GENERAL COLLECTION PROCEDURES
Contents
1. TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS CULTURE STOOL 1 3DAYS SEE BACTERIOLOGY SPECIMENS STOOL CULTURE THROAT 1 3DAYS SEE BACTERIOLOGY SPECIMENS THROAT CULTURE URINE 1 3 DAYS SEE BACTERIOLOGY SPECIMENS URINE D DIMER SAME DAY GREEN TOP DEPAKANE SAME DAY SEE VALPROIC ACID DHEA SULFATE R RED TOP DIFFERENTIAL WBC SAME DAY PURPLE TOP COUNT DIGOXIN SAME DAY GREEN OR RED TOP COLLECT PREDOSE OR LEAST 8 HOURS POST DOSE DILANTIN SAME DAY SEE PHENYTONIN dsDNA ANTIBODIES R RED TOP DRUG SCREEN URINE SAME DAY URINE 10 ML ELECTROLYTES SAME DAY GREEN OR RED TOP ENDOMYSIAL AB IGA R RED TOP EOSINOPHIL COUNT SAME DAY PURPLE TOP EPSTEIN BARR VIRUS R RED TOP EBV ACUTE ANTIBODIES ESR ERYTROCYTE SAME DAY PURPLE TOP SEDIMENTATION RATE STABLE 4 HOURS AT ROOM TEMP STABLE 12 HOURS REFRIGERATED ESTRADIOL R RED TOP ESTROGEN R GREEN OR RED TOP ETHYL ALCOHOL SAME DAY SEE ALCOHOL ETHYL ETOH FECAL FAT R STOOL 3 GRAMS MINIMUM QUALITATIVE FECAL FAT R CONTACT LAB FOR SPECIMEN COLLECTION QUANTITAIVE MATERIALS FECAL LEUCOCYTE SAME DAY STOOL RANDOM STAIN FERRITIN SAME DAY TOP FIBRINOGEN SAME DAY TOP FLU TEST SAME DAY NASAL WASHING OR NASAL NASOPHARYNGEAL SWAB GREEN CAP 12 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS FOLIC ACID R RED TO2. TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS CLO TEST 1 DAY BIOPSY IN CLO TEST MEDIA CLOZAPINE R PLAIN RED TOP NO GEL CLOZARIL CMV CYTOMEGALO R RED TOP VIRUS ANTIBODIES CO2 SEE CARBON DIOXIDE COAG FACTOR ASSAYS R BLUE TOP 2 ML FOR EACH FACTOR REQUESTED COMPLEMENT C3 R RED TOP COMPLEMENT C4 R RED TOP COMPLEMENT TOTAL R RED TOP COMPREHENSIVE SAME DAY GREEN OR RED TOP METABOLIC PANEL COOMBS DIRECT SAME DAY PINK OR PURPLE TOP COOMBS INDIRECT SAME DAY PINK OR PURPLE TOP SEE TYPENEX PROCEDURE BELOW COPPER SERUM R ROYAL BLUE TOP TUBE NO ANTICOAGULANT CORTISOL A M R RED TOP COLLECT AT 8 00 A M CORTISOL P M R RED TOP COLLECT AT 4 00 P M CORTISOL URINARY R USE JUG CONTAINING BORIC ACID SUPPLIED FREE BY LABCORP CPK SAME DAY GREEN OR RED TOP CREATININE SAME DAY 24 HOUR URINE KEEP ON ICE ALSO NEED CLEARANCE GREEN OR RED TOP COLLECTED DURING COLLECTION OF URINE SEE PATIENT EDUCATION SERIES CREATININE SAME DAY GREEN OR RED TOP CREATININE URINE SAME DAY URINE 10 ML CROSS MATCH SAME DAY PINK OR PURPLE TOP SEE BLOOD BANK TYPENEX PROCEDURE CRYPTOSPIRIDIUM R STOOL 2mL or 2g EIA CSF CELL COUNT SAME DAY CSF 1 ML CSF GLUCOSE SAME DAY CSF 1 ML CSF PROTEIN SAME DAY CSF 1 ML CULTURE BLOOD 1 5 DAYS SEE BACTERIOLOGY SPECIMENS BLOOD CULTURE SPUTUM 1 3 DAYS SEE BACTERIOLOGY SPECIMENS SPUTUM 11 BACK TO TOP
3. 17 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS RENIN R PURPLE TOP RETICULOCYTE COUNT SAME DAY PURPLE TOP RETICULIN AGA AB R RED TOP ROTAVIRUS SAME DAY STOOL 2 ML RPR 1 3 DAYS RED OR PURPLE TOP RSV SAME DAY NASOPHARYNGEAL WASHINGS OR GREEN CAPPED SWAB RUBELLA TITER 166 R RED TOP ANTIBODIES RUBEOLA ANTIBODIES R RED TOP 116 SALICYLATE SAME DAY GREEN OR RED TOP COLLECT 1 3 HOURS POST DOSE SED RATE SAME DAY SEE ESR SERUM PROTEIN R RED TOP ELECTROPHORESIS SEP SICKLE CELL SCREEN R PURPLE TOP SIROLIMUS R PURPLE TOP RAPAMUNE SODIUM SAME DAY GREEN OR RED SPECIFIC GRAVITY SAME DAY URINE 12 ML URINE SPERM COUNT N A Not performed at AGH lab SPINAL FLUID See CSF ANALYSIS STOOL REDUCING SAME DAY STOOL 2 GRAMS PROCESS WITHIN 1 HOUR SUBST AFTER COLLECTION SWEAT TEST N A Not performed at AGH lab T3 FREE R RED TOP T3 TOTAL R RED TOP T UPTAKE SAME DAY GREEN OR RED 4 SAME DAY GREEN OR RED FREE SAME DAY GREEN OR RED T TU Ta SAME DAY GREEN OR RED TACROLIMUS R PURPLE OR GREEN TOP PROGRAF TEGRETOL SEE CARBAMAZAPINE TESTOSTERONE R RED TOP TOTAL TESTOSTERONE FREE R RED TOP THEOPHYLLINE R PLAIN RED TOP NO GEL 18 BACK TO TOP T
4. 1 ML VDRL SERUM W TITER R RED TOP VITAMIN A R RED TOP PROTECT FROM LIGHT PATIENT MUST BE FASTING 8 HRS CONTACT LAB FOR MORE INFORMATION VITAMIN By R PURPLE TOP PROTECT FROM LIGHT THIAMINE VITAMIN Biz R RED TOP PATIENT FASTING RECOMMENDED VITAMIN D 25 0H R RED TOP VITAMIN E R RED TOP PROTECT FROM LIGHT WBC SAME DAY PURPLE TOP WBC DIFFERENTIAL See DIFFERENTIAL WBC COUNT WSR See ESR ZINC R ROYAL BLUE TOP EDTA 21 sm TABLE INCLUDES ALL TESTS PERFORMED AT ABBEVILLE GENERAL AND COMMONLY ORDERED REFERRED PROCEDURES FOR INFORMATION PROCEDURES NOT LISTED CALL 898 6296 FOR ADDITIONAL SPECI MEN REQUIREMENTS Revised October 2014 IV BLOOD BANK TYPENEX PROCEDURE When drawing blood for crossmatching the following procedure must be followed 1 Verify the patient s identification comparing the identification on the requisition with the information on patient s armband and asking patient to state their name and date of birth 20 BACK TO TOP V On the label of the typenex band Write the patient s name hospital number date and time of collection patient s date of birth and the initials of the phlebotomist Draw one pink top tube Remove the completed self sticking label and press onto the pink top tube Place the typenex band on the patient s wrist or ankle with the numbers and information side out Firmly close the clip with the
