1. Directorate of Laboratory Medicine1 Sample handling Malcolm Dunlop Directorate Quality Manager

2. Directorate of Laboratory Medicine2 Clinical Sciences Building 1

3. Directorate of Laboratory Medicine3 Clinical Sciences Building 2

4. Directorate of Laboratory Medicine4 Laboratory Departments Typical DGH Clinical Biochemistry (Chemical Pathology) Haematology Histopathology Microbiology

5. Directorate of Laboratory Medicine5 Laboratory Departments Teaching hospital / tertiary referral Clinical Biochemistry (Chemical Pathology) Haematology Histopathology Microbiology Immunology Virology Sub Fertility – associate department Cytology Others e.g. Genetics

6. Directorate of Laboratory Medicine6 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

7. Directorate of Laboratory Medicine7 Infection risks All samples must be considered to be infectious Use of “Universal Precautions” handling Never assume any sample is “safe” Today’s symptoms may be tomorrow’s diagnosis of infection

8. Directorate of Laboratory Medicine8 Phases of analysis Pre-analytical (from the patient to the lab) Analytical Post-analytical (from the lab to the notes)

9. Directorate of Laboratory Medicine9 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

10. Directorate of Laboratory Medicine10 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.

11. Directorate of Laboratory Medicine11 The Patient Do patients always disclose history? Confused Frightened In pain Want to help !!! Are previous diagnoses available?

12. Directorate of Laboratory Medicine12 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

13. Directorate of Laboratory Medicine13 Requesting Requested on PAS = electronic return Requested manually = NO electronic return Electronic/ manual mixed requesting = break in electronic record

14. Directorate of Laboratory Medicine14 Results Telephoned results are the most unsafe method Electronic are safest and quickest Hardcopy reports must be filed as per instructions

15. Directorate of Laboratory Medicine15 Blood collection Ask patients to identify themselves When blood taken write all relevant details on collection tubes immediately

16. Directorate of Laboratory Medicine16 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

17. Directorate of Laboratory Medicine17 Sample acceptance The sample MUST include patient’s:- –Surname –Forename –Date of Birth or Hospital Number or NHS number –Histology specimens MUST include Hospital number

18. Directorate of Laboratory Medicine18 Other information SHOULD include –Ward –Date of collection –Time of collection e.g. Cortisol

19. Directorate of Laboratory Medicine19 Sample acceptance Request form MUST contain patient’s:- –Surname –Forename –Date of Birth and/ or Hospital or NHS number –Ward or clinic –Tests requested

20. Directorate of Laboratory Medicine20 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

21. Directorate of Laboratory Medicine21 Venous blood sampling SyringeHybridEvacuated

22. Directorate of Laboratory Medicine22 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

23. Directorate of Laboratory Medicine23 Sampling problems - blood Inappropriate site – drip arm, mastectomy, burns etc Timing Incorrect use of tourniquet Wrong container Incorrect order of draw Transportation

24. Directorate of Laboratory Medicine24 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

25. Directorate of Laboratory Medicine25 Urine samples Incorrect timing Inappropriate for test required Sterility Volume

26. Directorate of Laboratory Medicine26 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

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