboratory promptly or make provisions to store
the specimen in an environment that will not degrade the suspected
organism(s).
 Notify the laboratory in advance if unusual pathogens or agents of bioterrorism
are suspected.
 TYPES OF SPECIMENS
 Blood
 Tissue
 Urine
 Stool
 Sputum
 Vomitus
 Semen
 Saliva
 CSF
 Amniotic Fluid
 SAFETY AND DISPOSAL
CONSIDERATIONS IN
SPECIMEN
 In COLLECTION
all settings in which specimens are collected and prepared for testing, laboratory and
health care personnel should follow current recommended sterile techniques, including
precautions regarding the use of needles and other sterile equipment.
 Treat all biological material as material that is potentially hazardous as well as
contaminated specimen collection supplies.
 For all those who are involved in specimen collection and preparation, the
responsibility to adhere to current recommendations designed to maintain the safety of
both patients and health care workers does not end when the patient is dismissed.
 There are four steps involved in obtaining a good quality specimen for testing: (1)
preparation of the patient, (2) collection of the specimen, (3) processing the specimen,
and (4) storing and/or transporting the specimen.
 PREPARATION
 Prior to each collection, review the appropriate test description, including the specimen type
indicated, the volume, the procedure, the collection materials, patient preparation, and storage and
handling instructions.
 Preparing the Patient. Provide the patient, in advance, with appropriate collection instructions and
information on fasting, diet, and medication restrictions when indicated for the specific test.
 Preparing the Specimen. Verify the patient's identification. Proper identification of specimens is
extremely important. All primary specimen containers must be labeled with at least two identifiers at
the time of collection. Submitted slides may be labeled with a single identifier, but two identifiers are
preferred. Examples of acceptable identifiers include (but are not limited to): patient's name (patient's
first and last name exactly as they appear on the test request form), date of birth, hospital number, test
request form number, accession number, or unique random number.
 If chain of custody documentation is necessary for the procedure, follow the appropriate protocol. All
specimens should be labeled in the presence of the patient.
 Process and store the specimen(s) as required. Appropriate storage and handling are necessary to
maintain the integrity of the specimen and, consequently, the test results.
 PREPARING THE PATIENT
 Patient Instructions: It is important to gain the patient's understanding and cooperation in
obtaining an acceptable specimen.
 Patient States
 Basal State. In general, specimens for determining the concentration of body constituents should
be collected when the patient is in a basal state (ie, in the early morning after awakening and
about 12 to 14 hours after the last ingestion of food). Reference intervals are most frequently
based on specimens from this collection period.
 The composition of blood is altered after meals by nutrients being absorbed into the bloodstream.
Consequently, postprandial blood (blood drawn after a meal) is not suitable for some chemistry
tests. An overnight fast is preferable (from 6 PM of the evening previous to collection) to ensure
that the patient is in the basal state. This minimizes the effects of ingested substances on the test
results.
 PREPARING THE PATIENT
 Fasting or diet restrictions, such as low-fat diets, should be explained in detail,
particularly to aged or overanxious patients or their caregivers.
 When specimens are not collected in the basal state, the following additional effects
should be considered when interpreting test results.
 Exercise. Moderate exercise can cause an increase in blood glucose, lactic acid,
serum proteins, and creatine kinase (CK).
 Emotional or Physical Stress. The clinical status of the patient can cause variations
in test results.
 Time of Day of Collection. Diurnal variations and variations in circadian rhythm can
also affect test results. For example, growth hormone peaks in the morning before
waking and decreases throughout the day. Serum iron levels may change as much as
30% to 50%, depending on individual variation, from morning until evening.
 Note: For chemistry profiles, 12- to 14-hour fasting specimens are recommended.
 COLLECTION
PROCEDURES
 Collection of Vacuum Tubes Containing Additives (eg, anticoagulants,
preservatives, clot activators). When using vacuum tubes containing an additive:
 Tap the tube gently at a point just below the top to release any additive adhering to
the tube or top.
 Permit the tube to fill completely to ensure the proper ratio of blood to additive. There
will be some dead space at the top of the tube.
 To allow for adequate mixing of blood with the anticoagulant or preservative, use a
slow rolling wrist motion to invert the tube gently four to eight times. Failure to
invert tubes may lead to the formation of microscopic clots.
