Pengambilan Sampel

PENGAMBILAN SAMPEL DARAH UNTUK PEMERIKSAAN HEMATOLOGI KIMIA KLINIK DAN IMUNOSEROLOGI DARAH VENA Tujuan : mendapatkan spesimen darah vena tanpa anti koagulan yang memenuhi persyaratan untuk pemeriksaan kimia klinik dan imunoserologi Lokasi : – vena mediana cubiti ( dewasa ) -vena jugularis superficialis ( bayi ) Alat-alat : – kapas alkohol -diaspossible syringe / vacutainer 10 cc -Tabung reaksi pyrex 10 cc -kapas steril -plester Cara kerja : 1. Bersihkan daerah vena mediana cubiti dengan alcohol 70% dan biarkan menjadi kering kembali 2. Pasang ikatan pembendung/torniquit diatas fossa cubiti. Mintakan pasien yang akan diambil darahnya untuk mengepal dan membuka tangannya beberapa kali agar vena jelas terlihat. Pembendungan vena tidak boleh terlalu kuat . 3. Tegangkan kulit diatas vena dengan jari tangan kiri agar vena tidak bergerak 4. Tusuk kulit diatas vena dengan jarum/nald dengan tangan kanan sampai menembus lumen vena 5. Lepaskan pembendungan dan ambillah darah sesuai yang dibutuhkan 6. Taruh kapas diatas jarum/nald dan cabut perlahan 7. Mintakan agar pasien menekan bekas tusukan dengan kapas tadi 8. Alirkan darah dari syringe kedalam tabung melaluji dinding tabung 9. Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen DARAH EDTA Tujuan : mendapatkan spesimen darah EDTAbyang memenuhi persyaratan untuk pemeriksaan morfologi sel darah tepi dan hitung jumlah trombosit Lokasi : – vena mediana cubiti ( dewasa ) -vena jugularis superficialis ( bayi ) Alat-alat : – kapas alkohol -diaspossible syringe / vacutainer 10 cc -Tabung reaksi pyrex 10 cc/tabung EDTA -kapas steril -plester Reagensia : EDTA 10% Cara kerja : 1. teknis pengambilan darah serupa dengan pengambilan sample darah vena 2. darah yang telah diambil dialirkan kedalam tabung yang telah berisi EDTA 10% 3. Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen

DARAH SITRAT Tujuan : mendapatkan spesimen darah SITRAT yang memenuhi persyaratan untuk pemeriksaan laju endapan darah metode Weatergreen dan pemeriksaan tes hemoragik Lokasi : – vena mediana cubiti ( dewasa ) -vena jugularis superficialis ( bayi ) Alat-alat : – kapas alkohol -diaspossible syringe / vacutainer 10 cc -Tabung reaksi pyrex 10 cc -kapas steril -plester Reagensia : Natrium sitrat 3.8% Cara kerja : 1 teknis pengambilan darah serupa dengan pengambilan sample darah vena 2 darah yang telah diambil sebanyak 1.6 ml dialirkan kedalam tabung yang telah berisi natriumsitrat 3.8 % sebanyak 0.4 ml 3 Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen DARAH KAPILER Tujuan : mendapatkan spesimen darah kapiler yang memenuhi persyaratan untuk pemeriksaan golongan darah dan beberapa pemeriksaan rapid test imunologi Lokasi : – ujung jari tangan / anak daun telinga ( dewasa ) - tumit / ibu jari kaki ( bayi ) Alat-alat : – alcohol 70% - lancet steril -kapas steril -plester Cara kerja : 1. Bersihkan daerah yang akan di tusuk alcohol 70% dan biarkan menjadi kering kembali 2. Pegang bagian yang akan di tusuk supaya tidak bergerak dan di tekan sedikit agar rasa nyeri berkurang 3. Tusuk dengan cepat memakai lancet steril. Pada ibu jari tusukan tegak lurus dengan garis sidik jari. Bila memakai anak daun telinga tusukan dilakukan dipinggir bukan pada sisinya. Tusukan harus cukup dalam . 4. Buang tetes darah pertama keluar dengan memakai kapas kering. Tetes darah berikutnya dipakai untuk Pemeriksaan. PENGAMBILAN SAMPEL URINE UNTUK PEMERIKSAAN URINALISA Tujuan : mendapatkan spesimen urine yang memenuhi persyaratan untuk pemeriksaan urinalisa Waktu : pengambilan sebaiknya sebelum pemberian anti biotik. Untuk Pemeriksaan test kehamilan dan sedimen dipakai urine pagi hari. Alat-alat : wadah setril dari gelas/plastik bermulut lebar bertutut rapat, ukuran ± 50 ml Cara kerja : 1. Penderita diminta untuk mengeluarkan urine 2. Aliran urine ditampung dalam wadah yang sudah disediakan. 3. Hindari urine mengenai lapisan tepi wadah .

