The value of any sort of test can be assessed in two ways; firstly – does the test give the correct answer and secondly – is the test reproducible, that is does it give the same answer each time it is used. These are the concepts of accuracy (getting the correct answer) and precision (getting the same answer each time the test is used).  These two concepts are not the same as it is possible to consistently get the wrong answer with a test or to get the correct answer but with a broad spread of results.

Salivary cortisol [late-night sample] for diagnosis of Cushing’s syndrome has been found to be a valid and useful test. However, all other salivary hormone tests for reproductive hormones, thyroid disease, Addison’s disease and other disorders of cortisol, melatonin etc., have not been established as valid investigations.

Assessment by FSM

Wall St Journal article

Assessment by FSM

This is a large and complex area covering a range of tests e.g.:

Liver Detoxification Profile

Complete Digestion Analysis (also described separately)

Intestinal Permeability

Amino Acid Profile

Organic Acid Profile

Neuroendocrine Metabolites

Essential Fatty Acids

Vitamins and Antioxidants

The Liver Detoxification Profile can vary from different laboratories. However most commonly it involves the person taking several common drugs e.g. paracetamol, aspirin and caffeine and then measuring their metabolites in blood and urine afterwards. The amount and ratios of metabolites present are an indication of the amount of phase I and phase II metabolism going on in the liver. However there is a lack of evidence that the results have any clinical utility in patients who are not suffering from advanced liver disease. The results are sometimes used by alternative practitioners to suggest that the patient has problems that are unrelated to liver function. People having this test may then be recommended to undertake “detoxification” treatment which as this WebMD article shows, may be beneficial if the person leads a healthier lifestyle but this has nothing to  do with removal of any “toxins”.

 

Intestinal permeability testing is usually used to diagnose “leaky gut syndrome”. Increased intestinal permeability can occur in a variety of severe gastrointestinal disorders but this is not what is meant by “leaky gut syndrome” in alternative and fringe practice. Read the article by the UK National Health Service in NHS Choices for an unbiased assessment. Quackwatch has included “leaky gut syndrome” in a list of “fad” diagnoses.

 

For more information on the above two tests click HERE for an opinion by an Australian gastroenterologist.

 

Some of these “functional” tests have clinically valid uses in particular circumstances e.g. inborn errors of metabolism in very sick newborns and infants (organic acids, amino acids, fatty acids). In these cases the abnormalities are generally extreme and when combined with the clinical findings in the child the diagnosis can be made. However there is no good evidence that any of these tests are useful in the general population with vague symptoms. However it is common for an alternative health website to say something like; “Are you feeling unwell or tired and your doctor can’t find anything wrong with you? Come and have our range of functional health testing and we may find something wrong that will allow us to identify treatment options for you”. What do you think is going to happen when a large set of numbers are generated by the testing, normal variations due to diet and other factors are poorly defined and agreed protocols to interpret the results are non-existent? You will almost certainly be opening your purse or your wallet again to pay for more services.

Assessment by FSM

There is no evidence that this test is of any use. See also:

Quackwatch – Bolan’s Clot Retraction Test: Another Scheme to Sell You Something

Assessment by FSM

Analysis of stool for a number of substances can be useful in medical practice. The test used by mainstream medical practitioners, especially gastroenterologists, is described in this WebMD article. However the Complete Digestive Stool Analysis discussed here includes a number of other items for which there is little or no evidence that they add clinical utility to the test profile. What they do add is extra cost and extra leeway to make non-scientific interpretations of the results if the practitioner so desires.

Assessment by FSM

Assessment by ASCIA

From the ASCIA assessment:

Hair analysis

Method: Trace elements are measured from samples of hair, and nutritional deficiencies or excesses are related to the patient’s symptoms.

Evidence: No evidence

Comment: While hair analysis is employed for toxicological/forensic use, there is no evidence that vitamin or mineral analysis from hair samples is useful for diagnosing disease or that treatment based on its results has any clinical utility. Blinded studies have shown variable and non-reproducible results from the same samples sent to the same and different laboratories.