5. current date and time of collection Send specimen directly to AGH lab for processing If you are not able to separate the plasma from the red cells either by centrifugation and removing the plasma or by 2 BACK TO TOP centrifuging a plasma separator tube it is important that the specimen be transported to the laboratory immediately after collection PLASMA WHOLE BLOOD TUBES GREEN TOP CHEMISTRY LITHIUM HEPARIN TESTING BLUE TOP COAGULATION SODIUM CITRATE PURPLE TOP HEMATOLOGY EDTA PINK TOP BLOOD BANK 3 BACK TO TOP GREY CAP LACTIC ACID TESTING MUST BE SODIUM FLUORIDE COLLECTED ON POTASSIUM CITRATE ICE AND IMMEDIATELY PROCESSED B Whole blood For collecting whole blood fill the proper color coded tube and mix immediately by slowly inverting the tube 8 10 times Do not centrifuge the tube C Serum Chemistry testing Serology testing and most reference lab testing may require serum For collecting specimens completely fill the required red top tube Allow the tube to clot for at least 15 minutes then centrifuge for 15 minutes at approximately 3500 rpm Place the serum in a transfer tube if not on gel using either a clean disposable transfer pipette or by carefully decanting Cap the transfer tube securely and label with the patient s name date of birth date and time of collection If you are not able to separate the serum from the red
6. fallopian tube 2 Male prostatic or seminal fluids Surgical specimens Material from gallbladder etc Respiratory Transtracheal aspirate Urine Suprapubic aspiration 15 B Specimens NOT ACCEPTABLE for anaerobic culture Exudate Pus from superficial wounds or abscesses Genital specimens 1 Female Vaginal cervical or urethral swabs 2 Male Urethral swabs 3 Lesions Materials form burns cysts or ulcers 4 Respiratory Throat tonsillar nasal nasopharyngeal or ear swabs bronchial washings expectorated sputum 5 Gastrointestinal Stool or rectal swab 6 Urine Voided or catheterized urine N Any commercially available anaerobic collection and transport device will be accepted These swabs are available from the lab upon request VI VIROLOGY SPECIMEN COLLECTION PROCEDURES 27 BACK TO TOP A INFLUENZA TESTING Use freshly collected specimens for best test performance Inadequate specimen collection or improper sample handling transport may yield a false negative result The following sample types are acceptable for Flu testing 1 Nasal Wash Aspirate Collect nasal washes in a clean standard container Test as soon as possible Washes can be held at 2 8 degrees centigrade for up to 24 hours before testing Note Nasal washing are generally collected by trained cardiopulmonary personnel Do not attempt specimen collection by this method unless you have been trained
7. 16 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS PRIMIDONE R PLAIN RED TOP PROCAINAMIDE R PLAIN RED TOP PROCALCITONIN R RED TOP PROGESTERONE R RED TOP PROGRAF SEE TACROLIMUS PROINSULIN R RED TOP PROLACTIN R RED TOP PROTEIN SEE SERUM PROTEIN ELECTROPHORESIS ELECTROPHORESIS SEE URINE PROTEIN ELECTROPHORESIS SERUM OR URINE PROTEIN TOTAL SAME DAY GREEN OR RED TOP PROTEIN URINE SAME DAY URINE 10 ML COLLECT 24 HOUR URINE PSA PROSTATIC SAME DAY GREEN OR RED SPECIFIC ANTIGEN PT PROTHROMBIN SAME DAY BLUE TOP TIME TUBE MUST BE FILLED TO THE BLACK TRIANGLE INDICATOR SPECIMENS BELOW THE INDICATOR LEVEL WILL BE REJECTED CENTRIFUGE AND REMOVE PLASMA FROM CELLS IF POSSIBLE DO NOT POUR MULIPLE TUBES TOGETHER PTH INTACT R PURPLE TOP PTH PLUS CALCIUM RED AND PURPLE TOP REQUIRED PTT PARTIAL SAME DAY BLUE TOP THROMBOPLASTIN TUBE MUST BE FILLED TO THE BLACK TIME TRIANGLE INDICATOR SPECIMENS BELOW THE INDICATOR LEVEL WILL BE REJECTED CENTRIFUGE AND REMOVE PLASMA FROM CELLS IF POSSIBLE DO NOT POUR MULIPLE TUBES TOGETHER QUAD SCREEN R 2 FULL RED GEL SEPARATOR TUBES AFP TETRA MATERNAL INFORMATION SHEET REQUIRED AS WELL QUANTITATIVE HCG SEE HCG QUANTITATIVE QUINIDINE R PLAIN RED TOP NO GEL RAPAMUNE SEE SIROLIMUS RHEUMATOID R RED TOP ARTHRITIS RA FACTOR RENAL PANEL SAME DAY GREEN OR RED
