I. Methods of venous blood collection, precautions and safe disposal of materials used for sample collection
1. Tourniquet or pulse depressor: When collecting venous blood, the tourniquet should not be used for too long a period of time to compress the vein, and it should be suitable for not more than 40 seconds, otherwise, it will easily lead to bruising, venous dilatation, and affect the results of certain indexes, such as the increase of lactic acid, the decrease of pH value, the increase of K+, Ca2+, creatine kinase, and so on. Otherwise, it may cause bruising, venous dilatation, and affect the results of certain indicators, such as lactic acid elevation, lower pH value, K +, Ca 2 +, creatine kinase elevation, and so on.
2, blood collection time and location: most of the laboratory tests require early morning, fasting, collection of venous blood should be avoided as far as possible at the same time as the transfusion of blood, transfusion not only makes the blood dilution, but also on the laboratory results of the occurrence of serious interference, in particular, blood glucose and electrolytes.
3, to avoid hemolysis, impurity pollution: blood collection instruments must be sterile, dry, clean. Avoid particularly hard suction and injection, avoid chemical pollution and bacterial pollution caused by hemolysis. Because some components of red blood cells and serum (plasma) is different, sample hemolysis can make some components of red blood cells released, affecting the results of laboratory tests.
4, the collection of blood samples: blood samples are required to be collected at the same time each day, the ideal time is 7:00 to 8:00 in the morning, especially for monitoring purposes, it is more important to ensure that the specimen collection time is uniform. The last food and fluid intake should be between 6:00 p.m. and 7:00 p.m. the day before (except for emergency testing). Blood samples should be collected during periods when medications are not being taken, such as in the morning before taking them. Blood samples should be collected with the patient in the supine position and in the same vein, usually the arm vein.
5. The specimen should be sent for examination immediately after collection, and placed for too long to affect the test results. When the blood collection is not smooth, do not repeatedly puncture in the same place, easy to lead to hemolysis of the specimen or a small clot, affecting the test results.
6, the collection of blood culture specimens should be injected first anaerobic vials, minimize exposure to air time.
7, trace element determination of specimen collection syringe and container can not contain free metal.
8, the collection of samples used in the safe disposal of materials: after the use of blood collection needles, syringe needles and other sharp objects should be placed directly into the sharps box can not be pierced or destroy the type of device for safe disposal, it is prohibited to use the disposable needle recapitulation, prohibit direct contact with the hands of the used needles, razor blades and other sharp objects; syringe cartridges, swabs, and other medical wastes into the yellow medical waste bag, the medical waste and household waste are collected and stored separately. Medical waste and domestic garbage are collected and stored separately. After disinfection and disfigurement of medical waste must be handed over to the designated medical waste treatment plant, and shall not be abandoned without authorization.
Second, clinical chemistry/immunoassay specimens
Clinical chemistry/immunoassay mostly non-anticoagulant blood specimens, the best use of vacuum negative pressure blood collection tube.
The main precautions for specimen collection are:
1, most of the chemical items need to be fasting venous blood collection, a number of single chemical test items combined test can generally be taken tube blood;
2, the amount of blood collected depending on the number of different items of the test, usually 4.0-5.0ml;
3, a number of combination of test items at the same time blood should be taken in accordance with the following The order of blood collection should be as follows:
Blood culture --- coagulation tube without additives --- tube with additives
The order of tube with additives is as follows: citrate tube --- heparin tube --EDTA tube -- oxalate/sodium fluoride tube
4. Whether it is anticoagulated or non-anticoagulated blood, in order to shorten the contact time between serum or plasma and blood cells, the serum or plasma should be separated from whole blood as early as possible after the blood specimen is collected to avoid the impact of the test on the blood. Separate the serum or plasma from the whole blood as early as possible after collection of the blood specimen to avoid affecting the accuracy of the test results. From the beginning of blood specimen collection, whole blood must be processed into serum or plasma within 2h.
1) serum (non-anticoagulated blood): after blood collection, the specimen can completely coagulate by itself (spontaneous) after 15-30min at 22-25℃ (room temperature), and it is forbidden to peel off the clots with a wooden stick and a glass rod, etc. The coagulation of refrigerated specimens is slower, and is accelerated by adding procoagulants.
2) plasma (anticoagulant): blood should be collected by anticoagulant tubes, immediately after blood collection, mix 5-10 times upside down, and centrifugation can be used to separate plasma within a few minutes after blood collection.
3) Refrigerated specimens: used to stabilize the temperature-dependent components of blood (inhibition of cellular metabolism) test items, the specimen in 2 ~ 8 ℃ refrigeration (specimens immediately after the collection of the refrigerator, refrigeration must be sufficient); specimens need to be refrigerated for the determination of the following items: catecholamines, gastrin, parathyroid hormone, PH / blood gases, NH3, lactic acid, pyruvic acid and so on. Whole blood specimens are generally not refrigerated, potassium specimens shall not be refrigerated >2h. Whole blood specimens should not be frozen.
4) the application of metabolic inhibitors and preservatives: used to inhibit cellular metabolism. After adding sodium fluoride to the blood specimen, the blood cells were not
Separation of blood specimens in the Glu, 22 ~ 25 ℃ stable 24h.2 ~ 8 ℃ stable 48h; sodium fluoride is not suitable for newborns and children's Glu determination (due to the children's PCV is high, it is difficult to control the cellular glycolysis); sodium fluoride, a muscimol mixture is not suitable for enzyme detection (due to the sodium fluoride, a muscimol mixture of inhibition of enzyme activity)); formaldehyde oxalic acid mixture is not suitable for enzymatic testing (because of sodium fluoride a muscimol mixture inhibition of enzyme activity)); formaldehyde oxalic acid mixture is not suitable for enzymatic testing. activity)); potassium formaldehyde oxalate anticoagulant preservative is not suitable for blood glucose assays.
Third, the erythrocyte sedimentation rate (ESR) test specimen
Intravenous collection of sodium citrate (109 mmol / L, or 32.06 g / L) anticoagulant blood (sodium citrate anticoagulant tube blood collection), the black cap tube.
Precautions for blood collection:
1. Collect 1 tube of blood individually, and prepare to collect blood to the 2 ml mark (anticoagulant: whole blood=1:4);
2. Mix the blood 5~10 times by turning up and down immediately after blood collection;
3. Send the blood to the hospital for testing as soon as possible after blood collection (the test must be performed within 2h).
Fourth, blood routine (whole blood cell analysis) test specimens
The general use of EDTA 1.5 ~ 2.2mg / ml anticoagulation (EDTA anticoagulation blood collection tube - purple cap tube).
Precautions for blood collection:
1. Immediately after blood collection, mix up and down upside down, 5 to 10 times. Do not shake;
2, should be in accordance with the anticoagulant tube scale blood collection to 2 ml, can not be fasting;
3, blood collection should be sent to the examination as soon as possible (need to observe the morphology of the specimen microscope should be pushed in time to fix the specimen after the blood collection, because more than 2 hours the WBC morphology will be changed);
4, the blood type and blood can be collected in a tube of blood.
V. 75-g glucose tolerance test (OGTT)/insulin release test/C-peptide release test
1. Patient preparation: 3 days before the test, the amount of carbohydrates should not be less than 250-300 grams per day and normal activities should be maintained, and drugs affecting the test (e.g., oral contraceptives, salicylates) should be stopped 3 days before the test. Drugs affecting the test (eg: oral contraceptives, salicylates, etc.) should be discontinued 3 days before the test, and the patient should not eat for 10 to 16 hours before the test.
2, specimen collection: the common clinical method is to draw fasting blood in the early morning, 75 grams of glucose orally, and then 0.5, 1, 2, 3 hours after the sugar each 2ml / 1 time (*** 5 times).
3. Specimen preservation: Separate the serum within 1 hour after blood collection and send it to the hospital for examination or use the special anticoagulation tube for blood glucose to collect the blood, and store it at 2～8℃.
4. Precautions: Insulin measurement is greatly affected by hemolysis, and hemolysis should be avoided during blood collection.
6, hypertension series test specimens
1, hypertension three (renin, angiotensin I, II)
1) patient preparation: β-blockers, vasodilators, diuretics and steroid hormones, licorice and other impact on the body's level of renin, generally to be measured in the 2 weeks after the cessation of drugs Renin Activity (PRA), Lipitor and other slow metabolism. In general, PRA should be measured at 2 weeks after stopping the drug, and slow metabolizing drugs such as reserpine should be measured at 3 weeks after stopping the drug. Patients who should not discontinue the drug should be switched to antihypertensive drugs such as guanethidine, which have less effect on PRA. Sodium intake affects the PRA level, so patients should reduce salt intake 3 days before PRA measurement, and it is best to measure the urinary sodium content 24 hours before blood sampling for reference when analyzing PRA results;
2) Specimen collection: 4-5 ml of blood was taken from the vein, and injected slowly into a special anticoagulation tube after removing the needle, capping the stopper and turning it up and down for 5 times, mixing, and centrifuging for 5-10 minutes at 2500 rpm. After mixing, centrifuge for 5-10 minutes at 2500 rpm, then separate the plasma and put the plasma into a special plasma tube and send it to the laboratory at low temperature. If the plasma cannot be sent for testing immediately, it should be frozen as soon as possible (-15℃). Hemolyzed specimen can not be detected;
3) Specimen type, specimen volume: special anticoagulation tube blood collection, separation of plasma, take 2 ml of delivery;
4) specimen preservation: low-temperature refrigerator preservation (-15 ℃ or less), can be stored for 2 months;
5) Precautions: the application form should indicate the position of the body when the blood is drawn (prone: the patient in the morning before getting up from 6-8 a.m. to get venous blood; standing position: the patient gets up to the floor to get the blood). The application form should indicate the position in which the blood was drawn (lying position: before the patient woke up at 6-8 am, venous blood was taken; standing position: 3 hours after the patient woke up and moved around, venous blood was taken.) The results can be affected by the lack of timely separation of plasma, repeated freezing and thawing of the specimen, hemolysis, improper preservation, and the use of expired anticoagulant tubes.
2, aldosterone
1) patient preparation: before leaving the sample should stop taking diuretics for at least 3 weeks, stop taking antihypertensive drugs for 1 week;
2) specimen collection: plasma aldosterone determination should be used to heparin anticoagulation, plasma is separated immediately after the collection, and stored at -20 ℃ for measurement; urine specimens are retained in the 24 hours of urine, and preserved in 10-15mL of concentrated hydrochloric acid;
3) the application of the application of the plasma anticoagulation, the plasma is separated immediately after the collection, and stored at -20℃ for measurement. p>
3) The application form should indicate: the position (lying, standing) and diet (general diet, low-sodium diet) at the time of blood sampling; the urine specimen should be accurately recorded 24-hour urine volume.
VII. Cortisol specimen collection and precautions
Normal human cortisol secretion exists in a circadian rhythm, usually 8:00 a.m. or 4:00 p.m. blood collection, please be sure to specify the time of collection of blood in the application form when you send the test.
VIII. Specimen collection and precautions for flow cytometry test
1, lymphocyte subpopulation series
Specimen requirements: 2ml of whole blood anticoagulated with EDTA or heparin (EDTA anticoagulation is recommended)
Note: The reference value of the cell count of this series of items in different age groups varies.
2, leukemia immunophenotyping
Specimen requirements: heparin anticoagulated bone marrow or whole blood 2 ml
Note: Please use the special application form for leukemia immunophenotyping.
3, human leukocyte antigen B27 test (HLA-B27) / paroxysmal sleep hemoglobinuria (PNH) test specimen requirements: EDTA or heparin anticoagulation of whole blood 2 ml Note: to ensure that the specimen is fresh, the flow cytometry testing program needs to be sent within 24 hours of the test.
9, trace element test specimen collection requirements
1, all blood collection personnel should be rigorously trained and familiar with the process of blood collection, and know the impact of operating techniques on the quality of trace elements (especially lead and zinc) testing.
2, blood collection personnel should wear latex or polyethylene gloves, if the gloves are coated with powder, you need to use venous blood collection skin cleaning method to deal with the gloves after operation.
3. When collecting blood for blood lead test, use 0.2% nitric acid, pure water, iodine and alcohol to clean the skin of the blood collection area in order to prevent environmental contamination of blood lead test.
4. Rubber plugs are contaminated with zinc, so ordinary blood collection tubes can not be used, please use the special tubes provided by the center.
5. Collection method: collect 0.5-1.0mL of venous blood, gently invert and mix immediately after collection, stick on the barcode, and put it into a self-sealing bag for inspection.
6. If the blood can not be sent for testing in time, it should be placed in the refrigerator at 2-8℃ for storage.
7, the specimen coagulation or containing clots, can not be detected.
X. Genetic testing specimen collection requirements
1, specimen collection: peripheral blood specimens can be used in the center of distribution of heparin anticoagulant tubes (genetics-specific) and blood collection needles for the collection of the collection of the collection of the tube immediately after the collection of the test tube gently upside down mixing, so as to avoid coagulation; umbilical cord blood specimens, bone marrow specimens can be in the success of the puncture, open the center of distribution of heparin anticoagulant tube cap, the blood collection needle to the center of distribution. After successful puncture, open the cap of the heparin anticoagulation tube and inject the cord blood or bone marrow into the collection tube, and immediately mix the tube gently upside down to avoid coagulation, please pay attention to the aseptic operation and do not contaminate the cap of the tube. Please avoid using a syringe to collect specimen and then inject it directly into the collection tube to avoid hemolysis; please do not use EDTA or other anticoagulant tubes to collect specimen.
2. Specimen volume: 4 ml each of peripheral blood, umbilical cord blood, and bone marrow;
3. Specimen delivery: Qualified specimens should be delivered to the Genetic Laboratory the same day of the blood collection, so please notify Adicon staff to receive the specimens in a timely manner after the specimens are collected; hemolysis and coagulation of specimens are considered to be unqualified specimens. Bone marrow specimens should be sent to the laboratory as soon as possible.
4. Preservation of specimen: The specimen should be preserved at 18～25℃ after collection, and should not be frozen or placed in a high temperature environment.
5. Application form: Please fill in the application form completely, especially the time of specimen collection, gender, medical history and clinical diagnosis.
XI, genetic testing specimen collection requirements
1, all for genetic diagnosis 'specimens must be retained in sterile tubes or containers, the use of heparin anticoagulant tubes is strictly prohibited, the collection of specimens to pay attention to the aseptic operation.
2, in order to avoid contamination, send the genetic diagnosis specimen project need to be a single person, a single project, a single tube.
3. Collection methods:
1) Blood specimen
Draw the patient's venous blood, put it into a sterile test tube for natural coagulation at room temperature or centrifuge it at 2000 rpm, and then take the separated EDTA-anticoagulated plasma/serum and send it to the laboratory for examination;
2) Women's secretion specimen
1) Sampling of secretion specimen should be carried out in the non-menstrual period; no use of intravaginal medication within 3 days before the sample is collected; no use of intravaginal medication within 3 days before sampling. (2) When collecting the specimens, first use a cotton swab to gently wipe away the excessive secretions from the cervical or urethral opening, replace the cotton swab, extend the cotton swab into the cervix, pass through the epithelial junction, and rotate it for 3-5 weeks to ensure that a larger number of columnar epithelial specimens are obtained, and try to collect as much as possible of the lesion for the patients who are suspected to have HPV infection, which can increase the number of HPV specimens. For patients with suspected HPV infection, try to collect as many lesions as possible, which can improve the detection rate of HPV. Put the cotton swab after sampling into the supporting hose and tighten the cap;
(3) male secretion specimen: clean the urethral orifice first, extend the cotton swab into the male urethra for 1cm, rotate it for 3-5 times to obtain the specimen, and then put the swab into the supporting hose and tighten the cap;
(4) herpes fluid or wart specimen: for the genitals or perianal area, there are warts, and warts are suspected. Warts: For genital or perianal warts, it is advisable to collect warts directly and place them in the specimen tube for examination. Note: For wart specimens, it is necessary to write "warts" in the specimen type column on the application form.
4, specimen preservation: detection of the target nucleic acid for DNA specimens, can be stored in 2 ~ 8 ℃ for 3 days; detection of the target nucleic acid for RNA specimens, should be stored in -20 ℃.
XII, bone marrow examination requirements and precautions
1, smear requirements: two blood film, six bone marrow film, suspected of leukemia requires eight bone marrow film. The bone marrow blood film indicates "B", the bone marrow film indicates "M", to show the difference.
2. Notes on the application form:
1) Case summary: it should be filled out comprehensively, especially the symptoms related to blood diseases such as liver, spleen, lymph nodes, bleeding status, and the application of medication should be filled out clearly;
2) Laboratory results: the routine blood results must not be missing, and, if possible, the MCV, MCH, MCHC, and the classification of the same;
3) the results of the blood tests: the results of the routine blood tests must not be missing;
4) the results of the blood tests must not be missing;
5) the results of the blood tests must not be missing. p>
3) the site of taking bone marrow should also be filled in, if the bone marrow is not taken smoothly, it should be re-drawn so as not to delay the patient;
4) write down the contact information of the attending physician, such as departmental telephone number, cell phone number, etc. (in order to have close contact with the clinic).