4. Setelah penampungan urine selesai wadah di tutup dengan rapat 5. Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen PENGAMBILAN SAMPEL TINJA UNTUK PEMERIKSAAN FESES RUTIN Tujuan : mendapatkan spesimen tinja/feses yang memenuhi persyaratan untuk pemeriksaan feses rutine Waktu : pengambilan dilakukan setiap saat, terutama pada gejala awal dan sebaiknya sebelum pemberian anti biotik. Alat-alat : – lidi kapas steril - pot tinja Cara kerja : 1. Penderita diharuskan buang air kecil terlebih dahulu karena tinja tidak boleh boleh tercemar urine 2. inntruksikan pada penderita untuk buang air besar langsung kedalam pot tinja ( kira kira 5 gram ) 3. tutup pot dengan rapat 4. Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen PENGAMBILAN SAMPEL SPUTUM UNTUK PEMERIKSAAN BASIL TAHAN ASAM (Mycobacterium tuberculosis) Tujuan : mendapatkan spesimen sputum yang memenuhi persyaratan untuk pemeriksaan pewarnaan basil tahan asam Waktu : diperlukan 3 kali pengambilan ssputum dalam 2 kali kunjungan, yaitu Sputum sewaktu (S), yaitu ketika penderita pertama kali dating; Sputum pagi (P) , keesokan harinya ketika penderita dating lagi dengan membawa sputum pagi ( sputum pertama setelah bangun tidur) Sputum sewaktu (S), yaitu saat penderita tiba di laboratorium.,penderita diminta mengeluarkan sputumnya lagi Alat-alat : – wadah setril dari gelas/plastik bermulut lebar bertutut ulir Cara kerja : 1. Berikan penjelasan pada penderita bagaimana cara membantukkan sputum yang baik yaitu : kumur- kumur lebih dahulu, tarik nafas 2 – 3 kali, tahan beberapa detik , kemudian batukkan kuat-kuat 2. Taruh wadah sputum dekat bibir dan masukkan sputum kedalamnya. 3. sputum yang baik adalah yang kental dan jumlahnya cukup 2 – 3 ml 4. tutup wadah sputum dengan rapat 5. Berikan label berisi tanggal pemeriksaan,nama pasien dan jenis spesimen CSF Analysis Also known as: Spinal fluid analysis Formal name: Cerebrospinal fluid analysis Related tests: Glucose, Total Protein, CBC (Complete Blood Count), Lactate, Protein Electrophoresis, Antibody Tests, AFB Smear and Culture, Blood Culture, Herpes, Lyme Disease, Rubella, Syphilis, West Nile Virus

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The Test Sample What is being tested? Cerebrospinal fluid (CSF) is a clear watery liquid filtrate that is formed and secreted by the choroid plexus, special tissue that has many blood vessels and lines the small cavities or chambers (ventricles) in the brain. CSF flows around the brain and spinal cord, surrounding and protecting them. It is continually produced, circulated, and then absorbed into the blood system. About 500 mL is produced each day. This rate of production means that all of the CSF is replaced every few hours. A protective blood-brain barrier separates the brain from circulating blood and regulates the distribution of substances between the blood and the CSF. It helps keep large molecules, toxins, and most blood cells away from the brain. Any condition that disrupts this protective barrier may result in a change in the normal level or type of constituents of CSF. Because CSF surrounds the brain and spinal cord, testing a sample of CSF can be very valuable in diagnosing a variety of conditions affecting the central nervous system (CNS). Though a sample of CSF may be more difficult to obtain than, for example, urine or blood, the results may reveal more directly the cause of CNS symptoms. For example, infections and inflammation in the meninges (called meningitis) or the brain (called encephalitis) can disrupt the blood-brain barrier and allow white and red blood cells and increased amounts of protein into the CSF. Meningitis and encephalitis can also lead to the production of antibodies. Immune diseases that affect the CNS, such as Guillain-Barré Syndrome, and multiple sclerosis can also produce antibodies that can be found in the CSF. Cancers such as leukemia can lead to an increase in CSF white blood cells (WBCs), and cancerous tumors can result in the presence of abnormal cells. These changes from normal CSF constituents make the examination of cerebrospinal fluid valuable as a diagnostic tool. CSF analysis usually involves an initial basic set of tests performed when CSF analysis is requested: CSF color, clarity and pressure during collection CSF protein CSF glucose CSF cell count CSF differential If infection is suspected, CSF gram stain and culture A wide variety of other tests may be ordered as follow-up depending on the results of the first set of tests. The specific tests that are ordered may also depend on the signs and symptoms of the patient and the disease the doctor suspects is the cause. Each of these tests can be grouped according to the type of exam that is performed: Physical characteristics —includes measurement of the pressure during sample collection

