This document discusses techniques for sampling and processing pleural fluid. It describes how to prepare patients, collect pleural fluid samples, and divide samples into different tubes for various tests and storage. The key steps are: 1. Collect pleural fluid using sterile technique by inserting a catheter into the pleural space and aspirating fluid. 2. Divide the fluid among several tubes - one with EDTA for cell counts, one with heparin for blood gas analysis, one with heparin for chemistry tests, one sterile heparin tube for culture, and one with heparin for cytology. 3. Label samples with patient information, date, tests needed, and store appropriately - analyzing blood gas

1. SAMPLING AND PHLEBOTOMY
TECHNIQUES II
GROUP 2
D-IV SARJANA TERAPAN
TEKNOLOGI LABORATORIUM MEDIK
POLTEKKES KEMENKES BANDUNG

2. GROUP 2
Members :
Betaria Angelina Hutapea P17334122510
Christian Dwi Prananda P17334122511
Danni Irawan P17334122512
Della Nidianti P17334122513
Desi Maya Lestari P17334122514
Goddess Parwati P17334122515
Dima Romansyah P17334122516
Dwi Veni Endarwati P17334122517
Dzikri Muhammad Nur P17334122518
Encep Yana Aditia P17334122519
Erik Surahmat P17334122520
Fitrianingsih Saputra P17334122521

3. 1. PLEURAL EFUSION
2. PATIENT PREPARATION
3. SPECIMEN COLLECTION
4. SPECIMEN TRANSPORTATION
5. STORAGE
PLEURAL FLUID

4. PLEURAL EFUSION
Serous effusion is fluid pathological bodies collected from serosal
cavities such as pleural, peritoneal and pericardial cavities
accumulated due to various kinds of diseases, both benign and
malignant.
Pleural effusion is something circumstances Where happen buildup
fluid exceeds normal in the pleural cavity between the parietal and
visceral pleura can form transudate or fluid exudate. Pleural effusion
is disease secondary to other diseases, rarely which are primary
disease. Normally the pleural space contains a number small liquid (5-
15ml) works as possible lubricant movable pleural surface without
exists friction.

5. PLEURAL EFUSION
 Pleural effusion often reflects spread of disease elsewhere to
pleural cavity with infectious, inflammatory, or metastatic
processes edema.
 Fluid enter or go out from pleural cavity occurs Because
difference the pressure that arises consequence movement
breathing and flow blood.
 However, many cellular processes are active cause fluid enter to
pleural cavity _ excessive.
 the cause can in a manner genetics, environment, and spread of
infection to the pleura.

6. PLEURAL FLUID COMPOSITION
Pleural fluid contains 1500 – 4500 cells/mL, consisting of macrophages (75%),
lymphocytes (23%), red blood cells and free mesothelium. Normal pleural fluid
contains 1 – 2 g/100 mL protein. Pleural fluid protein electrophoresis showed that
pleural fluid protein levels were equivalent to serum protein levels, but low
molecular weight protein levels, such as albumin, were higher in pleural fluid.
Pleural fluid bicarbonate molecule levels are 20-25% higher than plasma bicarbonate
levels, while sodium ion levels are 3-5% lower and chloride ion levels are 6-9%
lower so that the pH of pleural fluid is higher than plasma pH. This ionic balance is
regulated by mesothelial active transport.

7. PATIENT PREPARATION FOR PLEURAL
FLUID SAMPLING
Sampling can be done at any time but it is better if it is taken before being given
anti-microbial drugs. In general, there is no special preparation for the patient,
except when checking the protein levels of the pleura, the patient must fast 6-8
hours before taking the sample.

