DR.KHODAVERDIAN

Specimen Management r

OBJECTIVESAt the end of this module, you will be

able to: Describe the importance of specimen

management. Define the specimen management

process for receipt, rejection, identification, transport, storage, inventory and disposal.

Identify policies and procedures needed to support specimen management.

Purchasing &

Inventory

Assessment

Occurrence

Management

Information

Management

Process Improveme

nt

Customer Service

Facilities & Safety

A SYSTEMS APPROACH TO LABORATORY QUALITY

Organization

Personnel

Equipment

Documents &

Records

Process Control (QC &

EQA) & Specimen

Management

4

The result of any laboratory examination is only as good as the sample received in the laboratory

IMPORTANCE OF SPECIMEN MANAGEMENT

Why is specimen management important?

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Influences laboratory efficiency

Directly affects

patient care and outcome

Influences therapeutic

decisions

Essential to accurate

laboratory diagnosis

Good sample

management

Goodsample

management

Impacts patient length of stay, hospital costs, and laboratory costs

SPECIMEN MANAGEMENT MEANS…

Policies, procedures and infrastructure to support

the safe handling and treatment of biological

specimens

PITFALLS Saying “Yes” to everything

Accepting every specimen

Afraid to say “No” to physicians Someone with sufficient authority MUST

support laboratory policy Good lab practice – Patients first!

Having no boundaries for technical issues

PITFALLS Saying “Yes” to everything

Accepting every specimen

Afraid to say “No” to physicians Someone with sufficient authority MUST

support laboratory policy Good lab practice – Patients first!

Having no boundaries for technical issues

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COMPONENTS

Information needed

Transport

Retention, storage, disposal

Assessing, processing,

tracking

Labeling

Collection, preservation

LaboratoryHandbook

Policies & Practices

TEST REQUISITION

Patient identification Clinical data, where indicated Contact info for requesting physician or

authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate

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Define a good labeling systemAssess all samples -

preexamination

Provide sample collection information

What- When- How

The Laboratory’s Responsibilities

Provide appropriate containers and supplies

OUTCOMES OF IMPROPER COLLECTION Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis / treatment Injury Death

SPECIMEN COLLECTION PROCEDURES Should include instructions for:

Positively identifying the patient before collecting a specimen

Required specimen for each requested test Preparation of patient Type of collection container, required

volume, timing Preservation of specimen, e.g., transport

media Proper specimen labeling Special handling instructions, e.g.,

refrigeration

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COLLECTION REQUIREMENTS patient preparation patient identification type of sample required type of container needed labeling special handling safety precautions

وريدی خون نمونه آوری جمع

بيمار 1. مشخصات با آزمايش درخواست برگه مشخصات انطباق

گيري 2. نمونه از پيش غذايي رژيم ازرعايت اطمينان

نياز 3. مورد وسايل انتخاب

دستکش 4. از استفاده

.5) ( الکتات تورنيکه بستن

مناسب 6. وريد انتخاب

نمونه گيري 7. محل تميزكردن

گيري 8. نمونه

تورنیکه 9. کردن بازسوزن 10. سر دفعخون 11. تخلیه.12 : نمونه زمان و ،تاریخ شناسایی خانوادگی،شماره نام نام گذاری برچسب

گیر نمونه فرد نام گیری،

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LABELING

Each sample should be labeled with:-patient’s name-patient’s unique ID number -test ordered-time and date of collection-collector’s initials

Use computer-generated bar codes when possible

ها نکته نمونه بدنبال زمان کوتاهترين در بايد پالسما يا سرم

گردد جدا خوني هاي سلول از زمان. گيري حداکثرپالسما يا سرم جداسازي جهت پس ساعت 2 مجاز

(. گردد مي پيشنهاد گيري نمونه در 15-10از دقیقه1000 -1200g)

: عمل از قبل تا بايد ها نمونه بعضي نمودن سردشوند داري نگه سرما در جداسازي

پوش در وجود لوله وضعیتزمانهمولیز نور به مجاورت

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مناسب : نواحی ( سوم دست انگشتان انتهایی بند

) چهارم یاپا پاشنه وخارجی داخلی سطح

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SAMPLE TRACKING-MANUAL confirm receipt of samples, include date and time label samples appropriately; keep with the test

requisition until laboratory ID is assigned track aliquots–traceable to the original sample

SPECIMEN REJECTION CRITERIA:

Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of

preservative Insufficient quantity Prolonged transport

SPECIMEN HANDLING

Handle all specimens as if infectious Use tracking system for all specimens:

