Sample handling

Malcolm Dunlop
Directorate Quality Manager

Directorate of Laboratory Medicine

Clinical Sciences Building 1

Clinical Sciences Building 2

Laboratory Departments
Typical DGH
Clinical Biochemistry (Chemical
Pathology)
Haematology
Histopathology
Microbiology

Laboratory Departments
Teaching hospital / tertiary referral

Clinical Biochemistry (Chemical Pathology)

Haematology
Histopathology
Microbiology
Immunology
Virology
Sub Fertility associate department
Cytology
Others e.g. Genetics

What constitutes a sample

Any biological material taken from a
patient for diagnostic, prognostic or
therapeutic monitoring
Under the new Human Tissues Act
tissue includes

blood
urine & other fluids
faeces
sweat
semen
tissue

Infection risks
All samples must be considered to be
infectious
Use of Universal Precautions
handling
Never assume any sample is safe
Todays symptoms may be
tomorrows diagnosis of infection

Phases of analysis
Pre-analytical (from the patient to the
lab)
Analytical
Post-analytical (from the lab to the
notes)

From the patient to the lab

What can (and does) go wrong

Incorrect identification of patient
Patient preparation fasting, diet,
supine, time, drugs.
Sample poorly/ incorrectly taken
Inaccurate timing
Wrong type of sample

From the patient to the lab

What can (does) go wrong?

Incorrect container(s)
Under-filling
Mislabelling/ no labelling
Incorrect storage/ transport (ice,
warm, delay)
Loss, breakage etc.

The Patient

Do patients always disclose history?

Confused
Frightened
In pain
Want to help !!!
Are previous diagnoses available?

Quality
Laboratories can only produce
quality results on quality samples
And on quality requests
Rubbish In Rubbish Out
Ideal sample mimics the in vivo state

Requesting
Requested on PAS = electronic return
Requested manually = NO electronic
return
Electronic/ manual mixed requesting
= break in electronic record

Results
Telephoned results are the most
unsafe method
Electronic are safest and quickest
Hardcopy reports must be filed as
per instructions

Blood collection
Ask patients to identify themselves
When blood taken write all relevant
details on collection tubes
immediately

Sample acceptance
Patient safety is of the utmost
importance
Samples and requests MUST allow
clear identification the patient
Samples identified incorrectly will
NOT be processed

Sample acceptance
The sample MUST include patients: Surname
Forename
Date of Birth or Hospital Number or NHS
number
Histology specimens MUST include
Hospital number

Other information
SHOULD include
Ward
Date of collection
Time of collection e.g. Cortisol

Sample acceptance
Request form MUST contain
patients: Surname
Forename
Date of Birth and/ or Hospital or NHS
number
Ward or clinic
Tests requested

Samples for Blood Transfusion

MANDATORY identification
requirements
As previous plus signature and printed
name of requestor on form
Signature of person collecting the blood
on the sample tube(s) and on request
form
Date of request and of sample

See Blood Transfusion Policy

Venous blood sampling

Syringe

Hybrid

Evacuated

Blood collection
Use the blood collection system in
use
Advantages over needle & syringe
Higher quality sample
Minimises clotting mechanism
Produces correct blood to anticoagulant
ratio when properly filled
Easier
Quicker

Sampling problems - blood

Inappropriate site drip arm,
mastectomy, burns etc
Timing
Incorrect use of tourniquet
Wrong container
Incorrect order of draw
Transportation

Urine collection
24 hour sample must include all urine
passed in this period
If less than 24h, inform the lab
Mid stream sample self explanatory
Early morning sample often best
Correct container type

Urine samples

Incorrect timing
Inappropriate for test required
Sterility
Volume

Other considerations
Swabs for culture may need specific
transport media e.g. Chlamydia
Blood cultures special bottles &
technique for taking the blood
Tissue for Histology fixative *
Extreme care needed when using
formalin