sample collection in children
TRANSCRIPT
Sample collection
in children Basant Kumar Karn
Asst. Professor
Dept. of Pediatric Nursing
College of Nursing, BPKIHS
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Preparation of Pediatric Patients
Find out –Is it the first time for the child?
Find out about past experience. How did the child react ? How did the parents react ?
Explain – To parent and child about procedure (if possible with dolls or puppets)Explain need of second attempt if required
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Important steps before collection
Identification of the patient Labeling correctly: very very important Re-checking which test is requiredKeeping ready all the necessary equipment :
drawing of blood and bulbs for collectionClean up the area before and after
collection
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Parental co-operation
Assess - Parental ability to participate or assist you
Decide - Whether parent should be present or not
If present - Decide how will they assist : physical restrain, distraction, emotional support , explanation
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
How to relieve Anxiety & Fear
Collect blood away from other patients in a special room. Never in the hospital bed. This is a comfort zone
Area should be child friendly. Uniforms should be colourful
Keep equipment out of site Ask child’s preference of hand Allow child to select comfort objectStop procedure if child combative Try later or another person
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Minimizing PAIN
Topical anesthetic like AMETOP, EMLA Cost, time ( 10-60min)More than one site tried, allergy Sucrose or pacifier
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Selection of Site
Very important to get adequate volume Will be decided by
Age of the child: heel or finger stick, IV Whether arterial or venous blood required Equipment available eg neonate capillary
tubes, vacutainers, routine needle & syringe etc
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Infants and Neonates HEEL stick puncture
Lateral plantar bottom surface 3 - 5 min Pre-Warming > blood flow (arterializes)Pediatric lancet New born 2.5mm L /1mm D,
Preterm o.75 mm L / 0 .85 mm DDepth of major BV is 0.03 mm to 1.6 mm from skin
to calcaneous> 2.4 mm depth injury: Osteomyelitis
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Infants and Neonates HEEL stick puncture
Do not use anteromedial area or posterior curve of C
Do not use alcohol swabs to stop bleeding : stinging; Use sterile gauze for pressure
Do not use adhesive tapes :maceration and bruising of skin
Do not squeeze or milk excessively : hemolysis or dilutes blood with tissue and interstitial fluid : erroneous results
Discard first drop Complications cellulitis, abscess, scarring, tissue
loss, calcified nodules 04/08/23 16:16
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Older child : > one yr age finger prick
Damaged veins, arm in cast or bandaged Do not use if edema, infection,
< circulationShould not go >2.4 mm deepPediatric lancet sizes 1.75/1.25/0.85 mm
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Intravenous blood collection
Site selection Tourniquet not
excessively tightSpecial
precautions whenHeparin lock or IV line collection
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
What is required from the sample Does the test require : whole blood ,
serum or plasma.
How much is the volume required : 2, 4, 5, ml etc. Pre-term 10 ml may be 5 % of total volume
What are the special bulbs or ready made tubes required : e.g. fluoride bulb for sugar, chemistry bulb for urea , EDTA for hematology etc
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
In What to collect blood ?
BULB FUNCTION USED FOR
EDTA Chelates Ca preserves cellular elements
CBC,Reticulocytes, ESR,G6PD, Hb electrophoresis
Trisodium citrate
Converts Ca into non-ionized form
PT, APTT, TT Fibrinogen etc
Flouride Enzyme poison. Inhibits Glycolysis In RBC (Glucose destroyed at 5% / hr)
Glucose
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 04/08/23 16:16
When & How to get Serum & Plasma
Serum sample blood collected without
any anti-coagulant and centrifuged
clear supernatant fluid devoid of any fibrin products
Plain bulb Most enzymes, Biochemical LFT,KFT, S Electro. Serological :Widal,
VDRL
Plasma sample blood collected & mixed
with anticoagulant and centrifuged
clear supernatant fluid with thrombosis inhibited. Most satisfactory sample. No changes occur in blood
Heparinized bulb PH, NH4, RBC levels,
Plasma cortisol, testosterone, globin,cholinesterase
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
For Special Testing
PCR, Genetic, ammonia, blood gases, drug, antibiotic & hormone levels etc.
