SOP: Secondary Prophylactic for VL

Study code ITMC0109

ClinTrialGov code: NCT01360762

SOP FOR SPLENIC ASPIRATION Title: Splenic aspiration Prepared by: Ermias Diro Approved by: Prof Asrat Hailu To be reviewed by July 31, 2014 Version: 1.1 Date modified: July 20, 2012 Date of approval: August 1, 2012 Effective date: August 1, 2012

Objective To define the procedure of splenic aspiration used for parasitologic diagnosis Scope The SOP describes the steps for splenic aspiration from material preparation to specimen collection and observation for possible complications Process - Materials required o Syringe (5ml) and needle 1-inch X 21 guage/32X0.8mm) o Clean microscope slides o NNN culture medium o Wooden applicator or tooth picks o Spirit lamp with sufficient flame o Drapes o Sterile gloves o Sterile cotton and gauze o Plaster, labels, pen and pencil/marker - Check for contraindications o Patient with bleeding tendency and jaundice o Platelet count less than 40,000 o PT 5 seconds longer than control o Patient cannot lie still (eg children) o Small spleen size less than 3 cm on expiration o Hgb less than 3gm/dl o Advanced stage of pregnancy - Aspiration procedure o Explain the procedure and indication to the patient and get consent o Let the patient to lie supine on examination couch o Palpate the outline of the spleen. Demarcating the margin with a pencil is possible. o Put on sterile gloves o Clean the skin at the site of aspiration with alcohol and allow to dry. The site of aspiration is 2-4cm below the left coastal margin anteriorly o Cover the site of aspiration with sterile drape

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SOP: Secondary Prophylactic for VL

Study code ITMC0109

ClinTrialGov code: NCT01360762

o With the needle attached to the syringe puncture the skin at midway of the edges of the spleen. The direction of the need be at an angle of 45o to the abdominal wall cranially o While tip of the needle is in the subcutaneous tissue form a 1cc vacuum by pulling on the plunger of the syringe o Maintaining the 1cc vacuum push the needle into the spleen (about 3cm depth) and immediately withdraw in a quick in-and-out jerk o Handling of the syringe during aspiration should be done with a single hand o Axis of needle entry and exit must be the same o In children and restless patients an assistant needs to hold the hold the patient with the arms on the chest, and the pelvis hold still. o Once the aspirate needle is removed, pull the plunger to 2-3cc mark slowly. It is minute amount of splenic tissue that will be aspirated and visible in the syringe and /or on the plunger o The aspirated material is then expelled on to the clean slides and inoculated into NNN culture medium. o To inoculate on the culture media, heat the edge of the culture media containing tube, insert the needle in to the tube and push the plunger so that the aspirate will be expelled on to the side wall of the tube. Repeat similar procedure in a second test tube. o For smears, expel the remaining aspirated material gently on the clean slides holding the tip of the needle on to the slide surface and immediately smear o Tooth pick or wooden applicators can be used to remove tissue that lodge on the plunger or in the syringe. - Post procedure precautions o Write the procedure note o Monitor vital signs closely; every 30 minutes for the first 4hours and then hourly for the next 6 hours o Patient should remain in bed for 12 hours o Abdominal examination for possible signs of intra abdominal bleeding (abdominal girth, signs of fluid collection) o Refer the SOP for emergency situation management if signs of bleeding is detected Responsibility Splenic aspirate and examination is a team work Nurse prepare materials required for splenic aspiration, the patients medical documents, follow and report vital signs after the procedure Laboratory technician label the slide and culture media, smear, stain and examine slides under microscope. S/he will also inoculate culture and report the result. Physician the aspiration procedure will be done by the physician The physician should also check for contraindications. S/he will also document the procedure and do follow up.

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