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LABORATORY BOTTLES/ INTRAVENOUS FLUIDS

LABORATORY BOTTLES/ INTRAVENOUS FLUIDS. Shobanjo Ibrahim Showunmi Felix Onayemi Oluwaseye. OUTLINE. Introduction Classification Types and international colour coding of laboratory bottles Uses of laboratory bottles Precautions while using laboratory bottles. OUTLINE cont.

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LABORATORY BOTTLES/ INTRAVENOUS FLUIDS

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  1. LABORATORY BOTTLES/ INTRAVENOUS FLUIDS Shobanjo Ibrahim Showunmi Felix OnayemiOluwaseye

  2. OUTLINE • Introduction • Classification • Types and international colour coding of laboratory bottles • Uses of laboratory bottles • Precautions while using laboratory bottles

  3. OUTLINE cont. • Classification of intravenous fluids • Composition of intravenous fluids • Indications for intravenous fluids • Contraindications for intravenous fluids • Conclusion

  4. INTRODUCTION

  5. CLASSIFICATION • Hematology Ethylene diamine tetra acetic bottle Plain bottles • Chemical pathology Lithium heparin bottle Fluoride oxalate bottle • Microbiology Sterile universal bottle • Histopathology Containers with fixatives

  6. TYPES AND INTERNATIONAL COLOUR CODING OF LABORATORY BOTTLES The following are various types of laboratory bottles and their functions; • FLOURIDE OXALATE BOTTLE • LITHIUM HEPARIN BOTTLE • EDTA [Ethylenediaminetetraacetic acid] BOTTLE • PLAIN SPECIMEN BOTTLE • STERILE UNIVERSAL BOTTLE

  7. FLOURIDE OXALATE BOTTLE COLOUR- GREY Mechanism of action Flouride inhibit enolase enzyme in glycolytic pathway preventing preventing red blood cell utilization and thus further depletion of glucose in the sample. Oxalate chelates calcium.

  8. Function • To collect sample or specimen for sugar analysis example a].Blood sample for fasting and random blood sugar estimation in conditions like diabetes mellitus ,protein energy malnutrition,severemalaria,IDM,neonatalseizure,neonatalhypoglycaemia,post term and LGA neonates,childhood poisoning. b].In meningitis for interpretation of csf sugar c].suspected inborn errors of metabolism d].serous fluid like pleural effusion,pericardialeffusion,ascitic fluid.

  9. LITHIUM HEPARIN BOTTLE • COLOUR- GREEN Mechanism of action Anticoagulant is lithium salt of heparin. Heparin acts by potentiating effect of antithrombin III that inhibits factors IX,X,XI and XII and protein C and S. Heparin is the best anticoagulant because it does not produce any change in composition of blood.

  10. Function To collect sample for the following analysis; a].Electrolyte analysis such as chloride,sodium b].Urea and creatinine measurement c].Total protein and albumin estimation d].Uric acid measurement e].Hormonal assays f].Csf proteins and ions

  11. EDTA[Ethylene diaminetetraaceticacid] BOTTLE COLOUR- PURPLE OR LAVENDER Mechanism of action Anticoagulant is sodium or potassium salt of EDTA.EDTA chelates calcium making it unavailable to participate in coagulation reactions

  12. Function For haematological investigations like; a].Full blood count b].Packed cell volume c].Erythrocyte sedimentation rate d].Blood film for malaria parasite e].Reticulocytecount f].peripheral blood smear g].clotting profile h].Hb electrophoresis(HB genotype)

  13. PLAIN BOTTLE COLOUR- WHITE Mechanism of action Contains no anticoagulant,serum obtained from blood in it after 2-7minutes

  14. Function To collect blood sample for; a].Blood grouping and cross matching b].Coomb’s test c].serum protein electrophoresis d].Bilirubin (Total and conjugated bilirubin in neonatal jaundice) e].Antibody assay(immunoglobin assay) f].Enzymes assay example aspartatetransaminase,alaninetransaminase

  15. STERILE UNIVERSAL BOTTLE COLOUR- RED Contains no anticoagulant

  16. FunctionS To collect sample for microbiological investigations; a].Blood for veneral disease research laboratory test,filarialworms,flukes,hepatitis B surface antigen b].Urine for microscopy culture and sensitivity (MCS) c].Stool for MCS d].CSF for MCS e].Gastric washout for AAFB f].Pus and vesicular fluid for MCS g].Serous fluid example pleural aspirate,ascetic fluid etc for MCS.

  17. Precautions while using lab bottles • seek the consent of the patient or parent/guardian if patient is a minor • proper introduction of yourself to the patient • explain the procedure to the patient • identify the patient prior to sample collection • This is done by ascertaining the name , date of birth of patient, hospital number and test required. • do not collect any specimen unless two positive identifications can be made.

