sample management

1. Neonatal blood sampling (heel prick)
 Purpose and indications
 The neonatal heel prick is a common
procedure for taking a blood sample from the
heel of newborn which is used for a variety of
tests, such as Bilirubin and TSH.
 Site
 The recommended location for blood
collection on a newborn baby or infant is the
heel, only lateral parts are used not central
part to avoid medial calcaneus nerve, injury
to this nerve can cause necrotizing
osteochondritis.

2. Procedure
1. Clean the site to be punctured with warm water sponge
2. Hold the baby's foot firmly to avoid sudden movement and to
apply slight tension to the skin.
3. Using a sterile blood lancet, puncture the heel.
4. Wipe away the first drop of blood with a piece of clean, dry
cotton
5. Collect blood sample using test tube, capillary tube, or automatic
pipette.
6. When finished, elevate the heel, place a piece of clean, dry cotton
on the puncture site, and hold it in place until the bleeding has
stopped.

4. Urine sampleS

5. introduction
 Why urine analysis is done?
o As a general evaluation of health.
o To screen for a disease or infection of the urinary tract.
o To monitor the treatment of certain conditions such as kidney
stones, a urinary tract infection (UTI)
o Diagnosis of some metabolic and endocrine disturbances in the
body such as diabetes.
 Symptoms and conditions that require urine test;
o Discolored or foul-smelling urine
o Pain during urination
o Blood in the urine (hematuria)
o Frequent urination, abdominal pain, or back pain
 Pregnant women to chick the risk of pregnancy toxemia

6. Type of urine samples
 Laboratory urine specimens are classified by the type of
collection conducted or by the collection procedure used to
obtain the specimen.
 Random Sample
 First Morning Sample
 Midstream Sample
 Timed Collection Sample
 Catheter Collection Sample
 Suprapubic Aspiration Sample
 Pediatric Sample

7. Random Sample
 This is the specimen most commonly sent to
the laboratory for analysis
 usually submitted for urinalysis and
microscopic analysis
 Although there are no specific guidelines for
how the collection should be conducted,
avoiding the introduction of contaminants into
the specimen is recommended.
 This requires explicit instructions to patients so
that they do not touch the inside of the cup or
cup lid.

8. First Morning Sample
 Why the first voided morning specimen is preferred?
► Because it is usually more concentrated and therefore more
likely to reveal abnormalities.
► This is usually hypertonic and reflects the ability of the kidney
to concentrate urine during dehydration which occurs overnight.
 Precautions
► All samples should be midstream and collected in a clean sterile
container.
► Avoid touching the inside or rim of the container with your
fingers or genital area.

9. Midstream Sample
► Clean the area around your genitals.
► Begin urinating into the toilet.
► After the urine has flowed for several seconds,
place the collection container into the stream and
collect this midstream urine without interrupting
the flow.
► Finish urinating into the toilet.
► Carefully replace the lid on the container and
return it to the lab.

10. Pediatric Sample
 For infants and small
children, a special urine
collection bag is adhered to
the skin surrounding the
urethral area.
 Once the collection is
completed, the urine is
poured into a collection cup
 Urine collected from a
diaper is not recommended
for laboratory testing since
contamination from the
diaper material may affect
test results.

11. Catheter Collection Sample
 This assisted procedure is
conducted when a
patient is bedridden or
cannot urinate
independently.
 Specimens may be
collected directly from a
Foley into an evacuated
tube or transferred from
a syringe into a tube or
cup.

12. Suprapubic Aspiration Sample
 This method is used
when a bedridden patient
cannot be catheterized or
a sterile specimen is
required.
 The urine specimen is
collected by needle
aspiration through the
abdominal wall into the
bladder.

13. Precautions for urine analysis:
 -
‫ـ‬ The ideal situation is when the
specimen is analyzed shortly after
collection (within 1h).
‫ـ‬ If examination can't be done directly
after collection the sample must be
refrigerated within 1 hour of collection.
‫ـ‬ If the specimen is not refrigerated
within 1 hour of collection,
‫ـ‬ the following changes in composition
may occur:
 Increased pH from the breakdown of
urea to ammonia by urease-producing
bacteria)
 Decreased glucose from glycolysis and
bacterial utilization
 Decreased ketones because of
volatilization
 Decreased bilirubin from exposure to
light
 Increased bacteria from bacterial
reproduction
 Increased nitrite from bacterial reduction
of nitrate
 Precipitation of amorphous urates.
 Changes in color caused by oxidation or
reduction of metabolites
 Increased turbidity caused by bacterial
growth and precipitation of amorphous
material
 Disintegration of red blood cells (RBCs)
and casts, particularly in dilute alkaline
urine

14.  Preservation of urine:
 Urine specimens should not
remain un-refrigerated for
longer than two hours.
Refrigeration will slow
microbial growth and tends to
stabilize most urine
components for up to 12 hours.
 Note: you must re-warm the
sample before analysis.
 Urine sample rejection:
 Generally specimens that could
lead to false interpretation should
be rejected such as:
 The sample must be sufficient
quantity {the widely accepted
urine volume is 12 ml}.
 Specimens that is contaminated
from a woman's menstrual
period.
 Not getting urine sample to lab
in 2 hour.
 Urine sample that is taken in
dirty container.
 Specimens that is contaminated
with feces.

15. Timed Collection Sample
 A timed specimen is collected to measure the
concentration of these substances in urine over
a specified length of time, usually 8 or 24
hours.
 Among the most commonly performed tests
requiring timed specimens are those measuring
creatinine, total protein.
 In this collection method, the bladder is
emptied prior to beginning the timed collection.
 The specimen should be refrigerated during the
collection period, unless otherwise requested by
the physician.
 Urine collection containers for 24-hour
specimens commonly have a 3 liter capacity.

16. Sampling for total protein in urine

 Overview:
o The urine protein test measures the amount of protein being
excreted in the urine.
o The quantity of protein in a 24-hour urine sample are
measured and reported as the amount of protein excreted per
24 hours.
 Why it is done?
1. If two or more urinalyses are positive for protein.
2. To evaluate and monitor kidney function.
3. To help detect and diagnose early kidney damage and
disease.