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Upper Valley Medical Center Laboratory Service Manual Table of

1. 104 Test Description Coagulation Studies QUEST send out test QU if indicated Specimen Instruction Tube COAGULATION STUDIES All Lt Blue top tubes must be filled to the indicated line to be accepted Lt Blue top tubes with Yellow striped labels 3 2 Sodium Citrate Coagulation Factor Il DNA Analysis Prothrombin Gene Mutation Analysis QU 30326X Need 2 Full Tubes 2 lavender top tubes 7mls whole blood Specimens drawn in EDTA royal blue top sodium heparin lithium heparin and ACD solution B yellow top tubes are also acceptable Do not centrifuge specimens Keep at room temperature Coagulation Factor V Activity QU 344X Special Instructions Call Lab 1 Full 4 5ml Lt blue top tube 3 2 or 3 8 Sodium Citrate are acceptable Immediately centrifuge for 15 minutes at 3500 rpm separate and freeze plasma Submit separate frozen vials for each special coagulation assay ordered Coagulation Factor V Leiden Mutation Analysis QU 22722X Need 5mls whole blood from EDTA lavender tube Also acceptable Royal blue top EDTA or Green top sodium heparin or lithium heparin or Yellow top ACD Solution B Must be Room Temperature Specimen stability is crucial For prenatal fetal specimens call lab Coagulation Factor VII Activity Stable Factor QU 346X Special Instructions Call Lab 1 Full tube in It blue top tube 3 2 or 3 8 Sodium citrate Spin at 3500
2. D e test QU if Specimen Instruction Tube indicated Medical screens DO NOT require a chain of custody form DRUG SCREENS Legal drug screens DO require a chain of custody form Urine Drug Screen UVMC S 7 drugs of abuse panel Amphet Barb Benzo In house Min 30mL urine in urine container Cannab Cocaine Opiate amp PCP Urine Drug Screen 9 Panel Employee i a br f Includes the 7 panel drug screen and Propoxy amp In house Min 30mL urine in urine container Methadone Employee Drug Screen 9 Panel In house Min 30mL urine in urine container Drug Screen Meconium 9 Panel QU 30427X 5gm fresh meconium 1gm min Refrigerate Drug Screen Amphetamines in house test Min 30mL urine in urine container Drug Screen Barbiturate in house test Min 30mL urine in urine container Drug Screen Benzodiazepine in house test Min 30mL urine in urine container Drug Screen Cannabinoids in house test Min 30mL urine in urine container Drug Screen Cocaine in house test Min 30mL urine in urine container Drug Screen Methadone in house test Min 30mL urine in urine container Drug Screen Opiates in house test Min 30mL urine in urine container Drug Screen PCP Phencyclidine in house test Min 30mL urine in urine container Drug Screen Propoxyphene Darvocet in house test Min 30mL urine in urine container MCM Drug of Abuse Scre
3. Test Description QUEST send out test QU if Specimen Instruction Tube Cytology indicated Thin Prep with HPV reflex When ordering nhai Special Media Preserve CYST Solution for use with Thin MUST STATE diagnostic or screen Prep GYN Request Urine diagnostic screen Cytology Non Gyn Request DIALYSIS ONLY Quest send out ee test QU if Specimen Instructions Tube Shipping Test Description indicated Dialysis Pre BUN innedise 1 full tube min 3mls blood in green black top tube Preferred or gold top tube Dialysis Glucose MR BUSe 1 full tube min 3mls blood in green black top tube Preferred or gold top tube Dialysis HgbA1C In house 1 full tube lavender top tube EDTA Dialysate Profile Urea dialysate creatinine dialysate Protein dialysate amp In house 1 ml dialysate Glucose dialysate Dialysis Profile Potassium Chloride Bicarb BUN Creatinine LD SGOT Alk Phos T Protein Alb In house a eee eee oe ua ble oi oka aan nea lao abe Globulin Calcium Phosphorous PLUS CBC poc IM ae eee Re MINUS DIFF Dialysis Profile Potassium Chloride Bicarb BUN Creatinine LD SGOT Alk Phos T Protein Alb Globulin mhouse 1 full tube blood in gold top tube or green black top tube AND 2 Calcium Phosphorous PLUS CBC MINUS DIFF ml blood in lavender top tube 113 Test Description QUEST send out
4. Anti viral therapeutics should be noted on test requistion Legionella Culture QU 5934P Fresh biopsy tissue lower respiratory tract specimens or pleural fluid in sterile screw capped container KEEP REFRIGERATED Neonatal Culture gram stain incl In house State Source Microbiology transport medium red or blue cap Nose Culture gram stain incl In house Nose Microbiology transport medium red or blue cap Mycobacteria Culture Blood AFB Acid Fast Culture QU 41194F Special Tube 7 10mls blood collected in an Isolator Tube green top heparin vacutainer tube or yellow top SPS vacutainer tube Invert tube gently at least 4 times after drawing Refrigerate Mycobacteria Culture Misc Source W Decontamination AFB Acid Fast Culture QU 3986 Sources Bronchial Washings and Bronchial Alveolar Lavage material Gastric Aspirate material Stool and Colon Aspirate material Submit in sterile container Refrigerate Swab specimens will be rejected 109 Test Description Cultures QUEST send out test QU if Specimen Instruction Tube indicated 5 mls of sputum or tracheal aspiration material in a sterile wax Mycobacteria Culture amp Stain Sputum QU 3251A free container Collect an early morning specimen from deep productive cough on three consecutive days Minimum specimen is 5ml volume Refrigerate Sources T
5. Laboratory Compendium In House and Out Reach Facilities Red top tube no additive no gel serum be sure that blood is fully clotted before centrifuging Lt Blue top tube or Blue black 3 2 Sodium Citrate tube plasma Tube must be filled to the indicated line Gold top tube gel serum be sure tube has clotted before centrifuging Green black top tube Lithium Heparin gel plasma Green top tube no gel Lithium heparin plasma Read label Lavender top tube EDTA plasma 1 ml min draw on 3 ml tube or 3 ml min draw on 7 ml tube Blood Bank tube EDTA Lavender top 7ml tube must be arm banded accordingly Grey top tube Sodium Fluoride Potassium Oxalate Green top tube plasma no gel Sodium Heparin 5 ml tube read tube label Royal Blue tube Sodium Heparin 7 ml tube and EDTA 7 ml tube and No Additive 7 ml tube Contact Laboratory for assistance PLEASE REFER TO Proper Order of Drawing for specimens Body Fluids CSF Fluids and Culture Sections when appropriate Keep all specimens Refrigerated unless noted below QUEST send out Test Description ery if Specimen Instructions Tube Indicated 10ml aliquot of 24hr urine Use 25ml of 6N HCL as preservative Collection may be done with out preservative if PH is below 6 and specimen is shipped 5 HIAA QU 9936N Hels Patient should avoid foods high in indoles Avocado banana omato plum walnut pineapple and eggplant Also avoid tobacco tea and
6. 3 Minimum permissible time between autologous donation is 72 hours 4 Age pregnancy being underweight and uncomplicated coronary artery disease are not necessarily contraindicated for this procedure 5 Disadvantage a Increased cost over random supply b Donor must go to the Dayton Community Blood Center to have component collected 164 B Directed Donor Donation IV V VI VII Not statistically safer than blood from the random supply volunteer donors 2 Advantage Positive psychological benefit for the patient 3 Disadvantages a Increased cost over random supply b Donor must go to Dayton CBC to have component collected c Potential legal problems donors lose their anonymity transfusion transmitted diseases C Intraoperative Blood Salvage Performed during surgery under the direction of the Chief of the Medical Staff Laboratory Responsibility A B When Blood Bank work is completed the results will be available in the hospital computer system Nursing Stations will be notified when products ordered to be transfused are ready or if there will be a delay in supplying requested products The Blood Transfusion Record will be placed with the unit of blood Signing Blood Out of Blood Bank A Nursing personnel must bring a paper with the patient s information stamped on it The patient s blood bank armband ID number must also be recorded and brought to Blood Bank Pertinent
7. Biopsy a Call Histology x4638 IEK Time E As of March 28 2007 this test had been discontinued Please refer to 9 Platelet Function Analysis for collection protocol ao Test Description ABCDEFG HIJ KLMNOPQRSTUVW Blood Group amp Rh Type and Rh Blood Smear Pathology Interpretation Blood Urine BMP Basic Metabolic Panel Lytes Glucose BUN Creatinine Calcium BMP minus glucose BNP Brain Natriuretic Peptide Body Fluids Body Fluid Albumin Body Fluid Alkaline Phosphatase Body Fluid Amylase Body Fluid BF Cell Count Body Fluid Cholesterol Body Fluid Culture Includes gram smear Body Fluid Glucose Body Fluid HDL QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ Inhouse 1 full 7ml EDTA lavender tube Blood Bank tube in house Whole blood in Lavender top tube 1ml min draw in a 3 ml tube or 3 ml min draw in a 7 ml tube In house 1 ml random urine in a sterile container 1 full tube min 3 mls blood in green black top tube or gold top tube 1 full tube min 3 mls blood in green black top tube or gold top tube 1 full 3 5 ml tube blood in Dark Purple Black tube Draw separate inhouse specimen for this test This tube is acceptable for BNP s only If testing is delayed store EDTA plasma in plastic tubes at 2 8C or freeze at or below 20C if delay is more than 24hours seat ents Seecmentotay 1m
8. Birth 2 weeks lt 6 5 g dL lt 50 x 10 uL or gt 999 x 10 uL INR gt 6 5 gt 100 seconds Adults lt 2 0x10 uLor gt 40 0 x 10 uL CHEMISTRY CRITICAL VALUES Acetominophen Amylase Bilirubin neonatal Calcium Carbamazepine Digoxin Glucose serum lonized Calcium gt 120 ug mL 4 hrs post gt 50 ug mL 12 hrs post gt 1000 U L gt 15 00 mg dL lt 6 0 mg dL or gt 13 0 mg dL gt 12 0 ug mL gt 2 5 ng mL Adult Pediatric lt 40 mg dL gt 40 mg dL gt 450 mg dL gt 300 mg dL lt 3 2 mg dL or gt 6 2 mg dL lt 8 5 g dL or gt 24 g dL Neonates Birth 2 week lt 4 0 x 10 uL or gt 30 0 x 107 uL 14 Lactate gt 24 mg dL CHEMISTRY CRITICAL VALUES CONTINUE Lithium gt 1 5 mmol L post 12 hour dose Magnesium lt 1 0 mg dL or gt 5 0 mg dL Phenobarbital gt 45 0 ug mL Phenytoin gt 30 0 ug mL Phosphorous lt 1 0 mg dL Potassium Adult Newborn lt 2 9 mEq L lt 3 0 mEq L gt 6 1 mEq L gt 7 0 mEq L Sodium lt 125 mEq L or gt 160 mEq L Troponin gt 0 780 ng mL Valproic Acid gt 125 ug mL SEND OUT CRITICAL VALUES REFERENCE LAB Send out test results are defined as critical using the reference lab s critical values list These results will be called directly to us and a copy of the results will be sent via fax It is then our responsibility to inform the ordering physician using our normal critical result procedure See attachment for list of send out criticals SEND
9. COMMONLY USED Revised procedure April 27 2007 Supercedes revised procedure prepared by TMC date 9 11 06 supersedes procedure written 1 03 tmc 139 UPPER VALLEY MEDICAL CENTER North Dixie Highway Troy Ohio 45373 CAPILLARY SKINPUNCTURE PROCEDURE Purpose To provide a standard method for collection of blood samples by capillary skin puncture Equipment 70 alcohol prep pads dry gauze and a sterile lancet of appropriate size Appropriate microtainer and personal protective equipment Procedure Wash hands and put on personal protective equipment gloves face shield Identify the patient using name and date of birth Organize all equipment needed for procedure 1 Select appropriate puncture site Heel in infants finger in your collecting specimen on a child adolescent adult or geriatric patient See the diagram below for the puncture sites for finger sticks and for heel sticks LATERAL 140 2 Increase the blood flow of the puncture site up to 7 times by using a warm washcloth 40 42 degrees Celsius for 3 minutes Make sure that the washcloth is not too hot Test it with the inside of your wrist to make sure 3 Cleanse the puncture site appropriately making sure the area is well cleaned with the alcohol prep pad 4 Hemolysis of the specimen may occur from residual alcohol at the skin puncture site make sure it is dry 5 Hold the site firmly so the patient does not move it When doing a heel stick ho
10. Do Not Tube to Laboratory Must bring down CSF Bacterial Antigen Panel 1ml of CSF in sterile container CSF CSF Cell Count 1 ml CSF in sterile container Send to Lab ASAP CSF Culture includes gram stain 0 5 mls CSF in sterile container DO NOT Refrigerate Send to Lab ASAP CSF Glucose 0 5 mls CSF in sterile container CSF Lactate Lactic Acid 0 5 mls CSF in sterile container CSF Protein Total 1 ml CSF in sterile container CULTURES See Culture Listing at the end of the pink pages Cyanide Blood QU 56341E 5 mls whole blood in Grey top tube is the only acceptable specimen Refrigerate Cyclic Citrulline Peptide IgG QU 11173X_ 1 full tube blood in Gold top Red top or Red Black top tube Min 3 mls blood Specimen Instructions Tube Lab Use Only XYZ 1 full tube whole blood in 7ml lavender top tube green top sodium heparin Yee eT ECIM Ma CIE SAUX or sodium heparin lead free tan top tube Draw 1 hour before next dose 5 mls whole blood in Lavender top tube EDTA Whole blood from ACD iE Solution A or B yellow top Sodium heparin green top or EDTA royal Blue CEE Camer reen QU 10458N top tubes are also acceptable Indicate ethnicity of patient and the clinical y indication for testing on the test request form Store and ship ambient immediately Do not freeze Room Temp ol QUEST send out Test Description oe a if Specimen Instructions Tube Indicated L
11. If the outside of a tube or other container becomes contaminated it should be wiped with gauze or Kim wipe moistened with 10 bleach or other hospital approved disinfectant The use of alcohol or of disinfectants containing alcohol should be avoided because it damages the print on our barcode labels making them unreadable 6 Pipetting is to be done using a suction bulb or other safety device never by mouth 7 Safety transfer devices are available for the transfer of a specimen from a syringe to a vacutainer tube If a needle must be used for transfer do not hold the tube or bottle in your hand as the needle is inserted through the stopper the tube should be placed in a rack or other holder Allow the vacuum in the tube to draw the specimen from the syringe Do not force liquid into a vacutainer tube if insufficient vacuum is present the stopper may pop creating aerosols and or splashing If the liquid isn t drawn into the tube try another tube if this fails the transfer device or needle may need to be removed and the specimen ejected into an unstoppered tube as described in the next paragraph 8 If it is necessary to eject a fluid from a syringe as with some microbiology specimens always remove the needle after activating the safety feature using either a safety device designed for this purpose or a hemostat discard the needle in a sharps disposal container and allow the fluid to run down the inside of the container
12. If the specimen has been improperly stored during storage or transportation or the specimen exceeds it s stability requirement the specimen will be rejected and a new specimen must be collected unless there are special circumstances involved Consult the Medical Director or Administrative Director for guidance on releasing test with a disclaimer under special circumstances SPECIMEN REJECTIONS THAT MUST BE APPROVED BY A TECHNOLOGIST Improperly centrifuging of specimens Any specimen that appears to not have been spun down correctly from another facility it must be the decision of the resulting technologist whether the specimen will be rejected and a new specimen collected DO NOT RE SPIN tubes without checking with technologist first When a specimen is hemolyzed or lipemic and this condition is documented as causing inaccurate test results it will be the decision of the resulting technologist whether the specimen will be rejected and a new specimen collected When a specimen quantity is insufficient for proper performance of procedure see lab services manual for minimum requirements it will be the decision of the resulting technologist whether the specimen will be rejected and a new specimen collected When specimen integrity issues are in question it will be the decision of the resulting technologist whether the specimen will be rejected and a new specimen collected INCORRECT ORDERS If the orders do not match the specimen label a
13. See CMP minus glucose Coombs Indirect Antibody Screen See Antibody Screen 48 QUEST send out Test Description or alee Specimen Instructions Tube ABCDEFG HIJ KLMNOPQRSTUVW Special Instructions COLLECT IN SPECIAL TRACE ELLEMENT KIT Copper Blood QU 363X Contact Lab for kit Refrain from taking vitamins minerals or herbal supplements for one week prior to specimen collection Separate serum and refrigerate Royal Blue EDTA plasma also acceptable for this test collection Room Temp See 24 hour Urine Collections Procedure Cord Blood Bilirubin Collect cord blood in red or gold top tube Protect from light 6 ml cord blood in pink top tube Protect from light Label with Baby s name Cord Blood Workup In house or Mom s name but MUST be ordered on Baby s account Mark specimen as Cord Blood 49 7m aliquot from 24 hr Urine collection Special Instructions Collect urine in an acid washed metal free container Do not measure volume Send Copper 24 hr Urine QU 7567N 24hr aliquot in an acid washed metal free container Patient should refrain from taking vitamins minerals or herbal supplements for one week prior to RSC HDL EK piu proie ETT Inhouse Lipid Profile with LDL HDL Ratio 1 full tube min 3 mis blood in green black With LDL HDL ratio top tube or gold top tube Fasting Recommended 1 full tube min 3mls blood in red top tube Plasma is not acceptable Cortisol Total serum In house KEE Refr
14. The laboratory centrifuge is for the separation of the serum from the clot or the plasma from the cells of aspecimen The load on the centrifuge should be symmetrical before operating the unit This is essential for safety in operating the unit and also prolongs the life of the centrifuge Please mix plasma and serum tubes appropriately when collected and follow the UVMC Laboratory s procedure titled Processing Blood Specimens for Serum Testing for proper clot formation before centrifugation of all serum specimens 12 Set the unit on a flat sturdy surface A centrifuge does need space for air circulation around it 13 Plug into power supply 14 Turn on the main power switch 15 Do a visual check rotor is in place and locking nut is tight and that tube holders are in appropriate positions 16 Load the centrifuge with tubes Balance the tubes symmetrically and by fluid levels and by identical tube types Properly balanced loads will improve sample separation and extend the life of the centrifuge 17 Close the lid 18 Each centrifuge will have a timer All blood specimens are to be centrifuged for 15 mins unless it is noted otherwise per UVMC Laboratory please see list for centrifuge exceptions If you are using a VanGuard please turn the timer clockwise all the way to 60 and then back to the time needed to centrifuge blood tubes 19 Some centrifuges have a place to set speed RPM s please refer to your specific centrif
15. This tube is acceptable for BNP s only If testing is Brain Natriuretic Peptide BNP In house Breast Cancer Profile Paraffin Block Call Histology x4638 I Call Histology x4638 See Cytology 4 slides sprayed with cytology fixative Bronchial Brushings In house Non GYN Request delayed store EDTA plasma in plastic tubes at 2 8C or freeze at or below 20C if delay is more than 24hours gt Test Description ABCDEFG HIJ KLMNOPQRSTUVW Bronchial Washings Bun Urea Nitrogen Blood Bun 24 hr urine Bun Random urine C 3 Complement C 4 Complement CD4 CD8 Ratio Helper Suppressor Panel CH 50 Complement CA 19 9 Carbohydrate Antigen CA 27 29 Cancer Antigen CA 125 CO2 Bicarbonate or Carbon Dioxide C Difficile C Diff Toxin Screen QUEST send out test QU if indicated Lab Use Only Specimen Instructions Tube XYZ Call Histology x4638 See Cytology Send to Lab ASAP 1 full tube min 3 mls blood in green black top tube or gold top tube See In house Urea Nitrogen in house 10 ml aliquot of urine from 24hour collection with no preservative Pick up container from lab Keep refrigerated Record date and volume Inhouse f ml random urine in plastic container QU 44859W 1 full tube of blood in a serum separator tube or red top tube Call lab for pediatric specimen requirements QU 44982E 1 full tube of blood in a serum separator tube or re
16. and label it with your name and the date amp time of collection Note the consistency of the stool on the side of the container This container should not be refrigerated Bring it to UVMC as soon as possible no longer than 96 hours after collection The specimen can also be dropped of at one of the outreach facilities Hyatt Stanfield Medical Services North and Medical Services South as long as time permits Collection of Stool for O amp P Pink and Gray Cap Containers Directions for placing the stool sample into the preservative vials must be followed carefully Stool samples for ova parasite testing must be put into preservative solutions within 1 hour of collection 23 1 Collect the specimen in the clean over the toilet container that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine 2 Transfer enough stool specimen into the pink and gray capped containers to raise the level of the liquid to the red line Do this slowly and in small increments if possible to avoid overfilling the container DO NOT ADD AN EXCESSIVE AMOUNT OF STOOL SPECIMEN WHICH CAN CAUSE THE LIQUID TO GO OVER THE RED LINE Overfilling or under filling will be reason for rejection of the specimen and recollection will be necessary Recap both containers tightly and label with your name and time amp date of collection Note the consistency of the stool specimen on the labels of pink and gray capped conta
