The main difference with the Amplicor collection swabs is, that once collected, the swab should be agitated in the transport media and then discarded, this differs from the current method where the swab is left in the tube.
NOTE: FOR AMPLICOR COLLECTION KIT ONLY
1. Remove mucus from the endocervix using one of the large swabs provided and discard.2. Insert the other large swab provided into the endocervical canal until the tip of the swab is no longer visible.3. Rotate the swab for 3-5 seconds and withdraw, avoiding contact with vaginal surfaces.4. Place the swab into the Amplicor transport tube, vigorously swirling or agitating the swab in the liquid for 15 seconds.5. Express the liquid from the swab by pressing the swab against the side of the tube.6. Cap the tube, seal and label the tube and transport to the laboratory.
Any excess mucus should be removed at this time by collecting it on the swab. Express any residual liquid from the mucus by pressing the swab against the tube. Remove the swab and any mucus and discard the swab.
PATIENT SPECIMEN COLLECTION CENTRES
270 Invermay Road, Mowbray
Commencing on Monday 26th May 2003 the Mowbray rooms will open earlier commencing at 8.30am. The new operating hours will be 8.30am – 1.30pm and 2.00pm – 4.30pm.
159 St John Street, Launceston
The St John Street rooms are now open from 7.30am – 8.00pm [Monday to Friday] and
8.00am – 12.00noon Saturday.
21 Brisbane Street
The Brisbane Street rooms are now open from 8.30am – 12.30pm, Monday to Friday.
LABORATORY POLICY FOR ACCEPTANCE OF SAMPLES FOR PRE-TRANSFUSION TESTING
In accordance with the Guidelines for Pre-transfusion Testing 4th Edition 2002 provided by the Australian and New Zealand Society of Blood Transfusion Inc. The laboratory has developed the following requirements:Patients identity must be verified at the time of collection by checking details on the wrist band and / or by direct questioning, ie. asking the patient to state and spell their name and give their date of birth.The details on the sample must contain the following:
Surname and first name
Date of birth and / or UR number
Date of collection
Time of collection
Signature of person collecting the sample
A special transfusion request form must accompany the sample and must contain the following:
Surname and first name
Date of birth and / or UR number
Date of collection
Time of collection
Signature of the collector to confirm correct labelling of the sample at the time of collection
The laboratory reserves the right to reject any request submitted for pre-transfusion testing where the above conditions are not met.
FAECES TESTING
Recent changes to the HIC Pathology Services Schedule effective 1st May 2003, limit the laboratory to the microscopic examination of two [2] faeces samples in any 7 day period [item numbers 69336 and 69339] and the culture of one [1] faecal sample in any 7 day period [item number 69345].The faeces samples must be obtained from a separately collected and identified sample ie. two samples from the same motion are not acceptable.These changes do not alter the recommended collection of 3 separately collected faecal samples for occult blood test [in any 28-day period].The new guidelines above also precludes our past practice of testing all infants <5 years of age for Rotavirus between the months of May and October. In future we would suggest that all negative samples in this group of patients have follow up samples sent specifically to exclude Rotavirus.If you require any additional information please do not hesitate to contact Dr John Roberts or Dr Don Clark on 63 34 3636. RECOMMENDED PROCEDURES FOR WARFARIN OVERDOSE
The recommended procedures for warfarin overdose relate to the level of the increased INR and whether there is significant bleeding or evidence of haemostatic failure. Age probably also needs to be taken into consideration as older people bleed more at any particular INR level. The INR often remains elevated for days after warfarin is withheld and small oral doses of vitamin K1 will quickly correct the INR to safe levels within 24 hours. Vitamin K1 levels >5mg should not be given if patient’s anticoagulation is to be continued.
RAISED INR WITH NO BLEEDING
INR >5.0 but <9.0
Stop the warfarin. It is recommended that vitamin K1 be given at a 2mg doseVitamin K1 is best given orally and may most conveniently be given by using paediatric vitamin K1 ampoules [Konakion MM Paediatric]. Vitamin K1 has a delayed effect taking between 6-12 hours to exert an effect on the INR and in 80% of cases a 2mg oral dose will normalise the INR within 24 hours.The INR should be measured within 24 hours and warfarin restarted at a reduced dose once the INR has dropped below 5.0.
RAISED INR >9.0 WITH NO BLEEDING
Stop warfarin in this situation. It is recommended that a higher dose of vitamin K1, 4mg is given orally and that the INR is re-measured within 24 hours and warfarin restarted at reduced dose, once the INR is <5.0. Clotting factor replacement maybe considered if there is considered to be a high risk of bleeding.
MAJOR BLEEDING [ANY LEVEL OF INR]
Stop the warfarin and give 4mg of vitamin K1 orally and refer for immediate clotting factor replacement, with either fresh frozen plasma or Prothrombinex.It should be remembered that whilst FFP and Prothrombinex have an immediate effect, this lasts only for a 12-24 hour period and should always be given with vitamin K1 for a more prolonged effect.
A PATIENT WHOSE WARFARIN IS BEING MANAGED AND DOSEDBY LAUNCESTON PATHOLOGY
If an INR is >5.0 is recorded in one of your patients you will be phoned. If we cannot contact you to discuss the administration of vitamin K1, we will ring your after hours service. If these attempts to contact you are unsuccessful we will arrange for the patient to receive appropriate vitamin K1 therapy as soon as possible.
INR REQUESTS ON PATIENTS MANAGED BY DOCTOR
It is our policy to phone all INR results of >4.0 to you as a matter of course.Reference:
Consensus Guidelines for warfarin therapy MJA Volume 172 19 June 2000 Page 600-605
Dr Michael Beamish
Clinical Haematologist