Institutional Animal Care and Use Committee (IACUC)


Blood Collection Protocol in Rodents Application Form

Instructions: If applicable, submit this Form with the IACUC Animal Use Protocol (AUP)
1. Administrative Information
Project Title:
Project Type:
Principal Investigator (PI):
Academic Rank:
Faculty:
Department:
UOB Extension:
Cell phone:
Email:
2. Animals to be Used:
Species (Common Name)
Strain
Gender
Age
Body Weight
Building & Room Number where blood collection will be performed
Animal Housing Location - University Facility: If no, specify location
3. Blood Collection
4. Methodology & Sampling Frequency for Survival Blood Sampling
Collection Site
Method of collection
Size of Needle Used
Size and Type of Capillary Tube
Minimum volume required for analysis/animal
Maximum volume collected for analysis/animal
Frequency of blood collection
Total Number of blood collection events planned/animal
Type of Samples Required
5. Will the animals be restrained for the blood collection procedure?
If yes:
a. Indicate the duration of the restraint

b. Describe how the animals will be restrained.
6. Will the animals be anesthetized for the blood collection procedure?

If yes:
Anesthetic
Dose (mg/Kg)
Volume (ml)
Administration route
If no, justify the decision of not administering anesthetic agents.

7. For terminal blood sampling, indicate the site of collection.
8. For terminal blood sampling, will the animals be euthanized immediately following blood collection?

If yes, indicate:
Euthanizing agent
Dose (mg/Kg)
Volume (ml)
Administration route
If no, justify the decision of not performing animal euthanasia.

9. Experience and Training of the investigator(s)
a. The PI has the technical expertise needed to perform blood collection:
b. The investigators listed on the AUP have had the appropriate training and experience to perform blood collection:
Principal Investigator
Signature
Date