17. if possible 9 Liquid respiratory specimens such as nasal nasopharyngeal washings and the extraction step of respiratory antigen testing such as Influenza or Strep A should be handled in a laminar flow hood or behind a countertop shield over a plastic backed absorbent mat in addition to using appropriate PPE gloves lab coat to prevent disease transmission due to aerosol and or droplet contamination of counters nearby equipment and other items GENERAL GUIDELINES FOR HANDLING OF BIOLOGICAL SPECIMENS continued 10 All containers of bronchopulmonary washings or brushings nasal washings or sputum are to be handled as if they are contaminated on the outside They should not be included in a bag with other specimens These containers are to be transported and delivered to laboratory departments in secondary containers such as zip closure specimen transport bags see 13 All outside surfaces of these containers must be decontaminated or the specimen transferred to a properly labeled clean container with a secure closure before sending to a reference laboratory NOTE A container that does not have a secure closure cannot be sent to a reference laboratory the specimen must be transferred to a container with a secure closure before sending To prevent possible contamination of another specimen container resulting from re use any bag that has contained one of these respiratory specimens must be discarded the bag may be used for storag
18. member of patient or the Cerner sign in of the UVMC employee All steps must be done at the same time 174 Send specimens slip with remaining stickers and paperwork to Blood Bank Also send a copy of the physician s orders to Blood Bank so the Blood Bank tech can confirm what is ordered The Blood Bank tests must be ordered in the computer T amp S and requested components This is done by the department requesting the tests If you have any questions see the complete Identification for Blood Bank with Armband procedure in the Lab Services Manual lll EMERGENCY REMOVAL OF ARMBAND AND REPLACEMENT NOTE In an emergency where an armband is cut off the lab must be called immediately The lab staff will bring or send a new green armband If the person who cut it off still has the armband and can positively identify the patient from whom the armband was cut they can remove identification materials from the armband They can insert the identification materials in the new green armband and will attach it to the patient s arm A Blood Bank Identification Transfer Record should be signed by the person who removed the armband This will be kept on file in the Blood Bank until that specimen has outdated If the actions listed above do not occur it will necessitate a restick of the patient and a repeat of the type and crossmatches The patient can not be charged again Redraws will be necessary on cases where armbands are found tape
19. tea tobacco and strenuous exercise prior to collection A A QUEST send out Test Description test QU if Specimen Instructions Tube Lab Use Only indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ Whole blood in Lavender top tube CESS UTE RIAA INE 1 ml min draw in a 3ml tube or 3 ml min draw in a 7ml tube CBC Complete Blood Count Bouse Whole blood in Lavender top tube Includes Differential 1 ml min draw in a 3ml tube or 3 ml min draw in a 7ml tube CCP Antibody See Cyclic Citrulline Peptide IgG CEA Carcinoembryonic Antigen 1 full tube min 3 mls blood in green black top tube or gold top tube 1ml body fluid in EDTA or Heparin to prevent clotting State Body Fluid Gell Coumi Bedy Fluid Source Send entire specimen See Body Fluid BF Cell Count Cell Count CSF Fluid 1 ml CSF fluid in sterile container Send to Lab ASAP Celiac Panel Cae includes Gliadin AB IgG amp IgA Panel Tissue are oe Transolutaminase igh Reticulin ABIIGA wiratlex 1 full tube blood in a gold top or red top tube Spin and separate Refrigerate titer Reticulin AB lgG w reflex titer Ceruloplasmin QU 20644R 1 Full tube min 3 mls blood in a gold top or red top tube Spin and separate immediately Refrigerate PREFERRED SPECIMEN REQUIREMENTS Dacron Rayon swab from endocervix urethra conjunctiva rectal mucosa without feces fluid aspirate tissue nasopharynx or throat in Microteast M4 microbe t
20. template of all critical results in the computer under Order Notes if the test is released or Result Notes if not already released If the patient is a Home Health or Hospice patient call the Home Health or Hospice office If the office is closed call the UVMC operator who will page the on call nurse for that location When paging tell the operator this is a STAT page for a critical result The critical result should be called immediately not to exceed 10 minutes upon discovery If not able to reach Hospice or Home Health 19 immediately not to exceed 10 minutes document the date time you paged the on call RN for Home Health or Hospice and your initials under result notes and release the results If the RN has not called back within 30 minutes repage them through the UVMC operator Continue to page until successful Once the result has been given to the RN you will need to go back and document the date time called to called by and read back using the CR template of all criticals in the computer in Order Notes or Result Notes CRITICAL REVIEW Critical review Exception Report will print automatically from Cerner to include these time intervals 3 shift 21 00 to 03 00 1st shift 03 01 to 13 00 and 2nd shift 13 01 to 21 00 Actual auto print times on the Chemistry Printer will be approximately 3 30 am 13 30 pm amp 21 30 pm The Chemistry Techs on each shift are responsible to review the report and to call any critical resu
21. 06 from http Awww bd com vacutainer pdfs blood_collection_tubes_product_insert_VDP40035 pdf New procedure prepared by __Jeff Kirk date 10 17 06 126 Quick Reference Guide for Tubes to Use Purple Lavender Top Blue Top Must be FULL 3 ML TUBE PROTIME CBC CBC DIFF PTT APTT HEMOGLOBIN A1C GLYCOHEMOGLOBIN FIBRIN FIBRINOGEN SPLIT PLATLET COUNT RETICULOCUTE COUNT RETIC AMMONIA DELIVER ON ICE 7 ML TUBE BLOOD BANK DRAWS TYPE AND SCREEN TYPE AND CROSSMATCH PLATLET TRANSFUSIONS BNP Green Black Speckled Top Gel Barrier ACETONE ALBUMIN ALKALINE PHOS AMYLASE BUN BICARB BILIRUBIN CALCIUM CHLORIDE CHOLESTEROL GGTP CKMB CREATININE D BILI FERRITIN LIPASE MAGNES PHOSPHOR POTASS HCG QUANT PROTEIN T4 TROPONIN T UPTAKE TSH AST SGOT ALT SGPT SODIUM TRIGLYC TIBC UIBC URIC ACID Green Top NO GEL CARBAMAZEPINE Tegretol DIGOXIN GENTAMICIN PHENOBARBITAL PHENYTOIN Dilantin QUINIDINE VALPROIC ACID VANCOMYCIN Gold Top Gel Barrier HCG QUAL PREG TEST VITAMIN B12 Protect from light FOLATE Protect from light HBSAG HBSAB LH LITHIUM PSA PROLACTIN SALICYLATE Gray Top Tube LACTIC ACID No tourniquet to be used for draws GLUCOSE ALCOHOL Remember if you do not know which tube to use please refer to the Lab Services Manual as a reference also Prepared 11 24 2008 MET 127 128 TYPES OF BLOOD SPECIMENS Purpose To provide an explanation and guideline on how to differentiate between the different types of b
22. 1 full tube of blood in red top tube or serum separator top tube Samples that are grossly hemolyzed or lipemic will be rejected Ea See Sjogren s Antibody QU 42481A 1 full tube min 3mls blood in red top tube or gold top tube QU 80994R 1 full tube min 3mls blood in red top tube or gold top tube QU 4044F 1 full tube min 3mls blood in red top tube or gold top tube QU 2766F Tee tube blood in red top or gold top tube Positive samples will reflex to a QU 52654P_ 1 full tube min 2mls blood in red top tube or gold top tube 1 full 7ml lavender top EDTA top tube or 2 full 4ml lavender tops Keep QU 140129P specimen at room temperature Do not Centrifuge Do not refrigerate or freeze oO O Test Description QUEST send out test QU if indicated Specimen Instructions Tube Anti Ro Anti SS A Anti SS B Anti Scleroderma SCL 70 AntiSmooth Muscle Antibodies AntiStreptolysin O Antibody ASO AntiStriational Antibody Antithrombin III Activity Antithrombin III Ag Thrombin III Antigen Plasma AntiThyroglobulin Antibody Thyroglobulin Antibody Anti Yo Apheresed Platelets APTT Activated Partial Thromboplastin or PTT ABCDEFG HIJ a QU 53488W QU 42085F QU 53702E QU 42119N QU 216X QU 18689P QU 80986R QU 52605P In house In house KEMNOPQRSTUVW See Sjogren s Antibody See Sjogren s Antibody 1 full tube blood in re
23. 1 hr glucose and urine 2 hr glucose and urine 3 hour tolerance test Fasting glucose and urine 1 hr glucose and urine 2 hr glucose and urine 3 hr glucose and urine 4 hour tolerance test Fasting glucose and urine 1 hour glucose and urine 2 hr glucose and urine 3 hr glucose and urine 4 hr glucose and urine 5 hour tolerance test Fasting glucose and urine 1 hr glucose and urine 2 hr glucose and urine 3 hr glucose and urine 4 hr glucose and urine 5 hr glucose and urine Ask the patient to remain in their bed for the duration of the test Patients are not to walk or do any kind of therapy during a glucose tolerance test Make certain that the patient understands How often to obtain urine samples and how often he she will have blood drawn That he she is to remain in bed during the entire test That he she is allowed water only during the test Smoking is not permitted during the test That if he she should feel nauseated faintness dizziness a headache or vomits that he she is to notify the PCT Nurse immediately When each hour has elapsed draw a blood sample and collect another urine sample from the patient 118 8 If the patient vomits after ingesting the glucose beverage place appropriate comments in the Cerner system and note the time that the patient vomited The glucose tolerance test should be canceled and rescheduled at anther time Contact the ward secretary nurse and have them notify the ordering Physicia
24. 24620E See Immunoglobulin E Total Prist Specimen Instructions Tube Lab Use Only XYZ bates 1 full tube min 3mLs blood in red top tube Do NOT use serum separator sles tel Lee Poel al aay QU 851A tube Check with lab for SUGGESTED DRAW TIME Progesterone in house 1 full tube min 3mLs blood in red top tube or gold top tube Serum that has 9 been stored on barrier gel for more than 24 hour is not acceptable 1 full tube min 3 mls blood in gold top tube Draw before rectal examination Prostatic Specific Antigen PSA Serum In house or biopsy procedure Centrifuge separate serum amp Freeze if more that 24 hours before testing Frozen foc oo QUEST send out Lab Use Only Specimen Instructions Tube Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW Prostatic Specific Antigen Complex b Con 1 full tube blood in red top or gold top tube Freeze serum if testing will be PSA Complex SO Bayer p delayed more than 24 hours Prostatic Specific Antigen Free QU 31348X Special Instructions 1 full tube blood in red top or gold top tube Includes Total PSA Centrifuge separate serum and Freeze ABN required for Medicare Protein Body Fluid mA See Body Fluid Protein Special Instructions Call Lab 1 full tubes blood in Lt blue top tube fill to Protein C Functional QU 1777X indicated line 3 2 citrated sodium Immediately spin at 3500rpm for 10 min then separate
25. Collect 2 Aerobic red capped swabs using same technique as for throat a SII culture See instructions for Collection of Microbiology specimens Striational Antibodies Serum Striated Muscle Antibody QU 42119N 1 full tube min 3mls in red top tube or gold top tube 1 full 10 ml red black top sst tube Refrigerate serum DO NOT SHIP AT Sulfatide AB IgG IgM QU 9266N ROOM E Sural Nerve Biopsy ooo Call Histology x4638 48 hrs in advanced Fresh tissue amp tissue request Surface Marker Studies iS Call Histology x4638 Synovial Fluid Count oe Order Under Body Fluid Count TB Blood Test See QuantiFeron Plus Call Histology x4638 See Thyroxine Binding Globulin T amp B Cell Study TBG T Uptake for FTI order anT uptake amp T4 Muet nave Sse erie Belt In house 1 full tube min 3 mls blood in green black top tube or gold top tube 1 full tube blood in red top tube Keep covered and upright Refrigerate serum T3 Free Triiodothyronine Serum In house for up to 2 days freeze if longer Patients on heparin should not be drawn for this test Grossly lipemic specimens need ultracentrifuged n 1 full tube blood in red top tube Keep covered and upright Refrigerate serum To Toa nde rents for up to 7days freeze if longer Grossly lipemic specimens need ultracentrifuge T4 Free Thyroxine Direct 1 full tube min 3 mls blood in a green black red or gold top tube T4 Thyroxine Total For FTI ord
26. DINA LAKE solution B yellow top are also acceptable specimens Refrigerate Herpes Culture Sa See Culture Herpes 1ml CSF Frozen is the preferred sample Samples that are also acceptable 1ml of serum plasma or whole blood from EDTA lavender top or ACD B yellow top tubes Serum plasma specimens ship frozen whole blood Herpes Type 1 amp 2 DNA PCR CSF Sent to Compunet specimens ship refrigerated Most body fluids or specimens collected on swabs collected on M4 viral transport medium shipped frozen are also acceptable Call lab for details Herpes Simplex Virus amp II IgG QU 6447T 1 full tube min 3mls blood in red top tube or gold top tube Samples that HSV amp Il IgG Herpeselect AB are grossly hemolyzed or lipemic will be rejected Herpes Simplex Virus IgM QU 7438X 1 full tube min 3mls blood in red top tube or gold top tube Samples that HSV amp Il is not differentiated in this test are grossly hemolyzed or lipemic will be rejected op o QUEST send out Lab Use Only Test Description test QU if Specimen Instructions Tube indicated XYZ ABCDEFG HIJ KLMNOPQRSTUVW Herpes Simplex Virus Type II Antibody QU 10005F 1 full tube min 3mls blood in red top tube or gold top tube Samples that IgG are grossly lipemic or hemolyzed will be rejected High Density Lipoprotein See HDL Hirsutism Profile Comprehensive Need 2 Tubes 2 tubes of blood in red top tubes or gold to
27. GGT Gamma Glutamy Transpeptidase 1 full tube min 3 mls blood in green black top tube or gold top tube 5g fresh stool in 10 formalin O amp P KIT Keep specimen at room temperature OTHER ACCEPTABLE SPECIMENS fresh unpreserved stool hook refrigerated less than 48 hours old or frozen Rejection Criteria Stool Aaroa Camela Arigen Ea IETS preserved in medium other than 10 formalin and PVA SAF or MIF Stool in 10 formalin received frozen Stool submitted in expired transport vial Room Temp Globulin Order both Total Protein amp Albumin 2 full lavender top tubes Centrifuge separate and Freeze plasma Glucagon Plasma QU 519X immediately Glucose 6 Phosphate Dehydrogenase Blood amp RBC Count G 6 PD QU 23572P 1 ML EDTA whole blood drawn in a LAVENDER TOP TUBE Do not freeze O QUEST send out Test Description test QU if indicated Specimen Instructions Tube Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW 2 specimens one blood one urine needed for each hour of the Glucose Tolerance tolerance Refer to collection procedure in the phlebotomy section of the Lab AONE CAT Po ee CTT ang Inhouse Services Manual t is preferred that Outpatients schedule testing with Central scheduling Glutamic Acid Decarboxylase 65 Antibody QU 34878X 1 full gold top or red black top tube Refrigerate Glycohemoglobin or HgbA1C See Hemoglobin A1C GM 1Ab IgG amp IgM QU 7997N See G
28. PREGNANCY RECORD PLACE LABEL HERE Date of surgery or transfusion Use large label with date of birth and physician s name acknowledge that have verified the recipient s identification collected and properly labeled the specimen have applied the if possible Blood Bank armband to the patient s arm or given the armband to PAT patient and explained to him her that it must be brought back and securely applied to his her arm on day of admission Collector s signature have been transfused pregnant within the Date__ past 3 months circle one YES NO NOT SURE Patient s signature Verifier Labsuper Jean s file General Armband bb nursing rev1 2 08 rtf New Procedure Supersedes 11 21 07 Prepared by js 12 26 08 172 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N Dixie Highway Troy OH 45373 BRIEF OUTLINE ON SPECIMEN IDENTIFICATION FOR BLOOD BANK WITH DOWNTIME ID NUMBERS The UVMC Transfusion Service is using an armband system for identification of all patients who have specimens collected for Type and Screens crossmatches or transfusion of blood components platelets FFP etc This armband will serve as verification that the numbered specimen was drawn from this patient for Blood Bank purposes Green is the official color for Blood Bank armbands in Ohio At Upper Valley Medical Center Blood Bank armbands are green For platelets fresh frozen plasma and cryoprecipita
29. QU if Specimen Instructions Tube Click here to access 24 hour urine indicated Collection Procedure 10 ml aliquot from 24hour urine collected with no 24 hr Urine Protein Creatinine Ratio In house preservative Record total volume Pick up container from lab Keep refrigerated 10 ml aliquot from 24hour urine collected with no 24 hr Urine Sodium In house preservative Record total volume Pick up container from lab Keep refrigerated 10 ml aliquot from 24hour urine collected with no 24 hr Urine Sodium amp Potassium In house preservative Record total volume Pick up container from lab Keep refrigerated 10 ml aliquot from 24hour urine collected with no 24 hr Urine Urea Nitrogen BUN In house preservative Record total volume Pick up container from lab Keep refrigerated 10 ml aliquot from 24hour urine collected with no 24 hr Urine Uric Acid In house preservative Record total volume Pick up container from lab Keep refrigerated 10ml aliquot urine from 24hr urine containing 6N HCL 24hr urine with out preservative is acceptable if the ph is below 6 and it is shipped frozen Record volume on requisition and 2A nr ine YMA QU 934X urine vial Keep Refrigerated Itis preferable for the patient to Vanillylamandelic Acid w o creatinine be off medications for three days prior to collection Call lab for exceptions Patient should avoid alcohol coffee tea tobacco and strenuous exercise prior to collection
30. Special Instructions 1 full tube 7 ml EDTA lavender top tube Centrifuge ASAP and pour off plasma and put into transfer tube labeled EDTA plasma amp Vitamin B1 Plasma QU 29991P wrap in foil to protect from light Specimens drawn in green top sodium or lithium heparin or white top PPT Potassium EDTA or red and gold top tubes are also acceptable Frozen Special Instructions 1 full tube min 3 mls blood in red top tube or gold Vitamin B12 Serum In house top tube Fasting preferred Wrap in foil to protect from light Draw before B12 therapy begins Syn Special Instructions 1 full tube in red top tube or gold top tube Fasting Vitamini BAA S Folate serum preferred Wrap in foil to protect from light Draw before B12 therapy begins 1 full tube blood in red top tube preferred or gold top tube Separate serum Vitamin D 25 Hydroxy D2 and D3 Labcorp from the cells immediately A fasting specimen is recommended but MuE e E not required LabCorp 1 full tube blood in red top tube or gold top tube Lavender top EDTA green Vitamin D 1 25 Dihydroxy QU 16493P top sodium heparin and Lt blue sodium citrate plasma are also acceptable Separate and freeze serum within 3 hours of collection Ship frozen ay See Vanillylamandelic Acid Special Instructions Call Lab 3 full tubes in It blue top tube tubes must be filled to appropriate line Spin specimen at 3500rpm for 15 minutes then Von Willebrand Profile QU 2
31. Typing QU 48215P _ freeze or refrigerate Specimen must reach testing site within 24 hours of collection Send Monday through Friday only Room Temp Homocystine Serum Horsham Allergy Panel HPV Human Papillomavirus High Low Risk Digene Hybrid Capture HPV Human Papillomavirus High Risk Only Digene Hybrid Capture HPV with Thin Prep HSV I amp Il IgG HSV I amp II IgM HSV Culture Rapid HSV Type II antibody HTLV III Anti Hu Anti Hu CSF Human Papillomavirus QUEST send out test QU if Specimen Instructions Tube indicated Lab Use Only XYZ 1 full tube 3 mls min blood in gold or red top tube 10 hour fast is strongly QU 24281E recommended before specimen collection Keep blood on ice and separate from cells within 1 hour of draw EDTA lavender top or sodium heparin green top tubes are also acceptable QU 12165 1 full tube blood in gold red top or red and black top tube Minimum requirement 5 mL blood Room Temp QU 9662N Cervical swab brush or fresh cervical biopsy Thin prep vial or Digene Kit Room Temp QU 10801A Thin Prep Vial or Digene Kit Room Temp See Thin Prep with HPV reflex See Herpes Simplex Virus amp Il IgG See Herpes Simplex Virus amp II IgM i See Herpes Culture cS See Herpes Simplex Virus Type II Antibody See HIV See Neuronal Nuclear HU AB See Neuronal Nuclear Hu AB CSF See HPV Digene Hybrid Capture test selections O
32. Vanquish Psychiatric Drugs Nortriptyline Aventyl Amytriptyline Elavil Desipramine Norpramine Doxepin Sinequan Tryfluoroperazine Chlorpromazine Thorazine Imipramine 196 Cardiovascular Respiratory Aminophylline Clofibrate Miscellaneous Drugs Alcohol Aminocaproic acid Phenoxybenzamine Dibenzyline Diphenhydramine Benadryl Dicumarol Dihydroergotamine Dipyridamone Persantine Heparin Hydralazine Isoproterenol Isuprel Nitroglycerin Nitroprusside Papaverine Propranolol Phentolamine Regitine Reserpine Theophylline Verapamil Caffeine Cyclosporine Dextran Glycerol guaiacolate Hydroxyethl starch Hydrocortisone Methylprednisolone Cyproheptadine Promethazine Phenergan Methysergide maleate Tocopherol Tranexamic acid Vinblastine Vincristine Medications Containing Aspirin Prescription Aggrenox Ascriptin w Codeine Tablets A S A w Codeine compound Axotal Tablets Bufferin w Codeine 3 Tablets Darvon wW A S A Pulvules Darvon compound 65 Disalcid Capsules Easprin Empirin w codeine Tablets Equagesic Tablets Fiorinal Tablets Fiorinal w codeine Magan Tablets Micrainin tablets Norgesic amp Norgesic Forte Tablets Pabalate SF tablets Percodan amp Percodan Demi Tablets Robaxisal Tablets Synalgos DC Capsules Trillsate Tablets amp Liquid Talwin compound Zorprin Tablets Anesthetics Cocaine Dibucaine Nupercaine Procaine Lidocaine Xylocain
