GENERAL SPECIMEN COLLECTION AND HANDLING

Effective Date: 
Tue, 05/01/2012
Reviewed: 
Tue, 01/10/2017
Policy: 

PURPOSE

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

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 request forms ("super bill", encounter form, outside written orders or electronic order) should include patient name, medical record number or second identifier (Patient ID or medical record number) as applicable, age, sex, date and time of collection, phlebotomists’ initials, and pertinent patient information. 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 can requirements may also be found in the Specimen Handling sections of individual assay procedures.

• Specimens must be properly labeled with the patient’s complete name and secondary identifier (Patient ID or medical record number), date and time of collection, and initials of phlebotomist.

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

• Specimens submitted with a chain of custody form are to meet the same criteria mentioned above, and the form must include the required signatures and medication documentation, according to the instructions for each test and reference laboratory.

SPECIMEN REJECTION

When a specimen is rejected, the laboratory personnel may need to call the patient and ask for a redraw of the specimen. Log the incident as a specimen rejection in the General Quality Assessment Documentation and Corrective Action Log.

Testing will be performed ONLY when the minimum identification criteria is met.

Specimens will be rejected when:

• Clots are present in anticoagulated tubes.

• Specimens are grossly hemolyzed.

• Tubes or specimens were not properly labeled or were mishandled (ie, not stored or shipped at proper temperature, etc.).

• The quantity of specimen is not sufficient to adequately perform testing.

• The specimen was not collected in the proper container or tube.

Procedure: 

GENERAL PROCESSING REQUIREMENTS FOR BLOOD SPECIMENS

SERUM SPECIMENS:

Allow to clot for 30 minutes and spin for 10 minutes at 3000 rpm. If analysis of the specimen is to be delayed, 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 method manufacturer.

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. Separate plasma from cells if testing will not be performed immediately. No patient special preparation is necessary. Plasma anticoagulated with 3.2% sodium citrate is recommended (check specific laboratory requirements). Reject insufficient draws ("short samples") because the plasma-to-anticoagulant ratio is critical. Perform the test within four hours of collection if possible; after this time, store the specimen at 2-8 degrees C. If plasma is frozen, it should be frozen rapidly (-20 degrees C or lower) and thawed rapidly to prevent denaturation of the coagulation factors.

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. The white cell size distribution may shift when specimens are run between 5 and 25 minutes after collection or more than eight hours after collection——this may affect the automated differential results, and cause instrument flags.

LITHIUM 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.

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

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, and do not add preservative to the urine before processing.

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

CLEAN-CATCH PROCEDURES FOR FEMALE PATIENTS

• The urine cup must be labeled with the patient’s full name (use pre—printed label if available).

• 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.

• Bring the cup to the reception area where a staff member will accept the specimen.

CLEAN-CATCH PROCEDURES FOR MALE PATIENTS

• The urine cup must be labeled with the patient’s full name (use pre-printed label if available).

• 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.

• Bring the cup to the reception area where a staff member will accept the specimen.

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 in 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. Also, record the patient’s sex, weight and height. Separate two aliquots of urine and label both adequately. Send one to the reference laboratory and keep one in the facility laboratory refrigerator until completed results from the reference laboratory are received.

REFERRAL TESTING

Process specimens that require testing at a reference laboratory according to the reference lab manual. Each reference laboratory has its own specifications that should be followed.

Send specimens to the reference laboratories specified by the patient’s insurance carrier.