8. FASTING LITHIUM SAME DAY PLAIN RED TOP NO GEL COLLECT PREDOSE 15 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS LIVER PROFILE See HEPATIC PANEL LUPUS PANEL R RED TOP MAGNESIUM SAME DAY GREEN OR RED TOP MALARIA PREP R PURPLE TOP 5 ML AND 2 THIN AND THICK SMEARS METHYLMALONIC ACID R RED TOP MYCOPLASMA IGG R RED TOP MYCOPLASMA IGM R RED TOP MITOCHONDRIAL R RED TOP ANTIBODY M2 MONOSPOT SAME DAY GREEN OR RED TOP MUMPS ANTIBODIES R RED TOP 146 Na SEE SODIUM O SULLIVAN SCREEN SAME DAY GREEN OR RED TOP SEE PATIENT EDUCATION SERIES OCCULT BLOOD SAME DAY STOOL STOOL SEE PATIENT EDUCATION SERIES OCP STOOL FOR R STOOL 10 GRAMS FRESH RANDOM OVA CYSTS amp PARASITES OSMOLALITY SERUM R RED TOP OSMOLALTIY URINE R URINE 25 RANDOM OXCARBAZEPI NE R PLAIN RED TOP NO GEL OR PURPLE TOP TILEPTAL PANCREASTATIN R COLLECT IN Z PRESERVATIVE TUBE CONTACT LAB FOR INSTRUCTIONS PAP SMEAR R FIXED SMEAR PHENOBARBITOL R PLAIN RED TOP NO GEL COLLECT PREDOSE PHENYTOIN SAME DAY GREEN OR RED TOP COLLECT PREDOSE PHOSPHORUS SAME DAY GREEN OR RED TOP PIN WORM PREP SAME DAY PINWORM SLIDE PKU R CAPILLARY BLOOD ON PKU CARD PLATELET COUNT SAME DAY PURPLE TOP POTASSIUM SAME DAY GREEN OR RED TOP AVOID HEMOLYSIS PROLONGED TOURNIQUET APPLICATION AND EXCESSIVE FIST CLENCHING PREALBUMIN R RED TOP
9. MATERNAL SUBMIT PRENATAL AFP REQUEST FORM ALPHA FETOPROTEIN R RED TOP 8 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS TUMOR MARKER ALPHA FETOPROTEIN R RED TOP WITH L3 ALT SAME DAY GREEN OR RED TOP AMIKACIN PEAK R PLAIN RED TOP NO GEL COLLECT WITHIN 15 MINUTES AFTER A 60 MINUTE INFUSION 30 MINUTES AFTER A 30 MIN INFUSION AMIKACIN TROUGH R PLAIN RED TOP NO GEL COLLECT PREDOSE AMMONIA SAME DAY GREEN TOP PLACE SPECIMEN ON ICE AFTER COLLECTION SEND TO LAB IMMEDIATELY AMYLASE SAME DAY GREEN OR RED TOP AMYLASE URINE SAME DAY URINE 10 ML COLLECT A TIMED TWO HOUR SPECIMEN OR 24 HOUR URINE REFRIGERATE DURING COLLECTION ANGIOTENSIN R RED TOP CONVERTING ENZYME ACE ANA ANTI NUCLEAR R RED TOP ANTIBODIES ANTITHROMBIN III R BLUE TOP AST R GREEN OR RED TOP BARTONELLA R RED TOP TUBE ANTIBODY PROFILE CAT SCRATCH SEROLOGY BASIC METABOLIC SAME DAY GREEN OR RED PANEL BILIRUBIN SEE BILIRUBIN DIRECT CONJ UGATED BILIRUBIN DIRECT SAME DAY GREEN OR RED PROTECT FROM LIGHT BILIRUBIN TOTAL SAME DAY GREEN OR RED PROTECT FROM LIGHT BLEEDING TIME SAME DAY SEND PATIENT TO LABORATORY BLOOD TYPE amp RH SAME DAY PINK OR PURPLE SEE TYPENEX PROCEDURE BELOW BLOOD UREA SEE BUN NITROGEN BNP SAME DAY GREEN NT PRO BNP IN HOUSE PURPLE TOP BNP RE
10. clockwise for 2 to 3 seconds in the urethra to ensure adequate sampling 3 Withdraw the swab carefully 4 Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube 5 Carefully break the swab shaft against the side of the tube at the score line and discard the top portion of the swab shaft use to avoid splashing of contents 6 Re cap the swab specimen transport tube tightly Specimen Transport and Storage After collection transport and store the swab in the swab specimen transport tube at 2 C to 30 C until tested Specimens must be assayed with the APTIMA assays within 60 days of collection If longer storage is needed refer to the appropriate APTIMA assay package insert MSW USER S MANUAL GENERAL COLLECTION PROCEDURES Back to Top 32 BACK TO TOP
11. eye lid and corneal scrapings as well as chamber fluids Please specify source Ear specimens may be of both internal and external origin Please specify Sinus specimens may include swabs of nares as well as the nasopharyngeal area Note MRSA screening here at AGH is not the same as a sinus culture MRSA screening must be ordered separately and collected with a Red Capped Double swab B ANAEROBIC CULTURES 1 Proper collection and transport of clinical specimens is of primary importance in recovery of anaerobes The sample should be collected from the site of the infection and precautions must be taken to exclude contaminants and aeration of the sample Specimens must be placed under anaerobic conditions as soon as collected for transport to the laboratory since some anaerobes are oxygen toxic and will die rapidly in an aerobic environment Samples must not be refrigerated since chilling is detrimental to some anaerobes PINK CAPPED SWAB FOR ANAEROBIC CULTURE CONTAINS GEL 2 Guidelines for Diagnostic Anaerobic Cultures 26 BACK TO TOP A Specimens ACCEPTABLE for anaerobic culture 1 Body fluids Asitic Cerebrospinal Pericardial Pleural Prostatic Seminal Synovial Thoracentisis Bile Bone Marrow transudate 2 Exudates Aspirated pus from wounds or abscess or if sulfur granules are present 3 Genital specimens 1 Female material from placenta glands culdocentesis endometrium