33. and containers with significant amounts of solid or semi solid waste should be packaged in securely closed plastic bags or large specimen containers such as for large tissue samples with an amount of absorbent material sufficient to absorb all of the liquid waste being discarded before being placed in red lined biohazard boxes Alternatively contents of vacuum bottles or suction 149 containers including solid or semi solid waste may be solidified with a material such as SafeSorb Boxes bearing the words may contain sharps may contain only those sharps already properly packaged in puncture proof containers or sharps which will not puncture the red bag or human skin such as soft plastic transfer pipettes and syringes without needles Do NOT over fill Allow room for secure closure of the bags Filling to approximately two thirds to three fourths of the apparent capacity of the box will allow sufficient room for tying the bags Take care not to exceed the weight limit which is printed on each box To prevent both puncture of bags and ejection of contents biohazard waste must NEVER be compacted either mechanically or manually by compressing or agitating the contents When a box becomes no more than two thirds to three fourths full each bag is to be individually securely closed by twisting and tying in a single knot so as to prevent leakage before sealing the outer cardboard box with two inch wide pressure sensitive poly
34. assay assay ordered for 4 hrs after draw time Factor VIII Von Willebrand Factor QU 20231 See Von Willebrand Profile Antigen Ristocetin a 1 full tube blood in blue black center or It blue top tube 3 2 citrated fe eae Begtedatonmreduee on plasma The tube must be filled to the indicated line Specimen in only stable 56 QUEST send out Test Description ae an a Specimen Instructions Tube Lab Use Only Indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ zc Frai euan r SI A 5gm random fresh stool in sterile container Stool specimens in transport Qualitative i QU 22707W_ media or on a swab will be rejected Ship Frozen Order as Miscellaneous test Special Instructions Call Lab 24 48 or 72 hour stool collection Record total collection time and weight on test requisition Keep Fecal Fat Quantitative or Stool Fat QU 3046N refrigerated Use 1gallon plastic leak proof container with screw cap Quantitative Specimens collected in metal paint containers will be rejected Patient should be on a diet including 100 grams of fat per day for 3 days prior to and during collection Reducing Substances a metal can Fecal WBC Smear or Stool WBC 1g fresh stool random in sterile container Stable up to 24 hours refrigerated Fecalimeduc ng Substances or Stodi Collect 10 30 grams stool in plastic container Seal container in a plastic bag g QU 5022X before shipping Store and ship specimen frozen D
35. been placed inside the zippered compartment with any specimen container that is to be handled as if contaminated on the outside are to be considered contaminated and handled according to UVMC Contaminated Documents policies Barcode labels can be reprinted other paperwork can be inserted in a page protector and copied before discading with the copy dated and initialed original chain of custody paperwork must be retained and can be kept in a page protector marked contaminated STORAGE 1 All specimens must be securely closed or covered during storage 2 Toavoid contamination of paperwork barcode labels or other documents should not be placed in a bucket or basin with specimens that may leak and should never be placed in the zippered compartment of a transport bag with a specimen unless required for chain of custody purposes 3 Bronchopulmonary washings nasal washings sputum fecal stool specimens colon or duodenal washings or aspirates and cerebrospinal fluid specimens are to be stored in zippered bags in addition to being closed securely Multiple specimens may be stored in the same bag 4 Refrigerators and freezers used for storage of biological specimens controls and or reagents are clearly marked and are not used for storage of food 5 Blood bank refrigerators and freezers are used for storage of blood bank specimens reagents and products and for Platelet Function Analyzer test cartridges and are not us
36. do not load onto the instrument POLICY FOR HANDLING LESS THAN OPTIMUM SPECIMEN VOLUME The recommended 5 to 10 ml volume of blood sample per 40 ml culture bottle gives the optimal blood to broth ration of 1 5 to 1 10 which will counteract the normal bactericidal activities of chemical and cellular mediator of immunity As the volume of blood drawn is increased from 2 ml to 20 ml for a 2 bottle draw the yield of positive cultures may increase by 30 50 Therefore 5 10 ml of blood per bottle should be drawn from adults to prevent false negatives Although smaller amounts can be used volumes of less than 10 cc lessen the probability of recovery when there is a small population of an organism However when a difficult venipuncture is encountered on an adult patient and less than 10 ml total is drawn place the entire sample into an aerobic bottle and note that an anaerobic bottle was not drawn due to sample size insufficiency Pediatric patients less than 14 years of age typically have more circulating bacterial per ml during a septic episode than adults therefore smaller volumes of blood sample are adequate As a general rule the suggested volume of blood to be drawn from children is one ml per each year of age with infants younger than one year of age less than 1 ml may be available for culture Place all samples from pediatric patients into FAN aerobic bottles unless specifically requested by the physician to collect an anaerobic sa
37. employee All UVMC employees must use their Cerner ID Blood Bank specimens drawn for purposes of cross matching and potential transfusion of blood products must have the unique Blood Bank identification number on them This same unique number must be attached to the patient in the form of a blood bank armband Vv VV VY RETRIEVABLE SPECIMENS No retrievable specimen collected by UVMC staff will be accepted if any of the information defined above under the Specimen Identification guidelines is missing on the specimen label Missing information such as collector ID or time must be obtained before processing the specimen Any unlabeled specimen will be rejected and must be recollected Any specimen that is received only partially labeled must have patient s name at the minimum will not be received until all information is complete In the event that patient care will be compromised or the sample in question is STAT consult with a Supervisor Administrative Laboratory Director or Medical Laboratory Director for guidance Special circumstances may require the specimen to be processed prior to having non identifying information missing from the label Any specimen that is mislabeled will be rejected and the accessions will be cancelled with the correct cancellation code if the mistake is discovered before test results are released Problem logs must be written for any mislabeled specimens whether results have been released or not See th
38. external contamination of the container likely Any transfer to another container for testing or storage should take place behind a shield or in a laminar flow hood Cerebrospinal fluid specimens from patients with possible meningitis must be handled with extreme care in order to reduce the potential for exposure to Neisseria meningitidis Diagnosis may mention fever weakness headache stiff neck lack of coordination or unresponsiveness the word meningitis is not always included Outsides of containers should be decontaminated upon removal from transport bags before centrifugation or distributing to laboratory departments Culture set up must take place in the laminar flow hood in the Microbiology department and work with any culture suspicious for Neisseria meningitidis regardless of source must be performed in the laminar flow hood Culture plates from suspicious sources or containing suspicious colonies are to be taped shut when not in the laminar flow hood To prevent possible contamination of another specimen container resulting from re use any bag that has contained a CSF specimen must be discarded 13 Any and all containers with attached suction tubing syringes or other containers with closures that are not secure are to be transported and delivered to laboratory departments in secondary containers such as zip closure specimen transport bags The specimen must be transferred to a clean container with a secure closure before s
39. follow the UVMC Laboratory s procedure titled Processing Blood Specimens for Serum Testing for proper clot formation before centrifugation of all serum specimens 1 Set the unit on a flat sturdy surface A centrifuge does need space for air circulation around it 2 Plug into power supply 3 Turn on the main power switch 4 Doa visual check rotor is in place and locking nut is tight and that tube holders are in appropriate positions 5 Load the centrifuge with tubes Balance the tubes symmetrically and by fluid levels and by identical tube types Properly balanced loads will improve sample separation and extend the life of the centrifuge 6 Close the lid 7 Each centrifuge will have a timer Plasma and serum tubes that are less than or equal to 5 ml are to be centrifuged for Plasma and serum tubes greater tham 5ml are to be centrifuged for 15 mins some centrifuges may have different specification due to age of said centrifuges if a higher rpm is specified by the chemistry supervisor then a shorter spin time maybe used please see list for centrifuge exceptions 190 8 Some centrifuges have a place to set speed RPM s please refer to your specific centrifuge manual for this step 3500 is the recommended speed 9 Clean spillage as needed interior and exterior 10 Listen for any unusual noise or vibrations if anything out of the ordinary please 11 Clean spillage as needed interior and exterior
40. full gold top or red black top tube Ship serum refrigerated Gross Myocardial Antibody with reflex to titer QU 52605P hemylosis is unacceptable Myoglobin Quantitative Serum QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ QU 42481A 1full tube of blood in a red or gold top tube Avoid extremes of hot and cold Specimens that have gross hemolysis or lipemia will be rejected oo see Protime ana Tr eS See Methylmalonic acid serum See Methylmalonic acid urine 1 full tube min 3 mls blood in red top tube or 3 mls blood in lavender top In house be QU 36165X See Methylenetetrahydrofolate Reductase QU 85845N 1 full red top tube Do not collect in a gel barrier tube Refrigerate QU 64766R 1 full gold or red black top tube Refrigerate Gross lipemia and hemolysis are unaccepatable Injected by Nursing Send routing slip to Lab immediately Call Histology x4638 to schedule prior to procedure Fresh tissue or tongue blade QU 136648P 1 full 10 ml red black top sst tube Avoid hemolysis Overnight fasting is preferred Refrigerate serum QU 660X 1 full tube of blood in red top tube or gold top tube N oO Test Description QUEST send out test QU if indicated ABCDEFG Myoglobin Quantitative Urine Mysoline NAPA Narcolepsy Evaluation HLA N Neisseria Gonorrhea DNA Probe Female Endocervical or Male Urethral Neuronal Nu
41. identification bands In accordance with nursing policies the armband should never be removed unless the patient s welfare necessitates such removal In this event another green Blood Bank band should be securely affixed immediately to the same or a different part of the patient s body The Blood Bank band and a Blood Bank Identification Transfer Record form can be obtained from Blood Bank The transfer record must be completed and sent the Blood Bank as documentation of the band switch See below for details c Preadmission Testing Patients PATs If the patient is having a procedure the same day securely fasten the Blood Bank armband around the patient s wrist If the surgery date is a later date the patient can wear the armband which is preferred or can carry it with them On the date of admission the armband must be brought back and secured to the patient s wrist after proper identification of comparing the patient s name and birthdate on the paperwork with those given verbally by the patient If the actions listed above do not occur it will necessitate a restick of the patient and a repeat of the type and crossmatches 2 Have the patient read and sign the Transfusion Pregnancy Record T P circling Yes No or Not Sure to the question of them having been transfused or pregnant within the past 3 months This will help determine if the specimen outdates in 72 hours or 10 days If the patient can t s
42. identifying information on the request form is in agreement with that on the specimen label If there is a discrepancy or doubt the problem must be solved before the test is performed Another specimen will be collected to resolve the problem if there is any doubt EXTERNAL CONTAMINATION Obvious external contamination provides a health hazard to everyone handling the specimen not just the laboratory personnel The specimen should not be accepted into the laboratory with external contamination Save the sample until a replacement is obtained While waiting for the replacement the specimen may be stored in a small biohazard bag Attach a piece of tape to the outside of the bag explaining the situation For blood tubes wearing rubber gloves the specimen can be transferred to a new tube Properly label the new tube Properly dispose of the contaminated tube AMOUNT OF SPECIMEN A specimen that has too small an amount for proper testing should be recollected For a blood sample have a phlebotomist redraw the sample A 7 ml lavender EDTA top tube is requested REFERENCE Laboratory Specimen Rejection Policy New Procedure Supersedes _ 1 04 99 Prepared by jas 12 18 06 12 18 2006 mawc 177 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 PROCEDURE FOR HANDLING SPECIMENS FOR HISTOLOGY CYTOLOGY PRINCIPLE To ensure that all specimens are handled in a timely and efficient manner The Histology Cyt
43. in SST gold top tube or red top tube serum Separate serum In house P Hormone immediately and refrigerate ae PTT APTT 1 full tube of blood in It blue top tube must fill to top of label 3 2 citrated sodium PTT APTT Mixing Studies Quest 2 3 full tubes blood in It blue top tube Tube must be filled to the indicated Coagulation line Need a minimum of 3mls of citrated plasma Freeze plasma Quad Screen E See Maternal Serum Screen IV o O QUEST send out Test Description test QU if indicated Specimen Instructions Tube Lab Use Only Order test as Miscellaneous testing 1 full tube blood in green top Lithium or QuantiFeron Gold TB blood test Sodium heparin tube Only collectable on Tuesdays and Thursdays due to specimen stability 12 hour stability Maintain at room temperature Quantitative Immunoglobulins Urine ooo See Immunofixation Urine Quinidine QU 66944R Fa tube min 3 mls blood in red top tube Do not use serum separator RA Latex Rheumatoid Factor Serum NOTE If positive a titer is performed Sonum inhouse 1 full tube min 3 mis blood in gold top tube Rapid HIV 1 Screen See HIV 1 Rapid Screen Rapid Strep A Screen ae See Strep A Rapid Screen Call Lab for special media Clotest After collection bring to Lab Rapid Urease In house immediately Special Order Call Blood Bank Enter of Units No Specimen RBC Autologous ee needed Specimen wil
44. in red top tube Do not use serum separator tube State Dilantin Free Phenytoin Free QU 39693E fine of lactdose Direct Coombs 7 mls blood in lavender top tube Blood Bank Tube Ol N Test Description ABCDEFG Direct LDL Directed RBC Directed RBC Irradiated Disopyramide Norpace Serum DNA DS Antibodies DNA SS Antibodies DNA Cell Cycle Analysis DNA Histogram Drug Screens EBV E Coli Electrolyte Panel Lytes Sodium Chloride Potassium Carbon Dioxide QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ KEMNOPQRSTUVW Call Blood Bank for Product Order Call Blood Bank for Product Order QU 35766P 1 full tube of blood in red top tube Serum separator SST tube not acceptable Metin ae ia top sst tube Grossly lipemic and hemolyzed OO i eos O OO i osos O a See Drug Screens 1 full tube min 3 mls blood in green black top tube or gold top tube Ol oO Test Description QUEST send out F p pa abet Specimen Instructions Tube Lab Use Only Indicated ABCDEFG HIJ KLMNOPQRSTU Protein Electrophoresis CSF Electrophoresis IFE amp EPP Profile Serum Electrophoresis Protein w protein Serum Electrophoresis Protein Total Random Urine Electrophoresis Protein Total 24 Hour Urine Immunofixation Urine Eosinophil Count EPO Erythropoietin Protein Electrophoresis CSF QU 749X 1 m
45. lab coag department with any questions about specimen collection All specimen requirements must be met to provide accurate results Click for list of interfering medications Von Willebrand Profile Special Instructions Call Lab 4 5 full 4 5ml Lt Blue top Includes Factor VIII Activity von Willebrand QU 20231 tubes 3 2 or 3 8 Sodium Citrate Centrifuge for 15 minutes Factor Antigen von Willebrand Ristocetin Co factor at 3500 rpm separate and freeze plasma immediately Submit separate frozen vials for each special coagulation assay ordered 106 Test Description QUEST send out test QU if Specimen Instruction Tube Cultures indicated See Instructions for collection of Microbiology Culture Listing specimens Abscess Culture gram stain incl In house Microbiology transport media red or blue cap Aerobic ID gram stain incl Sources may include Pleural fluid pericardial fluid ventricular For sites A listed in this ratalo QU 6346R fluid sinus mouth urethra and tissues Use culture swab 9 transport system or a sterile tube or cup Anaerobic Culture gram stain incl In house Microbiology transport media blue top with gel After betadine or chlorhexidine skin preparation 10mls blood Blood Culture Note all pediatric draws collected aseptically in both aerobic and anaerobic broth Note If 14 yrs of less must 6 he ATODI FAN In house patient is r
46. mg L gt 10 Thallium Blood mcg L gt 80 Thallium Urine 24 hr mcg L gt 200 New procedure written 12 14 06 Revised 7 20 09 supercedes revised procedure written 1 15 08 17 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 PROCEDURE FOR CALLING LAB RESULTS PURPOSE To provide continuity of patient care insuring timely communication of significant results to the physician GENERAL POLICY Most of our UVMC medical staff offices are linked to our Cerner computer system Those physicians msp Medical Services Practitioner that are linked have their reports sent to them via either printer or fax There is a comprehensive list located in the laboratory secretary s office and on the desktop computers named Physician Phone amp Fax icon The procedure below will address these outpatient physicians In all cases if an outpatient s physician is not linked to our computer all STAT results need to be manually called or faxed and documented as such The manual expedite tool within Order Result Viewer allows the processing staff to enter the miscellaneous physician s fax number for all appropriate accession numbers and mark them to generate a report that will print at the time the technologist verifies the results Refer to Manually Created Expedite Reports Created upon Authentication of Results procedure for questions additional information f STATS All STAT orders are to take
47. must never be transported through the pneumatic tube system as abrupt motion of the carrier is likely to cause leaking or loss of the specimen 8 Irretrievable specimens are never to be transported through the pneumatic tube system Any paperwork barcode labels etc which have been placed inside the zippered compartment with any specimen container that is to be handled as if contaminated on the outside are to be considered contaminated and handledaccording to UVMC Contaminated Documents policies Barcode labels can be reprinted other paperwork can be inserted in a page protector and copied before discarding with the copy dated and initialed original chain of custody paperwork must be retained and can be kept in a page protector marked contaminated GUIDELINES FOR SPECIMEN HANDLING DURING TRANSPORT TO AND FROM VARIOUS UVMC FACILITIES 1 Specimens for laboratory analysis are to be collected labeled and processed as specified in the UVMC Laboratory Services Manual Please confirm specific instructions and storage requirements before processing and transporting specimens for each test that is being collected in order to ensure specimen stability 2 Lids of all specimen containers must be closed carefully ensuring a secure fit to minimize leakage Lids that could loosen easily during transport due to vibration or movement should be secured with parafilm or tape taking care to avoid applying tape to the patient specimen ide
48. not refrigerate or freeze Room Temp Platelets Apheresed Irradiated Leukoreduced 0 QUEST send out Test Description ae alee Specimen Instructions Tube ABCDEFG HIJ KLMNOPQRSTUVW Special Instructions All of the following conditions must be met 1 The veinipuncture should be performed using a 21gauge needle 2 The specimen needs collected via vacutainer collection Do not use a syringe or butterfly to collect The specimen needs to Go directly into the anticoagulent tube Draw 2 Light blue black center 3 2 Na Citrate Plastic tubes Discard sample if the vein collapses or blood flow stops Hemolysis is not acceptable ie SO ponie UAE ISS Poe Sample is stable only 4 hours at room tempurature Do not refrigerate or centrifuge Do not allow the specimen to become chilled by courier transit Specimens cannot be rewarmed or remixed 8 Do not send through the pneumtic tube system Call the lab coag department with any questions about specimen collection All specimen requirements must be met to provide accurate results Click here for a list of interfering medications Porphyrins Fractionated Quantitative QU 36592X 2ml random urine in 5g sodium carbonate or no preservative container Random urine Protect from light during collection Refrigerate Barssum Ebod ae min 3 mls blood in green black top tube or gold top tube Avoid Potassium Random Urine In house 10 mls random urine in urine co