  18. note that all specimens are regarded as potentially hazardous and infectious hence strict universal precautions should be adhered to. • Make sure both hands are gloved properly • Make sure materials are ready before venepuncture in order to prevent blood spilling. • Patient should be assured and stabilized before venepuncture.However, if confronted with a noncompliant patient , he/she should be held still before the procedure

  19. Use the appropriate sized syringe depending on the volume of specimen needed • As soon as procedure is done place a swab on the site of puncture while pressure is applied, do not leave patient to bleed about. • Test requisition must include • Patient’s name • Hospital number • Hospital unit • Name and signature of authorized provider requesting the test • The test or procedure being ordered • Date and time of specimen collection • Diagnosis

  20. Always check out the colour of the bottle or name of additive[i.e anticoagulant] before use • The right or specific specimen should be taken • Fasting blood specimen for fasting blood sugar • Postprandial blood specimen for postprandial sugar • Early morning gastric washout for acid, alcohol fast bacillus[AAFB] • Avoid contamination of collected specimen • Specimen should be tighly sealed in a leak proof container.

  21. Classification of intravenous fluids • Crystalloids -0.9% sodium chloride -Ringer’s lactate -Hypertonic saline 3% • Colloids -5% human serum albumin in 0.9% NaCl -6% hydroxylethyl starch in 0.9% NaCl -10% dextran 40 in 5% dextrosein water -fresh frozen plasma -Whole blood

  22. Composition of IVF • Ringer’s lactate :- -Na+ 150mmol/l -K+ 4mmol/l -Ca+ 3mmol/l -Cl- 109mmol/l

  23. Half strength darrow solution -Na+ 61mmol/l - K+ 18mmol/l - Cl- 52mmol/l - HCO3- 27mmol/l

  24. Normal saline:- Na+ 154mmol/l Cl- 154mmol/l • 4.3% dextrose in 0.18%[1/5] saline Na+ 30mmol/l Cl- 50mmol/l dextrose 286mmol/l

  25. Indications for IVF. NORMAL SALINE/0.9% SALINE/ISOTONIC SALINE a]Fluid resuscitation in severe dehydration or shock (note that ringer’s lactate is the fluid of choice but not readily available). b].Rehydration fluid in sickle cell vasoocclusive crisis c].Initial fluid resuscitation in burns. d].partial exchange transfusion. e].Initial resuscitation in diabetic ketoacidosis f]. Administration of some intravenous drugs example

  26. DARROW’S SOLUTION 2 Types namely1].Half strength 2].full strenghtNote;Fullstrenghtdarrow’s is not used in paediatrics because of its light potassium content.

  27. Indications • Mainly for potassium replacement (Note that potassium chloride and potassium phosphate are preferred to darrow’s solution because potassium deficit is replaced faster) in conditions like; Diarrheadiseases,hypertrophic pyloric stenosis,drug induced hypokalaemia example thiazide and loop diuretics,paralyticileus.

  28. 50% DEXTROSE • Indications include a].To increase glucose concentration of other fluids such as in preparation of D10 and D12.5 in latter,75ml (instead of 50ml in former )of 50% dextrose is added to a bag of 4.3% dextrose from which equal volume of fluid has been withdrawn. b].In the management of hyperkalaemia as glucose potassium insulin c].Correction of hypoglycaemia (0.4ml/kg of solution)

  29. CONTRAINDICATIONS TO INTRAVENOUS FLUIDS • Certain fluids are contraindicated in some health conditions.These are; • Normal saline:-contraindicated when there is metabolic acidosis because it can cause acidosis itself.

  30. Darrows:- • These are mainly contraindications to potassium replacement.They include; • Severe dehydration or shock • Acute renal failure • Burns • Immediate post operative period • Severe crush injury[rhabdomyolysis]

  31. Patient on hyperkaemia inducing drugs • Potassium sparing diuretics e.gspirinolactone ,amiloride • Angiostensin converting enzyme inhibitors e.gcaptopril ,enalapril , lysinopril • Angiostensin receptor blockers e.gvalsertan, candesertan • Beta blockers e.gpropanolol, timolol , pindolol • Suxamethonium • Cytotoxic drugs e.gcyclophosphomide , • Patient who has hypoaldosteronism.

  32. Patient at risk of increased intracranial pressure • Patient with acute neurological dysfunction. • Patient at risk of third space fluid shift • Elevated blood glucose.

  33. Ringer’s lactate Contraindicated in; • Cases of metabolic alkalosis • Severe hypernatraemia

  34. COLLOIDS It is contraindicated in; • Severe Anaemia • Acute renal failure….dextran 70 • Bleeding diathesis….dextran 70,dextran 40. • Pulmonary edema • Congestive cardiac failure • Reactions to colloids

  35. REFERENCES • en.wikipedia.com • Introduction to clinical laboratory techniques; Akinyinka A. Oyekola. 2011. • The Guide; MSSN UITH ILORIN. • Principles and practice of surgery in the tropics, 2nd Ed.; Badoe et al.

  36. Thanks for listening.

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