Accession / logging process Confirm actual receipt of specimens Date and time of specimen receipt Track aliquots – traceable to the original

sample

SPECIMEN HANDLING

Establish procedures for handling: Stat / urgent requests Delayed testing, e.g., storage, separation

of serum/plasma from cells Leaking containers Contaminated forms Preservation of specimens

SPECIMEN TRANSPORT

Train personnel in appropriate safety and packaging procedures

Package and preserve specimens appropriately

Transport specimens at appropriate temperature

Determine acceptable transport time Determine mode of transport

Courier, ambulance, clinic/lab staff Adhere to the International Air Transport

Association (IATA) regulations

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SAMPLE TRANSPORT

Maintain integrity of sample: temperature preservation of sample special transport containers time limitations

Assure safety regulationsare met

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Transport Regulations

Where do they come from?

Who develops them?

National transport regulations ICAO/IATA transport regulations (air)

rail, road, and sea traffic agencies postal services private couriers

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SAMPLE STORAGE-WRITTEN POLICY

describe samples to be stored determine retention time determine location describe proper conditions establish method of

organizing samples

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SAMPLE RETENTION

set policy for retention monitor stored samples,

including freeze/thaw cycles

maintain an organized, accessible system

establish a schedule to review all stored samples

establish tracking procedures

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SAMPLE REFERRAL Record:

samples referred date of referral name of person referring test

Monitor / Track, and Record: turnaround time results delivery (from referral laboratory,

to requestor) problems with referral

بالينی های نمونه ارجاع دستورالعمل

ارجاع آزمايشگاه انتخاب معيارهایخدمات - کيفيت

نمونه، - ) انتقال شيوه ها، آزمايش دامنه خدمات ارايه کارايی) ارتباطی ،سيستم نتايج تفسير کاری،نحوه چرخه زمان

بخشی - اثر هزينه

قرارداد عقد آزمايشگاهی های نمونه وانتقال بندی بسته دهنده ارجاع آزمايشگاه الزامات ارجاع آزمايشگاه الزامات

SPECIMEN DISPOSAL

Develop policy for disposal of medical waste Establish and follow disinfection procedures Comply with local regulations Include policy of disposal of rejected specimens

Appoint someone with oversight responsibilities

Establish a schedule to review all stored specimens

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SUMMARY provide a laboratory handbook with collection

information to all users have a system for tracking samples as they move

through the laboratory establish and implement a policy for sample

storage and sample disposal maintain sample integrity assure that all transport regulations and

requirements are met

Always follow universal precautions

37

KEY MESSAGES

laboratory must have good samples in order to ensure accuracy and reliability of testing and confidence in results

Sample management directly affects patient care and outcome

مايعات

نوع نمونهظروف وملزومات

مورد نيازآماده سازی بيمار راهنمايی خاص

شرايط انتقال به آزمايشگاه

شرايط نگه داری تا قبل از انجام

آزمايش

محيط های کشت اوليه مورد نياز

تهيه گسترش مستقيم

توضيحات

مايع مغزی نخاعیلوله در پيچ دار

استريلضد عفونی کردن

پوست قبل ازآسپيراسيون نمونه

فوری-دمای اتاق ساعت در دمای 6 درجه –جهت 37

شناسايی ويروس ها روزدر 3نمونه تا

درجه قابل 4دمای نگه داری است

BA-CA گرم محيط تايو جهت تهيه شده از CSFتمونه

شانت استفاده شود.

گوشداخلی لوله در پيچ دار

استريل يا حاوی محيط انتقالی غير

هوازی

تميز نمودن کانال گوش با محلول

صابونی ماليم قبل از سوراخ نمودن پرده

آسپيره نمودن ترشحات پشت پرده گوش-در

صورت پاره بودن پرده جمع آوری ترشحات به

کمک سواپ

فوری-دمای اتاق ساعت در دمای 6اتاق

BA-CA-MACقبل از درمان

استفاده از محيط تايو

گرم استفاده از محيط بی هوازی جهت

نمونه های تيمپانو سنتزيس

خارجی سواپ مرطوب شده با محيط استوات يا

آميس

پوسته ها به کمک سالين استريل پاک

گردد

سواپ داخل مجرای گوش محکم چرخانده شود

ساعت2 4تادمای اتاق

ساعت24تا دمای اتاق

BA-CA-MAC گرم

چشمملتحمه سواپ مرطوب شده

با محيط استوات يا آميس

نمونه گيری از هر دو چشم-استفاده از سواپ مرطوب شده با سالين

استريل

ساعت2 4تادمای اتاق

ساعت24تا دمای اتاق

BA-CA-MAC گرم ،آکريدين نارنجي رنگ آميزی های

هيستولوژيک(نظير گيمسا)

QUESTION