Quackwatch – Commercial Hair Analysis: A Cardinal Sign of Quackery

Assessment by FSM

Experts agree that while there is little harm in this diet apart from the inconvenience that it causes in selecting foods, there is no scientific evidence that there is any relationship at all between blood type and dietary needs or preferences.

WebMD article

Reuters news report

American Journal of Clinical Nutrition review of the evidence

Beware of unvalidated cancer marker tests. There are very few reliable blood or urine tests that provide early indication of the presence of cancer of any kind. For more information please read our article on Tumour Markers.

See AMAS test and BTA TRAK test following

AMAS is one example of an unvalidated cancer test. Anti-malignin antibody in serum (AMAS) is a test offered by only one laboratory in the USA. While it is described by its manufacturer as useful in early diagnosis for those at high risk for cancer and in monitoring cancer progression, there is little published evidence from independent sources to support this claim. Despite more than 20 years of availability, the test has not earned the confidence of most in the medical community given the lack of data regarding its clinical utility.

The AMAS test is not specific to one particular type of cancer, which brings into question the test’s impact on patient health outcomes. In other words, it is unclear how the test’s results can be used to advance a diagnosis or develop a treatment plan for a patient.

The AMAS test, if used, should never be used alone to diagnose cancer nor to screen asymptomatic people for cancer. The available evidence indicates that a negative AMAS test should never be interpreted as an “all-clear” message if there is any other reason to suspect the possibility of cancer.

Cancer Research UK: AMAS or AMA (Anti-Malignan Antibody) blood test for cancer

Dr. Weil: Is AMAS a Worthwhile Cancer Test? 

Friedlander, E: Anti-Malignin Antibdy – A Screening Test for Cancer? 

Oncolab: AMAS

(also known as Bryans’ or ALCAT testing)

 

From the ASCIA website:

 

Use: Diagnosis of food sensitivity / allergy.

Method: A suspension of patient white cells is incubated with dried food extracts on a microscope slide. Changes in the appearance and movement of cells are interpreted as representing a sensitivity or “allergy” to that food. The ALCAT test is a variation, whereby a mixture of blood and food extracts is analysed in an automated Coulter counter (cell counter).

Comment: These results have been shown to not be reproducible, give different results when duplicate samples are analysed blindly, don’t correlate with those from conventional testing, and “diagnose” food hypersensitivity in subjects with conditions where food allergy is not considered to play a pathogenic role.

Inappropriate use of conventional testing: Food specific IgG, IgG4, Food specific IgE (RAST, ImmunoCap testing), Lymphocyte subset analysis.

 

From the ASCIA website:


Food specific IgG, IgG4


Use: Diagnosis of food sensitivity / allergy.

Method: Antibodies to food are measured using standard laboratory techniques.

Comment: IgG antibodies to food are commonly detectable in healthy adult patients and children, independent of the presence of absence of food-related symptoms. There is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms. In fact, IgG antibodies reflect exposure to allergen but not the presence of disease. The exception is that gliadin IgG antibodies are sometimes useful in monitoring adherence to a gluten-free diet patients with histologically confirmed coeliac disease. Otherwise, inappropriate use of food allergy testing (or misinterpretation of results) in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. Despite studies showing the uselessness of this technique, it continues to be promoted in the community, even for diagnosing disorders for which no evidence of immune system involvement exists.


Food specific IgE (RAST, ImmunoCap testing)


Use: Diagnosis of food sensitivity / allergy.

Method: Antibodies to food are measured using standard laboratory techniques. Some laboratories may present data inappropriately as raw counts or as “response factors”.


Comment: Inappropriate use may be divided into three areas:

(1) Inappropriate patient selection. As with any diagnostic test, use in patients where there is no evidence that food allergy plays a role in pathogenesis increases the likelihood of irrelevant false positive results. Use of food allergy testing in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. 