Before collection of sample ascertain that you know everything about the sample collection
Confirm from lab how much volume, what bulb, procedure, timing etc
Recollection of blood is distressing for everyone: Child-parent- doctor & adds to cost
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
HEMOLYSIS OF SAMPLES
Contact with water Excessive heat or cold Rigorous mechanical injury to RBS ( thin gauge )
Prolonged storage Hemolyzed samples will give
erroneous results
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
PREVENTION OF HEMOLYSIS
Equipment used to collect : absolutely dry
Minimum constriction of limbUse correct gauge Collect slowly and steadily Remove needle and put immediately into the bulb
Easier if collection in Vacutainer
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Following safety precautions
Do no harm to your patient Ensure use of safe and sterile equipment
Do no harm to yourself Follow universal precautions Avoid needle stick injuries and splashing of
blood into your eyes, skin or mucous membrane
Do no harm to the community Ensure that you have safely and correctly
disposed all equipment so that no other person can get exposure
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Transport & Storage of samples Ideally the sample should be collected
in the laboratory and immediately into the processing
If it cannot be sent immediately one should follow instructions carefully for Storage (where should it be kept ? : room temp, cold storage-what temp )
Transport What are the precautions during
transport 04/08/23 16:16
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Summary
Blood collection in children is a traumatic and invasive procedure
All efforts should be made to reduce the discomfort
Care should be taken to avoid need for repeat puncture
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Urine collection
Urine has a long, rich history as a source for measuring health and well-being and remains an important tool for clinical diagnosis.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Types of Collection
Random Specimen This is the specimen most commonly sent to the laboratory for analysis, primarily because it is the easiest to obtain and is readily available. This specimen is usually submitted for urinalysis and microscopic analysis, e.g. RE/ME.
First Morning Specimen Since the urine is generally more concentrated (due to the length of time the urine is allowed to remain in the bladder) and, therefore, contains relatively higher levels of cellular elements and analytes such as protein, if present. Also called an 8-hour specimen.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont….
Midstream Clean Catch Specimen This is the preferred type of specimen for culture and sensitivity testing because of the reduced incidence of cellular and microbial contamination. The urine midstream is then collected into a clean container .
Timed Collection Specimen Among the most commonly performed tests requiring timed specimens are those measuring creatinine, urine urea nitrogen, glucose, sodium, potassium, or analytes such as catecholamines and 17-hydroxysteroids that are affected by diurnal variations.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Methods of collectionCatheter Collection Specimen
This assisted procedure is conducted when a patient is bedridden or cannot urinate independently.
Pediatric Specimen For infants and small children, a special urine collection bag is adhered to the skin surrounding the urethral area. Once the collection is completed, the urine is poured into a collection cup or transferred directly into an evacuated tube with a transfer straw. Urine collected from a diaper is not recommended for laboratory testing since.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont……
Suprapubic Aspiration Specimen This method is used when a bedridden patient cannot be catheterized or a sterile specimen is required. The urine specimen is collected by needle aspiration through the abdominal wall into the bladder.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont….
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Specimen Collection and Transport Guidelines
All urine collection and/or transport containers should be clean and free of particles.
The collection and/or transport container should have a secure lid and be leak-resistent.
It is good practice to use containers that are made of break-resistant plastic, which is safer than glass.
Specimen containers should not be reused.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont…
Collection containers and/or transport tubes should be compatible with the pneumatic tube system
Recommend the use of a primary collection container that holds at least 50 mL, has a wide base and an opening of at least 4 cm.1 The wide base prevents spillage and a 4 cm opening is an adequate target for urine collection. The 24-hour containers should hold up to 3L.