12. E DAY PURPLE HEPATIC PANEL SAME DAY GREEN OR RED TOP HEPATITIS A R RED OR PURPLE TOP ANTIBODY HEPATITIS B SURFACE R RED TOP ANTIGEN HBSAg HEPATITIS B CORE R RED OR PURPLE TOP ANTIBODY TOTAL HEPATITIS B CORE R RED OR PURPLE TOP ANTIBODY IcM HEPATITIS B SURFACE R RED TOP ANTIBODY HBSAb HEPATITIS C VIRUS R RED OR PURPLE TOP ANTIBODY HCV RT PCR R PURPLE TOP QUANTITATIVE HEPATITIS PANEL R RED TOP HIV 1 2 R RED TOP HIV RAPID POST SAME DAY FINGERSTICK OR PURPLE TOP EXPOSURE ONLY l A R RED TOP l E R RED TOP l G R RED TOP l M R RED TOP 14 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS IMMUNOGLOBULINS R RED TOP 6 11 6 11 INDIA INK PREP R CSF 1 ML INSULIN R RED TOP IRON SAME DAY RED TOP IRON BINDING SAME DAY RED TOP CAPACITY K SEE POTASSIUM KEPPRA SEE LEVTIRACETAM KOH PREP R SWAB OR PRIMARY SPECIMEN IN KOH LEUKOCYTE ALKALINE R GREEN TOP PHOSPHATASE STAIN LAP LUTEINIZING R RED TOP HORMONE LH LD SEE LDH LDH SAME DAY GREEN OR RED LDH R RED TOP ELECTROPHORESIS LDL SAME DAY GREEN OR RED TOP PATIENT MUST BE FASTING LEAD R ROYAL BLUE WHOLE BLOOD WITH ANTICOAGULANT 21 LEVETIRACETAM R PLAIN RED TOP NO GEL KEPPRA LH LEUTINIZING R RED TOP HORMONE LIDOCAINE R PLAIN RED TOP NO GEL LIPASE SAME DAY GREEN OR RED LIPID PROFILE SAME DAY GREEN OR RED TOP PATIENT MUST BE
13. EST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS COLLECT IV DOSE 30 MIN AFTER COMPLETED ORAL DOSE 2 HOURS POST DOSE THYROGLOBULIN R RED TOP ANTIBODY THYROGLOBULIN R RED TOP QUANTITATIVE TIBC SEE IRON BINDING CAPACITY TISSUE R RED TOP TRANSGLUTAMINASE IGA 166 TISSUE R RED TOP TRANSGLUTAMINASE IGG TRANSFERRIN SAME DAY RED TOP SATURATION TRIAGE DRUG SCREEN SEE DRUG SCREEN Urine TRICHOMONAS PREP SAME DAY VAGINAL SWAB PLACED IN A SMALL AMOUNT OF SALINE TRILEPTAL SEE OXCARBAZEPINE TRIGLYCERIDE SAME DAY GREEN OR RED TOP PATIENT MUST BE FASTING THYROID PEROXIDASE R RED TOP TPO ANTIBODIES THYROID SAME DAY GREEN OR RED STIMULATING HORMONE TSH TYPE AND RH SAME DAY PINK OR PURPLE TOP UCG SAME DAY URINE 12 ML RANDOM URIC ACID SAME DAY GREEN OR RED TOP URINALYSIS SAME DAY URINE 12 ML STABLE 1 HOUR AT ROOM TEMP STABLE 24 HOURS REFRIGERATED URINE PROTEIN R URINE 100 ML ALIQUOT OF A 24 HOUR URINE ELECTROPHORESIS COLLECTION OR 10 ML RANDOM URIN VALPROIC ACID SAME DAY GREEN OR RED TOP COLLECT PREDOSE VANCOMYCIN PEAK SAME DAY GREEN OR RED TOP COLLECT 2 HOURS AFTER THE COMPLETION OF A 60 MINUTE VANCOMYCIN SAME DAY GREEN OR RED 19 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS TROUGH COLLECT PREDOSE VARICELLA ZOSTER R RED TOP VIRUS VZV 146 VDRL CSF R CSF
14. F LAB BUN SAME DAY GREEN OR RED TOP 9 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS CBC SAME DAY PURPLE TOP 24 HRS ROOM TEMP 36 HRS REFRIGERATED C REACTIVE PROTEIN R RED TOP QUANTITATIVE C REACTIVE PROTIEN R RED PURPLE OR GREEN TOP CARDIAC HIGH SENS SEND IMMEDIATELY AFTER COLLECTION C DIFFICILE TOXIN SAME DAY STOOL MINIMUM 2 GRAMS C S F ANALYSIS SAME DAY CSF IN 4 STERILE TUBES IMMEDIATELY TRANSPORT TO THE LABORATORY DO NOT REFRIGERATE CA 125 R RED TOP CA 15 3 R RED TOP CA 19 9 R RED TOP CA 27 29 R RED TOP CAFFEINE R PLAIN RED TOP NO GEL CALCIUM SAME DAY GREEN OR RED TOP CARBAMAZAPINE SAME DAY PLAIN RED TOP GEL CARBON DIOXIDE SAME DAY GREEN OR RED TOP CCP ANTIBODIES IGA R RED TOP GEL RECOMMENDED 166 CEA R RED TOP TUBE CARCINOEMBRYONIC AG CHLAMYDIA CULTURE R ENDOCERVICAL OR URETHRAL SWAB COLLECTED WITH CULTURETTE PLACED IN CHLAMYDIA TRANSPORT MEDIA SEE BACTERIOLOGY SECTION BELOW CHLAMYDIA PROBE BY R APTIMA UNISEX SWAB TRANSPORT KIT GEN PROBE at CHLORIDE SERUM SAME DAY GREEN OR RED TOP CHOLESTEROL SAME DAY GREEN OR RED TOP CHOLINESTERASE R RED AND OR PURPLE TOP CHOLINESTERASE RBC R PURPLE TOP CK SEE CKMB SAME DAY GREEN OR RED TOP CL SEE CHLORIDE CLINITEST URINE SAME DAY RANDOM URINE REFRIGERATE 10 BACK TO TOP
15. GENERAL SPECIMEN COLLECTION PROCEDURES ABBEVILLE GENERAL HOSPITAL LABORATORY TABLE OF CONTENTS IV VI VII SPECIMEN PREPARATION AND HANDLING INTRODUCTION A PLASMA B WHOLE BLOOD C SERUM D URINE E STORAGE AND TRANSPORT LABELING OF SPECIMENS A CRITERIA FOR REJECTION SPECIMEN REQUIREMENTS TABLE BLOOD BANK TYPENEX PROCEDURE BACTERIOLOGY A AEROBIC CULTURES 1 THROAT SWABS SPUTUM URINE VAGINAL CERVICAL URETHRAL STOOL CEREBROSPINAL FLUID CSF SYNOVIAL JOINT FLUID BLOOD CULTURES WOUNDS ABSCESSES EXUDATES 10 MRSA SCREENING 11 EYE EAR SINUS CULTURES B ANAEROBIC CULTURES 1 ANAEROBIC CULTURE TRANSPORT 2 GUIDELINES FOR ANAEROBIC CULTURE VIROLOGY SPECIMEN COLLECTION PROCEDURES A INFLUENZAE TESTING B RSV TESTING PARASITOLOGY SPECIMEN COLLECTION PROCEDURES VII OTHER SPECIMEN COLLECTION PROCEDURES MISCELLANEOUS BACK TO TOP l SPECIMEN PREPARATION AND HANDLING INTRODUCTION Proper specimen collection preparation and handling are imperative to ensure valid laboratory results Improper technique in obtaining and preserving specimens may yield false analytical values The following information summarizes our recommendations for collecting handling and preserving specimens In order that the results of analysis truly reflect the patient s condition we suggest that these recommendations be followed closely Also in this directory specific specimen requirements for each test ar
