sample collection in children

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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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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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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Minimizing PAIN

Topical anesthetic like AMETOP, EMLA Cost, time ( 10-60min)More than one site tried, allergy Sucrose or pacifier

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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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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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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

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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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Intravenous blood collection

Site selection Tourniquet not

excessively tightSpecial

precautions whenHeparin lock or IV line collection

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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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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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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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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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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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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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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

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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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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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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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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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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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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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Cont….

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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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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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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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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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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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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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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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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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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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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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Bone marrow

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Renal Biopsy

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Liver Biopsy

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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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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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Secretion collection by Swab Stick

Pus and Eye, Ear Discharge

Burn InjuryThroat swab

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Cont…..

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Cont…..

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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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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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sample collection in children

Documents

site y

surface y

bandaged y

calcaneous y

colourful y

patient y

circulation y

sample12 y