 Rapid wrist motion or vigorous shaking may contribute to hemolysis. Check to see
that all the preservative or anticoagulant is dissolved. If any preservative powder is
visible, continue inverting the tube slowly until the powder is dissolved.
 COLLECTION
PROCEDURES
 If multiple samples are being drawn, invert each specimen as soon as it is drawn. Do
not delay. Place the tube upright in a rack as quickly as possible after collection.
 Collection of Vacuum Tubes Without Anticoagulants. When using vacuum tubes
containing no additives:
 Permit the tube to fill completely.
 Let the specimen stand for 30 to 60 minutes and (preferably) not longer than 60
minutes prior to centrifugation.
 Centrifuge the specimen at the end of the waiting period in accordance with the
manufacturer's instructions for speed.
 BLOOD SPECIMEN
COLLECTION
 Article required: Spirit, Sterile topical cleaner, Receiver for soiled swabs, A
tourniquet, Assorted specimen bottles, A lab request form, Gloves, blood slides,
Sterile lancet/needle, Syringes (5ml, 10ml, 20ml), A vacutainer, Labels, Sharps
container.
 Anemia, Blood disorders, Pre and post operative preparation, Antenatal
investigations, Infective conditions.
 Procedure
 Provide privacy
 Wash hand and put on gloves to minimize transfer of micro organisms
 Clean the site with spirit swabs in circular motion
 Apply tourniquet 2-3 inches above the identified site for easy visibility
 Ask the client to make a fist
 BLOOD SPECIMEN
COLLECTION
 Assess the site with a needle and prick, then draw 2-5mls of blood
 Release tourniquet
 Remove needle and apply pressure using a sterile swab for 2 min
 Dispose the needle and syringe in sharps container
 Remove gloves and dispose appropriately
 Position client comfortably
 Put samples in a biohazard bag and send to laboratory immediately
 Inform the client when the results is to be collected
 Evaluate for clients reaction during and after procedure and for bleeding.
VACUTAINER TUBE TYPES
FOR VENIPUNCTURE
 URINE SPECIMEN
 ToCOLLECTION
rule out pregnancy, Routine medical examination, Renal failure, Diabetes mellitus,
Sexually transmitted infections, Dehydration.
 ROUTINE URINE COLLECTION If client is able to give specimen independently,
give instructions as follows:
 Clean vulva/penis with soap and water to promote hygiene and prevent contamination
 Pass approximately 30mls of urine directly into bottle.
 Pass the remaining into the toilet/bedpan/urinal
 Wipe vulva/penis with toilet paper.
 Properly dispose urine from the bedpan/urinal.
 URINE SPECIMEN
COLLECTION
 If client has an indwelling catheter:
 Wash hands put on gloves
 Mount needle to syringe
 Clamp drainage tube
 Using antiseptic swab entire port
 Insert the needle at about 45degrees just above where the catheter is attached to
drainage port
 Draw 3mls for culture or 20mls for routine urinalysis
 Transfer the urine to appropriate container and close lid
 Discard needle into sharps container
 Unclamp the catheter
 URINE SPECIMEN
COLLECTION
 MIDSTREAM SPECIMEN
 If client is independent instruct him/her as follows:
 Clean vulva/penis with soap and water
 Open specimen bottle without touching inside
 Initiate urine stream and allow first flow into the toilet
 Pass mid flow into bottle
 Pass rest into the toilet
 Wipe and dry self
 STOOL SPECIMEN
COLLECTION
 Infective conditions, worm infestations, gastroenteritis, peptic ulcer disease.
 Explain procedure and obtain consent to allay anxiety and gain cooperation
Independent client give stool container instructions :
 Pass urine first into the toilet to avoid stool contamination with urine.
 Place tissue on toilet seat/floor and pass stool for easy sample collection
 Using spatula scoop stool (1 teaspoonful or 1/3 of specimen container) in
order to achieve an adequate amount.
 Cover the specimen container
 SPUTUM SPECIMEN
COLLECTION
 Bronchitis, Pulmonary tuberculosis, Other respiratory infections, Lung cancer and
tumours
 Sputum mug, Specimen container, Lab request form, Gloves, Mask, Toilet paper.
 Screen/draw the curtains for privacy. Explain procedure to the patient to allay anxiety
and gain cooperation . Wash hands and don gloves
 Instruct client to Take 3-4 deep breaths to stimulate cough reflex. Cough and
expectorate after full inhalation to promote removal of secretions. Spit directly into
the specimen container and cover it.
