Junaid Mohamed: December 2008

UNSUITABLE SAMPLE

Unlabeled or incorrectly labeled samples or specimens
The container of stool is full
Sputum sample contaminated with food particles or other substances
Insufficient samples such as urine and blood

Actions we can take

Inform the ward sister to send a repeat sample
If the sample is insufficient, clotted, contaminated or heamolysed inform the ward sister immediately for a repeat sample and document in the repeat sample register
If it is an OPD patient, try to contact the patient and explain the problem to the patient
If the OPD sample is insufficient or unsuitable on receiving, ask for a repeat sample before registering

Patient preparation for different laboratory test

Fasting blood sugar
Ask the patient to fast for 8 hours
Post parandial blood sugar
Collect blood 2 hours from the time of taking food
Post glucose blood sugar
Patient is ask to come after 8 hours fasting, 50grams of glucose is given orally and blood is collected after 2 hours
Oral Glucose Tolerance Test
Ask the patient to fast 8 hours
Ask the patient to bring 100 grams glucose packet and a lemon
Patient is asked to collect a fasting urine sample and blood is collected
Patient is given 75 grams of glucose
Take 3 more blood sample.
Instruct the patient to collect a urine sample with each blood sample
Lipid profile
Instruct the patient to come for blood collection after 13 hours fasting

Urine collection for routine test

The container need not to be sterile but
should be free from detergents and other impurities.
Minimum of 10ml should be collected.
For urinary porphobilinogen urine sample should be collected in a dark bottle

Collection of stool for routine test

The container for specimen collection need not be sterile
It should be a clean, leak proof, disinfectant free, wide mouthed.
The faeces specimen should not be contaminated with urine

Instruct the patient to collect a very little amount of stool.( 1 – 2 grams )

MANTOUX TEST

Materials required
1.Spirit swab
2.Dry swab
3.Tuberculin PPD ( 10TU/0.1ml ), make sure that it comes to room temperature before administering and check the expiry date.
4.Tuberculin syringe

PROCEDURE

The preferred site for the test is the flexor dorsal surface of the forearm about 4 inches below the elbow join
Clean the chosen site by using 70% alcohol or spirit and allow to dry
The stopper of the PPD vial is cleaned with spirit or 70% alcohol
0.1ml of the Tuberculin PPD solution is drawn into the sterile tuberculin syringe fitted with a short 26 – gauge needle
Insert the needle-point with the bevelled side upwards so that the needle opening is visible
Stretch the skin between finger and thumb
Hold the needle almost parallel to the skin
PPD is injected intradermally by inserting the tip of the needle into the most superficial layers of the skin with needle bevel pointing upwards
As the solution is injected a pale white bleb, 6 – 10 mm in diameter will rise at the needle point

NOTE

If significant part of the dose leaks from the injection site, the result should be repeated immediately at another site, 5 cms away from the first site
Instruct the patient not to scratch the area and not to apply any lotion or cosmetics
Instruct the patient to come to the laboratory for result of the Mantoux test which should be read at 40 – 72 hours after the injection

Can You Solve These Problems

Case 1

Gasim comes to the Laboratory to do some investigations urgently. He gives the blood sample and is asked to come to collect the report at 2.30pm. Due to some reason he was unable to come at 2.30pm and came at 3.00pm. When he comes to the laboratory counter he finds that there is only one girl at the reception, and she is busy attending a patient. The counter is crowded and Gasim is unable to give the report collection slip. After a few minutes he is finally able to get near the counter and when he gives the Report collection slip, the girl looks at it and asks him to wait and gets busy attending another patient. After a few minutes when Gasim still didn’t get the report, he asks the girl whether it is not ready. The girl then asks his name, and tell him that it will take some time. She then takes the report collection slip and goes inside leaving the counter empty. A few minutes later she comes out and tells Gasim that one test has to be repeated

What are the problems?

How do you solve them?

Case 2

Habeeba is a Diabetic patient who tests her blood sugar regularly. She comes to laboratory to do a RBS. The sample for RBS was tested and found to be 800mg/dL. She was not reached so a message was given to come and give a repeat sample as soon as possible. No explanation was given as to why the sample has to be repeated.
Zulaikha was posted in the sample collection room that day and was told about Habeeba coming for a repeat sample. When Habeeba comes to give the blood sample Zulaikha was on her tea break and only Ameena was in the sample collection room. She was busy attending to another patient. Habeeba was asked to wait. When asked as to why a repeat has to be collected Ameena was unable to explain the reason as Zulaikha had not told her. Habeeba refused to give another sample

What are the problems?

How do you solve them?

Case 3

It is 10.00am and the 125 phone has been ringing for a while when Shaira picks it up. She has been at the counter alone for a while as her other two colleagues has gone for tea. The counter is very busy since this is the time most patients arrive for testing and receiving the reports. Shaira answers the phone and finds out that it is Medical Officer from M/W wanting to talk to the pathologist. She passes the phone to 121. Again she attends to the waiting patients and the phone again starts ringing. Shaira picks it up and was told that the line got cut the last time she passed the phone. The doctor tells her to call a pathologist as he wants to discuss a patients thyroid results. Shaira asks him to wait and goes inside, comes back after a few minutes and then tell him that the doctor is not available. All this time there is no one in the counter and the people get irritated and start making all sorts of complaints when Shaira comes back

What are the problems?

How do you solve them?

Case 4

It is a Saturday and the ward samples keep coming constantly. Shihama is posted at the ward counter to receive ward specimens and since 9.00am she has been receiving specimens from different wards. At 9.30am from Casualty they send 3 urgent samples and Shihama asks the attendant to wait while she checks the samples. Just then from Medical Ward an ABG arrives. Shihama asks the casualty attendant to wait and takes the ABG inside. She gives the ABG to the coordinator and then comes out to check the casualty samples, signs the book and sends the attendant. Before she can register these samples, from ICCU a sister comes with a sample for Hb/PCV and asks for the report immediately. Shihama keeps away the casualty samples for later and attends to this ICCU sample, registers it, takes it in, and after a few minutes comes out with the report and issues it to the sister. It is now 9.50am. All this time the casualty samples are outside it has been 20 minutes since she received the samples. She then registers the samples and finds out that the EDTA sample is clotted

What are the problems?

How can you solve them?

Problems and Solutions for Case no 1

???? after you guys give me some coments.Help me to make this a succeess