16. OP Some tests require special patient preparations fasting states or timing of samples It is important that these requirements are followed in order for the test results to be meaningful to the physician interpreting the results Specimen requirements for blood samples will be listed as Plasma Serum or Whole Blood D URINE COLLECTION Collection of urine should be into chemically clean receptacle tightly sealed and labeled with the patient s name date of birth and date and time of collection Some procedures may require timed specimens or samples collected over a 24 hour period Urine collection for culture and sensitivity will be outlined below in bacteriology section E STORAGE AND TRANSPORT Specimens should be transported to the laboratory immediately after collection If the serum or plasma will be separated from the red cells before being sent to the laboratory the table will indicate the proper storage temperature If the serum or plasma cannot be separated contact the laboratory for instructions Frozen specimens Some specimens should be frozen soon after collection if testing will be delayed Serum or plasma can only be frozen after they have been centrifuged and placed in a plastic transfer tube NEVER FREEZE A TUBE WHICH STILL CONTAINS RED BLOOD CELLS NEVER FREEZE A GLASS TUBE 6 BACK TO TOP ll LABELING OF SPECIMENS In order to assure positive identification and optimum integrity of patient specim
17. P FOLIC ACID RBC R 2 PINK TOPS FILLED FOLLI CLE R RED TOP STIMULATING HORMONE FSH FTA ABS R RED TOP G 6PD R 2 PURPLE TOPS FILLED GASTROCCULT SAME DAY EMESIS GASTRIC ASPIRATE GENTAMYCIN PEAK SAME DAY GREEN OR RED TOP COLLECT WITHIN 15 MINUTES AFTER A 60 MINUTE INFUSION 30 MINUTES AFTER A 30 MIN INFUSION GENTAMYCIN TROUGH SAME DAY GREEN OR RED TOP COLLECT PREDOSE GGT GAMMA R GREEN OR RED TOP GLUTAMYL TRANSPEPTI DASE GIARDIA ANTIGEN R STOOL 2 GRAM MINIMUM GLIADIN AB IGA R RED TOP GLI ADIN IGG R RED TOP GLUCOSE TOLERANCE SAME DAY SEE SPECIAL PROCEDURES GLUCOSE 2 HOUR SAME DAY GREEN OR RED TOP POST PRANDIAL GLUCOSE SAME DAY GREEN OR RED TOP GLUCOSE URINE SAME DAY URINE RANDOM 10 ML GLUTAMIC ACID R DECARBOLYLASE GDA GLYCOHEMOGLOBIN SEE HEMOGLOBIN A c GRAM STAIN SAME DAY PREPARED SLIDE OR PRIMARY SPECIMEN GROUP B CULTURE 1 3 DAYS WHITE CAPPED SWAB VAGINAL ANORECTAL AREA 13 BACK TO TOP TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS GROWTH HORMONE R RED TOP H PYLORI ANTIBODY SAME DAY RED TOP H PYLORI ANTIGEN R STOOL 2mL or 2g HCG QUALITATIVE SAME DAY RED TOP HCG QUANTITATIVE SAME DAY GREEN OR RED TOP HDL CHOLESTEROL SAME DAY GREEN OR RED TOP HEMATOCRIT SAME DAY PURPLE HEMOGLOBIN R PURPLE TOP ELECTROPHORESIS HEMOGLOBIN SAME DAY PURPLE HEMOGLOBIN SAM
18. band between the front and rear guides The band becomes tamperproof when the clip is properly closed Tear or cut the remaining numbers from typenex band Send blood and remaining typenex numbers to the laboratory THE TYPENEX BAND MUST BE APPLIED AT THE TIME THE BLOOD IS COLLECTED BACTERIOLOGY SPECIMEN COLLECTION PROCEDURES A AEROBIC CULTURES 1 THROAT SWABS Using a tongue blade depress the tongue enough to be able to visualize the back of the throat Using a Culturette swab swab the back of the throat and the tonsillar area being careful not to touch the tongue or mouth Replace swab 21 BACK TO TOP into carrier Specimens can be kept at room temperature until processed See diagram below for acceptable throat swabs WHITE CAPPED SWABS RED CAPPED DOUBLE SWABS PREFERRED O O 157 SWAB USED FOR OFFSITE RAPID 5 TESTING 2ND SWAB SENT TO AGH LAB FOR CONFIRMATORY CULTURE 2 SPUTUM Have the patient remove excess saliva from the mouth then cough up sputum from deep within the chest Collect the sample into a sterile specimen cup Transport immediately to the laboratory Note refer to the patient education series for detailed information for the patient 3 URINE Urines should be collected into sterile specimen cups by one of the following methods a Clean catch mid stream b Catheterized c Foley catheter or d Suprapubic aspiration Refrigerate all urine specimens immediatel
