SPECIMEN COLLECTION, RECEPTION AND REGISTRATION

SPECIMEN COLLECTION

Many different types of specimen are received daily in a routine medical laboratory as these
aids in diagnosis of diseases. For effective diagnosis of disease, the correct specimen must be
collected from the proper body sites of infection either directly or indirectly placed in the
proper container collected with the right material, transported to the laboratory and processed
without delay. Thus it is important for the medical lab scientist to know how to collect
specimen (though not necessary all types) from patients

BLOOD

Blood can be collected by capillary puncture

● Veni puncture
● Arterial puncture

CAPILLARY PUNTURE

It can be done on ear loop, heel digits and toes by using a sterile lancet. First the site is
cleaned with cotton wool soaked in 70% ethanol or isopropyl alcohol or methylated Spirit. It
is allowed to dry before the sample is collected.

The cleaning with alcohol aids blood flow and reduces contamination which may lead to
erroneous result. When the alcohol has dried, a puncture is made into the skin quickly with a
sterile lancet

Allow the blood to flow, clean the first few drops of blood and then collect the next few
drops into an into an appropriate container (capillary Tube)

Capillary puncture is useful in neonates, patients with extensive burns and when small
volume of blood is required

VENI PUNT URE

This is usually carried out in the arm or wrist.

For the arm, the cubital vein is preferred. The arm or wrist is tied with a tourniquet close to
the selected site of puncture. This facilitates the blood flow into the collection material. The
site is cleaned with cotton wool sab coated with methylated spirit when the alcohol is dried; a
sterile needle is attached to the syringe. It is introduced into the vein, in suitable manner. As
soon as blood enters the syringe, the plunger is withdrawn slowly until the required amount
of blood is reached then the tourniquet is removed. The needle is then removed. A dried
(cotton wool swab is applied to the puncture and press down firmly to stop bleeding. The
blood in the syringe is then introduced into the appropriate container
Urine

Urine can be collected to diagnose disease or infection of the urinary tract, urethra bladder,
ureter and kidney disease outside the urinary tracts and certain physiological changes
(pregnancy). Different types of urine specimen are collected and they include

● Midstream urine (MSU)

● Catheter specimen urine (CSU)
● Supra-pubic urine (SPU)
● Early morning urine (EMU)
● 24hrs urine

For midstream urine, few mls of urine are passed, the mid portion is collected into an
appropriate container (universal container) the urine is sent to the lab and processed
immediately. If delay is envisaged, few crystals of boric acid or other preservatives
depending on the test required is assessed to the container before the specimen is collected

Early morning urine is the first urine the individual passes out as she wakes up in the
morning. It is used for determining pregnancy

For 24 hours urine, the patient is given a large container (3-4 litre containers with a Suitable
preservative 20ml of 2 Molar HCL. The container must be covered. The patient empties their
bladder at exactly 8a.m and from then till 8a.m and fro then till 8a.m the next day. All the
urine is collected

Sputum

Early morning sputum is collected into a sterile universal container after the mouth has been
washed. But not brushed with toothpaste (3 consecutive samples are collected for diagnosis
of tuberculosis). Real sputum not saliva should be collected and handled with great care, the
container should be tightly closed, rapped in tissue paper or cotton wool to avoid pillage,
hand should be thoroughly washed after handing and before touching anything else

Swabs

There are various Kinds of swabs for various specimen but most of them are sent to the
laboratory without delay. If delay is envisaged the swabs should be put in transport media to
maintain the viability of the organism present; high vagina and endo-cervical swabs are
collected with the aid of a speculum.

Two Swabs should be collected ideally. Urethra, ear, eye, month, wound and nasal swabs are
collected from appropriate Site and sent the lab without delay. Throat Swab is collected with
the aid of a tongue depressor without touching the mouth parts except the inflamed area of
the throat.
Stool Sample

Stool Samples should be collected in a sterile clean wide-necked universal Container and
send to the lab. Stool shouldn't be collected from bed pans as this may contain disinfectants

Pus should be collected either by using a swab or a sterile needle and syringe. The pus is then
transported to the lab in this form or is placed in a universal container

Serum

For serum, the blood collected is placed inside a clean or sterile container (plain bottles). The
blood allowed to clot and the serum Separated, preferably after centrifugation.

Cerebrospinal fluid (CSF)

Cerebrospinal fluid (CSF) is collected by an experienced personnel from Lumbar puncture it

is collected into a sterile universal container.

PATIENTS CONSIDERATION

● Use appropriate specimen collection technique

● Techniques must be safe respectful of persons and stress-free as possible and
culturally acceptable
● Avoid repeated collection as much as possible

EDTA (Ethylene diamine tetra acetic acid) bottles

EDTA is an anticoagulant that functions by Chelating Calcium ions in blood, thus removing
it and preventing coagulation or clotting of blood. The salts sodium, potassium and lithium
ppthough potassium EDTA is frequently used, it is usually used at a Concentration of 1.5 to 2
mg/ml of blood.

