Presentation on theme: "Learning Objectives Collect Dried Blood Spots (DBS) for HIV testing"— Presentation transcript:
1 Collection, Storage and Transportation of Dried Blood Spots for Infant Diagnosis
2 Learning Objectives Collect Dried Blood Spots (DBS) for HIV testing Package and store DBS so as to maintain specimen integrityDistinguish between valid and invalid DBS
3 Step 1 Equipment DBS sample collection card DBS Lab requisition Form Sterile lancetSterile alcohol prepSterile gauze/cotton swabGlovesDrying rackLow Gas Permeable zip-lock bagDesiccantHumidity indicator cardYou should assemble all the equipment you need before hand.
4 Step 2 Correctly complete all the information on the requisition form Keep copy for your records
5 Step 3 Wash hands and dry thoroughly Put on gloves Confirm identity of the infant and write the baby’s name, date of the test and the unique identifier on the filter paperDo no not contaminate by touching or allowing spillage on the filter paperJane DoeMay 12th 2006Do not allow water, formulae, powder from gloves, antiseptic solutions to come into contact with filter paper before or after collection of sample
6 Step 4 Choosing the site Small infants (<9kg) Puncture the heel.Do not puncture the fingers; there is risk of hitting the bone.Larger infants (> 9kg)Puncture the heel; if callous is visible, you may use the lateral aspect of the big toe.Do not stick the fingers or small toes; there is risk of hitting the bone.Fingers are safe in children > 2 years of ageThis is also true when doing an HIV rapid test. Do not stick fingers or small toes of small children. Fingers are safe around age 2)
7 Step 5Do not puncture hereSafeDraw an imaginary line from midpoint of the big toe to the heel and one from between the 4th and 5th toe to the heel.Shaded area indicates safe areas for puncture siteDo not puncture the back of the heel or Achilles tendon or the medial aspect of the big toeDraw an imaginary line from midpoint of the big toe to the heel and one form the between the 4th and 5th toe to the heel.safesafeDo not puncture here
8 Step 6 Position baby with foot down This will help the blood flow more easilyWarm site with soft cloth moistened with warm water up to 410c for 3 to 5 minutes
9 Step 7 Clean site with alcohol prep Allow to air dry for 30 seconds Failure to allow alcohol to dry may dilute the specimenFailure to allow alcohol to dry may dilute the specimen
10 Step 8Puncture the toe to a depth less than 2 mm using a sterile lancet
11 Step 9 Wipe away first blood with sterile gauze pad The initial drop contains tissue fluid that may dilute the specimenAllow another large blood drop to form
12 Step 10 Lightly touch the filter paper to the large drop of blood Allow to soak through and completely fill the circleTo enhance flow very gently apply intermittent pressure to area above the puncture site.Excessive milking or squeezing the puncture may cause hemolysis and mix tissue fluid with specimen affecting the results
13 Step 11Apply blood to one side of the filter paper only, the side with the printingDo not layer successive drops of blood or apply blood more than once to the same collection circleAvoid touching or smearing the spots
14 Step 12Fill remaining circles in the same manner with successive drops of bloodIf blood flow is diminished repeat steps 10 and 11
15 Step 13Inspect card to ensure you have collected enough blood, and the specimen is validJane DoeMay 12th 2006Do not allow water, formulae, powder from gloves antiseptic solutions to come into contact with filter care before or after collection of sampleValid Specimen
16 Step 14Place filter paper on a horizontal clean dry surface to AIR DRY for at least 3 hoursKeep away from direct sunlight, dust, and bugsDo not allow blood spots to come into contact with any surface or each other.Do not stack , heat or expose to excessive sunlight during drying. Allow to dry completely before placing in the Ziploc bag. Insufficient drying will affect the results.
17 Step 15Place dried DBS cards between sheets of glassine paper so that the DBS cards are not touching each otherFold ends of the glassine paper
18 Step 16 Place dried filter paper into Ziploc bag Add desiccant package Minimum of 2 desiccant packages per specimenIt is safe to add at least 10 silica desiccant packages per bag.
19 Step 17 Add humidity indicator card Remove air and seal bag Keep packaged DBS (in sealable plastic bags) refrigerated until transported to reference laboratory
20 Step 18 Transportation Place bag into envelope Add lab requisition slips and specimen delivery check listClearly label outside of the envelopeTransport to central laboratory for processing
21 Step 19During transportation do not leave in vehicle, as sun and heat will deteriorate DBS
22 Invalid Specimen Specimen quantity insufficient for testing Removing filter paper before blood has completely filled circle or before blood has soaked through to second side.Applying blood to filter paper with a capillary tubeTouching the filter paper before or after specimen collection with a gloved or ungloved hands, hand lotion etc.Allowing the filter paper to come into contact with gloved or ungloved hands or stances such as hand lotion or powder, either before or after blood specimen collection.
23 Invalid Specimen Specimen appears scratched or abraded Applying blood with a capillary tube or other device
24 Invalid Specimen Specimen not dry before mailing Mailing specimen before drying for a minimum of 3 hours
25 Invalid Specimen Specimen exhibits serum rings Not wiping alcohol from puncture siteAllowing filter paper to come into contact with alcohol , hand lotion etc.Squeezing area surrounding puncture site excessivelyDrying specimen improperlyApplying blood to filter paper with capillary tube
26 Specimen appears diluted, discolored Invalid SpecimenSpecimen appears diluted, discoloredor contaminatedSqueezing or milking of area surrounding puncture siteAllowing filter paper to come into contact with gloved or ungloved hands or substances such as alcohol, formula, antiseptic, water, powder etc. before or after blood specimen collectionExposing blood spots to direct heat
27 Invalid SpecimenNo bloodFailure to obtain specimen
28 Specimen appears clotted or layered Invalid SpecimenSpecimen appears clotted or layeredTouching the same circle on filter paper to blood several timesFilling circle on both sides.
29 Specimen appears super saturated Invalid SpecimenSpecimen appears super saturatedApplying excess blood to filter paper, usually with a deviceApplying blood to both sides of filter paper.
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