(2) Misinterpretation of results. Low levels of food-reactive IgE are found in some healthy individuals without clinical reactivity. Challenge studies have shown a correlation between allergen-specific IgE and then likelihood of reactivity to some (such as cows milk, egg and peanut) but not all foods. In the absence of a history of clinical reactivity, low levels of allergen-specific IgE are usually of little diagnostic significance. 

(3) Inappropriate data presentation. Presentation of data as “raw counts” has no scientific or clinical rationale, has not been shown to correlate with clinical reactivity and renders results more liable to misinterpretation.


Lymphocyte subset analysisp


Use: Conventionally used for the assessment of patients with suspected immunodeficiency or lymphoid malignancy. Also used by some unorthodox practitioners to assess patients with suspected “chemical sensitivity”, chronic fatigue syndrome or “environmental allergies”.

Method: Lymphocyte subsets are measured using standard laboratory techniques.

Comment: Lymphocytes in the blood are in transit between the various lymphoid organs and tissues where they perform their functions. Their numbers and proportions in the blood vary from day to day and are influenced by a wide range of physiological and pathological factors, including: time of collection, exercise, pregnancy, cigarette smoking, alcohol, medications, allergen exposure, infection and the presence of a variety of chronic disease states, including anxiety and depression. Misinterpretation of minor changes in the absence of evidence of immune deficiency or malignancy can be very misleading and may reinforce a patient’s concern that they are suffering from an immune disorder. This commonly occurs when the distinction between concepts of “energy” and “immunity” are blurred, and when health professionals offer ill-informed and unsubstantiated opinions about “immune dysfunction”.

This is a discredited test used by naturopaths and orthomolecular psychiatry practitioners. Excessive pyrrole excretion in the urine was originally claimed to be causative and diagnostic of a specific form of schizophrenic porphyria. Later practitioners have claimed without evidence that disordered porphyrin metabolism underlies a host of other conditions that are separate from the well-understood group of genetic and occasionally acquired diseases called the porphyrias.

The articles below discuss the so-called pyrolurias and the evidence against their existence.

Dr Bill Sukala – Pyroluria is a common “disease” and also a myth

Wikipedia –Orthomolecular psychiatry

Science Based Medicine – Pyroluria and Orthomolecular Psychiatry

The value of any sort of test can be assessed in two ways; firstly – does the test give the correct answer and secondly – is the test reproducible, that is does it give the same answer each time it is used. These are the concepts of accuracy (getting the correct answer) and precision (getting the same answer each time the test is used).  These two concepts are not the same as it is possible to consistently get the wrong answer with a test or to get the correct answer but with a broad spread of results.

Coping with discomfort and anxiety 

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 If undergoing pathology tests makes you or someone you care for anxious, embarrassed, or even difficult to manage here are some general tips on how to make the experience less stressful.

Sometimes, undergoing an unfamiliar pathology procedure can turn out to be a tense, upsetting, or even frightening experience but with a little preparation you can help ensure that your test is as quick, painless, and accurate as possible. Emotional distress is more likely when your experience with a procedure does not match your expectations or you (or someone you know) have had a bad experience. Knowing what will happen is a good way to reduce this.

The pathology tests you are being asked to have are important in managing your health. Understanding why a test is being performed and how it helps your doctors can improve your attitude and preparation for the test. Being well prepared also helps you feel more relaxed and in control of the situation. Ask your doctor to explain the reasons for your test and how the test will be conducted.  The information you will find under Tests and Conditions/Diseases on this website will also give you useful background information.

When your doctor requests some tests, you should find out why they need to be done, how they will be done, and what the doctor expects to learn from them. Here are some questions you might want to ask:

Why does this test need to be done? How could it change the course of my care?

What do you (the patient or carer) need to know or do before the test?

What happens during and after the test?

How much will the test hurt or cause inconvenience? What are its risks?

How much will the test cost? Is it covered by Medicare or private insurance?

How long will the test take? When will results be available?

Where do you need to go to take the test? Is there a ‘good’ time to have the test?

What are normal results? What do abnormal results mean?

What factors can affect the results?

What course of action may be next, after the test? 

Your doctor (or sometimes a nurse) is the best person to answer these questions. No matter how brief the answers may be, they are likely to provide you with the answer most specific to your situation. After you hear from them, you can get more details from this website.

Knowing a few simple relaxation and focusing techniques can help you avoid tensing your muscles or becoming faint during any difficult pathology procedure. Although the practitioners performing these procedures are generally very skilful and experienced at putting people at their ease,  the following techniques can be helpful.  If you need pathology tests frequently and are anxious, its worth practising these skills at home.

Breathe — Take in three slow breaths, counting one to three for each and breathing through your nose. Push your stomach out as you breathe in (to breathe more deeply). Breathe out through your mouth as you count to six. Slow down the breathing in if you start to feel lightheaded.

 

Relax your muscles — Consciously relax your muscles. Let them feel loose.

 

Focus — Find a focal point to look at, or think of a pleasing image.

 

Count — Count slowly and silently one to ten.

 

Talk — Chat with someone in the room. The distraction can relax you.

 

Generally speaking, pathology tests are less intrusive and more comfortable than they were in the past. These days, sample collection equipment has been specially designed with patient comfort in mind.

Understanding what will happen, communicating your needs to the health care providers who are assisting you, using simple relaxation techniques, and knowing how to take care of any associated physical pains will help you. Even the most apprehensive among us can be comfortable and prepared for a pathology test.  The next time your doctor requests some ‘routine tests’ you can take comfort in knowing the routine

For most people having blood taken is not a problem, just a minor inconvenience. Others feel anxious and need some strategies to help them cope.  As common and as quick as it is, giving a blood sample is the procedure that causes greatest apprehension.

For a few people the physical condition of their veins makes the procedure hard. This might be because their veins are sore from intravenous (IV) therapy, scarred from frequent venipunctures, or just hard to find and use for blood collection.

There are two main issues:

 

1) the physical one, enduring the needle, and

2) the emotional one, to see your blood being removed.

The blood needed for a diagnostic test is usually fairly easy to obtain. It requires a procedure called venipuncture (a term which quite simply means ‘puncturing the vein’). The person performing this procedure may be your doctor, a nurse, or someone specially trained in collecting blood samples, a phlebotomist.

Phlebotomists who work in hospitals, cancer clinics, and outpatient settings perform many venipunctures each day. Their experience makes them good at handling difficult situations and people who are distressed. The phlebotomist knows how to put patients at ease and how to help someone who is feeling lightheaded, dizzy or faint.  Knowing that the person collecting your sample has been thoroughly trained and has a high level of competency is reassuring.

 

What will happen? During venipuncture, the phlebotomist inserts a needle through your skin and into a vein. Most often, they are able to identify a vein in the crook of your elbow that is easily accessible.  The elbow area does not have many nerves so this is a good site; the wrist, hand and foot are other sites that can be used.. A tourniquet is applied around the upper arm to make the vein more obvious. Clenching your fist, when you are asked to, helps make the vein more prominent. The procedure usually takes less than three minutes. Afterward, the patient, or carer, is usually asked to apply gentle pressure, over a clean dressing, to help the blood clot and prevent swelling and bruising.

 

The amount of blood needed for the tests is taken out through the needle into a syringe. It is usually put into a special tube or tubes. The tubes are sent to a laboratory where the blood is analysed as your doctor has requested on the referral form. After taking the blood, a clean dressing is put over the skin puncture and the patient, or a carer, is usually asked to apply gentle pressure with the fingers. This is to help the blood clot and prevent swelling and bruising.

 

Will it hurt? When the needle is inserted under the skin you might feel a slight sting and there may be additional discomfort when it is withdrawn. If you are accompanying a child or someone who is anxious, it helps to explain that he or she will feel momentary pain or discomfort. 

