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~ \ ( K $ 0 $ @ L " 6 X , ) X X \ X X \ Form #: IACUC 005/05
American University of Beirut
Institutional Animal Care and Use Committee
ANTE MORTEM SPECIMEN COLLECTION
Name of Principal Investigator:
Proposal Title:
1. Blood Collection. Will blood be collected from live animals (anesthetized or awake) as part
of this proposal?
FORMCHECKBOX NO.
FORMCHECKBOX YES. Complete the table below.
Site and Method of blood collectionAmount of blood collected, expressed as volume (ml) and % of body weight (assume 1 ml of blood weighs 1 gram)Number of blood collectionsInterval between collections
2. Other Tissue Collection. Will other body fluids (e.g. cerebrospinal fluid, peritoneal fluid, urine) or tissues be collected from live animals (awake or anesthetized) as part of this protocol?
FORMCHECKBOX NO. Proceed to item 3.
FORMCHECKBOX YES. Complete the following table.
Tissue or fluid collectedSite & method of collectionAmount (g) or volume (ml)Number of collectionsInterval between collections
Form #: IACUC 005/05
3. Use of Anesthetics, Tranquilizers, or Analgesics for Collection of Fluids or Tissues. Will anesthetics, tranquilizers, or analgesics be used to prevent pain or stress during collection of body fluids or tissues described in item 3 above?
FORMCHECKBOX NO. Justify the omission of pain-relieving agents (either scientifically or because the collection method involves no or momentary pain) and completely describe the physical restraint that will be used during collection here.
FORMCHECKBOX YES. Complete the following table.
Anesthetic, tranquilizer, or analgesic agentDose (mg/kg) & volume (ml)RouteFrequency
PAGE
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