19. cells by centrifugation and removing the serum it is important that the specimen be transported to the laboratory immediately after collection 4 BACK TO TOP SERUM TUBES RED TOP PLAIN SST CHEMISTRY NO SEROLOGY SEND ANTICOAGULANT OFF TESTING ETC MOST OF THE TIME A YELLOW RING OF THE CAP WILL INDICATE THAT THE TUBE CONTAINS A GEL SEPARATOR A WHITE RING WILL INDICATE THAT IT IS A SHORT SAMPLE TUBE AND A BLACK RING WILL INDICATE THAT A TUBE HAS NO GEL SHORT DRAW TUBE USE CAUTION AS MOST DO NOT CONTAIN GEL NOR MAY THEY MEET MINIMUM SPECIMEN VOLUME REQUIREMENTS DIRECT ANY QUESTIONS ON SPECIMEN COLLECTION REQUIREMENTS TO AGH LAB AT 337 898 6475 When blood is collected fill the labeled proper color coded tube completely with blood to ensure the correct ratio of specimen to anticoagulant preservative The exception to this is the blue top citrated tube which is a partial draw tube Allow the tube to fill until the vacuum of the tube is depleted to assure proper volume It is very critical for coagulation testing that the tube be allowed to fill to the appropriate volume Immediately after filling invert all tubes slowly 8 10 times to thoroughly mix the blood and the anticoagulant Avoid vigorous mixing which can cause hemolysis and adversely affect some tests results Instructions for proper blood drawing phlebotomy are available from our laboratory on request 5 BACK TO T
20. cimens Inappropriately collected specimens Insufficient quantity Specimens submitted in incorrect or expired transport media 7 BACK TO TOP Il SPECIMEN REQUIREMENTS The following table lists specimen requirements by test name Additional specific specimen collection procedures follow the table when indicated SERUM UNLESS SPECIFICALLY INDICATED EITHER A PLAIN RED OR A RED SERUM SEPARATOR TUBE MAY BE USED PLAIN RED IDICATES THAT SERUM SEPARATOR TUBES SHOULD NOT BE USED GREEN TOP INDICATES LITHIUM HEPARIN ANTICOAGULANT UNLESS NOTED RED TOP INDICATES ANY RED TOP TUBE UNLESS NOTED LABCORP REFERENCE LABORATORY REF LAB SEE LINK BELOW FOR ALL SPECIMEN REQUIREMENTS https www labcorp com wps portal provider testmenu R SPECIMENS REFERRED TO REFERENCE LABS INFORMATION ON TESTING SCHEDULES CAN BE OBTAINED BY CALLING THE LABORATORY TEST RESULTS SPECIMEN NAME AVAILABLE REQUIREMENTS ACETAMINOPHEN SAME DAY GREEN OR RED TOP ACETONE SERUM SAME DAY GREEN OR RED TOP ACETONE URINE SAME DAY URINE 5 ML ACID PHOSPHATASE R ANY RED TOP ACTH R PURPLE TOP EDTA PLASMA ACTIN SMOOTH R RED TOP MUSCLE ANTIBODY AFB CULTURE AND R SPUTUM BRONCHIAL WASH ETC STAIN Refrigerate ALBUMIN SAME DAY GREEN OR RED TOP ALCOHOL ETHYL SAME DAY GREEN OR RED TOP CLEAN SKIN WITH A DISINFECTANT OTHER THAN ALCOHOL ALKALINE SAME DAY GREEN OR RED PHOSHPATASE ALP ALPHA FETOPROTEIN R RED TOP
21. e given and these must be followed carefully Please call the laboratory if you have any questions about obtaining a valid specimen for the test desired Blood specimens will be drawn for procedures requiring plasma serum or whole blood The tops of collection tubes are color coded according to the anticoagulant or preservative plasma or lack thereof serum In the alphabetical listing of tests the proper tube is indicated by anticoagulant used or as a specific quantity of serum red top The following table is provided as a guide to the anticoagulant preservative in the various collection tubes A Plasma Most chemistry tests processed here at AGH require clear unhemolyzed plasma obtained from green top tubes Red top serum may be used as well The required green top tube for chemistry testing at AGH contains Lithium Heparin as the anticoagulant and has a gel separator included The gel containing plasma separator tube is preferred over the non separator due to its preservative properties removing plasma from the red cells reduces eliminates metabolism of analytes tested thus preserving the accurate analytical value If possible immediately centrifuge the tube at 3500 rom for 15 minutes If a gel separator tube is not used i e in the case of coagulation tests in a blue top tube the plasma only no red cells must be decanted and pipetted into a capped transport tube Properly label the tube with the patient s name date of birth