Proper labeling should be applied to the collection container or tubes.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Specimen Preservation Guidelines
For Microbiological urine testing use chemical preservatives if the specimen cannot be processed within 2 hours of collection. Otherwise, these specimens should be refrigerated at 2-8°C.
The proper specimen-to-additive ratio must be maintained when using a chemical preservative to ensure accurate test results.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Urine Specimen Handling Guidelines
Labels: Include the patient name and identification labels on tube not lid.
Volume: Ensure that there is sufficient volume to fill the tubes
Collection Date and Time Include collection time and date on the specimen label. This will confirm that the collection was done correctly. For timed specimens.
Proper Preservation Check if there is a chemical preservative present or if the specimen has not been refrigerated for greater than two hours post collection.
Light Protection Verify that specimens submitted for testing of light-sensitive analytes are collected in containers that protect the specimen from light.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
CSF Collection
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. Cerebrospinal fluid acts as a cushion, protecting the brain and spine from injury.
Also known as Spinal tap; Ventricular puncture; Lumbar puncture; Cisternal puncture.
Resuscitation, suctioning and oxygen equipment should be ready for use.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Technique of Cerebral spinal fluid (CSF) collection
The patient lies on his or her side, with knees pulled up toward the chest, and chin tucked downward. Sometimes the test is done with the person sitting up, but bent forward.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont…
After the back is cleaned, the health care provider will inject a local numbing medicine (anesthetic) into the lower spine.
A spinal needle is inserted, usually into the lower back area.
Once the needle is properly positioned, CSF pressure is measured and a sample is collected.
The needle is removed, the area is cleaned, and a bandage is placed over the needle site. The person is often asked to lie down for a short time after the test.
Cisternal puncture uses a needle placed below the occipital bone (back of the skull). It can be dangerous because it is so close to the brain stem. It is always done with fluoroscopy.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
How to Prepare
The physician must ensure that ICP is not raised.
The patient (or guardian) must give the health care team permission to do the test.
Afterward, you should plan to provide rest to the patient for several hours, even if they feel fine to prevent leakage of CSF around the site of the puncture.
CSF analysis can be used to diagnose certain neurologic disorders, particularly infections (such as meningitis) and brain or spinal cord damage.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
RisksBleeding into the spinal canalDiscomfort during the procedureHeadache after the procedureHypersensitivity (allergic) reaction to the anestheticInfection introduced by the needle going through the
skinBrain herniation may occur if this test is done on a
person with a mass in the brain (such as a tumor or abscess).
Damage to the nerves in the spinal cord may occur, particularly if the person moves during the procedure.
Cisternal puncture or ventricular puncture carry additional risks of brain or spinal cord damage and bleeding within the brain.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Tissue Biopsy & Aspiration
The most commonly used fixative in histology is formaldehyde. It is usually used as a 10% Neutral Buffered Formalin.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Bone marrow
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Renal Biopsy
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Liver Biopsy
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Stool Collection
Rarely neededNeed wide mouth containerPerianal swab sometime can workCan be taken from dipperShould be sent as soon as possibleCan be collected any time, thus child
do not need to be on fasting.Personal Precaution must be taken
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Sputum Collection
Only elder child can bring sputum out
Throat swab can be an alternate
Early morning gastric aspirate in newborn is indicated
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Secretion collection by Swab Stick
Pus and Eye, Ear Discharge
Burn InjuryThroat swab
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont…..
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont…..
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Nurses roles
Prepare the parents- Explain the procedure , its importance, cost and expected duration of result.
Prepare child- Explain Procedure, Minimum pain that is expected and their cooperation.
Prepare articles especially if the procedure is invasive, ensure that it is sterile.
Get containers ready and libeled.Position the child if needed.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Cont….
Assist physician if needed.Take universal precaution.Do not use parents for restraining.Avoid presence of parents if the
procedure is painful.Compile procedures to minimize
invasion.Immediately send the sample to the lab.
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
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Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD