User talk:Geetanjali Murari

SOP for Blood sample collection
Table of Contents 1.	Purpose	3 2.	Scope	3 3.	Responsibilities	3 4.	Obtaining Samples	3 4.1	Requirements…………………………………………………………………….3 4.2	Details……………………………………………………………………………..3 4.3	Personnel…………………………………………………………………………3 4.4	Health and Safety……………………………………………………...................3 5.	Materials and Equipments required	4 6.	Precautions	4 7.	Procedure……………………………………………………………………………..4 7.1	Specimen collection…………………………………………………....................4 7.2	Skin puncture……………………………………………………………….........4 7.3	Venipuncture……………………………………………………………………..5 8.	Testing………………………………………………………………………………...5 9.	Different types of Blood Glucose Test……………………………………………....6 10.	Safebox instructions…………………………………………………………….........7 11.	Timing of Sample Delivery………………………………………………………......8 12.	Sample Transport…………………………………………………………................9 13.	Sample Storage……………………………………………………………….............9 14.	References………………………………………………………………………….....9

1. Purpose: 1.1 This SOP describe the step-by-step method to obtain peripheral blood samples from adults needed for laboratory testing, with proper specimen identification and handling, while ensuring patient and staff safety. 1.2 Proper collection of an appropriate clinical specimen is the first step in obtaining an accurate laboratory diagnosis of an infectious disease.

2. Scope: 2.1 The sample will be collected in the area specified for sample collection having appropriate table and chair with arm rest. 2.2 The sample will be sent to the laboratory for specified tests.

3. Responsibilities: 3.1 Laboratory / Center staff is responsible for the collection of samples according to this document. 3.2 Officer / center incharge is responsible to implement this SOP by providing the SOP specific training and thereafter by inspections.

4. Obtaining samples 4.1 Requirements prior to collection • Bloods should be taken at the end of the last imaging session. • Sample tubes should be labelled with the bar-code prior to blood collection. 4.2 Details to be recorded: • Samples collected (i.e. blood [which tubes and how many and in which order]). • Date and time the samples were taken (blood). Name, Address and Contact no of the subject • Last time the subject consumed food/drink. 4.3 Personnel 1. Appropriate staff to undertake venepuncture may include: 2. Research Nurse/ Practitioners 3. Clinical Research Fellows 4. Members of clinical staff trained to take blood, including doctors and nurses on the unit. Practitioners taking blood should be GCP trained and on the delegation log to take blood samples. They should have sufficient experience and training according to local research governance procedures. 4.4 Health and Safety 1. Standard precautions are required. Always wear gloves and white apron when handling blood samples. 2. Refer to the risk assessment, hazard data sheets and the Departmental policy at your site for additional safety information.

5. Materials and Equipment Required: 	 Disposable gloves 	 Alcohol swabs, isopropyl alcohol / spirit 	 Tourniquet 	 Vacutainer specimen tubes 	 Vacutainer holders 	 Appropriate size sterile disposable needles. 	 Cotton balls/swabs 	 Sharps disposal container 	 10%household bleach 	 Markers 	 Refrigerator 	 Centrifuge Machine

6.Precaution: taken before collecting blood sample 	Hand washing to be undertaken as per infection control guidelines. 	 Unsterile gloves to be worn when undertaking the procedure. 	The patient washes/cleanse their hands to remove any possible contaminates that may affect the blood test result. Washing with warm water is best (no soap or alcohol wipes). It is essential that the patient’s hands are dry. 	 Prepare the equipment in accordance with the manufacturer’s guidelines. 	 Ensure the test strips are correct, in date and match the calibration on the 	 meter. 	Only use a single use lancet e.g. Unistix/Accu-chek Safe-T-Pro Plus. 	Do not use thumb or index finger. 	Do not squeeze the finger - ‘milk’ the finger instead.

7. Procedure:- 7.1 Specimen collection 	Most hematology tests use liquid ethylenediaminetetraacetic acid (EDTA) as an anticoagulant. 	Tubes with anticoagulants should be gently but completely inverted end over end 7 to 10 times after collection. This action ensures complete mixing of anticoagulants with blood to prevent clot formation. Even slightly clotted blood invalidates the test, and the sample must be redrawn.

7.2 Skin Puncture Capillary blood is preferred for a peripheral blood smear and can also be used for other hematology studies.

Collection Procedure 	Observe standard Operational Guidelines and Precautions. 	Obtain capillary blood from fingertips or earlobes (adults) or from the great toe or heel (infants). 	Disinfect puncture site, dry the site, and puncture skin with sterile disposable lancet no deeper than 2 mm. 	Wipe away the initial drop of blood. 	Collect subsequent drops in a microtube or prepare a smear directly from a drop of blood.

Patient Intervention Procedure 	Instruct patient about purpose and procedure of test. 	Inform patient that mild discomfort may be felt when the needle is inserted. 	Ensure that there is no bleeding from the site. 	Apply small dressing or adhesive strip to cover. 	Slightly pressure the site if it continues to bleed. 	Evaluate patient's medication history for anticoagulation or acetylsalicylic acid (ASA)-type drug ingestion.

7.3 Venipuncture Procurement of larger quantities of blood for testing is done through Venipuncture. The antecubital veins are the veins of choice because of ease of access and the blood values remain constant no matter which venipuncture site is selected, so long as it is venous and not arterial blood.

Collection Procedure 	Use a tourniquet on the upper arm to produce venous congestion. 	Tell patient to close the fist in the designated arm and select an accessible vein. 	Disinfect puncture site, dry the site, 	Puncture the vein according to accepted technique. 	Usually, for an adult, anything smaller than a 21-gauge needle might make blood withdrawal more difficult. 	Blood will fill vacuum tubes automatically because of negative pressure within the collection tube. 	Remove the tourniquet before removing the needle from the puncture site. 	Remove needle. Apply pressure and put a sterile dressing strip on the site. Note that even slightly clotted blood invalidates the test and the sample must be redrawn.

Patient Intervention Procedure 	Instruct patient about purpose and procedure of test. 	Inform patient that mild discomfort may be felt when the needle is inserted. 	Place the arm in a fully extended position with palmar surface facing upwards. 	Ensure that there is no bleeding from the site. 	Apply small dressing or adhesive strip to cover. 	Slightly pressure the site if it continues to bleed. 	Sometimes patient may become dizzy, faint, or nauseated during the venipuncture. The phlebotomist must be constantly aware of the patient's condition. If a patient feels faint, immediately remove the tourniquet and terminate the procedure. If the patient is sitting, lower the head between the legs and instruct the patient to breathe deeply. A cool, wet towel may be applied to the forehead and back of the neck, Call the physician immediately when you feel something strange or if the patient faints. 8.Testing A blood sugar test is taken as a diagnostic tool for diabetes testing. This test is carried out in different ways – 	You may be required to fast for at least 14 hours beforehand. 	You don't have to fast. Blood samples are taken randomly several times during the course of the day. 	You are given a drink containing high levels of glucose and blood samples are taken and checked at regular intervals for two hours.

9.Diffrent of types Blood Glucose Test 9.1 Fasting Blood Glucose Test A fasting blood glucose test — also called a fasting plasma glucose, or FPG test measures blood glucose levels after you've gone without food for at least eight hours. It's reliable, and the results aren't affected by your age or the amount of physical activity you do. Many doctors prefer the fasting plasma glucose test because it's easy, fast and inexpensive. 9.2 Postprandial glucose test A postprandial glucose test is a blood glucose test that determines the amount of a type of sugar, called glucose, in the blood after a meal. Glucose comes from carbohydrate foods. It is the main source of energy used by the body. Normally, blood glucose levels increase slightly after eating. This increase causes the pancreas to release insulin, which assists the body in removing glucose from the blood and storing it for energy. People with diabetes may not produce or respond properly to insulin, which causes their blood glucose to remain elevated. Blood glucose levels that remain high over time can damage the eyes, kidneys, nerves, and blood vessels. A 2-hour postprandial blood sugar test measures blood glucose exactly 2 hours after eating a meal. By this point blood sugar has usually gone back down in healthy people, but it may still be elevated in people with diabetes. Thus, it serves as a test of whether a person may have diabetes, or of whether a person who has diabetes is successfully controlling their blood sugar.

9.3 Random Blood Glucose Test Random glucose test is a blood sugar test taken from a non-fasting subject. In general, this can be determined from the few drops of blood obtained from a simple fingerstick, but your doctor may take blood from a vein in your arm. In general, this can be determined from the few drops of blood obtained from a simple fingerstick, but your doctor may take blood from a vein in your arm. A healthy blood glucose level is between 70 and 110 milligrams per deciliter (mg/dL). According to the guidelines of the American Diabetes Association, diabetes is diagnosed if the level is above 200 mg/dL in a random test, and the person has symptoms of diabetes. 9.4 Glucose Tolerance Test The test is used to determine whether the body has difficulty metabolising intake of sugar/carbohydrate. The patient is asked to take a glucose drink and their blood glucose level is measured before and at intervals after the sugary drink is taken. 10. SAFEBOX INSTRUCTIONS WARNING: Do not close the Safebox lid until all the contents are inside the package as packaging cannot be re-opened. 1. Samples must be in a 4.7mls EDTA tube. If there is a circumstance where you need to send more than one sample of blood in the same box, be please aware that no more than 3 samples (6 EDTA tubes) can be sent per Safebox. 2. Label the tubes clearly centre with patient study number, and date and time of sample collection. 3. Place the tubes in the absorbent white material, place in the plastic bag, seal the bag and then place in the clear plastic compartment 4. In the adjacent compartment within the safebox, place the blood taking & patient documentation form. Ensure the correct forms are placed with the matched blood samples. 5. Please ensure that all contents are inside the package before closing. Once the package has been closed it cannot be reopened without destroying it. 6. Remove the cardboard separator and place the lid over the top of the container and firmly press shut. 7. Peel the outer backing from the label and wrap around the Safebox. 8. Please ensure the outside of the SAFEBOX is clearly labelled with the name and address of the person responsible at site for sending the samples with a contact telephone number.

11. TIMING OF SAMPLE DELIVERY 1. Samples should ideally be sent as soon as they are obtained in the SAFEBOX described above. 2. If samples cannot be sent immediately then they can be stored at ambient temperature for up to one week before sending. 3. Once samples are safely secured inside the SAFEBOX, please alert the Study Co-ordinator (Clare Shakeshaft – c.shakeshaft@ucl.ac.uk) at the chief site of their impending arrival so arrangements can be made to store the samples.

12. Sample transport Samples should be sent every three months or when you have a sufficient number of samples and packaged appropriately with sufficient dry ice to ensure samples do not thaw and packaged in a manner that prevents breakage or leakage.

13. Sample storage 13.1 General guidelines For immediate storage, aliquoted samples and EDTA tubes for DNA need to be labelled with subject identifier, date of sample collection, visit number and sample type (e.g. serum, plasma), and assigned box numbers to aid location in the freezers.

13.2 Blood sample • Frozen at -20ºC (Short term storage) -80ºC (long term Storage)

13.2.2 Plasma •Frozen at -20ºC (Short term storage) -80ºC (long term Storage)

References: 1.	Protocol for the Collection of Venous Blood Samples from Study Volunteers using a Venous Catheter, University of Waterloo Human Research Ethics Committee Standard Operating Procedures uwhsop205 2.	Vinik, A., T. Erbas, T. Park, R. Nolan and G. Pittenge, 1 levels in the pre-dialysis stage were associated with 2001 3.	SOP, FAO Corporate Document Repository. 4.  Elalamy, I., T. Chakroun, G. Gerotziafas, have reported that HbA1C was   significantly associated A. Petropoulou, F. Robert, A. Karroum, F. Elgrably, M. Samama and M. Hatmi, 2008. 5. Raèki, S., L. Zaputovi., B. Vujièi., Crnèevi.-Orli., Š. Dvornik and ð. Mavri., 2007. 6. Gabbianelli, R., G. Falcioni, C. Dow, F. Vince B. Swoboda, 2003 7. Michelson, A.,1996. Flow Cytometry,Blood, 87: 4925-4937. 8. Winocour, P., 1992. Diabetes, 41(2): 26-31.Middle-East J. Sci. Res., 6 (6): 612-616, 2010, 616 8. Ishimura, E., S. Okuno, K. Kono, Y. Fujino-Kato, 9. Henry, M., L. Davidson, Z. Cohen, P. McDonagh,Y. Maeno, S. Kagitani, N. Tsuboniwa et al., 2009. P. Nolan and L. Ritter, 2009. 10. Okada, T., T. Nakao, H. Matsumoto, T. Shino, Y. Asano, A. Saito et al., 2007. Diabetes, glycaemic Y. Nagaoka, R. Tomaru et al., 2007. Diabetologia, 50: 1170-1177. 10. Cho, N., D. Becker, D. Ellis, L. Kuller, 11. Siljander, P., O. Carpen and R. Lassila, 1996. Complications, 23: 89-94. 12. Cromis-2 SOP for Blood sample collection.

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