22. ell counts cannot be performed on clotted samples Place an aliquot into a red top tube for chemistry procedures and an aliquot into a sterile tube for cultures 5 Chlamydia GC swabs for Gen Probe a Endocervical swab specimens 1 Remove excess mucus from the cervical os and surrounding mucosa using the cleaning swab white shaft swab in the package with red printing Discard this swab Note To remove excess mucus from the cervical os a large tipped swab not provided may be used 2 Insert the specimen collection swab blue shaft swab in the package with the green printing into the endocervical canal 3 Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling 31 BACK TO TOP 4 Withdraw the swab carefully avoid any contact with the vaginal mucosa 5 Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube 6 Carefully break the swab shaft against the side of the tube at the score line and discard the top portion of the swab shaft use care to avoid splashing of contents 7 Re cap the swab specimen transport tube tightly b Male urethral swab specimens The patient should not have urinated for at least 1 hour prior to sample collection 1 Insert the specimen collection swab blue shaft swab in the package with the green printing 2 to 4 cm into the urethra 2 Gently rotate the swab
23. ens from the time of collection until testing has been completed and results reported all specimens submitted to AGH laboratory for testing must be labeled with the patient name and a unique identifying number In general it would always be acceptable to use name and date of birth Multiple samples from the same patient on the same day should also be labeled with the time of collection or site specific information as appropriate Accrediting agencies require the laboratory to reject a specimen for analysis if there is no identification on the specimen Collectors will be notified of inappropriately labeled specimens A CRITERIA FOR REJECTION Specimens collected according to the requirements in the procedure list will be acceptable for analysis Specimens not collected according to guidelines may be subject to rejection The collection site or physician will be notified immediately of the rejection A specimen collection deficiency report will be filled out on these specimens and determinations will be made as to whether the patient s treatment was compromised Some criteria for rejection of specimens are Unlabeled specimens Improperly labeled specimens Specimens received without requests Incomplete or incorrect test request form e g no test marked Test order without a specimen Grossly hemolyzed blood Clots in an anticoagulated tube Compromised specimens e g grossly contaminated Leaky containers Improper storage of spe
24. erally collected by trained cardiopulmonary personnel Do not attempt specimen collection by this method unless you have been trained in this method of sample collection 2 Nasopharyngeal Swabs Only sterile cotton rayon foam or polyester flexible swabs are acceptable Do not use calcium alginate swabs Nasopharyngeal Insert nasopharyngeal swab beneath the inferior turbinate of either nares keep the swab near the septum and floor of the nose until entering the nasopharynx and rub and roll against the mucosal surface Remove swab taking care not to injure the nasal mucous membrane and insert swab into transport system SEND TO LAB IMMEDIATELY AFTER COLLECTION 29 BACK TO TOP VII VII 1 3 Nasal Insert sterile swab into either nares and carelully rotate the swab Place the sample into the transport system and keep at room temperature for up to 4 hours or refrigerate up to 48 hours Transport medial The following common media be used to transport the samples Amies Media Saline Stuart s Media Note Culturette swabs used at Abbeville General Hospital use Stuart s Media PARASITOLOGY SPECIMEN COLLECTION PROCEDURES A Stool for OCP Collect specimen in a clean well sealed container and submit to the laboratory as soon as possible If storage for a short time is required 2 4 hours place the specimen in the refrigerator B Gross Specimens for Identification a Worms should be submitted if poss
25. ible 10 formalin b Insects should be submitted in a clean container without preservatives OTHER SPECIMEN COLLECTION PROCEDURES Virology When viral antibody studies are requested both acute and convalescent specimens should be submitted Contact the laboratory for viral culture procedures Amniotic fluid Fluid should be sent immediately to the laboratory in a clean tube shielded from light SYNOVIAL JOINT FLUIDS Joint aspiration should be performed by a physician under strict sterile conditions For routine exam the fluid is obtained by syringe Some of the fluid collected should be transferred into a sterile tube for microbiology studies a green top tube for cell counts and a red top tube for chemistries t is important that the 30 BACK TO TOP specimen be added to the green top tube soon after collection in order to prevent clot formation For culture submit collected specimens as a swab a syringe REMOVE THE NEEDLE or ina sterile container Label the request with the source of the specimen i e right Knee fluid Specimens should be plated within four hours Do not refrigerate specimens 4 Pleural Pericardial amp Peritoneal fluid Obtain fluid by suction aspiration in a sterile trap or with a syringe Transfer an aliquot into a green top tube as soon as possible is important that the specimen be added to a green top tube soon after collection in order to prevent clot formation C
