Sample collection 1

in
children
Basant Kumar Karn
Asst. Professor
Dept. of Pediatric Nursing
College of Nursing, BPKIHS

12/08/21 02:16
 Preparation of Pediatric Patients
2

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
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 Important steps before collection
3

Identification of the patient

Labeling correctly: very very important
Re-checking which test is required
Keeping ready all the necessary equipment :
drawing of blood and bulbs for collection
Clean up the area before and after collection

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Parental co-operation
4

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
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 How to relieve Anxiety & Fear
5

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 object
Stop procedure if child combative
Try later or another person
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 Minimizing PAIN
6

Topical anesthetic like AMETOP, EMLA

Cost, time ( 10-60min)
More than one site tried, allergy
Sucrose or pacifier

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Selection of Site
7

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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Infants and Neonates
HEEL stick puncture
8

 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 D
 Depth of major BV is 0.03 mm to 1.6 mm from skin to
calcaneous
 > 2.4 mm depth injury: Osteomyelitis

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Infants and Neonates
HEEL stick puncture
9

 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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Older child : > one yr age finger prick
10

Damaged veins, arm in cast or bandaged

Do not use if edema, infection,
< circulation
Should not go >2.4 mm deep
Pediatric lancet sizes 1.75/1.25/0.85 mm

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Intravenous blood collection
11

Site selection
Tourniquet not
excessively tight
Special precautions
when
 Heparin lock or

 IV line collection

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 What is required from the sample
12

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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 In What to collect blood ?
13

BULB FUNCTION USED FOR

CBC,Reticulocytes,
Chelates Ca preserves
EDTA ESR,G6PD, Hb
cellular elements
electrophoresis
Trisodium Converts Ca into PT, APTT, TT
citrate non-ionized form Fibrinogen etc
Enzyme poison.
Inhibits Glycolysis
Flouride Glucose
In RBC (Glucose
destroyed at 5%/hr)

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 When & How to get Serum & Plasma
14

 Serum sample  Plasma sample

 blood collected without  blood collected & mixed with
any anti-coagulant and anticoagulant and
centrifuged centrifuged
 clear supernatant fluid  clear supernatant fluid with
devoid of any fibrin thrombosis inhibited. Most
products satisfactory sample. No
changes occur in blood
 Plain bulb
 Heparinized bulb
 Most enzymes,
 Biochemical LFT,KFT,  PH, NH4, RBC levels, Plasma
 S Electro. cortisol, testosterone,
globin,cholinesterase
 Serological :Widal, VDRL
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 For Special Testing
15

 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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 HEMOLYSIS OF SAMPLES
16

Contact with water

Excessive heat or cold
Rigorous mechanical injury to RBS
( thin gauge )
Prolonged storage
Hemolyzed samples will give erroneous
results
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 PREVENTION OF HEMOLYSIS
17

Equipment used to collect : absolutely

dry
Minimum constriction of limb
Use correct gauge
Collect slowly and steadily
Remove needle and put immediately
into the bulb
Easier if collection in Vacutainer

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Following safety precautions
18

 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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Transport & Storage of samples
19
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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Summary
20

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

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Urine collection
21

Urine has a long, rich history as a source for

measuring health and well-being and
remains an important tool for clinical
diagnosis.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Types of Collection
22

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont….
23

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Methods of
24
collection
Catheter 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont……
25

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont….
26

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Specimen Collection and Transport
Guidelines
27

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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont…
28

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.
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 Specimen Preservation Guidelines
29

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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Urine Specimen Handling Guidelines
30

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

CSF Collection
31

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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 Technique of Cerebral spinal fluid (CSF)
collection
32

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont…
33

 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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

How to Prepare
34

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.
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
Risks
35
 Bleeding into the spinal canal
 Discomfort during the procedure
 Headache after the procedure
 Hypersensitivity (allergic) reaction to the anesthetic
 Infection introduced by the needle going through the skin
 Brain 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.
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 Tissue Biopsy & Aspiration
36

The most commonly used fixative in histology is

formaldehyde. It is usually used as a 10% Neutral Buffered
Formalin.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Bone marrow
37

12/08/21 02:16
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Renal Biopsy
38

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Liver Biopsy
39

12/08/21 02:16
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD
Stool Collection
40

Rarely needed
Need wide mouth container
Perianal swab sometime can work
Can be taken from dipper
Should be sent as soon as possible
Can be collected any time, thus child do not
need to be on fasting.
Personal Precaution must be taken

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Sputum Collection
41

Only elder child can bring

sputum out
Throat swab can be an
alternate
Early morning gastric aspirate
in newborn is indicated
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
 Secretion collection by Swab Stick
42

Pus and Eye, Ear

Discharge
Burn Injury
Throat swab

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont…..
43

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

Cont…..
44

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD

12/08/21 02:16
Nurses roles
45
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.
Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16
Cont….
46

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.

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16

 47

Basant Kumar Karn,Dett.of Pediatric Nursing, CON, BPKIHD 12/08/21 02:16