 

Not flowing well? Try drinking water and execrise. Drinking 8 to 10 glasses of liquid a day helps blood flow better and makes the veins more likely to stick up and be found easily, so drink plenty of fluids for a day or two before your test. But, also, remember to follow your doctor’s instructions – some tests require that you do not drink certain liquids prior to the test. You may also want to take a walk while waiting, or on your way to the test, to increase blood flow and keep the veins pumped up (routinely doing hand and arm exercises also helps those requiring frequent testing). Even eating well the day before, if fasting is not required, improves blood flow.

 

Dry Skin? Applying a moisturizer at least 4 times a day, from the hand to the elbow (or wherever you expect the sample to be taken) can make the puncture less painful. Lotions work best when applied just after the skin has just been wet, for example after bathing.

 

Cold hands? Being warm increases your blood circulation, which makes it easier for the phlebotomist to find a vein. While you are waiting, you may want to leave your coat or sweater on and let your arm dangle down to increase the blood pressure in the veins. If you have difficulty with blood being taken, lying down and warming your hands under a heating pad and blanket usually provide good results.

 

Getting anxious? Talk about or recall something pleasant while you wait. This takes your mind off your anxiety; you can also bring interesting reading, music, or even relaxation tapes to listen to on a portable player.

 

Feeling faint? If you are nervous or have a tendency to feel dizzy or faint, tell the phlebotomist before you begin. Your blood can be taken while you are lying down, which will help avoid fainting and causing injury. If, at any time, you feel faint or lightheaded, tell the phlebotomist or someone nearby. Putting your head between your knees or lying down should soon make you feel better. It may be best that avoid driving home

 

Can’t find the vein? If the phlebotomist does not succeed in reaching the vein, sometimes a colleague may step in to help. This keeps both the patient and the phlebotomist from becoming flustered and should be seen as a reassuring step.

 

What helps afterwards? If you experience swelling, bruising, or pain then follow general first-aid procedures, including putting ice on the site, using the affected arm as little as possible, and taking a pain killer if that is an allowable medication for you. Other complications related to venipuncture are rare.

Finger-pricks – A small number of blood tests require just a finger-prick. A very small sample of blood from your capillaries can be obtained from the fingertip or earlobe, or from the heel or big toe of a newborn baby.

 

Warming the skin with moist, hot compresses for about 10 minutes helps blood flow to the area. The skin is then pricked with a lancet. Because there are more nerves in the finger than in your elbow, you may find that a finger-prick is a bit more painful than venipuncture even though it can seem less intimidating.

 

Arterial samples – In more critical situations patients admitted into hospital may require blood to be taken from arteries. This procedure, known as an arterial sample, is performed by a doctor or specially-trained nurse. A local anaesthetic may be administered and afterwards the nurse applies pressure to stop the bleeding and prevent bruising.

Venipuncture is an invasive procedure because a needle is inserted through the skin to reach a vein. It is however a very safe procedure. Millions of venipunctures are performed in Australia every year. 

By far the most common complication of venipuncture is bruising at the site of the needle puncture. This usually appears within 24 hours and may range in size from a small spot to a large purple bruise. It is caused by blood leaking from the punctured vein out into the tissues just under the skin, which can be reduced by using finger pressure on the site for a minute or so after the venipuncture.

Bruising is more likely if the collection is difficult, if pressure is not maintained on the site for a minute or so after the venipuncture, if you are taking anti-clotting medicines such as aspirin or warfarin, you are an elderly person with fragile veins, or if you exercise your arm soon after the venipuncture for example by lifting heavy shopping bags.

While bruising is unsightly it is not dangerous and will slowly disappear over a few days or weeks, depending on how extensive it is. Large bruises may become tender for a few days because the cells that are involved in mopping up the bruise release substances that cause the area to become sore. This is uncommon but again not dangerous, it is part of the healing process. However, if the tenderness is bothering you, you should contact the person or clinic where you had the venipuncture.

Very rarely a small artery, which contains blood at much higher pressure than in veins, will lie unusually close to or underneath a vein. In this situation the artery may be accidentally punctured at the time of venipuncture. If this happens you generally become aware of it within a few minutes because a painful deep swelling can be felt and sometimes seen near the area of the venipuncture. Tell the collector if this happens as it is necessary to apply firm pressure to the area for at least 5 minutes. Almost inevitably you will develop extensive and sometimes spectacular bruising on the lower part of the arm over the next two to three days because the blood leaks to the underside of your arm with gravity. While this may appear dramatic it is not dangerous and will gradually disappear over a couple of weeks.