and the appearance of the CSF. Chemical tests —this group refers to those tests that detect or measure the chemical substances found in spinal fluid. CSF is basically an ultafiltrate of the blood, so it can also be affected by what is going on in the blood. Normally, certain constituents of CSF such as protein and glucose are a percentage of blood levels, so CSF levels are often evaluated in relation to blood levels. Microscopic examination (Cell count and differential)—any cells that may be present are counted and identified by cell type under a microscope. Infectious disease tests —numerous tests can be done to detect and identify microorganisms if an infection is suspected. How is the sample collected for testing? A sample of cerebrospinal fluid (CSF) is collected by a doctor from the lower back using a procedure called a lumbar puncture or spinal tap. Often, three or more separate tubes of CSF are collected, and multiple tests may be run on the different samples. NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests. Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample? The patient should empty their bladder and bowels prior to the sample collection. It will be necessary to lie still in a curled-up fetal position during the test and to lie quietly for a time period after the collection. How is it used? Cerebrospinal fluid (CSF) analysis may be used to help diagnose a wide variety of diseases and conditions affecting the central nervous system (CNS). They may be divided into four main categories: Infectious diseases such as meningitis and encephalitis—testing is used to determine if the cause is bacterial, tuberculous, fungal or viral, and to distinguish it from other conditions; may also be used to detect infections of or near the spinal cord or to investigate a fever of unknown origin. Bleeding (hemorrhaging) within the brain or skull Diseases that cause inflammation or other immune responses such as antibodies—these may include autoimmune disorders such as Guillain-Barré syndrome or sarcoidosis or diseases that cause the destruction of myelin such as multiple sclerosis Tumors located within the CNS (primary) or metastatic cancer

Procedure Before the actual procedure, a local anesthetic is sometimes given to relieve the pain when inserting the needle used to withdraw the fluid. A needle is usually inserted through the mother's abdominal wall through the wall of the uterus into the amniotic sac. With the aid of ultrasoundguidance, a physician aims towards an area of the sac that is away from the fetus and extracts approximately 20ml of amniotic fluid for testing. The puncture heals, and the amniotic sac replenishes the liquid over a day or so. After the amniotic fluid is extracted, the fetal cells are separated from it. The cells are grown in a culture medium, then fixed and stained. Under a microscope the chromosomes are examined for abnormalities. The most common abnormalities

detected are Down syndrome, Edward syndrome [Trisomy 18] and Turner syndrome [Monosomy X]. Amniocentesis is most safely performed after the 14th-16th week of pregnancy, does not need to be done before then due to risk it can do to the babys limbs. Usually genetic counseling is offered prior to amniocentesis.

[edit] Risks Although the procedure is routine, possible complications include infection of the amniotic sac from the needle, and failure of the puncture to heal properly, which can result in leakage or infection. Serious complications can result in miscarriage. Other possible complications include preterm labor and delivery, respiratory distress, postural deformities, fetal trauma and alloimmunisation (rhesus disease). Studies from the 1970s originally estimated the risk of amniocentesis-related miscarriage at around 1 in 200 (0.5%).[2] A more recent study (2006) has indicated this may actually be much lower, perhaps as low as 1 in 1,600 (0.06%).[2] In contrast, the risk of miscarriage from chorionic villus sampling (CVS) is believed to be approximately 1 in 100, although CVS may be done up to four weeks earlier, and may be preferable if the possibility of genetic defects is thought to be higher [3].

Amniocentesis and stem cells Recent studies discovered that in amniotic fluid there are a lot of multipotent stem cell, mesenchymal, hematopoietic, neural,epithelial and endothelial stem cell[1][2][3]. A potential benefit of using amniotic stem cells over those obtained from embryos is that they side-step ethical concerns among pro-life activists by obtaining pluripotent lines of undifferentiated cells without harm to a fetus or destruction of an embryo. Artificial heart valves, working tracheas, as well as muscle, fat, bone, heart, neural and liver cells have all been engineered through use of amniotic stem cells [4]. Tissues obtained from amniotic cell lines show enormous promise for patients suffering from congenital diseases/malformations of the heart, liver, lungs, kidneys, and cerebral tissue

Rujukan http://en.wikipedia.org/wiki/Amniocentesis