49. observance of presence only State time of collection collection form filled out and sent to LAB Semen Complete See Semen Analysis Fertility See Instructions for semen analysis collection 2 hour stability for Semen Analysis Fertility Analysis In house motility State time of collection Ph amp Viscosity included MUST have Special Instructions 1 full tube blood in red top or gold top tube Centrifuge and remove cells within 1 hour Freeze serum immediately Serotonin Serum QU 29405P_ _ Patients should avoid food high in indoles avocado banana tomato plum walnut pineapple and eggplant Patient should also avoid tobacco tea and coffee 3 days prior to specimen collection Patient should also avoid tobacco tea and coffee for three days prior to specimen collection Must be Drawn at UVMC Outpatient LAB due to special handling 2 Full EDTA lavender top tubes Transfer specimen to a plastic vial and add 5 35mg of ascorbic acid Mix well and freeze Patient should avoid food high in pool Eose CAS indoles avocado banana tomato plum walnut pineapple and eggplant Shillings Test oo See Intrinsic Factor Antibody oO QUEST send out Lab Use Only Test Description test QU if Specimen Instructions Tube indicated XYZ ABCDEFG HIJ KLMNOPQRSTUVW sieke cabean QU 68643E 1 full lavender EDTA top tube Absolute minimum specimen is 50ul of sample Sirolimus Rapamune R
50. of the patient and other clinical and laboratory findings Patients may be infected with multiple HCV subtypes PDL en Cenei URORT in house 1 tube blood in green black top tube or gold top tube Min 3 mls 12 hour fasting preferred H Metals Profile1 Blood Special Tube 2 tubes whole blood in Royal Blue Top EDTA tube eayy aa AS TOUET lie Sodium heparin royal blue top tubes are also acceptable To avoid Includes Arsenic Lead adult Mercury QU 7674N S contamination use powder less gloves for collection and handling And Creatinine Room Temp Used for Health Fairs Fireman Panel Call Lab 10ml aliquot from a Heavy Metals Profile 1 Urine 24HR 24hour urine collected in an acid wash metal free container Do not use a Includes Arsenic Mercury Lead and QU 6510N A x Creatinine atient should refrain from eating seafood 3 days prior to collection Do not measure total volume Send aliquot in trace element free container See 24 Hour Urine Collections Procedure O N Test Description ABCDEFG HIJ KLMNOPQRSTUVW Heavy Metals Profile 1 Urine 24HR Includes Arsenic Mercury Lead and Creatinine Heavy Metals Profile 1 Urine 24HR Includes Arsenic Mercury Lead and Creatinine Helicobacter Pylori IgG Antibody H Pylori IgG Hemochromotosis Hereditary DNA Hematocrit Hemoglobin Hemoglobin Electrophoresis Hemoglobin amp Hematocrit Hemoglobin A1C Glycohem
51. patient information on component patient s name medical record number account number and the unique blood bank armband ID number and the unit number must match the information on the Blood Transfusion Record All checks should be made by both the lab technologist and the nursing personnel Any discrepancies must be resolved prior to transfusion The Type and Rh should be reviewed If the patient and the component type are not the same two technologists should have reviewed the situation and initialed the Blood Transfusion Record The Nursing personnel should question why the type and Rh are not the same There are situations where this will occur The technologist is responsible for observing the condition appearance of the blood If the appearance of the blood is abnormal the unit should not be issued The technologist must take segments from the unit for red cell components and store them in Blood Bank Both the nursing personnel and the tech sign out on the Blood Transfusion Record Fill in the current date and time Nursing Responsibilities Before During Transfusion Prior to transfusion verify that the patient name and number on the armband agree with the name and number on the Blood Transfusion Record This verification requires the signatures of two 2 nurses Completely fill out all information required of the transfusionist Fill these out as appropriate patient vitals before 15 minutes after start and immediately aft
52. plasma and freeze ASAP in a plastic vial XYZ Special Instructions Call Lab 2 full tubes blood in Lt blue top tube fill to indicated line 3 2 citrated sodium Immediately spin at 3500rpm for 15 min then separate plasma ASAP and aliquot 1 ml plasma into each of 2 transport tubes and label tubes as citrated plasma Freeze immediately No hemolysis Frozen Special Instructions Call Lab 2 full tubes blood in Lt blue top tube fill to rele indicated line 3 2 citrated sodium Immediately spin at 3500rpm for 15 Poent n e OAG ni QU 20319 min then separate plasma ASAP and aliquot 1 ml plasma into each of 2 and Functional transport tubes and label tubes as citrated plasma Freeze immediately No Protein C Panel includes both Antigenic and Functional QU 20319 hemolysis Frozen Special Instructions Call Lab 1 full tubes blood in Lt blue top tube fill to indicated line 3 2 citrated sodium Immediately spin at 3500rpm for 15 Protein C Resistance QU 22X minutes then separate plasma ASAP and aliquot 1 ml plasma into each of 2 transport tubes and label tubes as citrated plasma Freeze immediately No hemolysis Protein CSF 1 ml CSF in sterile container 84 ye QUEST send out F p Test Description ae ap i Specimen Instructions Tube Lab Use Only inaicated 2 full tubes blood is red top tube or gold top tube Fasting specimens Electrophoresis IFE amp EPP Profile preferred
53. priority over everything else Inpatient and outpatient results will print automatically on the nursing station or physician office fax or printer if linked upon release of the results into the computer system CERNER All outpatient results must be called immediately upon release Document in Order Notes or Result Notes who was contacted and what time they were contacted Whenever possible when contacting the physician office make sure they are aware of the results printing and refer them to the printed report versus manually giving results over the phone This decreases the risk of a clerical error These results do NOT need to be called for inpatients except in two instances 1 The first exception is when the computer system Cerner or AS400 is down At this time the results need to be faxed or called to the nursing stations as soon as the results are completed When the computer systems s comes back up the date time called person called to and the tech that called the results must be documented 2 The second exception is if the STAT result is critical the nursing station or physician msp should be called immediately to inform them of the critical Refer below to Critical results If you have to manually call or fax a result the date time person called to and called by are to be documented in the computer in Result Notes or Order Notes 18 ASAP AND TIMED ASAP and Timed orders are to take priority after STAT testing The e
54. procedure written 9 6 96 1 13 99 9 4 02 1 27 05 158 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 QUICK REFERENCE FOR SPECIMEN STABILITY OAcetaminophen 3 days at 2 8 C 1Acetone tightly capped ASAP Albumin 72 hrs at 4 8 C Freeze at 20 C for storage longer than 72 hours Alcohol room temperature for 3 hours 7 days at 2 8 C and frozen for14 days OAlkaline Phosphatase 5 days at 2 8 C 1ALT 2 days at 2 8 C AMM needs placed on ice immediately separated plasma 3 hours at 4 C in a stoppered container Amylase 1 month at 4 degrees C or 7 days at 20 25 C AST 8 hrs at 20 24 C or 48 hrs at 2 8 C BNP keep tubes upright unstable is glass if testing delayed separate plasma freeze if gt 24 hrs BUN 14 days at 2 8 C or for two months frozen Bicarbonate 2 8 C for 7 day specimen must be capped stable 1 hr after uncapped Biliruben Total amp Direct assay immediately protect from light Tightly covered and refrigerated samples at 2 8 C for one 1 week with no light exposure B12 48 hrs at 2 8 C or freeze Ca 1 week at 2 8 C OCarbamazapine 5 hours at room temperature 5 days at 2 8 C and 14 days frozen ICEA 48 hrs at 2 8 C or freeze 2Chloride 5 hours at room temperature 5 days at 2 8 C and 14 days frozen 3Cholesterol 7 days at 2 8 C ACK 7 days at 2 8 C 1 month at 20 25 C 5CK MB 48 hrs at 2 8 C or freeze 6Crea
55. pushing the brush into the bottom of the vial 10 times forcing the bristles to bend apart to release the cervical material As a final step twirl the brush between the thumb and forefinger vigorously to further release cellular material Discard the collection device Cap the PreservCyt vial tightly Tighten the cap of the vial so that the black torque line on the cap passes the black torque line on the vial Warning Do Not use Cytobrush Plus GT cell collector gently touch tip for endometrial sampling Use for cervical sampling only For endometrial sampling use Medscand s Endorette cannla The Cytobrush device is not to be used on pregnant patients due to insufficient clinical data Revised 1 4 07 cmw 185 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 SCHEDULING AND REPORTING OF FROZEN SECTIONS SCHEDULING AUTOPSIES AND REPORTING OF SURGICAL SPECIMENS SCHEDULING OF FROZEN SECTIONS Frozen sections are scheduled with the Histology department via their printer from surgery scheduling Scheduling is requested as soon as a surgery requiring a frozen section has been scheduled in O R The following information must be provided Date and time of surgery Patient s full name Patient s age and sex Type of surgery Surgeon Type of anesthetic If applicable x ray localization If known special instructions ex EM cloning CONOARWDN The histology tec
56. site starting at center and moving in concentric circles to periphery of site 3 Without removing iodine or ChloroPrep solutions allow to stand for 60 90 seconds or ideally till dry Then proceed with venipuncture without further palpation of site COLLECTION OF BLOOD When the venipuncture site has been prepared the sample is collected using a butterfly set with adapter cap with optional insert Prepare selected bottles 1 Label the appropriate culture bottle s with patient information full name identification number date and time drawn and phlebotomist s initials and accession number If using a barcode label do not place over bottle barcodes The bottle must be at room temperature and upright 2 Observing the level of fluid in the bottle use a marking pen to indicate a line 10 cc above the media level to act as a guide for achieving the proper 5 10 cc of blood sample 3 Remove plastic flip top from each culture bottle and disinfect stoppers with iodine or CloroPrep To collect blood using a blood culture collection adapter 1 Connect the Adapter Cap to the luer connector of the collection set 2 Perform venipuncture aseptically When the needle is in the vein secure it with tape or hold it in place 3 Place Adapter Cap on the aerobic culture bottle septum and press down to penetrate and obtain blood flow Verify that blood flows into the bottle Hold the Adapter Cap down on the bottle during collection Line de
57. that positive HIV tests be reported to the Ohio Department of Health e Ifyou do not want your name used you can take an anonymous test Your name is not used Someone tells you the results but no written results are given to you Please Ask Questions If you have any questions about this test please ask a doctor a counselor or call the Ohio AIDS HIV STD Hotline at 1 800 332 AIDS 2437 The hotline is a free call have read the above or have had it read to me and agree to be tested for HIV Name Date Prepared under the authority of Ohio Revised Code 3701 242 A 3 155 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N Dixie Highway Troy Ohio 45373 POLICY ON LABORATORY PRIORITY LEVELS PURPOSE In order to maintain a standard of quality care certain terms are used to define the priority of tests and procedures within the UVMC laboratory This procedure will define each priority level used by the laboratory and will define the time frames for which specimens are to be collected and results reported If the turnaround time of any test s is going to be significantly delayed due to equipment malfunctions quality control issues etc especially stat testing notify the requester of the delay and give them an estimated time in which they can expect a result STAT Stat orders are considered critical tests due to the fact that they always require rapid communication of results normal or abnormal Stat orders a
58. the physicians on the case c Specific description of specimen s d Source of specimen e Date and time specimen s collection f Requisition must be signed by ordering nurse 4 Surgical specimen s will be logged in Surgical Tissue Specimen Record Book You will find Surgical Tissue Specimen Record Books and specimen buckets located outside the Endo rooms in Same Day Surgery and in the frozen room Specimen will be picked up from Surgery by a Histology tech The Histology tech will check containers and requisitions for proper patient identification and information and also check visually for specimen when appropriate The Histology tech will initial Surgical Tissue Specimen Record Book and transport the specimen s to the Histology department in a closed bio hazard labeled transport container When the specimen or the surgical order requisition is not completed correctly the histology tech will contact the surgery to correct the problem before transporting the specimen s to the Lab 6 When specimen s is brought to the Histology department by outside personnel the specimens must be logged on the irretrievable specimen log clipboard located in the Lab specimen processing area The entry must be include date time and signed by the person delivering the specimen and counter signed by a lab employee The specimen s must to be received in a bio hazard bag 7 Specimen s are processed Monday Friday surgical reports are usually availabl
59. transported in case of leakage and must be secured against movement in the vehicle GUIDELINES FOR SPECIMEN HANDLING DURING TRANSPORT TO AND FROM VARIOUS UVMC FACILITIES cont d 8 All laboratory personnel who package specimens to be transported must satisfactorily complete training and be certified in the specific requirements set forth by the U S Public Health Service the U S International Air Transport Association IATA the U S Department of Transportation DOT and the U S Postal Service These requirements apply to domestic transportation by land air or sea and to international air transportation Training and certification are required by CAP every 2 years Any paperwork barcode labels etc which have been placed inside the zippered compartment with any specimen container that is to be handled as if contaminated on the outside are to be considered contaminated and handled according to UVMC Contaminated Documents policies Barcode labels can be reprinted other paperwork can be inserted in a page protector and copied before discarding with the copy dated and initialed original chain of custody paperwork must be retained and can be kept in a page protector marked contaminated Special temperature and handling requirements are listed in the Laboratory Services Manual test directory please confirm requirements before processing and transporting specimens The absorbent material should be placed in the
60. 0231 separate and freeze 2 0ml of plasma in 3 separate vials for testing Overnight fasting is preferred Hemolyzed specimens are not acceptable Frozen WBC White Blood Cell Count Se erate A tube 1 mls min draw from a 3 ml tube or 3 WBC with Differential in house 3mls whole blood in lavender top tube 1 mls min draw from a 3 ml tube or 3 White Blood Cell Count ml min draw from a 7 ml draw QUEST send out Test Description test QU if Specimen Instructions Tube indicated ABCDEFG HIJ KLMNOPQRSTUVW wi es Lab Use Only XYZ White Blood Cell Count See WBC See WBC with differential WNV See West Nile Virus Pure culture of organism to be identified on an agar plate Transport in Yeast Isolate ID Fungus QU 43026F oole Walled container sas Cary Blair Media obtained from LAB bring preserved specimen to Lab Yersinia Seol Culture mouse Sane media expires after 96 hours Zone 8 Allergen Panel QU 20201 2 full red top tube or red black top tubes White Blood Cell Count with Differential 1 full tube blood in Royal Blue EDTA centrifuge 10 min 1000G or Royal Blue No Additive tube clot 30 min centrifuge 1000g for 10mi Using Zinc Blood QU 945X powderless gloves pour plasma serum into red vial tube in trace element kit Patient should refrain from taking vitamins or mineral supplements at least 3 days prior to specimen collection Transport at Room Temperature Zinc amp Lead Protoporp
61. 1870E 1 full tube blood in red top gold top or lavender top tube Testing will be done In house 1 full tube min 3mls blood in green black top tube or gold top tube Hepatitis B Virus Surface Antibody In house on M W F refrigerate unless testing is delayed more that 3 days then freeze O D QUEST send out Test Description test QU if Specimen Instructions Tube KEMNOPQRSTUVW Hepatitis B Virus Surface Antigen QU 265F 1 full tube blood in red top tube or gold top tube Hepatitis BE Panel Be Ag amp Be AB QU 27 1 full tube blood in red top tube or gold top tube No gross hemlysis or lipemia Hepatitis C Antibody w reflex to RIBA QU 37677X 1 full tube blood in red top tube or gold top tube Hepatitis C AB RIBA Confirmation only QU 1354N 1 full tube min 3mls blood in red top tube or gold top tube Centrifuge within 1 hour of collection ape 1 Full lavender top tube is preferred Serum is also acceptable Separate Set Eo O EEE QU 35645X plasma or serum from cells within 6hours by centrifuging 800 1600xg Quantitative viral load Lab Use Only XYZ for 20 minutes at room temperature Transport in polypropylene vial Hepatitis Panel Acute Hep B Surface Ag Hep A AB IgM Hep B Core AB IgM QU 10306F Need 2 Tubes 2 Full red top tubes or red black top tubes Hep C AB 1 full 7ml Lavender top EDTA tube Sodium heparin green top and ACD Hereditary Hemeochromotosis
62. 3972N Malignancy blood in sodium heparin green stopper tube Keep at Room Temperature Special Container Call Histology x4638 Preferred specimen 2x3mm Chromosome QU 14593X fresh tissue submitted in a sterile leak proof container with Hanks or Ringers Tissue Skin Products of Conception solution Specimens submitted in culture medium with antibiotics are also acceptable Refrigerate Do not Freeze CK Isoenzymes QU 1362A eon oy gold ap lube Separate serum into a plastic vial and freeze immediately CK MB Quantitative 1 full tube min 3mls blood in green black top tube or gold top tube CL Chloride See Chloride Clostridium Difficile Toxin Assay i Cytotoxin Assay See Cytotoxin Assay Clostridium Difficile Screen in house 5g fresh stool in sterile container without preservative Keep refrigerated C Difficile Toxin A amp B Detection EIA Must be in Lab within 24 hours of collection CMP Comprehensive Metabolic Panel Sodium Potassium Chloride CO2 Glu BUN Creat Calcium Alb T Bili Alk In house 1 full tube min 3 mls blood in green black top tube or gold top tube Phos T Protein ALT SGPT amp AST SGOT CMP Minus Glucose Comprehensive Marialle Panel minie guesse 1 full tube min 3 mls blood in green black top tube or gold top tube CMV IGG IGM and Panel QU 9928T 1 full tube blood in red top tube or gold top tube No hemolysis Refrigerate ay Erano ae
63. 7 31 0 62 0 40 18 2 31 8 34 0 41 18 7 32 7 65 0 42 19 1 33 4 67 0 43 19 5 34 2 68 0 44 20 0 35 0 70 0 45 20 4 35 7 71 0 46 20 9 36 6 73 0 47 21 4 37 5 75 0 48 21 8 38 2 76 0 49 22 2 38 9 78 0 50 22 8 40 0 80 0 51 23 2 40 6 81 0 52 23 6 41 4 83 0 53 24 1 42 2 84 0 120 Body weight Glucose Volume Ib kg gm 50 Solution ml 54 24 5 42 8 86 0 55 25 0 43 7 87 0 56 25 4 44 5 89 0 57 25 9 45 3 91 0 58 26 3 46 1 92 0 59 26 8 46 9 94 0 60 27 1 47 8 96 0 61 27 7 48 5 97 0 62 28 2 49 4 99 0 63 28 6 50 0 100 0 64 29 1 50 9 102 0 65 29 5 51 6 103 0 66 30 0 52 5 105 0 67 30 4 53 2 107 0 68 30 8 54 1 108 0 69 31 3 54 9 110 0 70 31 8 55 6 111 0 71 32 2 56 5 113 0 72 32 7 57 2 115 0 73 33 2 58 1 116 0 74 33 6 58 8 118 0 75 34 1 59 6 119 0 76 34 5 60 4 121 0 77 35 0 61 2 122 0 78 35 4 62 0 124 0 79 35 9 62 8 126 0 80 36 4 63 6 127 0 81 37 2 64 5 129 0 82 37 2 65 2 130 0 83 37 7 66 0 132 0 84 38 2 66 8 134 0 85 38 6 66 8 135 0 86 39 1 67 6 137 0 87 39 5 68 4 138 0 88 40 0 69 2 140 0 89 40 4 70 0 142 0 90 40 9 70 8 143 0 91 41 3 71 6 145 0 92 41 8 72 4 146 0 93 42 3 73 2 148 0 94 42 7 74 8 150 0 95 43 1 75 5 151 0 96 43 6 76 4 153 0 97 44 0 77 1 154 0 98 44 5 78 0 156 0 99 45 0 78 7 158 0 100 45 4 79 5 159 0 For patients weighing more than 100 Ib give the adult dose of 200 ml Of a 50 solution The whole 50 gm Bottle Revised 7 16 03 121 Upper Valley Medical Center Clinical Laboratory 3130 North Dix
