GENERAL SPECIMEN COLLECTION AND HANDLING *

Effective Date: 
Tue, 05/01/2012
Reviewed: 
Mon, 02/03/2020
Revised: 
Mon, 05/06/2019
Policy: 

PURPOSE

To assure that accurate laboratory results are obtained, it is essential that specimens be ordered, collected, processed and stored correctly.

Providers (and RNs - under certain conditions - see Ordering Lab Tests and X-rays in the Nursing Manual) order lab testing in Point and Click through the Encounter Pad in patients charts.  All internal and frequently ordered send out tests can be found in this section.  If the test is not in the "Pick Lists", the provider can select "Additional Lab Tests-Find".  A test can be selected from the list, or the list can be searched by test name. If the requested test does not appear in the list, enter "Quest" in the Search box,  choose "Quest Miscellaneous-Common" and, in the mandatory question field, enter the name of the test to be run. The Quest test code can also be included, if known. Lab staff will research the requested test and contact the ordering provider if there are any issues.

Detailed descriptions for proper collection, handling and storage of specimens for testing on specific analyzers, meters or other equipment may be found in the individual analyzer or meter Operation Manual and/ or package inserts.

Refer to the "Blood Collection” policy and procedure for a more detailed description on the collection of blood specimens prior to testing. Following are general guidelines for blood and urine (urinalysis) specimen processing and handling at this facility.

Consider all specimens, controls, reagents and calibrators that contain human blood, serum, urine or body fluids as potentially infectious. Use good laboratory working practices when handling specimens. Follow all bio-safety practices established by OSHA.

ACCEPTABLE SPECIMENS

All "outside" request forms should include patient name and birthdate.  When the specimen is collected, it should be labeled with the PnC patient label, and in the case of drawn blood, should include the phletomists initial.  All tests requested by the physician should be properly identified with a written or electronic order. These are requirements for acceptable specimens:

• Samples are to be collected according to specific laboratory instrument manuals (Reference Lab Manuals, instrument operator’s manuals) for individual specimen handling requirements. These requirements may also be found in the Specimen Handling sections of individual assay procedures.

• Specialized tests must include the type of sample (i.e. vaginal swab) or the site of collection (i.e. synovial fluid right knee).

SPECIMEN REJECTION

When a specimen is rejected, the laboratory personnel may need to call or message the patient and ask for a redraw of the specimen. Log the incident into the "Lab Error/Problems/Incidents" binder.

Specimens will be rejected when:

  • The minimum identification criteria is not met (See above)
    • Unlabeled or incorrectly labeled specimens will be discarded by Lab staff. The Lab Supervisor will notify the Medical Director, or their designee, who will message all clinicians potentially afffected by the discarded specimen.
  • Clots are present in anticoagulated tubes.
  • Specimens are grossly hemolyzed.
  • The quantity of specimen is not sufficient to adequately perform testing.
  • The specimen was not collected in the proper container or tube.
Procedure: 

GENERAL COLLECTION AND PROCESSING REQUIREMENTS FOR SPECIMENS 

SERUM SPECIMENS:

Allow to clot for a minimum of 20 minutes and spin for 10 minutes at 3000 rpm. If the specimen is collected in a plain red top tube, carefully separate the serum from the clot, and transfer it to a specimen container that can be capped and labeled. Label it with complete patient information. Store at conditions recommended by the reference lab.

Alternatively, collection tubes containing gel separators may be used; centrifuging these will provide a physical barrier between serum and red blood cells. Specimens collected in these tubes may be stored without transfer, as long as the gel creates a complete separation between serum and red cells.

CITRATED SPECIMENS:

Spin immediately for 10 minutes at 3000 rpm. Reject insufficient draws ("short samples") because the plasma-to-anticoagulant ratio is critical. Separate plasma from cells.  Follow reference lab instructions for storing and sending plasma.   If plasma is frozen, it should be frozen rapidly (-20 degrees C or lower).

EDTA SPECIMENS

Place on the hematology rocker before performing tests. The ICSH (International Committee for Standardization in Hematology) defines fresh blood specimens as processed within four hours after collection. Whole blood collected in EDTA provides accurate results for all parameters within eight hours of collection.

LITHIUM or NA HEPARIN SPECIMENS

Whole blood samples obtained by venipuncture must be homogeneous before use in patient testing. Gently invert the collection tube several times just prior to sample transfer. Do not shake the collection tube; shaking may cause hemolysis.

Whole blood venipuncture samples should be run within 60 minutes of collection for Chemistry analysis. Glucose concentrations are affected by the length of time since the patient has eaten and by the type of sample collected from the patient. To accurately determine glucose results, samples should be obtained from a patient who has been fasting for at least 12 hours. The glucose concentration decreases approximately 5-12 mg/ dL in 1 hour in uncentrifuged samples stored at room temperature.

If heparinized plasma is to be used for testing, centrifuge the collection tube for 10 minutes at 3000 rpm. If analysis of the specimen is to be delayed, carefully separate the plasma from the red blood cells, and transfer it to a specimen container that can be capped and labeled.