There are some rare complications of venipuncture but you have to be unlucky to suffer one of these. For example you may have a tiny branch of one of the sensory nerves of the arm actually running over the surface of the vein. Rarely, the needle will hit this tiny nerve on the way into the vein. This may cause a short, sharp electric-shock type pain. This may be all that happens; however in some cases tingling type of pain may persist for one to four weeks, as the nerve heals. This is inconvenient and may be unpleasant but it eventually heals up.

Another rare complication of venipuncture is for a small clot (or thrombus) to form in the vein at the site of the venipuncture. This is noticeable as a small firm lump just under the skin at the venipuncture site. The lump may or may not be tender and will go away over a couple of weeks.

Finally, there is the possibility of infection developing at the site of the venipuncture. This is extremely rare and would be noticed as developing redness and pain at the site of the venipuncture. Most times discolouration and tenderness around the venipuncture site are the result of bruises healing but if you are worried contact the person or clinic where you had the blood collection done or visit your doctor.

Children sometimes balk at the idea of collecting their urine in a cup, particularly if the idea is new to them. The assistance that may be required can seem like an invasion of their privacy and inappropriate. A child’s resistance can prolong the collection process, making it more stressful for both the child and the parent, so you will want to prepare the child and comfortably guide him or her through the process. The procedure itself is not painful unless there is an infection or rash.

Some suggestions to minimise the stress of the moment.

Anticipate — Inquire at the time you make the appointment if a urine sample will be required (for example, if you suspect a urinary tract infection). You may also want to know if it must be a sterile specimen, so you can prepare the child to wipe with a towelette first. Importantly, ask if you can collect the specimen at home

Rehearse — Letting the child rehearse may be helpful. If you know before your surgery visit that a urine sample will be needed (for example if there is a suspected urinary tract infection), spend some time the day before or that morning preparing your child. Ask the child if he or she can do this trick: let a bit of urine out into the toilet, then stop the flow and start again. Tell the child he or she will be asked to do this at the doctor’s surgery.

Raise their comfort level — Explain that even grown-ups collect a sample of urine this way when their doctor needs them to, or that even mothers need to use the towelettes when a sterile specimen is required. Assure them this is a normal procedure that is not difficult.

Drink up — Encourage the child to drink before the surgery visit as this can help the child to urinate when it is time to collect the sample.

Simplify — Ask what supplies are on hand to make the collection as easy as possible. For a younger girl, putting three to four urine specimen cups in a potty seat may allow you to collect the sample more easily than catching the flow midstream in a single cup. A receptacle placed in the toilet, such as a bedpan, can be simpler and more familiar for a child than catching urine in a cup.

Cope with pain — If urination is painful because of infection or a rash, there are several strategies you can use. One is to suggest the child “blow the feeling away” by blowing out a breath just as the urine starts to flow. Introducing this idea in advance gives the child time to practise the technique. You can also suggest focusing on another body part, for example, feeling your hand on their forehead or a cool cloth on their leg. Dripping cool water over the irritated area just as urination begins can be soothing and easier for boys (but cannot be used if a sterile specimen is required) .

Turn on the tap — The sound of running water can help the child begin to urinate.

Be cool — For an adolescent who may be embarrassed to carry a urine specimen from the toilet and into the surgery or collection area, you can ask for a bag or other suitable camouflage.

Make it interesting — When the test is for protein in the urine, tell the child the nurse will have to dip a special paper strip into the urine for a colour test.

Most older children are ‘turned off’ by the suggestion that they need to provide a faeces sample for testing, even if they can collect it in the privacy of their own bathroom. Fortunately, stool samples are not routinely required for children.