64. E over venipuncture site lightly Quickly remove the needle and then apply pressure to the site Fig 13 Do not have the patient bend their elbow Instruct the es patient to keep the arm extended in TONE eee a straight position and have them i unk ois hold the gauze pad or cotton ball against the wound at least 2 minutes 12 If venipuncture was a syringe draw fill tubes by using the BD vacutainer transfer device The vacuum in the tubes will pull the blood from the device After filling each tube gently invert them 5 times each Never hold the tubes in your hand and put the needle directly into the tubes This is a major safety violation HRRRELERERREREL EERE EEERELER SQV OS should still be Oe ee EERE EER EEEE EEE 13 Apply a Band Aid or tape over the gauze or cotton ball on the site of the venipuncture Make sure the patient is not allergic to adhesive tape prior to placing it on the venipuncture site 134 14 Dispose of vacutainer device into a puncture proof container or disposal unit YY gt f f eA ADHESIVE TAPE if no other label IS provided 15 Label all tubes with the bottom half of the barcode label the time collected and your Cerner ID If you do not have a barcode label make sure to hand label the tubes Refer to the Specimen Labeling Procedure Print this information clearly Fig 15 Take special care not to contaminate the test request form with the blood Keep the form separate from the speci
65. Free QU 39693E EDTA plasma lavender top or royal blue top tubes are also acceptable The Does not include total must order separately 80 QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW PKU Special Kit OB department collects newborn specimen Plasma Fresh Frozen ees See FFP or Fresh Frozen Plasma Special Instructions 1 full It blue top tube fill to indicated line Plasminogen QU 59709P_ Immediately spin at 3500 RPM for 15 minutes and separate and freeze plasma ASAP Platelet Antibodies Associated Special Instructions 2 full tubes blood in yellow top tube ACD B Whole Antibody blood specimen do not centrifuge Keep at room temperature Ordered from Special Order Call Blood Bank No specimen needed Specimen will be Community associated with Type and Rh Follow arm banding procedure May need to Blood Center order Type amp Rh Platelets Apheresed Leukoreduced Ordered from Special Order Call Blood Bank No specimen needed Specimen will be Community associated with Type and Rh Follow arm banding procedure May need to Blood Center order Type amp Rh Platelet Antibody Heparin Induced QU 53793P See Heparin Induced Platelet Antibody HIPA Platelet Antibody IgG Direct QU 140129P 1 full 7ml lavender top tube Or 2 full 4 ml lavender tops Keep tube at room temperature Do
66. HAZARD BOXES Redlined waste boxes are designated for biohazards other potentially infectious material and any items contaminated with biohazards or potentially infectious material Avoid discarding non biohazardous items or biohazardous liquid waste that can be flushed down a drain in redlined containers as this unnecessarily increases the cost of disposal Boxes are to be assembled so that the arrows on the sides point up while the box is being filled using two inch wide pressure sensitive poly tape or equivalent The assembled boxes are then lined with appropriate sized red bags provided by the contractor All biohazard waste boxes in the laboratory are double bagged Absorbent material which may include such items as paper towels or gauze is placed in each biohazard container in quantity sufficient to absorb all liquid waste discarded in that container whether the liquid is in a tube vial specimen container etc or not and at a level which will promote absorption of that waste if needed Discarded donor blood plasma or platelets should be flushed down the drain with large amounts of water followed by rinsing the sink and cleaning the sink and surrounding area with 10 bleach solution Liquid waste blood or body fluids contained in vacuum bottles or suction containers should be discarded in the same way The containers or blood product bags are then discarded in redlined waste receptacles Exception Blood or plasma that has clotted
67. Hemolyzed lipemic and plasma specimens may be rejected QU 5077 Serum Specimens that have been left uncapped are also unacceptable due to evaporation 1 full tube of blood in red top tube or gold top tube Fasting specimens Protein Electrophoresis w T Protein QU 687T preferred Hemolyzed lipemic and plasma specimens may be rejected Serum Specimens that have been left un capped are also unacceptable due to evaporation Protein Total Electrophoresis Urine 10mls random urine first morning specimen is preferred in container no QU 525X Random preservative Refrigerate Protein Electrophoresis CSF QU 749X 1 ml CSF in sterile container 10mls of urine from a 24hour urine collection No preservative Discard first UN morning specimen before starting 24hour collection Random urine sample is Immunofixation Urine QU 134403E also acceptable See 24 Hour Urine Collections Procedure Special Instructions 1 full tube in It blue top tube fill to indicated line Protein S Functional QU 1779X 3 2 citrated sodium Immediately spin at 3500 rpm for 15 minutes then separate and freeze plasma ASAP Special Instructions 2 full tubes in It blue top tube fill to indicated line Protein S Panel includes both Functional QU 20318 3 2 citrated sodium Immediately spin at 3500 rpm for 15 minutes then and Antigenic separate plasma ASAP and aliquot 1 ml plasma into each of 2 transport tubes Freeze immediately Pr
68. N QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW 17 Hydroxycorticosteroids 20ml aliquot from 24hr urine Place 10gm of boric acid into a 24hr container 24 hr Urine 170H QU 15202X prior to collection Call lab for container See 24 Hour Urine Collections Procedure 10 ml aliquot of 24hr urine Use 25ml of 6N HCL as preservative Collection sionin N CE may be done without preservative if PH is below 6 and specimen is shipped 24 ri E 5 HIAA 24 Hour a QU 9936N frozen Patient should avoid foods high in indoles Avocado banana tomato Specimen Instructions Tube Lab Use Only XYZ plum walnut pineapple and eggplant Also avoid tobacco tea and coffee three days prior to testing See 24 Hour Urine Collections Procedure 17 Hydroxyprogesterone Serum QU 17180X 1 full tube min 3mls blood in red top tube Gel barrier SST tubes are unacceptable ID amp Sensitivity from Culture device Call Lab Microbiology x4642 IgE Serum QU 24620E 1 full tube min 3 mls blood in gold top or red black top or red top tube IGF I Insulin like growth factor QU 839X 1 full tube min 3mLs blood in red top tube Centrifuge within one hour of Somatomedin C collection and transfer specimen to a plastic container Freeze specimen IgG Subclasses 1 4 QU 5173N 1 full tube in red top or gold top tube Centrifuge with in 1 hour of collection Includes Total IgG and transfer serum t
69. N Dixie Hwy Troy OH 45373 NURSING INSTRUCTIONS FOR REQUESTING BLOOD FOR TRANFUSION Test and Component Ordering A Blood Bank tests and components are ordered through Cerner Power Chart B In Cerner enter the tests and component including the number of components ordered C For components complete a Blood Product Order Form Fax a copy to the Blood Bank at 440 4393 D Notify the Blood Bank of STAT requests Call Blood Bank at phone number 440 4643 Type and Rh Versus Type and Screen A Type and Rh A type and Rh is performed on the patient The patient s plasma is not screened for unexpected antibodies A type and Rh is needed when platelets and plasma products FFP and CRYO are ordered B Type and Screen A type and Screen is needed when red blood cell products are ordered A type and Rh is performed on the patient and the patient s plasma is screened for unexpected antibodies With a type and Screen blood is not crossmatched If no unexpected antibodies are detected two units of type specific blood will be available in Blood Bank for crossmatch on the patient if ordered With a negative antibody screen when components are ordered a crossmatch can be performed in about 10 to 15 minutes In an emergency blood can also be signed out by the physician to be transfused uncrossmatched With a negative antibody screen there is a 99 chance that random units of type specific blood will be compatible If antibodies are presen
70. NLY difference between plasma and serum is the presence of anticoagulant in the blood collection tube Anticoagulant Anticoagulant is any substance or additive that prevents blood clotting Anticoagulants used to prevent clotting of blood specimens for laboratory analysis are heparin and several substances that make calcium ions unavailable to the clotting process including EDTA ethylenediaminetetraacetic acid citrate oxalate and fluoride Tubes Used for Whole Blood Specimens Lavender Contains K3 or K2 EDTA anticoagulant Does not contain a gel barrier Green Contains Sodium or Lithium Heparin anticoagulant Does not contain a gel barrier Yellow Contains ACD Solution A or B anticoagulant Does not contain a gel barrier Any tube containing anticoagulant without a gel barrier can be used for a whole blood specimen Use each tube according to the specimen requirements 129 Tubes Used for Serum Specimens Red Red Black Gold Sterile tube Contains no additive Does not contain a gel barrier Contains Clot Activator Contains a gel barrier Contains Clot Activator Contains a gel barrier Tubes Used for Plasma Specimens Lavender Green Green Black Blue Gray PPT Plasma Preparation Tube Prepared 10 30 03 pg Contains K3 or K2 EDTA anticoagulant Does not contain a gel barrier Contains Sodium or Lithium Heparin anticoagulant Does not contain a gel barrier Contains Lith
71. NOTE Specimen labeling and patient armbanding must occur at the same time that the patient is identified and the specimen is collected to eliminate errors and to ensure a true chain of identification D Blood Bank Armbanding 1 a Routine Put the patients s birthdate the time of the draw and the name of the person collecting the specimen first initial and last name on the barcode sticker of T amp Rh or T amp S accession label Attach the barcode sticker to an armband insert card Slide the card into the armband and securely fasten the Blood Bank armband around the patient s wrist Put the armband on so that it is comfortable for the patient but tight enough that it will not slide off over the wrist NOTE If PAT see 1c b Downtime Write name of patient last first and initial birthdate of patient date time of collection and name of the person collecting the specimen first initial and last name on the top numbered label of sticker sheet Label armband insert card with the patient s name patient s birthdate date time of collection and the 169 collector name Place a numbered sticker from the sticker sheet onto the armband and securely fasten the Blood Bank armband around the patient s wrist Put the armband on so that it is comfortable for the patient but tight enough that it will not slide off over the wrist NOTE If PAT see 1c NOTE The Blood Bank Armband should be placed on the patient s wrist with other
72. Nortriptyline total mcg L gt 1000 Amobarbital mg L gt 20 Butalbital mg L gt 10 Cadmium Blood mcg L 30 Caffeine mg L gt 50 Carboxyhemoglobin of total Hgb gt 20 Chlorpromazine ng ml gt 750 Clomipramine and Metabolite total ng ml gt 600 Cyanide mg L gt 1 0 Cyclosporine as Trough mcg L gt 600 Desipramine mcg L gt 600 Diazepam and Nordiazepam total mg L gt 3 0 Digitoxin mcg L 245 Disopyramide mg L gt 7 0 Doxepin Nordoxepin total mcg L gt 600 Ethosuximide mg L gt 150 Ethylene glycol mg L gt 100 Flecainide mg L gt 1 0 Fluphenazine mcg L gt 50 Ibuprofen mg L gt 100 Imipramine or Desipramine total mcg L gt 600 Isopropanol mg dL gt 50 Lead blood mcg dL gt 45 for lt 6 years Lidocaine mg L gt 6 Mercury Urine 24 hr mcg L gt 150 Mercury Urine Random mcg g creatinine gt 150 Methanol mg dL gt 5 Methemoglobin of total Hgb gt 70 Methotrexate at 24 h umol L gt 5 Mexiletine mg L gt 5 Methsuximide as Normethsuximide mg L gt 40 Nortriptyline mcg L gt 500 Phenytoin free mg L gt 3 0 Primidone mg L gt 15 0 Procainamide mg L gt 14 0 Procainamide NAPA total mg L gt 30 0 Protriptyline mcg L gt 500 Propafenone mg L gt 2 0 Quinidine
73. OUT MANAGED CARE Quest Diagnostics will call us with any critical values on a managed care patient It is then our responsibility to call the ordering physician using our normal calling critical result procedure Revised 12 23 08 by smw supersedes policy written 12 21 2007 by Dr Machicao 1 11 99 11 17 99 3 13 00 4 11 00 7 19 00 10 30 00 1 28 03 4 9 05 4 5 06 11 20 06 3 12 07 15 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OH 45373 UVMC REFERENCE LAB CRITICAL VALUES The following are UVMC critical values for reference work sent to Quest Diagnostics Laboratory Malaria parasites or other organisms Babesia Ehrlichia Trypanosomes Positive for verified Plasmodium falciparum or etc unidentified Plasmodium species Bacillus anthracis culture nucleic acid or antigen test Positive Bacterial meningitis antigens CSF Positive Brucella sp culture nucleic acid or antigen test Positive Cryptococcus antigen serum or CSF Positive Francisella tularensis culture nucleic acid or antigen test Positive Isolation and or identification of an Refer to Microbiology departmental infectious agent that procedure Procedure for Communicable requires immediate Public Diseases to Health Department for specific Health notification diseases and major public health concerns Yersinia pestis culture nucleic acid or antigen test Positive Amitriptyline
74. Or Caliah 1 full tube min 3mls blood in redtop tube or gold top tube D N QUEST send out Test Description test QU if Specimen Instructions Tube indicated ABC DEFG HIJ Complement C3 QU 44859W Call Lab for pediatric specimen requirements 1 full tube min 3 mls blood in redtop tube Refrigerate Call Lab for pediatric specimen requirements Compiement G Cae 1 full tube min 3 mls blood in redtop tube Refrigerate Lab Use Only Special Instructions 1 full tube min 3 mls blood in red top tube Draw sample without anticoagulant Allow specimen to fully clot Separate serum Complement Total CH50 QU 45328P_ into a plastic tube and freeze sample within 1 hour of time drawn Avoid hemolysis Specimens drawn in sst tubes are acceptable but not preferred Frozen Must be drawn at UVMC outpatient services due to special handling 1full tube of blood in a red top or gold top tube Bring specimen to Cold Agglutinins Titer QU 349X lab immediately so that the specimen can clot in warm waterbath then spin immediately and separate Do not refrigerate Do not draw on weekends Specimen is only stable for 2 days at room temperature Whole blood in Lavender top tube 1 ml min draw on a 3 ml tube Complete Blood Count CBC In house 3 ml min draw on a 7 ml tube Comprehensive Metabolic Panel See CMP Comprehensive Metabolic Panel minus glucose Coombs Direct wE S See Direct Coombs
75. Oxalic Acid Urine 24hr Specimen Instructions Tube Lab Use Only XYZ spinach coffee tea chocolate rhubarb for at least 48 hours prior to collection See 24 Hour Urine Collections Procedure a leukocyte removal at bedside Call Blood Bank for Order NOT orderable in Power Chart PAP Thin Prep See Thin Prep or Cytology Partial Thromboplastin Time PTT See PTT or Activated Partial Thromboplastin Time 1 full tube blood in red top or gold top tube Allow blood to clot at room Parvovirus B19 AB IgG IgM QU 14050N _ temperature Centrifuge at 1500rpm for 10 minutes within 1 hour of collection Avoid hemolysis Pathology Blood Smear Review See Blood Smear Interpretation PEP See Protein Electrophoresis i Fluid aspirated anaerobically into a syringe rinsed with heparin and sent to Pi bodyifiuid Lab ASAP on ice State Source PH stool QU 27557W 5g fresh random unpreserved stool in sterile container No barium or laxatives for 1week prior PH urine In house 1 ml random urine in urine container no preservative N QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW 1 tube blood in a green top tube sodium or lithium heparin no gel minimum volume is 2 mL Specical instructions Do not send specimen through the PH Wenous eeutanulionesy pneumatic tube system Call ext 4104 and leave the labeled specimen by i the ED barcode printer A respiratory tec
76. Platelet Leukoreduced RBC Leukoreduced RBC Irradiated LH Luteinizing Hormone Light Chains Urine Lipase Lipid Panel Cholesterol HDL TRIG calculated LDL amp VLDL Lipid Profile with LDL HDL Ratio Chol HDL TRIG calculated LDL amp VLDL QUEST send out test QU if Specimen Instructions Tube Lab Use Only indicated HIJ KEMNOPQRSTUVW QU 64477W 1ml clean catch urine collected in a sterile cup or a gray top tube Keep refrigerated Submit fresh biopsy tissue lower respiratory tract specimens or pleural fluid QU 668X in a sterile screw capped container Keep Refrigerated Do not fix samples G nzyme Peripheral Blood Contact Lab for special collection kit y Bone Marrow Contact Lab for special collection kit Oooo See Alkaline Phosphatase Leukocyte Ea See Platelet Apheresed XYZ l 1 full tube min 3 mls blood in green black top tube or gold top tube Fasting n house Recommended inhouse 1 full tube min 3 mls blood in green black top tube or gold top tube Fasting Recommended Also Called Coronary Risk Lipid Profile N R QUEST send out F p Test Description pas ap i Specimen Instructions Tube Lab Use Only indicated wis kLmNOPaARSIUYW xYZ Special Instructions 24 48 or 72 stool collection Record total collection time and weight on requisition Keep refrigerated Use a 1gallon plastic Lipids Total Stool QU 3046N leak proof container with screw cap Patient s
77. ThinPrep 2000 Processor and a gentle dispersion step breaks up blood mucus non diagnostic debris and thoroughly mixes the cell samples The cells are then collected on a TransCyt Filter specifically designed to collect diagnostic cells The ThinPrep 2000 Processor constantly monitors the rate of flow through the TransCyt Filter during the collection process in order to prevent the cellular presentation from being too scant or too dense A thin layer of cells is then transferred to a glass slide in a 2mm diaminter circle and the slide is automatically deposited into a fixative solution REAGENTS PreservCyt solution sample collection and transport Medium Cytobrush Plus GT Pap Perfect Plastic Spatulas Cervical Cytology Papette broom SPECIMEN COLLECTION PROCEDURE With patient in lithotomy position expose cervix using a vaginal speculum moistened with warm water Visually examine vaginal mucosa and cervix for lesions ulceration or discharge Document findings of the examination on patient s record and communicate the relevant clinical findings to laboratory for optimum cytological interpretation 1 To collect specimen from the ectocervix select contoured end of plastic spatula and rotate it 360 degrees around the entire ectocervix while maintaining thigh contact with ectocervical surface Remove spatula 2 Rinse contoured end of plastic spatula in a vial of PreservCyt solution by swirling vigorously ten 10 times Discard plastic spatul
78. ULING OF AUTOPSY Autopsies are scheduled with the Pathologist The Pathology Secretary will contact a diener to assist During the hours that the Pathology secretary is not here the tech in charge will notify the Pathologist of the autopsy and call for the diener REPORTING OF SURGICAL SPECIMENS Surgical reports are routinely rendered within 24 hours following surgery The exceptions are those specimens that at collected late Friday and during the weekend those specimens will be submitted on Monday A specimen may be held over for proper fixation decalcification or special stains at the Pathologist s discretion Reporting will be performed through the Anatomic Pathology portion of the UVMC Cerner computer system See Pathology Transcription Procedure revised 09 24 06 cmw supersedes procedure written 9 4 98 02 29 00 sch 187 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 GROSS ONLY SPECIMENS TO BE DICTATED BY THE PATHOLOGIST PURPOSE To establish a guideline that will be followed by both the UVMC Surgery units and the Histology department Ensuring that specimens that require a Gross Only status will be processed as Gross Only specimens unless the processing pathologist determines that the specimen requires microscopic examination CLINICAL SIGNIFICANCE This process is to ensuring that all specimens are handled in the appropriate manner aiding in the patient diagnosis and pos
79. Upper Valley Medical Center Laboratory Service Manual Table of Contents GENERAL Laboratory Hours and Staffing Biological Specimen Handling Transport and Storage UVMC Specimen Labeling Policy Refer to UVMC Online Procedures Criteria for Rejection of Specimens UVMC Laboratory Critical Values UVMC Reference Laboratory Critical Values Procedure For Calling Lab Results UVMC Instructions for Laboratory Specimen Collections UVMC Instructions for Stool Collections for Outpatients Semen Analysis Instructions and Colledtion Data Sheet UVMC Guidelines for Therapeutic Drug Monitoring UVMC APPROVED PANELS UVMC Approved Panel Sheet TEST DIRECTORY _UVMC Laboratory Compendium Test Directory Pink Section 24 Hour Urines Body Fluids Coagulation Studies CSF Fluids Cultures Cytology Dialysis Only Drug Screens Electrophoresis Protein Glucose Tolerance Occult Bloods Occupational Health Protein Electrophoresis Urine Tests Random O O O O 0O O 0 0 0 0 0 O 0O 0 PHLEBOTOMY Pour Off Specimens from Original Container Glucose Tolerance Testing Insulin Resistance Challenge 2hour Cleaning and Supplying the Blood Collection Tray Procedure for Collection of Blood Using Correct Sequence of Tubes General Blood Tube Description Processing Blood Specimens for Serum Testing Quick Tube Reference Guide for Which Tube to Use Expiration Dates on Blood Collection Tubes Types of Blood Specimens Venipuncture Procedure Capillary Skin Puncture Pr