Label it with complete patient information. Store at conditions recommended by the method manufacturer.

URINE SPECIMENS FOR URINALYSIS

Test urine as soon as possible (within one hour of collection) to avoid deterioration of the specimen. If specimen is not tested within one hour, refrigerate immediately (2~8 degrees C) in a closed container and test within four hours of collection. Bring the sample to room temperature before testing. If urine is not tested immediately, mix the specimen before testing. Do not centrifuge before performing the chemical portion of the analysis.

Patients will receive instructions, posted in the restrooms, for random, clean catch collection of urine as follows:

CLEAN-CATCH PROCEDURES FOR PATIENTS WITH A VAGINA

• The urine cup must be labeled with the patient label.

• Wash hands thoroughly.

• Separate the folds of skin around the urinary opening. Wipe the area around the opening thoroughly   with the antiseptic towelettes provided, wiping from front to back.

• Void a small amount of urine into the toilet; then collect a midstream sample of urine in the cup, ensuring it is at least 1/3 full. Take care not to touch the inside lip of the container or the underside of lid.

• Secure the lid on the urine cup.

• Place the cup in the silver door with the yellow sign.

CLEAN-CATCH PROCEDURES FOR PATIENTS WITH A PENIS

• The urine cup must be labeled with the patient label.

• Wash hands thoroughly.

• Wipe the end of the penis thoroughly with the antiseptic towelettes provided, beginning at the urethral opening and working away from it.

• Void a small amount of urine into the toilet; then collect a midstream sample of urine in the cup, ensuring it is at least 1/3 full. Take care not to touch the inside lip of the container or the underside of lid.

• Secure the lid on the urine cup.

• Put the cup in the silver door with the yellow sign.

24-HOUR URINE COLLECTION

Check the reference laboratory manual for the correct preservative for the test ordered.

Instruct the patient as follows:

• Excrete all the urine into the toilet and record the time.

• Collect all urine from that day until the same time the following day. At the end of this time, void one last time and add this sample to the container.

• Store the urine in the refrigerator or on ice and transport as soon as possible to the laboratory.

At the laboratory, measure the volume of urine and record if required by the reference laboratory.  Separate two aliquots of urine and label both adequately. Include the 24 urine volume on the labels. Send one to the reference laboratory and keep one in the facility laboratory refrigerator until completed results from the reference laboratory are received.

SELF-COLLECTED "DIRTY" URINE SPECIMENS (UNISEX)

  • Do not clean the genital area.
  • Urinate directly into the labeled cup, filling it approximately 1/3 full.
  • Secure the lid.
  • Place in silver door labeled with the yellow sign.

SELF-COLLECTED VAGINAL SWABS

The patient will be given thorough instructions by the phlebotomist or CLS before collecting the specimen.  There are also very specific instructions in the restrooms.

Procedure:

  •   Wash hands
  •  Set Aptima tube with patient label in test tube holder on the small table. Remove the cap.
  •   Open the packet with the blue swab.
  •   Insert the soft tip of the swab approximately 2 inches into vagina.  Gently rotate for 10 seconds.
  •  Withdraw the swab and place in open tube.
  •   Break off the top half of the swab at the mark.  Screw the cap tightly on the tube.
  •   Place the tube in the rack in the silver door with the yellow sign.

SELF-COLLECTED RECTAL SWABS

The patient will be given thorough instructions by the phlebotomist or CLS before collecting the specimen.  There are also very specific instructions in the restrooms.

Procedure:

  •  Wash hands
  • Set Aptima tube with patient label in test tube holder on the small table. Remove the cap.
  • Open the packet with the blue swab.
  • Insert the soft tip of the swab approximately 1 inch into rectum.  Gently rotate for 10 seconds.
  • Withdraw the swab and put it into the open tube.
  • Break off the top half of the swab at the mark. Screw the cap tightly on the tube.
  •   Place the tube in the rack in the silver door with the yellow sign.

REFERRAL TESTING

Process specimens that require testing at a reference laboratory according to the reference lab online instructions.

END OF DAY PROCESSING REQUIREMENTS FOR BLOOD SPECIMENS

Routine lab services end at 4:30 each day, however electronic patient check in for is available until 5pm. For patients checking in after 4:30, the Lab staff reviews the orders and consults with the ordering clinician or charge nurse, as necessary, to determine testing urgency.

Send-out blood draws end at 4:30 each day. This is necessary to allow for adequate clotting and spinning time prior to the daily reference lab pick up at 5pm.

In-house lab testing ends at 5:15 each day.

After 4:30, if an order contains both in-house and send-out tests, the patient is given the option to return the next day for a single draw. However, if the in-house labs are ordered STAT, the Lab staff will draw the in-house labs that day.

After 4:30, if the ordering clinician requests next day results, the clinician must call the Lab to notify the staff of the urgent draw. A late blood draw will be done, the blood processed, and the Lab will request a STAT pick up from our reference lab. In these cases, the outdoor lock box is used to secure the specimen until the reference lab courier arrives. Because the lock box is located outside, temperatures are variable and specimen quality may be compromised.

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