Preparation

Dissolve 10g of Sodium or di-potassium EDTA in 100ml of distilled water and add 0.05 ml
of this solution into small bottles or tubes. Allow to evaporate at room temperature and fix
the cap (preferably Screw caps) then label.

2.5ml EDTA containers are used to collect blood for routine haematological work but not for
coagulation studies because it inhibits platelets clumping and viability of factor VIII is
decreased.
SODIUM CITRATE

It is the best anticoagulant for coagulation Studies, It prevents clotting by forming a loose
ionic complex with calcium for coagulation studies. 1ml of anticoagulant to 9ml of blood is
required.

For ESR (erythrocytes sedimentation rate) one part anticoagulant to 4 part of blood sample
(1:4)

SODIUM FLUORIDE-POTASSIUM OXALATE

1.2g sodium fluoride and 6g neutral potassium oxalate grounded together and dissolved in
100ml of distilled water distributed at O.1ml in screw capped bottles. This container is used
to collect blood for glucose estimation using the glucose oxidase method because sodium
fluoride inhibits or prevents glycolysis while the potassium oxalate acts as the anticoagulant
by forming insoluble calcium oxalate with calcium in the blood.

HEPARIN BOTTLES

Heparin is a physiological anticoagulant and is used in concentration of 10-50units per ml of

blood Lithium heparin is preferred for electrolyte studies.

Clinical preparations of heparin consist of mixture of polymeric forms ranging in molecular

weight between 2000 and 4000. Heparin is ineffective as an oral anticoagulant because it
cannot be absorbed from the intestine

RECEPTION AND REGISTRATION

Various kinds of specimen are received daily in a routine medical laboratory and is necessary
to observe certain details in other to ensure accurate report for each specimen, specimen that
are mis-labelled/reported can be sent to the wrong person.

Each specimen entering the laboratory should be labelled with patient's name, hospital
number, ward, time of collection and test(s) to be carried out. Accompanying each specimen
is a lab request form which should have all the above information as well as the nature and
/or origin of specimen, provisional diagnosis (clinical information). Investigation is required
and other relevant information that can aid in laboratory diagnosis.

After checking to see that the information on the specimen container tally's with that on the
request form, it is received, registered and given a lab number for easy identification, during
processing and release of final result. It must be noted also that during reception of specimen,
the right specimen in the right container is what is accepted, Specimen that are suspected to
contain dangerous pathogens must have a danger of infections label affixed and be inserted
into a plastic envelope. Once a specimen has been received and sent along with the request
form to the appropriate area of the laboratory.
STORAGE OF CHEMICALS

Acids must be kept in glass-stopper bottles preferably in a drip tray. Winchester quart bottles
should be stored at floor level.

Alcohol Duty-free alcohols must be kept locked, and all details of its use recorded. Customs
and Excise officials periodically inspect the stock.

Ammonia must be kept tightly stoppered and away from heat and other chemicals.

Bromine ampoules must be stored in absorbent materials.

Cyanide and all other poisonous chemicals must be clearly marked 'poison' in red letters and
kept locked in a poisonous cupboard; details of all poisons issued should be entered in a
poison record book.

Deliquescent and hygroscopic chemicals must be stored in air-tight containers. Such

chemicals include potassium and sodium hydroxide, sodium carbonate, phenol and
phosphorus pent-oxide.

Ether must be kept in a glass bottle, stoppered with a tinfoil-covered cork or a wax-lined
Bakelite screw top. Never use a rubber bung, as ether attacks rubber, and never store in a
refrigerator.

Flammable liquids must be kept well stoppered in a metal container clearly marked
'flammable'. Stocks of such fluids should be kept in a store used solely for this purpose. The
store room should have a sunken floor so that in the event of breakages no liquid will flow
from the room. Keep the bottles as cool as possible; never use the liquids near a naked flame.

Hydrogen fluoride attacks glass and must be stored in a gutta-percha or polythene bottle.

Hydrogen peroxide must be kept in a brown glass bottle in a refrigerator. Exposure to

warmth and light causes oxygen to be evolved, and a pressure sufficient to cause the bottle to
explode may be built up.

Iodine must be kept in a brown glass bottle with a glass stopper. Never use a rubber bung, as
iodine attacks rubber.

Potassium hydroxide solution should be stored in bottles waxed on the inside, as it attacks
glass, forming sodium silicate. Glass stoppers must never be used, as the CO2 in the air
combines with the NaOH, forming Na2CO3 which acts as a cement, firmly fixing the stopper
into position. The solution in daily use should be stored in an aspirator. A soda-lime guard
tube will absorb and prevent any CO2 from entering the aspirator.

Potassium permanganate must be stored in a dark, glass-stoppered bottle, as it decomposes

when exposed to light.

Silver nitrate solution must be kept in a dark glass-stoppered bottle. Exposure to light
decomposes the silver nitrate to sliver oxide.
Sodium must never be allowed to come in contact with water, as spontaneous combustion
will result. Keep completely covered with xylene.

Sodium hydroxide solution (see potassium hydroxide above).

Sodium nitroprusside must be stored in a dark glass-stoppered bottle, as it decomposes upon

exposure to light.