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.
Know your tests
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.
— 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.
— Find a focal point to look at, or think of a pleasing image.
— Count slowly and silently one to ten.
— 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.
Giving a blood sample
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.
Blood test tips
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.
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.
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.
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.
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.
If you have difficulty with blood being taken
For most people, giving a blood sample is quick, easy and relatively painless. Some people, however, have veins that are quite small or difficult to access. Some veins are scarred from repeated punctures to the vein or they are blocked (occluded). People undergoing chemotherapy, for example, may have more difficulty when their blood is taken because their veins have been punctured so often. For these individuals, venipuncture can involve more than one attempt before the blood is successfully taken.
Experienced patients are likely to take an assertive role in the procedure, telling the person taking the blood the good spots to try or the needles, techniques, or instruments that work well. Women who have had a mastectomy, for example, are likely to tell the phlebotomist which arm to use to avoid the lymph nodes more prone to infection. If you are frustrated by a lack of quick success, try to stay open to the phlebotomist’s suggestions so that together you can create a process that works well for you.
Other methods of collecting blood samples
- 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.
- 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.
Complications related to venipuncture
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.
Tips to help children
The Royal Children’s Hospital Melbourne has produced a series of useful videos to help prepare children for the tests they are having. Go to ‘Be Positive’ on the hospital website
. Our video on the front page, 'Abby's Tips
' is from this source.
Although routine testing is less often requested for children than for adults, there are times when children need pathology tests and a helping hand through them. Here are some suggestions to help children through these procedures as well as some specific tips on blood tests, urine and stool specimens, and throat culture sample collections.
Prepare the child
— Calmly explain how the sample will be collected and why, giving the child time to adjust to the idea before anyone touches his or her body.
— At home or in a comfortable setting, suggest ways to rehearse. The child can practise having the sample taken or pretend that a toy is the patient.
Help the child put it in perspective
— Use something the child has mastered or is familiar with to put a time to the part of the procedure the child may find overwhelming. For example, explain that this will be over as fast as you can climb the stairs at home or before you can sing a favourite nursery rhyme.
Plan a reward
— Tell the child you will have a treat ready afterwards.
Because children's veins are smaller and the amount of blood withdrawn needs to be carefully monitored, children are treated with special care when their blood is taken. An experienced pathology collector is usually involved and they may be helped by an assistant. For children older than two years of age, a vein in the crook of the elbow is the commonly-used site. Here are some tips that can help.
Determine if the child wants to participate
— One of the most basic things you can do, is determine if the child wants to actively participate. Some children want to watch; others would rather look away. If the child does not want to watch, have an alternative focus in mind such as looking at a book or ipad or singing a favourite song or nursery rhyme. You can ask, "Do you want to see how the blood collector does this, or do you want to look at this book with me?"
— Suggest ways of practising at home beforehand. For example, the child can rehearse sitting still and you can join in by saying "show me how you stay still, now show me how you wiggle, now show me how you stay still again". Rehearsing can help the child feel composed and in control of his or her body.
Prepare them for the "Ouch"
. Explain that it will hurt a bit but it will be over very quickly and then the hurt will go away. Before you enter the room, talk about who you will see and what they are going to do. It is okay to tell children that having blood taken is difficult even for grown-ups.
Stay with your child
— You are strongly encouraged to stay and help their child while having their blood taken.
Count to three and blow the feeling away
— Blowing the feeling away can be a useful technique because the slow exhale helps keep veins full and loose which makes it easier to for the blood sample to be taken. It helps the child both mentally and physically. Allowing the child to count to three or to choose someone else to do the counting (the parent, nurse or phlebotomist) before the procedure gives the child more control. The child who does the counting is able to ensure he or she is mentally prepared before saying the last number, and the phlebotomist or nurse will be less inclined to insert the needle prematurely.
Don’t expect just a finger-prick
— Parents often make the mistake of telling their child that their blood test will require just a finger-prick. The surprise of a different approach can unnerve a child. Most diagnostic tests require a larger sample of blood, which is obtained from a vein not a capillary. You can inquire if a finger-prick option is available, but know which method will be used when you talk to your child so you can provide the most preparation and assurance.
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.
— 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
— 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.
— 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.
— 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.
— 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 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.
— 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.
Tips to help the elderly
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.
The challenge of getting there
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.
— 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.
Issues of safety
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.
— Before you begin, remove rugs and loose mats.
— Be on guard for spills and a slippery or wet floor.
— Encourage the elderly person to use grab bars or other supports near the toilet area to help prevent injuries from falls.
The need for help
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.
— 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 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.
— 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.
—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.