80. Weekly check off done in each dept NOTE DO NOT EVER OPEN THE LID WHEN CENTRIFUGE IS ROTATING rs NOTE Centrifuge spills broken tubes Shut off instrument and leave centrifuge shut for 30 minutes allow for aerosols to settle Always wear gloves when cleaning up broken glass and spilled liquids Always use forceps or hemostat to remove the broken glass Always put the broken glass in an approved sharps disposal container Never operate the centrifuge in this condition The centrifuge must be disinfected before operation can resume Use 10 Bleach when cleaning centrifuge interior and or exterior After using the 10 Bleach on any part of the centrifuge thoroughly rinse with water Dry all parts as much as possible ALWAYS STOP THE CENTRIFUGE IMMEDIATELY IF IT DOES NOT SOUND OR OPERATE RIGHT Twice yearly January and July GE Service will do preventative maintenance checks REFERENCE Operating manual for Clinifuge or Medifuge or VanGuard or Horizon Revised procedure prepared by dss date __ 04 24 08 Supersedes procedure written __07 31 06 Centrifuge Procedure PG 2 04 24 08 dss 191 Upper Valley Medical Center Clinical Laboratory 3130 North Dixie Highway Troy Ohio 45373 CENTRIFUGE OPERATION AND MAINTENANCE PROCEDURE For Doctor s offices and Nursing Home Facilities PRINCIPLE The laboratory centrifuge is for the separation of the serum from the clot or the plasma from the cells of aspecimen The load on
81. a Place cap on vial until step 4 3 Insert Cytobrush Plus GT into the endocervix until only the bottom most fibers are exposed Slowly rotate one quarter to one half turn in one direction Remove device Do not over rotate Additional rotation may cause bleeding and contaminate specimen 184 4 Rinse the Cytobrush Plus GT in the PreservCyt solution by rotating the device in the solution ten 10 times while pushing it against the wall of the vial Swirl the device vigorously to further release material Discard collection device 5 Tighten the PreservCyt vial cap so that the torque line on the cap passes the torque line on the vial Collection Technique using Brush spatula collection device 1 2 3 4 Sample ectocervix with a plastic spatula Rinse spatula in the PreservCyt vial by swirling vigorously 10 times Place cap on vial until step 4 Discard collection device Sample endocervix with an endocervical brush Rinse the brush in the PreservCyt solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall Swirl the brush vigorously to further release material Discard the collection device Tighten the PreservCyt vial cap so that the torque line on the cap passes the torque line on the vial Collection technique using broom like collection device 1 2 Obtain a sample from the cervix using a broom like device Rinse the collection device into a PreservCyt solution vial by
82. ab Use Only ABCDEFG H IJ KEMNOPQRST XYZ Cytomegalovirus Abs IgG amp IgM QU 9928T 1 full tube blood in red top tube or gold top tube No hemolysis Refrigerate 1 full tube blood in red top tube or gold top tube State acute or Cepeda yea eC GLENS Tas convalescent Grossly lipemic and hemolyzed specimens will be rejected 1 full tube blood in red top tube or gold top tube Recommended for acute eyeing evita AE IOM CLE Ae infections only Grossly lipemic and hemolyzed specimens will be rejected Cytomegalovirus AB Panel IgG and IgM QU 9928T 1 full tube of blood in red top or gold top tubes No hemolysis Refrigerate Cytotoxin Assay Antibody Neutralization Clostridium Difficile Toxin Assay QU 1174 1 full tube of blood in red top or sst tube Refrigerate D Di EDP 1 full tube blood in blue black center or It blue tube 3 2 citrated plasma Fibiin Degradation Procuce In house Must be filled to the indicated line 2 hr stability time If testing is delayed UVW centrifuge separate and store plasma refrigerated up to 48 hours Bepakene valproic Acid or Depakote E ae tae berg green top tube or red top tube No gel barrier DHEA Sulfate 1 full tube min 3 mls of blood in red top tube or gold top tuber Specify age Dehydroepiandrosterone Sulfate and sex on test request form bigoun E rey ee T es Dilantin Phenytoin Hee ane mls blood in red top tube or green top tube no gel State Bie 1 full tube of blood
83. ainer SS Urine Random Microalbumin In house 1 ml urine random in sterile container No preservative Keep refrigerated 97 Test Description ABCDEFG Urine Random Microalbumin Creatinine Ratio Urine Myoglobin Urine Osmolality Urine pH Urine Potassium Urine Pregnancy Urine Protein Urine Reducing Substances Urine Sodium Urine Sodium amp Potassium Urine Specific Gravity Urinalysis Complete UA Urinalysis Microscopic Only Uricult ID amp Sensitivity Valproic Acid Depakene Depakote Vancomycin PEAK QUEST send out test QU if Specimen Instructions Tube Lab Use Only HIiJ KLEMNOPQRSTUVW In house 1 ml urine random in sterile container No preservative Keep refrigerated LAB ORDER ONLY 10 mls random urine in sterile container No In house preservative A See ID amp Sensitivity from culture device inhouse 1 full tube min 3 mls blood in green top tube or red top tube No gel barrier tubes State time of last dose MNIE 1 full tube min 3 mls blood in red top tube or green top tube No gel barrier tubes State time of last dose XYZ ee QUEST send out Test Description ae a if Specimen Instructions Tube Indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ 1 full tube min 3 mls blood in red top tube or green top tube No gel barrier Vancomycin Pandam aoe State time of last dose ee 1 full tube min 3 mls blood in red top tube or gre
84. al 80 100 at least 12 18 hrs after dose weeks after initiation or change in regimen Plasma samples obtained Peak 1 3 hrs after dose before this time should be used either to determine whether an additional loading dose is needed or whether the maintenance dose should be Trough Immediately prior to next dose withheld Peak 30 60 minutes after dose Trough Immediately prior to next dose Peak 3 6 hours after dose Trough Immediately prior to next dose Recommend obtaining trough sample for routine monitoring of efficacy Peak to confirm toxicity can be The time required to achieve a steady state can be prolonged 1 5 weeks obtained 3 9 hrs after dose Plasma levels should be monitored prior to steady state to avoid under over dosing Levels prior to steady state must be used cautiously in designing Trough Immediately prior to next dose new dosing regimens Peak to confirm toxicity can be obtained 2 4 hrs after dose lt Phenytoin DILANTIN varies IV IM Primidone MYSOLINE 6 12 Trough Immediately prior to next dose Trough levels preferred Phenobarb is a metabolite of primidone and should be measured with primidone samples An assessment of steady state can be obtained as follows primidone 50 60 hours phenobarbital 10 25 days Procainamide Trough Immediately prior to next dose Trough levels are more reproducible Also measure N acetyl metabolite PRONESTYL 3 NAPA Steady state levels a
85. al Aspirate nasal wash pediatric patients nasal swab red capped UU SSE CUS SIS transport medium throat swab red capped transport medium Insulin Autoantibody QU 52324P 1 full tube blood in red top tube or gold top tube Transport at room temp 5 1 full tube blood in red top tube Patient should fast for 12 14 hours before Insulin Free amp Total QU 20021 specimen is collected Draw 1 gold top tube and 1 green black top tube for both the fasting and the 2 Insulin Resistance Challenge 2hour In house hour draw time Patient must be fasting See Insulin Resistance Challenge Lab Use Only XYZ Procedure r 1 full tube blood in red top or gold top tube OVERNIGHT FASTING Insulin Total QU 15701E REQUIRED 1 full red top or gold top tube Centrifuge within 1 hour of collection and Insulin like growth factor QU 24844P _ transfer into plastic container Freeze specimen Plasma is no longer an acceptable specimen O QUEST send out Specimen Instructions Tube Lab Use Only Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ Intrinsic Factor Blocking Antibody Serum Isoenzymes CPK 7 See Creatine Kinase Isoenzymes 5ml EDTA whole blood or bone marrow Call lab for other acceptable specimens JAK 2 Mutation Blood QU 16539X The draw time and date must be recorded on the tube Ship immediately the specimen is acceptable for up to 72 hours Ketones Blood Ac
86. an 14 sufficient volume is available or upon special request Also needed Sepps 10 povidone iodine ampules OR ChloroPrep ampules chlorhexidine 70 isopropyl alcohol prep venipuncture aids such as butterfly sets adapter cap sets adapter inserts Please note do not use chlorhexidine product on infants 2 months of age or younger Use iodine 144 STORAGE AND HANDLING OF BOTTLES BacT Alert culture bottles are ready for use Store protected from direct sunlight at room temperature 15 30 C An expiration date is printed on each bottle label Do not use bottles beyond the last day of the month indicated If the bottles are exposed to cold temperatures precipitates may form that will disappear when the bottles are warmed to room temperature Bottles must be at room temperature before use Prior to use examine each bottle for evidence of damage or deterioration discoloration The media in undisturbed bottles should be clear but there may be slight opalescence or a trace of precipitant due to the anticoagulant SPS Do not confuse opalescence with turbidity Do not use a bottle with media exhibiting turbidity or excess gas pressure these are signs of possible contamination PREPARATION OF THE PATIENT Correct specimen collection is extremely important when obtaining blood culture specimens Proper skin disinfection is an essential requirement to reduce the incidence of contamination Great care must be taken to prevent contam
87. and the time the plasma sample was obtained For example if a plasma sample is obtained before distribution of the drug into tissue is complete the measured level may be higher than expected Also samples obtained prior to steady state 4 to 5 times the half life may be different than expected The purpose of the following information is to provide useful guidelines in assuring the optimal utilization of drug level analysis based on pharmacokinetic principles The patient s current clinical status and response to therapy should always be considered when interpreting drug level results Refer to the result report for corresponding therapeutic or reference ranges as quantitative results may vary slightly based on differences in reagent source assay technology or instrument calibration GENERIC BRAND NAME SUGGESTED SAMPLE TIMES COMMENTS HALF LIFE hrs Amikacin Trough 15 30 minutes prior to infusion Trough could be obtained just prior to dose administration Peak will be AMIKIN Peak 15 30 minutes after dose infused affected by a short distribution phase A pair of peak and trough levels 1 7 Random Anytime during dose interval should be obtained around the 3rd dose in most patients Two random levels usually 1 1 5 half lives apart on the same dosage interval can be drawn on a loading dose Verify with the RN or MAR that dosing interval or administration time is as expected Document exact draw times on pharmacokinetic dosing service record
88. anglioside GM 1 Antibodies IgG IgM EIA GQ1B AB IgG QU 14254P_ 1 full red black top 10 ml tube Refrigerate serum Collect specimen using a culture swab red or blue or collect specimen in a Gram Stain Smear In house p sterile tube or sterile cup Graves Test Need to order both AntiThyroglobulin AB and TPO See Thyroid ABS H pylori al See Helicobacter Pylori IgG Antibody Ham s Test See Acid Hemolysis Haptoglobin QU 45427W_ 1 full tube blood in red top tube or gold top tube O QUEST send out Test Description test QU if Specimen Instructions Tube Lab Use Only indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ HCG Tumor Marker Quantitative ae blood in green black top red top tube or gold top tube Min 3 mls HCG Pregnancy Test Serum Human Chorionic Gonadotropin _ Za a aa a 2 full lavender EDTA tubes Separate plasma within 2 hours of collection and immediately freeze sample Interpretive Information Patients infected with HCV types other than 2 or 3 have a poor potential for response HCV RNA Genotype LIPA to treatment and require 48 weeks of therapy even if the virus is undetectable at 24 Henares Virai RNA Cenolype QU 37811X weeks Conversely in patients with type 2 Or 3 infection treatment may be stopped at 24 weeks Treatment decisions should also take into account other factors that may influence therapeutic response such as pretreament HCV viral load and cirrhosis status sex and age
89. ap tightly Interrupted intercourse and oral collections are not acceptable methods of collection because of bacterial contamination and pH changes Lubricants and ordinary condoms may interfere with the sperm viability and must not be used However if your physician provides a semen collection kit that special condom included in the kit may be used 4 Label the container with the patient s name date of birth and date and time the specimen was collected Keep the specimen as near to body temperature as possible and deliver to Upper Valley Medical Center Outpatient Testing within 30 minutes of collection All items highlighted must be completed by the patient and accompany the specimen to the lab circle Masturbation Other specify circle Sterile urine cup Other specify circle None Incomplete specimen Exposure to extreme temperature Other specify TIME OF SPECIMEN RECEIPT at lab 7 2009 26 GUIDELINES FOR THERAPEUTIC DRUG MONITORING Plasma drug concentrations are useful in the clinical setting to measure whether a sub therapeutic therapeutic or toxic level has resulted from a particular dosage regimen Interpretation of the result is based upon the premise that plasma drug levels reflect drug concentrations at the receptor site and therefore can be correlated with a pharmacological response It is essential to know when the drug regimen was initiated the administration time of the most recent dose
90. apamycin QU 36712P 1 full tube whole blood in EDTA Lavender top tube Optimal time to draw is 30 60 minutes prior to next dose Sjogren s Antibodies Anti SS A Anti SS B QU 8458T 1 full red top or gold top tube Specimens that are grossly hemolyzed or lipemic will be rejected Smear Gram Stain In house See Gram Stain Smear 1 full tube min 3 mls blood in red top tube or gold top tube Specimens Smooth Muscle Antibody ASMA QU 42085F should avoid extreme heat and cold Specimens that are grossly hemolyzed or lipemic will be rejected Sodium blood Inhouse f full tube min 3 mls blood in green black top tube or gold top tube Call Lab for 24 hr urine container 24 hour urine no preservative Refrigerate Sodium Urine 24 hr In house throughout collection See 24 Hour Urine Collections Procedure Sodium blood Inhouse 1 full tube min 3 mls blood in green black top tube or gold top tube Call Lab for 24 hr urine container 24 hour urine no preservative Refrigerate Sodium Urine 24 hr In house throughout collection See 24 Hour Urine Collections Procedure Sodium Urine Random 10 mls Random Urine no preservative in a sterile urine container Call Lab for 24 hr urine container 24 hour urine no preservative Refrigerate Sodium amp Potassium Urine 24 hour In house throughout collection See 24 Hour Urine Collections Procedure Sodium amp Potassium Random Urine 10 mls Random Urine no preservative in a ster
91. ary draws are acceptable during the transfusion of blood products If possible the hand opposite the transfusion site should be used If it is not possible to use the opposite side consult the pathologist for guidance 142 A venipuncture is recommended over a capillary stick for larger volumes of blood needed for testing A venipucture is the optimal specimen collection and causes less trauma to the child and helps to provide better specimen integrity for testing Reference The Phlebotomy Review Manual Copyright ABP Inc 1996 Revised procedure by T Cheney date 12 22 08 Supersedes Procedure Written by T Cheney date April 2007 143 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 COLLECTION OF BLOOD CULTURES DISCUSSION BacT Alert aerobic anaerobic and FAN culture bottles are used with the BacT Alert Microbial Detection system in qualitative procedures for the recovery and detection of micro organisms form blood The culture media provides suitable nutritional and environmental conditions for organisms commonly encountered in blood infections MATERIALS REQUIRED When barcode order Aerobic bottle color coded blue says STND Anaerobic bottle color coded purple When barcode order Aerobic FAN bottle color coded green says FAN Anaerobic bottle color coded purple When patient is Aerobic FAN bottle color coded green pediatric age Do not draw anaerobic bottle unless less th
92. ays frozen 33Phenytoin 8 hours at room temperature 7 days at 2 8 C and 14 days frozen 34Phosphorus 7 days 2 8 C or 14 days frozen 35Potassium 14 days at 2 8 C or frozen 36Prealbumin 3 days at 2 8 C and 14 days frozen 160 37Prolactin 48 hrs at 2 8 C or freeze 38Progesterone 48 hrs at 2 8 C or 6 months frozen 39PSA 48 hrs at 2 8 C or freeze 40PTH 4 hrs at room temp 48 hrs at 2 8 C or freeze 41Salicilate 3 days at 2 8 C 42Sodium 14 days at 2 8 C or frozen 43TBHCG 48 hrs at 2 8 C or freeze 44Total Protein 3 days at 2 8 C or 6 months frozen 45T4 48 hrs at 2 8 C or freeze 46T4 Free 48 hrs at 2 8 C or freeze 47Tobramycin 48 hrs at 2 8 C or freeze 48Theophylline 7 days at room temperature 7 days at 2 8 C and 14 days frozen 49Troponin I 24 hrs at 2 8 C or freeze 50Triglycerides 7 days at 2 8 C 51TSH 48 hrs at 2 8 C or freeze 52T uptake 48 hrs at 2 8 C or freeze 53TIBC UIBC 4 days at room temperature 7 days at 2 8 C and frozen for14 days 54Uric Acid 3 days at room temperature 5 days at 2 8 C and 14 days frozen 55Valproic acid 48 hrs at 2 8 C or freeze 56Vancomycin 48 hrs at 2 8 C or freeze Laboratory Form Updated 12 24 08 Approved 161 GENERAL GUIDELINES FOR MAXIMUM SURGICAL BLOOD ORDER Physicians must provide written orders for blood to be typed screened and crossmatched or typed and screened T amp S Type and Screen Number Uni
93. be blood in red top tube or gold top serum separator tube Serum must be refrigerated Lab Use Only XYZ N N QUEST send out Test Description a alee Specimen Instructions Tube Indicated KLMNOPQRSTU OB GI s 4 Different Specimens Draw a min of 3mls blood in green black top tube E ee ood E urine ibouse or gold top tube AND 1 ml urine Administer 50g Glucola Collect a 1 hour AND 1 hour E glucose Glucose draw 3 mls blood in red top or gold top and 1 ml urine Consult Procedure Obstetric Panel 4 Different Specimens 7 mls blood in lavender top tube Blood Bank CBC Hep B Surf Ag Rubella RPR In house tube 3 mls blood in EDTA lavender top tube 1 full tube blood in gold top Type amp Screen tube AND 1 full tube in red top tube Occult Blood Gastric imhouse 1 ml Gastric contents in sterile container Sample need to be sent to Lab 3 immediately for testing be ordered use specimens 2 amp 3 Feallecio Ae el TaN gt respectivel of collection Keep all cards untl all specimens are collected they must also respecte all be taken to the Laboratory within 14 days of first collection Occult Blood Stool Specimen 2 In house Hemoccult card same as above Stool Screening or diagnostic Occult Blood Stool Specimen 3 In house Hemoccult card same as above Stool screening r diagnostic 2 Different specimens 3 ml blood in red top tube or gold top tube AND 1 ml CSF 0 5 min It is preferred that t
94. be placed on a stand next to the patient within easy reach NEVER PLACE COLLECTION TRAY ON PATIENT S BED OR FLOOR 9 Select the venipuncture site Soa Inspect the area you plan to use Apply the tourniquet about midway between the elbow and shoulder on the desired arm of the patient NEVER LEAVE THE TOURNIQUET ON FOR MORE THAN 1 MINUTE Sl N AY TOURNIQUET L D BAND Request the patient to make a closed fist if they Paires are able to This will make the veins more prominent Using the index finder palpate for a vein This will ensure visibility and the direction of the vein Consult Fig 7 at the end of the procedure for the best sites for venipuncture the Median Cubital veins are most commonly used If a vein is difficult to find it may become easier to see after massaging the arm from the wrist to the elbow which forces blood into the vein If you are still uncertain about finding a vein examine the other arm Sometimes veins in one arm are small while those in the other arm are larger MAKE SURE THAT YOU DON T DRAW ABOVE AN IV 10 Clean the venipuncture site Remove the alcohol prep from the package and cleanse the venipuncture site in a circular motion from the center to periphery Fig 8 Allow the area to air dry or by fanning with your hand Do not blow on the site or touch the area after it has been cleaned If the vein is difficult to locate and you need to palpate again make sure to c
95. ber account number specimen type date and time of collection A copy of physicians order must accompany each specimen The source total volume color and consistency must be logged on the order form Fine Needle Aspirates should be put directly into CytoLyt fixative solution Please DO NOT Make Direct Smears All specimen s should be delivered to the lab as soon as possible to ensure specimen quality and integrity When problems do arise with any cytology specimen refer to the procedure Procedure for Specimen Rejection of Histology Cytology Specimens Reviewed 1 17 06 cmw 183 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 THINPREP PAP TEST PROCEDURE PreservCyt Solution Sample Collection and Transport Medium PURPOSE PreservCyt solution is designed for the use with the ThinPrep 2000 system PreservCyt solution is a methanol based preservation solution that serves as a transport preservative and antibacterial medium for gynecologic samples PRINCPLE The ThinPrep process begins with the patient s gynecologic sample being collected by the clinician using a cervical sampling device which rather than being smeared on a microscope slide is immersed and rinsed in a vial filled with PreservCyt solution The ThinPrep sample vial is then capped labeled and sent to a laboratory equipped with a ThinPrep 2000 Processor At the laboratory the PreservCyt sample vial is placed into a
