Sample Testing in Clinical Chemistry
Sample Testing in Clinical Chemistry
ØTypes of Samples & Sample Containers
ØSample Collection & Transportation
ØProcessing & Analysis of samples
ØReporting & Interpretation of test results
Sample Collection
-Blood
-Urine
-Cerebrospinal fluid (CSF)
-Pleural fluid
-Peritoneal fluid Body fluids
-Pericardial fluid
-Synovial fluid
Blood Sample Collection
• Blood for analysis obtained from
Veins
Capillaries
Arteries
• Venipuncture or Phlebotomy is the method for
obtaining this specimen
Venipuncture
Three Methods
• Evacuated tube system(ETS)/Closed collection
• Needle and syringe
• Winged infusion set
Evacuated Tube System
• Multisampling Needle
• Tube holders
• Vaccum evacuated tubes
Multisampling Needle
• Bevel is the slanted opening
at the end of the needle
• Shaft ranges from 1 to 1 ½
inches
• Threaded hub screws into
needle holder
• Rubber sheath makes it
possible to draw several
tubes of blood by
preventing leakage of blood
as tubes are changed
Holder
• The holder for vacuum blood collection is a
plastic sleeve into which the phlebotomist
screws the double pointed needle
Venipuncture Technique
STEP 1: Introduce yourself, identify patient & plan the
draw
• Introduce yourself, state your mission
• Patient identification with laboratory requisition forms
• Ask pre-requisites for a
particular test are being • Blood Culture Bottles
followed
• Coagulation tube (citrate)
• If the patient has not had a • Red/yellow-top tubes (with clot
previous blood draw, activator/gel)
explain the procedure to
them • EDTA (potassium salt) / Heparin
• NaF (glucose tube)
• Plan ‘order of draw’ for
multiple collections
STEP 2: Take personal
protective measures
• Put personal protective
measures
STEP 3: Apply tourniquet
• Tourniquet application
• Apply 3-5 inches above
antecubital fossa
• If the skin appears blanched
above and below the
tourniquet it is too tight
• If your finger can be
inserted between the
tourniquet and the patient's
skin it is too loose
• Not more than 1 min
Preferred Veins For Sample Collection
STEP 4: Selection of vein
1. Cephalic vein
2. Basilic vein
3. Median cubital vein
4. Median antebrachial vein
5. Accessory cephalic vein
Median Cubital Vein – First Choice
• This vein is located in the antecubital fossa (the area of
the arm in front of the elbow)
• Well anchored vein
• Large
• Prominent
Selection Of Vein For Puncture
• After tourniquet application ask patient to clench fist
• Feel for a vein that rebounds (bounces) when pushed or
tapped on
• Use index finger and middle finger to palpate
• Slight rotation of the arm may help to better
expose a vein
• Choose the vein that is large, accessible &
feels the best
STEP 5: Site preparation
• Cleanse the venipuncture site
with 70% isopropyl alcohol
• Vigorous back and forth
cleaning/circular concentric
cleansing
• After cleansing do not touch
the site, if the vein must be
repalpated the area must be
cleansed again
• Allow area to dry
• Anchor the chosen vein firmly
• Pull the skin down and away
from the intended site until the
skin is taut
STEP 6: Start blood collection
• Puncture the skin with needle
at approximately a 30-degree
angle or less to the arm with
bevel of the needle up
• The bevel of the needle should
enter and remain in the center
of the vein. You may feel a
slight “give” or decrease of
resistance when you are in the
vein
• In ETS put the tube forward in
the holder and change tubes
until all are filled
STEP 7: Inversion of tubes
& release of tourniquet
• After the fill remove tube
gently and invert tubes
containing additives
• For tubes with sodium
citrate as additive:3-4
• For other tubes with
additives:6-8
• Release the tourniquet
when blood begins to flow
STEP 8: Apply bandage &
label tubes
• Withdraw the needle swiftly,
apply pressure to the site &
apply adhesive bandage
strip
• Dispose off the
contaminated materials
• Label the vacuum
evacuated tubes with
relevant details
• If using a syringe, pull
back on the plunger with
a slow, even tension as
blood flows into the
syringe
• Do not pull back too
quickly to avoid
hemolysis
Sample Transport
STEP 9: Prepare samples for transport
• Specimen containers should be leak proof plastic or
metal transport boxes with tight fittings
• Specimen to be placed in upright position in racks
• Lab forms to accompany the box in a separate pocket
• Spill kit to be available in transport box
• Sample to reach lab as soon as possible
Sample Collection: Urine
Types Of Urine Sample
• Random urine sample
• A first voided morning urine sample
• A clean-catch midstream urine sample
• 24 hour urine sample
• Random urine sample: Collected any time of the day. eg for
performing glucose dipstick test
• First voided morning urine sample: Most concentrated
sample. eg pregnancy test
• Clean catch midstream urine sample: Used for
bacteriological examination
• 24 hour urine sample: Required for quantitative estimations
of analytes like proteins, urea, creatinine, uric acid
Collection Of 24 Hour Urine Sample
• Ideally big graduated urine containers are taken
• Desired preservatives to be present in urine containers
• Patient discards the first morning urine sample
• All subsequent urine samples are collected including the
first voided urine of next morning till 24 hours are
completed
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