 

Except for infants in nappies, where a sample can be collected from a soiled nappy, the procedure is the same as for an adult. The child, however, will probably need an adult to set them at ease about how the sample will be collected and to transfer the sample into a suitable container for transport to the doctor’s surgery or diagnostic laboratory.

 

Some tips to make sample collection go smoothly.

 

Acknowledge embarrassment — Acknowledge the child’s reluctance by saying something like “I know this may be embarrassing for you. It can be embarrassing for a grown-up who has to do it, too, but we need this because…” A statement such as this gives the child permission to express his or her feelings and become more comfortable in accepting the help that is required in this situation.

 

Simplify — Loosely fitting a sheet of plastic wrap over the toilet bowl but under the toilet seat allows the child to proceed fairly normally with a bowel movement. The child can then call an adult to remove the plastic and the stool. A bedpan placed under the toilet seat can work in the same way. A younger child can simply use a potty seat with its own collection container. In most cases, you do not need to be concerned about whether or not the sample has been contaminated by urine.

Throat cultures can be intimidating to a child but they do not need to be traumatic. The procedure causes only a moment of discomfort (a gagging reflex) as the swab makes contact with the throat. Explaining the procedure to the child and giving them control and coping methods helps, both in getting through the moment and for the next time.

Throat cultures can also be challenging; a child who is fearful and does not trust the nurse may refuse to open his or her mouth. This raises the stress levels and anxiety of everyone in the room. The encounter may be more difficult if the child has had a bad experience previously, for example having a tongue depressor forced into their mouth. It may be harder for the child to trust the medical personnel after an incident in which he or she was forced.

 

To put the child at ease you can show the child a swab, give the child a swab to hold and touch, and explain that the swab will be put into the mouth to collect a sample from the throat and is just like a big cotton bud.

If you anticipate a difficult time, ask what steps can be taken to avoid a struggle and to create a non-intimidating situation for the child.

What seems like a simple pathology test to the average adult can be significantly more challenging to the elderly person who is more frail. Here are a few reasons to take extra care when an older person requires a pathology test.

The elderly are more likely to have problems with their vision and hearing, which may make it difficult for them to follow instructions or understand what must happen for the specimen to be properly collected

Older people have more problems with balance and mobility, factors that can make some samples physically harder or more dangerous to provide

Even a blood test can be more difficult because the skin is thinner, the subcutaneous tissue is less resilient, and the veins are more fragile and prone to tearing when punctured. The person may prefer one phlebotomist in particular who they like or who handles them well

For a person with dementia, even a brief sample collection procedure can be very traumatic for the patient. In this case, the need for testing must be carefully scrutinised.

If testing is a burden for an elderly person you know, talk to the doctor about the situation.

Transport to the hospital, clinic or surgery can present problems for the elderly, who may not drive and may be dependent on someone else to take them to their medical appointments. Reducing stress on the driver can make for a more positive experience.

 

Planning ahead — If you must go somewhere unfamiliar for a test, get good directions on where it is and how far you must walk; this will help eliminate stress. Find out if it will be easier for the person having the test to be dropped off at a particular entrance. You may also want to inquire about busy times and plan to avoid them.

Falls are common and especially serious in older people. Bathrooms can be particularly hazardous. Pay attention to safety when collecting a urine or stool sample, particularly for individuals who have mobility or vision problems. Your focus on the collection process may prevent you from noticing hazards or unsafe conditions in the room, so gather what is needed and plan ahead.

Tripping — Before you begin, remove rugs and loose mats.

Slipping — Be on guard for spills and a slippery or wet floor.

Falls — Encourage the elderly person to use grab bars or other supports near the toilet area to help prevent injuries from falls.

Venipuncture is an invasive procedure because a needle is inserted through the skin to reach a vein. It is however a very safe procedure. Millions of venipunctures are performed in Australia every year. 

By far the most common complication of venipuncture is bruising at the site of the needle puncture. This usually appears within 24 hours and may range in size from a small spot to a large purple bruise. It is caused by blood leaking from the punctured vein out into the tissues just under the skin, which can be reduced by using finger pressure on the site for a minute or so after the venipuncture.