96. bes Use betadine to In house Lab Use Only XYZ Albumin 25 cleanse arm prior to venipuncture Do Not use alcohol to cleanse Keep specimen tightly capped Chain of Custody Alcohol requires 2 separate tubes Aldolase QU 66985R 1 full tube min 3mls blood in red top tube or gold top tube Refrigerate Aldosterone Serum QU 17181X 1 full tube min 3mls blood in red top tube Refrigerate Alcohol Blood Ethanol Level 15 ml of a well mixed 24 hour urine to which 1 gram of boric acid has been F added Record the total volume on specimen container and on the test ATOS ENONENANROUEUNNE eh Thule requisition Refrigerate during and after collection 24 hour urine collection procedure ORDER AS MISCELLANOUS TEST 1 full tube min 3mls blood in green black tube or gold top tube Hemolyzed iia no phalane Bigod specimens are not acceptable Alkaline Phosphatase Body Fluid 1 ml body fluid State source of body fluid Alkaline Phosphatase Isoenzymes QU 3228N 1 full tube min 3 mls blood in a redtop or gold top tube Refrigerate w o gt QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ SPECIAL INSTRUCTIONS 5ML 2 tubes whole blood bone marrow in Alkaline Phosphatase QU 233X green top tube or at least 2 blood or bone marrow slides Leukocyte LAP Score Collect Monday through Thursday only Quest courier must receive specimens on the day of c
97. bottom of the container in order to promote absorption of any leaking specimens s Contaminated absorbent material must be replaced and the transport container decontaminated as soon as feasible after the occurrence of any leaks GUIDELINES TO BE FOLLOWED AT DESTINATION FACILITY 1 Specimens are to be checked for integrity and appropriate labeling upon arrival at the testing facility and any necessary corrective measures taken immediately 2 Any respiratory fecal gastro intestinal or CSF specimen that may have leaked is to be handled only in the laminar flow hood in the Microbiology department utilizing appropriate personal protective equipment until the container has been decontaminated 3 Paperwork is to be processed as needed and specimens distributed to the appropriate departments according to the Guidelines For Handling of Biological Specimens 4 To avoid contamination of paperwork barcode labels or other documents should not be placed in a bucket or basin with specimens that may leak and should never be placed in the zippered compartment of a transport bag with a specimen unless required for chain of custody purposes 5 Specimen containers that are to be handled as if they are contaminated on the outside should not come in direct contact with any paperwork unless they have been decontaminated see General Guidelines for Handling of Biological Specimens above Any paperwork barcode labels etc which have
98. bsorbent material which may include such items as paper towels or gauze is placed in each biohazard container in quantity sufficient to absorb all liquid waste discarded in that container whether the liquid is in a tube vial soecimen container etc or not and at a level which will promote absorption of that waste if needed Discarded donor blood plasma or platelets should be flushed down the drain with large amounts of water followed by rinsing the sink and cleaning the sink and surrounding area with 10 bleach solution Liquid waste blood or body fluids contained in vacuum bottles or suction containers should be discarded in the same way The containers or blood product bags are then discarded in redlined waste receptacles Exception Blood or plasma that has clotted and containers with significant amounts of solid or semi solid waste should be packaged in securely closed plastic bags or large specimen containers such as for large tissue samples with an amount of absorbent material sufficient to absorb all of the liquid waste being discarded before being placed in red lined biohazard boxes Alternatively contents of vacuum bottles or suction containers including solid or semi solid waste may be solidified with a material such as SafeSorb Never place loose needles broken glass or other sharps directly into red bags they must first be properly packaged in plastic puncture proof containers Urine samples including 24 hour samples
99. cal record The same applies to any pertinent tissue and or cytological material and pertinent body fluid removed or obtained other than in surgery Tissue and non tissue specimens may be requested by the surgeon medical staff practitioner to be examined gross only This includes items to be identified and recorded for documentation purposes These items may be examined microscopically as deemed appropriate by the pathologist All tissues received in the Histology department will be examined by a Pathologist after examination and opinion has been rendered the tissue may be sent out for consultation Placentas shall be sent for pathological examination in accordance with The College of American Pathologists guidelines Materials and tissues removed during an operative or invasive procedures that are not sent to pathology shall be described by the surgeon in the patient s medical record Revised 12 29 08 cmw 189 Upper Valley Medical Center Clinical Laboratory 3130 North Dixie Highway Troy Ohio 45373 CENTRIFUGE OPERATION AND MAINTENANCE PROCEDURE For UVMC Laboratory PRINCIPLE The laboratory centrifuge is for the separation of the serum from the clot or the plasma from the cells of aspecimen The load on the centrifuge should be symmetrical before operating the unit This is essential for safety in operating the unit and also prolongs the life of the centrifuge Please mix plasma and serum tubes appropriately when collected and
100. cells into a clean test tube properly labeled with patient information and specimen type as serum for transport to the Laboratory Note The specimen in the original tube is to be centrifuged one time The tube should not be recentrifuged once the gel barrier is formed A potential for inaccurate test results is possible HORIZONTAL Figure 1 SEPARATION Serum FIXED ANGLE SEPARATION a Geel Barrier Packed Red Blood Cells 8 Once the specimen is properly centrifuged and the serum separated from the red blood cells notify the laboratory personnel immediately for specimen pickup Please inform the laboratory personnel of any collection or specimen handling issues that may be of importance 9 Upon receipt into the Laboratory the Specimen Processor will log any specimen handling and collection issues on the Chemistry Departments Specimen Integrity Log for Technologist review Examples of integrity issues include e Specimens received uncentrifuged longer than 2 hrs since collection e Presence of fibrin e Presence of red blood cells in serum e Hemolysis e Difficult collection Do not recentrifuge specimen with integrity issues that have already been centrifuged once Forward these specimens to the Chemistry Department Technologist for further evaluation References BD Diagnostics Tech Talk Volume 4 No 2 November 2005 BD Diagnostics BD Vacutainer Evacuated Blood Collection System Product Insert Taken 9 7
101. clear HU AB With reflex to Western Blot Neuronal Nuclear HU AB CSF With reflex to Western Blot Neurotin Level Gabapetin Neutrophil Cytoplasmic Antibodies ANCA Vasculitides Disopyramide Norpace Serum Nortriptyline Aventyl 5 Nucleatidase QU 661X QU 34339N QU 50286R QU 671X Specimen Instructions Tube KEMNOPQRSTUVW 5mls Random Urine no preservative Frozen 2 full yellow top tubes ACD Solution A or B It is essential that ethnic origin be included on requisition Do not freeze or refrigerate Specimen must reach Quest laboratory within 24 hours of collection Room Temp Collect specimen using the Chlamydia trachomatis Neisseria Gonorrhoeae Pace DNA Probe collection kit Separate kits available for male and female specimens Swabs must be submitted in the Gen Probe collection container 1 full 10 ml red black top tube Refrigerate serum Overnight fasting is perfered 3mls CSF 1 5 mls minimum Overnight fasting preferred Refrigerate 1 full tube blood in large 7 ml lavender top EDTA tube or 2 3 ml lavender top EDTA tubes DO NOT ise GEL TUBE 1 Full red top or gold top tube Specimens that are grossly hemolyzed lipemic or contain heavy visible particles are not acceptable 1 full tube min 3 mls blood in red top tube Do not use serum separator tube 1 full tube blood in red top green top or lavender EDTA tube Do not use serum separator tube 1 full tu
102. coffee three days prior to testing Call lab for container Keep refrigerated See 24 Hour Urine Collections Procedure 5 Nucleotidase QU 671X 1 full tube blood in red top or gold top tube Serum must be refrigerated 30 QUEST send out Test Description test QU if indicated BCDEFG HIJ KEMNOPQRSTUVW 17 a Hydroxprogesterone QU 17180X 1 full tube blood in red top tube Gel barrier SST tubes are unacceptable 20 ml aliquot from 24hour urine collection Place 10gm of boric acid into the 17 Hydroxycorticosteroids QU 15202X collection container prior to collection Call lab for container Keep Refrigerated See 24 Hour Urine Collections Procedure ABO amp RH See Type and Rh or Blood Group and Rh ABO and Screen See Type and Screen ABO and Screen a See Type and Screen ACE Angiotensin Converting Enzyme QU 18572E 1 full tube of blood in a red top tube SST tubes are also acceptable Acetaminophen Tylenol inhouse 1 full tube min 3 mls blood in red top tube only State time of last dose p y Deliver to lab immediately Specimen Instructions Tube Lab Use Only XYZ Acetone blood Ketones in house 1 full tube min 3 mls blood in green black tube or gold top tube Tubes that i have been previously opened are not acceptable due to evaporation Acetylcholine Receptor Antibodies QU 206X 1 full tube min 3 mls blood in red top or gold top tube Allow specimen to ACHR Binding clot at
103. collect specimens Go over all orders thoroughly for the tests requested to ensure you know correct specimen requirements Check the dates of supplies before going out to draw and never use outdated or expired material Revised 01 30 02 tmc Supersedes procedure written 12 2001 tmc 123 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 PROCEDURE FOR COLLECTING BLOOD USING THE CORRECT SEQUENCE OF TUBES Principle To ensure the proper guidelines to follow when collecting blood for multiple assays This procedure includes the proper collection technique to follow when collecting blood using the vacutainer method and when using the syringe method Procedure Follow these steps the order goes from the first tube drawn to the last tube drawn 1 OS OT EO Blood Cultures Use the aseptic drawing procedure see blood culture collection procedure for any questions Light Blue top Red or Tiger top Green and light green Purple EDTA Gray top Dark Blue Royal Blue Revised procedure prepared by _ TMC date _1 16 07 supersedes procedure written_ 1 30 03 124 Processing Blood Specimens for Serum Testing Principle Proper collection and processing of blood samples is a critical first step in ensuring specimen integrity and quality laboratory results This procedure will instruct personnel on the proper handling of specimens for serum testing after specimen collection Procedure 1 De
104. collection device When the specimen has been collected place in a sterile container and handle as directed above Collection of Sputum for Culture and or Cytology An early morning specimen is the most productive for testing of this specimen Sputum must result from a deep chest cough Saliva is not acceptable the specimen should be collected in a clean sterile container Label the container and submit to the laboratory along with the HIS routing slips or requisitions for all tests ordered within one hour of collection Glucose Tolerance Testing Please schedule with Central Scheduling Patient should be fasting between 8 to 12 hours prior to testing unless the physician advised differently Please contact either out pt testing or UVMC lab for any questions about your specimen collection requirements UVMC Lab 440 4625 UVMC Out Pt Testing 440 4568 Procedure updated 10 21 09 tmc 22 UPPERVALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 UVMC Instructions for Stool Collection by Outpatients Your physician has requested collection of stool for testing It is important that care be used in the collection of these specimens so that the test results are accurate These written instructions are intended to reinforce or supplement the verbal instructions you were given by your physician s office or the Outpatient Testing Dept at UVMC If you have questions regarding the collection of these samples p
105. containing preservatives may be flushed down the drain with large amounts of water followed by rinsing the sink and cleaning the sink and surrounding area with 10 bleach solution Empty urine containers with lids in place may be discarded in the regular trash Exception f any amount of blood is visible in or on the urine container it must be discarded in a redlined biohazard box after emptying Surgical specimens are disposed of by first pouring off the formalin into chemical waste containers or sanitary sewer system if quantity is small followed by large volumes of water and then emptying the tissues into redlined containers for disposal by off site waste contractor Emptied specimen containers may then be disposed of in the regular trash unless they appear to be contaminated with blood Limbs that are not released to the mortician for burial will be placed in redlined biohazard boxes bearing a special label for incineration for disposal by a qualified off site waste contractor SHARPS All sharp objects are to be placed in puncture resistant containers designated for sharps disposal The definition of sharps includes needles broken glassware slides glass pipettes plastic pipets and droppers of all types all syringes for phlebotomy or injection used or unused with or without needles microhematocrit tubes cover slips lancets surgical blades wooden applicator sticks any swabs wooden or plastic not enclosed in cul
106. ction Medications Containing Nonsteroidal Anti Inflammatory Agents Advil Alka Seltzer Anacin Anahist Anaprox APC APC w codeine APC w Demerol A S A A S A compound A S A compound w codeine Ascriptin A D Aspergum Aspirin USP Aspirin childrens Bayer Aspirin Bayer Children s Aspirin Bayer timed release Bufferin Calurin Cama Inlay Cope Coricidin Coricidin D Antibiotics Ampicillin Chlortetracycline Areomycin Carbenicillin Nitrofurantoin Furadantin Gentamicin Stelazine Cephalothin Keflin Moxalactam Tofranil Nafcillin Piperacillin Quinacrine Coricidin Demilets Coricidin Medilets Darvon W A S A Darvon N W A S A Darvon compound Dolene compound Dristan Easprin Ecotrin Empiral Empirin Empirin w codeine Emprazil Emprazil C Equagesic Excedrin Excedrin PM Fiorinal Fiorinal w codeine Fizrin 4 way cold tablets IBU Ibuprofen Tablets Liquiprin Lortab A S A Anti Inflammatory Drugs Sulfinpyrazone Acetyl salicylic acid Aspirin Colchicine Ibuprofen Motrin Indomethacin Fenoprofen Naproxen Naprosyn Phenylbutazone Mefenamic acid Ponstel Lodine Capsules Measurin Midol Meclomen Capsules Motrin Nalfon Naprosyn Norgesic Nuprin PAC compound PAC compound w codeine Pedia Profen Percodan Ponstel Relafen Robaxisal PH Sine OFF St Joseph s St Joseph s for Children Super Anahist Synalogs Synalogs DC Triaminicin Toradol
107. ctive equipment must be worn and required engineering and work practice controls used whenever contact with blood or other potentially infectious materials or contaminated surfaces can be reasonably anticipated Refer to Laboratory Task Exposure List for guidelines 2 All biological specimens must be covered capped corked or plugged except while being collected or in the process of separation pouring or analysis Various sizes of plastic caps and stoppers for tubes and parafilm are provided for this purpose 3 To avoid contamination of the outside of a tube the stopper should be covered with gauze or Kim wipe during removal or recapping and should be removed by gentle twisting to prevent formation of aerosols generated by popping Additionally specimens requiring transfer to another tube should be transferred by use of a bulb suction pipette such as a Dispo pipette rather than by pouring from the tube 4 To prevent contamination of paperwork specimen containers that are likely to leak or that are to be handled as if they are contaminated on the outside see s 10 11 and 12 should not be allowed to come in contact with barcode labels or other documents Barcode labels and other documents should not be placed in a bucket or basin that may contain specimens that could leak and should never be placed in the zippered compartment of a transport bag with any specimen unless required for chain of custody purposes 5
108. cult card OCH Occult Blood Stool 3 In house 1 ml stool on Hemoccult card 115 OCCUPATIONAL HEALTH Quest send out test ae Specimen Instructions Tube Shippin Test Description _ QU if p indicated Special Instructions 1 full tube blood in red top tube or gold OCH PSA Screening In house top tube Separate serum and freeze ASAP Freeze if more than 24 hours before testing OCH Panel V Includes BUN Creatinine CBC with diff and Urinanalysis Special Instructions 1 full tube blood in gold top or green black top tube AND 2ml blood in lavender top tube AND 10mls random urine OCH Toluene Exposure Profile Special Tube CALL UVMC LAB OCH U A dip 1 ml random urine in sterile container OCH U A dip Bus Driver 1 ml random urine in sterile container OCH Urine Cadmium Refer to OCH Collection Procedure OCH Urine Chromium Refer to OCH Collection Procedure OCH Urine Copper Refer to OCH Collection Procedure Send Corrections Additions to UVMC LAB X4625 ATTN Pat or Melodie Upper Valley Medical Center Clinical Laboratory 3130 N Dixie Highway Troy Ohio 45373 Updated 01 2009 116 Upper Valley Medical Center Clinical Laboratory 3130 N Dixie Highway Troy Ohio 45373 Pour Off Specimens from Original Container Purpose To ensure that each specimen container identifies the patient uniquely when pouring off specimen
109. d other than for storage and disposal of those specimens GUIDELINES FOR SPECIMEN HANDLING DURING TRANSPORT WITHIN THE FACILITY 1 Specimens for laboratory analysis are to be collected and labeled as specified in the UVMC Laboratory Services Manual 2 Lids of all specimen containers must be closed carefully ensuring a secure fit to minimize leakage If the specimen could puncture the primary container the primary container must be placed within a secondary container that is puncture resistant 3 The specimen container must be placed inside the zippered compartment of a specimen transport bag bearing the biohazard symbol and the bag sealed securely 4 All applicable specimen routing slips transport lists or written orders are to be placed in the outside pocket of the specimen transport bag Do not place paperwork of any kind inside the zippered compartment with the specimen container unless required for chain of custody purposes as this increases the possibility of contamination 5 The bagged specimen is then transported to the laboratory 6 Specimens transported through the pneumatic tube system must be double bagged The outer bag may be re used by laboratory personnel if it is known not to be contaminated the bag containing the specimen should be discarded to prevent possible contamination of another specimen container resulting from re use 7 Specimens contained in syringes or in other containers whose closures cannot be secured
110. d to beds or are missing The most frequent cause of fatal transfusion reactions is clerical identification errors a greater risk than AIDS armband bb nursing outline 3 doc New Procedure Supersedes 11 21 07 Prepared by js 12 26 08 jas 175 BLOOD BANK IDENTIFICATION OF PATIENT SPECIMEN NO ARMBAND REQUIRED This procedure is to be followed for Blood Bank specimens that are not intended for possible future crossmatches and therefore do not necessitate the need for the Blood Bank armband Such procedures include RhoGam workup Prenatal workup Direct Coombs Cord Blood workups etc New Procedure Revised by js 10 8 07 WHEN COLLECTING A SPECIMEN Patient Identification 1 2 Check armband to confirm the correct patient is being drawn Ask patient to give his her name and birth date If there is no armband or the patient is unable to communicate have RN from that floor identify the patient and verify patient s birth date If there is any doubt on patient identity they problem must be resolved before the specimen is collected Specimen Identification 1 3 Obtain needed specimen one 7ml EDTA purple top tube following proper specimen collection protocol For cord blood specimens use the pink topped EDTA tubes Label specimen with barcode sticker of accession label for test ordered Also write on tube the collection date and time and the collector s first initial and last name Or if no access
111. d top gold top or red black top tube NO lipemia hemolysis or microbial contamination 1 full red to or gold top tube Specimen should avoid extreme of heat and cold Specimens that are grossly hemolyzZed or lipemic will be rejected 1 full tube min 3 mls blood in red top tube or gold top tube 1 full red top or gold top tube 1 full Lt Blue top Sdium citrate tube Hemolyzed specimens are not acceptable Submit a separated frozen vial for each special coag assay ordered Freeze plasma Special Instructions 1 full tube of blood in light blue top tube 3 2 buffered sodium citrate Fill to indicated line PATIENT SHOULD ABSTAIN FROM ANABOLIC STEROIDS GEMFIBROZIL WARFARIN COUMADIN HEPARIN THERAPY ASPARAGINASE ESTROGENS GESTODENE AND ORAL CONTRCEPTIVES OPTIMALLY FOR THREE DAYS PRIOR TO SPECIMEN COLLECTION Overnight fasting is preferred Frozen 1 full tube of blood in red top or gold top tube 7 See Myocardial Antibod See Platelets Apheresed Ordered from Community Blood Center Call Blood Bank for STATS and ASAPS 1 full light blue top tube with 3 2 sodium citrate Tube must be filled to top of label Lab Use Only XYZ N QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW Arthritis Panel ae Order the Following Tests Individually Uric Acid W Sed Rate ANA amp Arthropod Identificat