8. 1. Officer introduce self to patient.
2. Officer ask identity patient.
3. Officer give explanation to patient about what to do done , purpose action , as well
possible risk _ happen and benefit action the.
4. After patient know about explanation action, officer submit informed consent to be
signed by the patient.
5. Patient entered in room action / space special For action pleural puncture.
6. Patient seated with position upright or his shoulder propped up to pillow or hugging
pillow in sitting state, then done percussion wall thorax behind For determine height deep
pleural fluid pleural cavity.
7. Evaluation return location function with method inspection physis and see Photo
thoracic.
8. Punctions are performed on the spot faintest percussion in the posterior axillary line.
Puncture must done above bone ribs so as not about vessels blood and nerves intercostal.
PREPARATION FOR SAMPLING OF
PLEURAL FLUID

9. PLEURAL FLUID SAMPLING TECHNIQUE
Tools and materials used :
1. Sheath hand sterile
2. Syringes 5 cc and 50 cc
3. Kateter Venous No. 16
4. Three way stopcock
5. Blood sets
6. Lidocaine 2%
7. Alcohol 70%
8. Betadine
9. Gauze sterile
10. Plaster
11. Several tube / syringe For specimen

10. The sampling procedure is as follows:
 Patient instructed sitting position when possible or half sitting, facing
backup chair with arm be on top backup chair.
 Define place aspirations with inspection physical and with help Photo thoracic.
 Give sign area to be placed on the linea posterior axillary, in particular place insertion
below the dim threshold on examination percussion, in space intercostal, edge on ribs.
 Disinfection with gauze sterile given betadine, from direction in to outside, then repeat
with 70% alcohol. Hang on sterile with hole in the place to be evacuated.
 Anesthesia local with lidocaine 2% 2-4 cc w/ 5 cc syringe, infiltrated anesthesia local
intradermal, wait moment Then continue to direction in until feels needle penetrate the pleura.
 If the needle has penetrate past pleural cavity done aspiration within pleural cavity to
syringe full, then syringe revoked.
 Used wound puncture close soon with betadine gauze.
 Next prick venous catheter number 16 in place puncture needle anesthesia local and when
has penetrate the pleura, then maindrain (piston) needle revoked.
PLEURAL FLUID SAMPLING TECHNIQUE

11. PLEURAL FLUID SAMPLING TECHNIQUE
 S connect part base needle with threeway stopcock ( stopkran ) and 50 cc syringe ( for
aspirations ).
 Done aspirations until fluid fulfil 50 cc
 other end of the three-way stopcock is connected with blood sets ( for disposal ).
 Done closing of the flow valve threeway stopcock to pleural cavity.
 Fluid in syringe thrown away through blood set flow.
 three-way stopcock faucet is turned again to direction pleural cavity and performed
aspirations back 50 cc.
 Done evacuation until amount fluid maximum 1500 cc.
 After finished evacuation venous catheter removed and wound used puncture closed with
gauze sterile that has given betadine.
 specimen Then labeled and shipped For inspection.

12. Because it cannot be known beforehand whether the liquid is a transudate or an exudate,
the working conditions are mandatory sterile and provide anticoagulants. Provide at the time
of the puncture, in addition to the usual container, also a sterile container (for culture) and a
container containing 20% sodium citrate solution or sterile heparin.
The pleural fluid that has been obtained is divided into several tubes:
1. 5-7 ml EDTA tube macroscopic examination, count the number of cells, count the cell
types.
2. Examination Blood gas analysis (pH, PCO2, PO2, HCO3) samples were included into
heparins.
3. 7-10 ml heparin test tube chemistry, total protein, glucose, LDH.
4. 7-10 ml tube of heparin sterile culture, gram stain, AFB.
5. 25 ml in place with heparin anticoagulant for cytological examination.
PLEURAL FLUID SPECIMEN PROCESSING

13. SPECIMEN LABELING
 NO RM
 Full name Patient
 Date and time taking
 Examination
 Type Inspection

14. SAMPLE STORAGE
Blood Gas Analysis Samples worked immediately moment after the
sample is taken
Morphology Fluid Samples were
adenosine deaminase Storage at 4 °C or -20°C sample is acceptable saved
up to 28 days

15. Thank you,
do you have any questions?