Bruising is more likely if the collection is difficult, if pressure is not maintained on the site for a minute or so after the venipuncture, if you are taking anti-clotting medicines such as aspirin or warfarin, you are an elderly person with fragile veins, or if you exercise your arm soon after the venipuncture for example by lifting heavy shopping bags.

While bruising is unsightly it is not dangerous and will slowly disappear over a few days or weeks, depending on how extensive it is. Large bruises may become tender for a few days because the cells that are involved in mopping up the bruise release substances that cause the area to become sore. This is uncommon but again not dangerous, it is part of the healing process. However, if the tenderness is bothering you, you should contact the person or clinic where you had the venipuncture.

Very rarely a small artery, which contains blood at much higher pressure than in veins, will lie unusually close to or underneath a vein. In this situation the artery may be accidentally punctured at the time of venipuncture. If this happens you generally become aware of it within a few minutes because a painful deep swelling can be felt and sometimes seen near the area of the venipuncture. Tell the collector if this happens as it is necessary to apply firm pressure to the area for at least 5 minutes. Almost inevitably you will develop extensive and sometimes spectacular bruising on the lower part of the arm over the next two to three days because the blood leaks to the underside of your arm with gravity. While this may appear dramatic it is not dangerous and will gradually disappear over a couple of weeks.

There are some rare complications of venipuncture but you have to be unlucky to suffer one of these. For example you may have a tiny branch of one of the sensory nerves of the arm actually running over the surface of the vein. Rarely, the needle will hit this tiny nerve on the way into the vein. This may cause a short, sharp electric-shock type pain. This may be all that happens; however in some cases tingling type of pain may persist for one to four weeks, as the nerve heals. This is inconvenient and may be unpleasant but it eventually heals up.

Another rare complication of venipuncture is for a small clot (or thrombus) to form in the vein at the site of the venipuncture. This is noticeable as a small firm lump just under the skin at the venipuncture site. The lump may or may not be tender and will go away over a couple of weeks.

Finally, there is the possibility of infection developing at the site of the venipuncture. This is extremely rare and would be noticed as developing redness and pain at the site of the venipuncture. Most times discolouration and tenderness around the venipuncture site are the result of bruises healing but if you are worried contact the person or clinic where you had the blood collection done or visit your doctor.

It is not uncommon for an elderly person to need some assistance when taking a sample for a pathology test. A person with arthritis, joint stiffness, or other mobility problems may find it difficult to obtain a urine or stool sample without some help.

A person with dementia may be unable to follow the instructions on obtaining an appropriate urine specimen. They may also become confused or agitated when someone tries to do this for them. A person who does not see well or has poor manual dexterity can have trouble using specimen cups, or blood glucose monitors for diabetes.Here are some tips to make the sample collection process go more smoothly.

Instructions — An older person may have trouble hearing verbal directions, reading printed instructions, remembering when a test is scheduled or what it is for. Always ask for written instructions, preferably concise ones in large type. When giving oral instructions, take it one step at a time, and use a calm and reassuring tone; before you begin, seek to minimise noise and distractions and create a calm environment.

Special equipment — Special equipment for collection can make certain procedures easier and safer. A urine sample may be more easily collected in a receptacle placed in the toilet rather than in a cup or jar that has to be held. A magnifying glass with a bright light attachment can help a diabetic patient with vision loss self-monitor their blood glucose. Using a different kind of lancet or needle may prove easier, less painful, or less intimidating to use to obtain the blood.

Hired help — Although nursing homes have personnel to assist with sample collection procedures, sheltered housing facilities do not always provide such nursing support. If you, as an elderly person, need assistance where none is available, you may be entitled to help from a community nurse or care assistant.

Privacy —Helping a person obtain a urine or stool sample can be a task neither party finds particularly pleasant. The person needing the help may be embarrassed, and the person providing the help may find the odours and cleaning tasks offensive. Provide as much privacy as is safely possible to increase everyone’s comfort levels.

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