 Give tissue paper to the client to promote comfort and hygiene.
 Remove gloves dispose appropriately and wash hands
 Position client and remove secretions from the bed
 Send the sample to the laboratory immediately
 SWAB SPECIMEN
COLLECTION
 It is the process of obtaining a specimen of pus/tissue fluid using a sterile swab/pad.
 Infected wounds, Suppuration of throat, Suspected pelvic inflammatory disease,
Infections of the genital tract, Ear/eye swab.
 Sterile swab, Wooden spatula, Torch, Surgical mask, Sterile speculum for cervix
examination, Sterile dressing pack, Warm sterile water gauze swab, Specimen
container, Lab request form, Sterile gloves, Trolley for wound dressing if necessary,
Culture media labels.
 Take equipment to the bed side for easy accessibility
 Screen/draw curtains for privacy
 Explain procedure to client
 Position the client
 Wash hands and don gloves
 SWAB SPECIMEN
COLLECTION
 Wound: Remove sterile swab and rotate swab on the wound. Replace swab into its
container. Continue procedure for wound dressing.
 Throat swab: Ask client to open mouth wide and put tongue out. Depress tongue
slightly with spatula. Directly light to back and ask client to say “aaaa”. Gently and
firmly sweep over the inflamed throat area with swab taking care not to touch tongue
with swab. Replace swab into container. Remove gloves and wash hands.
 Ear swab: Gently pull the pinna upwards and backwards(adults), downwards and
backward (children). Insert swab and rotate gently into the extended canal. Replace
swab into the container. Clean the ear. Remove gloves , dispose appropriately then
wash and dry hands. Reposition client and screen the bed. Send sample to lab
immediately.
 Nose swab: Moisten the swab with sterile water before inserting into the nose. Insert
the swab gently into nose and rotate it towards tip of mucosa. Replace swab into
container. Remove gloves wash and dry hands. Leave client comfortable
 SWAB SPECIMEN
COLLECTION
 High vaginal swab: Position client in lithotomy position. Direct light source into
perineum. Wash hands and glove. Warm speculum in sterile water. Using non
dominant hand separate labia in order to expose the vaginal orifice. Take swab as high
as possible around the fornices (near cervix). Replace swab into container. Remove
speculum noting characteristic of discharge. Decontaminate speculum. Clean client
using gauze and assist into comfortable position. Remove gloves and wash hands.
Label and send specimen to laboratory.
 TRANSPORTATION OF
 AllSPECIMEN
specimens must be placed into a primary container labeled with at least two
patient identifiers.
 Primary containers include blood tubes, urine cups, formalin containers, blood culture
bottles or any other suitable sealed container which safely contains the specimen for
testing.
 The specimen is then placed into a secondary leak proof container labeled biohazard.
The purpose of the secondary container is to contain the specimen if the primary
container breaks or leaks in transit to the laboratory.
 Secondary containers include small biohazard specimen bags, large red hospital
designated biohazard bags or any other suitable leak proof container which has a
biohazard label on it. Once the specimen has been sealed in a secondary container it
may be handled without gloves.
 TRANSPORTATION OF
SPECIMEN
 Any paperwork which must accompany the specimen to the laboratory must be
protected from contamination and separate from the primary specimen.
 If specimens are held in a refrigerator or freezer prior to transport, that appliance must
be labeled as containing a biohazard and be located in an area with restricted access.
 When appropriate, the specimen is then placed into a third rigid container which is
also a climate controlled environment. This helps to protect the integrity of the
specimen until it reaches the laboratory.
 Pneumatic Tube System Once the specimen is properly prepared for transport, it may
be delivered to the laboratory for testing. The hospital wide pneumatic tube system
may be used to send small specimens to the laboratory.
 STAFF PRECAUTIONS IN HANDLING
SPECIMEN
 Hands should be washed before and after specimen collection.
 In line with standard precautions, appropriate personal protective equipment should
be worn when collecting or handling specimens.
 Specimens should be collected in sterile containers with close fitting lids to avoid
contamination and spillage.
 Avoid patient identification errors
 Draw the tubes in the proper sequence
 Use proper containers for collection
 Mix all tubes ten times by gentle inversion immediately after collection
 Do not change specimens from one type of container into another
 Deliver specimens to the laboratory promptly