26. in this method of sample collection Nasopharyngeal and Nasal Swabs Only sterile cotton rayon foam or polyester flexible swabs are acceptable Do not use calcium alginate swabs NASOPHARYNGEAL SWAB GREEN CAP a Nasopharyngeal Insert nasopharyngeal swab beneath the inferior turbinate of either nares keep the swab near the septum and floor of the nose until entering the nasopharynx and rub and roll against the mucosal surface Remove swab taking care not to injure the nasal mucous membrane and insert swab into transport system SPECIMEN MUST BE ELUTED WITHIN 1 HR OF COLLECTION SEND TO LAB IMMEDIATELY AFTER COLLECTION 28 BACK TO TOP b Nasal Insert sterile swab into either nares and carefully rotate the swab SEND TO LAB IMMEDIATELY AFTER COLLECTION Transport media The following common media can be used to transport the samples Amies Media Saline Stuart s Media Note Culturette swabs used at Abbeville General Hospital use Stuart s Media RSV TESTING Use freshly collected specimens for best test performance Inadequate specimen collection or improper sample handling transport may yield a false negative result The following sample types are acceptable for RSV testing 1 Nasal Wash Aspirate Collect nasal washes in a clean standard container Test as soon as possible Washes can be held at 2 8 degrees centigrade for up to 24 hours before testing 4 HRS ROOM TEMP Note Nasal washing are gen
27. n For culture submit collected specimens as a swab in a syringe REMOVE THE NEEDLE or in a sterile container Label the request with the source of the specimen i e right Knee fluid Specimens should be plated within four hours Do not refrigerate specimens BLOOD CULTURES Aseptically draw blood into blood culture bottles Two bottles per set is required Do not refrigerate blood culture bottles after collection Ww r WOUNDS ABSCESSES EXUDATES Specimens be submitted as a swab or in a syringe REMOVE THE NEEDLE 24 BACK TO TOP Include on the request the source of the specimen Do not refrigerate specimens after collection GRAM STAINS PERFORMED ONLY IF ORDERED BY PHYSICIAN WHITE CAPPED SWAB WOUNDS ABSCESSES EXUDATES 10 MRSA SCREENING NARES ONLY A DOUBLE culture swab is used to swab each nasal opening Use both swabs at once to swab each nostril Testing performed by PCR technology Cepheid GeneXpert Results obtained within an hour Note MRSA is ONLY screened on the nares Tissue or other specimen types will be rejected Routine wound culture will detect MRSA if present in tissue RED CAPPED DOUBLE SWAB FOR MRSA TESTING AVAILABLE AT AGH LAB UPON REQUEST 25 BACK TO TOP 11 EYE EAR SINUS CULTURES Swabbed specimens may be submitted for culture White and green capped swabs are acceptable for eye ear and sinus specimens Eye specimens may include swabs of conjunctiva
28. y after collection URINES MUST BE PROCESSED WITHIN 24 HRS OF COLLECTION Urine collection patient education materials are available upon request 22 BACK TO TOP 4 VAGINAL CERVICAL URETHRAL Specimens should be collected using a culturette swab see below If culture is for GC transport the specimen immediately to the laboratory Do not refrigerate swabs after collection WHITE CAPPED SWABS GC CULTURE GROUP B STREP TESTING APTIMA UNISEX SWABS AVAILABLE FROM AGH LAB FOR GC CHLAMYDIA GENPROBE DNA TESTING 5 STOOL Submit fresh stool a clean well sealed container swab smeared through a stool specimen or a rectal swab is 23 BACK TO TOP 9 acceptable if collected with a transport device Do not refrigerate stool or swabs after collection CEREBROSPINAL FLUID CSF After aseptic collection into sterile tube send immediately to the laboratory Request as STAT Do not refrigerate CSF after collection SYNOVIAL JOINT FLUIDS Joint aspiration should be performed by a physician under strict sterile conditions For routine exam the fluid is obtained by syringe Some of the fluid collected should be transferred into a sterile tube for microbiology studies a green top tube for cell counts and a red top tube for chemistries It is important that the specimen be added to the green top tube soon after collection in order to prevent clot formatio
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