112. d top tube Call lab for pediatric specimen requirements See Lymphocyte Subset Panel i i kk QU 45328P 1 full tube of blood in a red top tube See Complement Total CH50 for details on special instructions for processing QU 20099W 1 full tube min 3mls red top or gold top tube QU 20123E 1 full tube min 3mls red top or gold top tube 1 full tube min 4mls red top tube Stable 1 day refrigerated freeze if testing In house is delayed 1 full tube min 3mls red top or gold top tube F See Clostridium Difficile ooo See Cytotoxin Assay A N er QUEST send out E p Test Description oe QU as Specimen Instructions Tube Lab Use Only indicated C Peptide Serum QU 19869W 1 full tube min 3 mls blood in red top tube or gold top tube Allow to clot separate and freeze serum immediately Frozen C Reactive Protein QU 19885R 1 full tube min 3 mls blood in gold top or red black top tube Store Refrigerated 1 Full tube min 3 mls blood in gold top or red black top tube Overnight C Reactive Protien Cardio QU 10124F fasting is preferred FDA approved for use in cardiac patients Requires ABN Range and CRP High Sensitvity will be performed at UVMC Laboratory Ifa CRP Cardio is requested please refer to C Reactive Protien Cardio Test is sent to reference Quest for testing 1 full tube min 3mls blood in gold top or red black top tube Overnight fasting is preferred Specimen must be separa
113. de label should have the following information on it WHICH MRS JONES Patient s Name Location Medical Record and Account numbers Test requested Date and time to be collected Priority Code STAT ASAP TIMED CALL RESULTS ROUTINE Accession number Figure 1 2 Verify specimen requirements optimal minimal volumes and appropriate anticoagulant or preservatives This is to be done before leaving the lab Consult the Quest on line service manual or the Lab Service Manual to determine requirements NEVER draw the blood without verifying the correct specimen requirement 3 Take all appropriate supplies Needles vacutainer or syringe Syringes and Vacutainer Adapter Evacuated blood collection tubes with appropriate anticoagulant or blood culture bottles if needed 131 Vacutainer Transfer device Tourniquet 70 alcohol prep pads or iodine preps Cotton balls or gauze squares Tape Band Aids or pressure wrap Gloves Good morning l am John Smith from the laboratory what is your name May I see your wrist identification Mr Jones Pm here to obtain a blood specimen from you My those are nice veins this won t take but a minute 4 Introduce yourself to the patient by stating your name and that you are from the lab Gain the patient s confidence and Figure 2 explain what you are going to do Reassure the patient and try to relieve any apprehension he or she may feel Wash hands don gl
114. dock Waste reagents in the Histology Cytology department and other chemical waste that cannot be recycled or discarded in the sanitary sewer system are held for disposal by outside contract currently LAB PAK additional information is available in the Histology manual B 5 and Bouins will be held in one gallon containers and picked up when the containers are full Based on UVMC waste management policies the following guidelines for laboratory waste disposal will be followed BIOLOGICAL SPECIMENS It must be stressed that extreme care must be taken when disposing of any item that has contained or does contain biological specimen s Tubes and disposable cups should be dropped gently into the biohazardous waste container to prevent both ejection of items from the container and splashing of fluids which may contaminate walls counter tops floors equipment or nearby personnel including yourself Care must be taken to package waste before it reaches the top of the container Biohazardous waste is not to be compacted by any means mechanically or manually by compressing or agitating the contents 150 Biohazards are discarded in redlined waste receptacles This includes blood body fluids feces tissues and other potentially infectious materials and articles contaminated with it Any article dripping or caked with blood or body fluids or that may release blood or body fluids if compressed must be discarded in a biohazard waste container A
115. dose in most patients Two random levels usually 1 1 5 half lives apart on the same dosage interval can be Trough 15 minutes prior to next dose drawn on a loading dose Verify with the RN or MAR that dosing interval or Peak 60 minutes after IM dose administration time is as expected Document exact draw times on pharmacokinetic dosing service records Valproic Acid PO IV DEPAKENE DEPACON DEPAKOTE 7 14 Trough 15 30 minutes prior to next dose Steady state levels should be obtained after 2 4 days lt Vancomycin VANCOCIN 6 12 Trough 15 30 minutes prior to infusion Trough could be obtained just prior to dose administration There is a long Alpha Peak 1 2 hr after dose infused distribution phase which affects alpha peak more than beta peak A pair of Beta Peak 4 6 hr after dose infused beta peak and trough levels should be obtained around the 3rd dose in Random During dose interval after beta most patients Two random levels usually 1 1 5 half lives apart on the peak has passed same dosage interval can be drawn on a loading dose Verify with the RN or MAR that dosing interval or administration time is as expected Document exact draw times on pharmacokinetic dosing service records Digoxin quinidine co administration Patients who are currently receiving digoxin and are initiated on quinidine therapy may require digoxin plasma level monitoring Ideally digoxin samples should be obtained at a time which c
116. draw is a separate event and requires a separate accession number and venipuncture The test should be ordered as a Mycobacterial Blood Culture or a Fungus Blood Culture instead of a regular blood culture Refer to separate procedure for collection of blood culture specimens for preparation of venipuncture site The blood will be collected into the green top tube instead of the BacT Alert bottles used for routine blood cultures Swab top of green top tube with iodine and allow to dry at least 30 seconds to remove commensal skin flora Aseptically draw blood into the tube with a Vacutainer device or draw blood into a sterile syringe before transferring the specimen into the tube Mix well by inverting several times When the collected specimen arrives at the lab use the LIS Specimen Log In Function Central Receiving site to record the time received in the lab and enter the time drawn and phlebotomist for each specimen The specimen processing department will send the specimen s to Quest Mycobacterial and Fungal blood cultures are sent at room temperature Reference Quest Directory of Service Manual no date provided Revised procedure prepared by _ddm__ date 8 18 06 supersedes procedure written_ 5 25 04 148 WASTE DISPOSAL Procedure Within the laboratory there are four types of designated waste containers 1 SHARPS Puncture proof containers designated for needles and sharps are located in all patient rooms outpatient
117. drawing rooms and emergency room as well as in all work areas of the laboratory Portable sharps containers are available for use on phlebotomy trays These are to remain closed during transport To prevent ejection of contents and possible injury DO NOT over fill Items in the container must NEVER protrude from the opening Most sharps containers have a full indicator line do not fill beyond this line or approximately full When full sharps containers must be securely sealed before placing in redlined bio boxes The definition of sharps includes needles broken glassware slides glass pipettes plastic pipets and droppers of all types all syringes for phlebotomy or injection used or unused with or without needles microhematocrit tubes cover slips lancets surgical blades wooden applicator sticks any swabs wooden or plastic not enclosed in culturette type sleeves inoculating loops and any object that may penetrate intact skin or a waste bag The Ohio EPA defines anything meeting Webster s definition of syringe as a sharp items which meet this definition of sharps but will not puncture a waste bag or intact skin such as soft plastic transfer pipettes or bulb syringes without sharp fittings may be discarded in red lined boxes bearing the words may contain sharps NEVER PLACE LOOSE NEEDLES OR SHARPS THAT MAY PUNCTURE A WASTE BAG OR INTACT SKIN IN RED OR CLEAR LINED RECEPTACLES 2 BIO
118. during sample handling and storage keep tube wrapped in foil See Vitamin B12 amp Folate 1 full tube min 3 mls blood in gold top tube Protect specimen from light Folic Acid serum Folate Serum In house No hemolysis Fasting required a Aae e eae SEC QU 22863E 1 full tube min 3 mls blood in gold top tube Food Profile Allergen Panel QU 20226 1full tube blood in gold top or red top tube Free PSA See Prostatic Specific Antigen Free Free T4 See T4 Free Free Testosterone See Testosterone Free Call Blood Bank Specimen is associated with Type amp Rh May need to order Type amp Rh Frozen Section In house Call Histology x4638 Tissue fresh specimen FSH QU 22863E 1 full tube blood in gold top tube Fresh Frozen Plasma FFP In house Ql 00 QUEST send out Test Description test QU if indicated Specimen Instructions Tube Lab Use Only ABCDEFG HIJ KLMNOPQRSTUVW XYZ FTA Abs Serum 1 full tube blood in red top tube or gold top tube Specimens will be rejected QU 53934R Fluorescent Treponemal Antibody for gross hemolysis or lipemia FTI Oooo Order both T uptake amp T4 Fungus KOH smear See KOH Smear G 6 PD Blood and RBC Count Glucose 1 ml whole EDTA blood lavender top tube or royal blue top tube Frozen eee QU 23572P 6Phosphate Dehydrogenase Quantitative samples are unacceptable 1 full 7ml lavender or royal blue EDTA top tube Sodium hepari
119. e Diuretics Acetozolamide Ethacrynic acid Furosemide Antiplateltet Drugs ReoPro Integrelin Aggrastat Clopidogrel Ticlid Non Prescription Alka Seltzer Effervescent tablets Alka Seltzer Plus Cold Medicine Anacin Tabs amp Caps Max strength Arthritis Str Bufferin Tablet A S A Tablets Ascriptin Tablets Ascriptin A D Tablets Aspergum Aspirin Tablet 5 grain BC Tablets and Powder Buffering Tablets Cama Arthritis Pain Reliever Congesprin Chewable Tablets Cope Tablets Coricidin D Decongestant Tablets Coricidin Tablets Doan s Pills Ecotrin Tablets Empirim Tablets Excedrin Tablets amp Capsules 4 Way Cold Tablets Measurin Tablets Midol Caplets 197 Ibuprofen The ibuprofen medications such as Advil Nuprin Motrin etc also cause a tendency towards bleeding For this reason avoid all ibuprofen medications beginning 2 days before testing Reference PFA 100 System Getting Started Training Guide Dade Behring 9020 6734 Revision B January 2004 3 27 2007 pmc 198 New Test Listing The following pages contain information on new tests that have been added to the UVMC Laboratory compemdium For each test listed there is a discription of clinical application methodology result interpretation limitations specimen requirements and reference values For additional information contact the laboratory at 440 4335 Test Date 199 200 201
120. e Lyme Disease DNA PCR QU 30297X siectnen Ecce SCS Lymphocyte Subset or T Lymph Call Lab for Special Tube and 2 Different Tubes Draw 2 full tubes Helper Suppressor Ratio Total Lymph Totall QU 7195X blood in lavender top tube Stable for 30 hours at Room Temperature only T cells T Lymphocytes subsets CBC not included Must submit Monday Thursday only Room Temp 73 QUEST send out Test Description ae a if Specimen Instructions Tube indicated ABCDEFG HIJ Lab Use Only KLMNOPQRSTUVW XYZ Lymphoma CLL Flow See Leukemia Lymphoma Evaluation Lytes Oooo See Electrolyte Panel MAG SGPG AB IGM QU 136648P See Myeline Associated Glycoprotein Sulfated Glucuronic Magnesium Blood 1 full tube in green black top tube or gold top tube 1 full tube blood in red top or gold top tube Maternal date of birth weight race insulin dependent status gestational age 14 22 weeks EDD method of determining EDD and date collected MUST be provided for interpretation of results See Obstetric Gynecology Requisition Form Quest recommends that client keep a duplicate sample frozen at the requesting lab Maternal Serum AFP ie See Maternal Serum Screen 1 Maternal Serum Screen Alpha fetoprotein Maternal QU 5059X 1 full tube blood in red top or gold top tube The Obstetric Gynecology Maternal Serum Screen III QU 7292X Requisition Form or equal information MUST be complete and sent with the AFP Quan
121. e of the specimen and then discarded with the specimen 11 All containers of fecal material stool specimens as well as colon or duodenal washings or aspirates are to be handled as if they are contaminated on the outside Due to the nature of these specimens pressure tends to build up in tightly closed containers and escapes explosively when the container is opened Pressure accumulation may also cause tubing to detach from the lid of a mucus trap Any container of fecal material colon or duodenal washings or aspirates should not be included in a bag with other specimens These containers are to be transported and delivered to laboratory departments in secondary containers such as zip closure specimen transport bags see 13 All outside surfaces of these containers must be decontaminated or the specimen transferred to a properly labeled clean container with a secure closure before sending to a reference laboratory NOTE A container that does not have a secure closure cannot be sent to a reference laboratory the specimen must be transferred to a container with a secure closure before sending To prevent possible contamination of another specimen container resulting from re use any bag that has contained one of these specimens must be discarded the bag may be used for storage of the specimen and then discarded with the specimen 12 Gloves must be worn when handling all containers of CSF the method of collection of these specimens makes
122. e section marked Incorrect Orders below for instructions on how to handle order discrepancies B DRUG SCREENING SPECIMENS Due to the confidentiality issue for this test no name is required However there must be a unique identifying number on the container The person responsible for collecting the specimen may come to the lab and fill in the additional information if that employee is able to verify without a doubt that the information is correct Once all information is on the specimen label the specimen can be received If the collector is unavailable for 10 a period of time and a delay would cause a specimen integrity issue or a significant delay in test results the specimen should be run with the results not being put into the computer until the issue can be resolved C IRRETRIEVABLE SPECIMENS An exception to labeling requirements will be made if dealing with irretrievable specimens such as surgical specimens CSF specimens and Pre and Post Dialysis specimens In the event that we receive an unlabeled or mislabeled irretrievable specimen the person collecting the specimen will be contacted Every attempt will be made to make a positive identification of the specimen in question The laboratory medical director or the laboratory administrative director must approve rejection of an irretrievable specimen The medical director lab administrative director or a UVMC lab supervisor must verify approval for acceptance of these speci
123. e within 24 hours following surgery with the exceptions of weekends Specimen s may be held over for special stains recuts more fixation or decalcification at the Pathologist s discretion which may cause some delay in reporting 179 8 Once a surgical report is released by a pathologist it can be viewed in the Cerner anatomical pathology system and in Powerchart Once released the system will automatically send copies of the report s to Health Information Services and to all the doctors listed on the case All significant or unexpected surgical pathology finding are called to the physicians and documented called by and given to date and time Revised 10 30 08 cmw Revised 9 06 06 cmw 180 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 PROCEDURE FOR HANDLING FRESH TISSUE SPECIMEN S PRINCIPLE To facilitate the handling of fresh tissue specimens from surgery for special studies PROPOSE Most fresh tissue pathology specimens must be sent out for specialized processing Due to the specific nature of each processing type each type of specimen must be prepared according to the guidelines that have been established by each reference lab PROCEDURE ALL specimens sent for non routine pathology MUST be labeled with proper patient identification and be accompanied with a completed surgical pathology requisition LYMPH NODE A section of lymph node free of fat necrosis should be placed
124. eceiving antibiotics must collect in aerobic FAN y g instead of standard broth Separate order required for each collection See Collection of Blood Culture Procedure Body Fluid Culture gram stain incl In house Sterile container Collect a nasopharyngeal specimen using a calcium alginate or PP oE EEE E E Cue TREE Dacron swab Place swab in Bordetella Regan Lowe medium Submit specimen on a Dacron rayon swab in M4 transport red or blue cap Acceptable Specimens endocervix urethra conjunctiva rectal mucosa without feces fluid aspirate tissue C Trachomatis Culture QU 63495R nasopharynx or throat swabs Other Acceptable Specimens Cytobrush and post hysterectomy specimens Refrigerate specimens Rejection Criteria Wooden shaft swabs calcium alginate swabs or dry swabs CSF Culture gram stain incl In house Sterile container DO NOT Refrigerate Send to Lab ASAP Ear Culture gram stain incl In house Microbiology transport media red or blue cap culturette Eye Culture smear incl In house Microbiology transport media red or blue cap culturette Collect skin hair or nail specimen by scraping infected area with Culture Fungus Hair Skin Nails QU 5751E scalpel blade into a sterile plastic container Indicate source of specimen in the comment field on the requisition and on the specimen container Keep at Room Temperature 107 Test Description Cultures QUEST send out test QU if indicated Spec
125. ecimens Factor Il DNA Analysis QU 30326X drawn in EDTA royal blue top sodium heparin lithium heparin and ACD Prothrombin Gene Mutation Analysis solution B yellow top tubes are also acceptable Do not centrifuge specimens Keep at room temperature Special Instructions Call Lab full It blue top tube 3 2 or 3 8 Sodium Factor V Activity QU 344X Citrate tubes are acceptable Immediately centrifuge for 15 minutes at 3500 rpm separate and freeze plasma Submit separate frozen vials for each coagulation assay ordered 5mls whole blood from EDTA lavender top tube Royal blue top EDTA green BAciGEY leiden QU 22722x top sodium heparin or lithium heparin and yellow top ACD solution B tubes are also acceptable Must be kept at room temperature Specimen stability is crucial For prenatal fetal specimens call the lab Factor VIII component Call Blood Bank for product order ordered Factor IX component Call Blood Bank for product order Special Instructions Call Lab 1 Full 4 5ml LT Blue top tube 3 2 or 5 Factor IX Activity QU 352X 3 8 Sodium Citrate tube Centrifuge for 15 minutes at 3500 rpm separate and freeze plasma immediately Submit separate frozen vials for each Special Instructions Call Lab 1 full Lt Blue top tube 3 2 or 3 8 Factor VII Activity QU 346X Sodium Citrate Centrifuge at 3500 rpm for 15 minutes Separate and freeze plasma immediately Submit separate frozen vials for each
126. ed for storage of food or other items Any paperwork barcode labels etc which have been placed inside the zippered compartment with any specimen container that is to be handled as if contaminated on the outside are to be considered contaminated and handled according to UVMC Contaminated Documents policies Barcode labels can be reprinted other paperwork can be inserted in a page protector and copied before discading with the copy dated and initialed original chain of custody paperwork must be retained and can be kept in a page protector marked contaminated REFERENCES OSHA Standard 29 CFR Part 1920 1030 Occupational Exposure to Bloodborne Pathogens DOT Standard 49CFR 178 Specifications for Packagings DOT Standard 49CFR 173 196 Infectious Substances etiologic agents DOT Standard 49CFR 173 199 Diagnostic specimens and used health care products NCCLS document H5 A3 Procedures for the Handling and Transport of Diagnostic Specimens and Etiologic Agents Third Edition Approved Standard NCCLS M29 A2 Protection of Laboratory Workers from Instrument Biohazards and Infectious Disease Transmitted by Blood Body Fluids and Tissue Approved Guideline second edition AABB Technical Manual 15 edition 2005 College of American Pathologists CAP Laboratory Accreditation Program Laboratory General Checklist GEN 40522 Revised procedure prepared by_ S T Saunders date_09 25 2009 supersedes proc
127. edure Manual These Collections refer to Central Line Draws Hickman Catheters Leonard and Broviac Catheters Triple Lumen Lines Saline Lock Draws Peripheral Line Draws I C Line Draws Vascular Access Devices VADs which include Implanted Ports with Groshong Catheters Arterial Access Lines ART Lines 4 Drawing above an I V Site There are rare occasions when a patient has an I V in both arms and there are no suitable veins to obtain a specimen In these cases the following procedure may be used A Look above the I V site to see if you can find a possible site for a successful venipuncture Once a vein is located ask the PATIENT S NURSE if it would be possible to turn off the I V for approximately two minutes B If the patient s nurse is able to shut down the V proceed with the venipuncture as follows First make sure that Heparin is not running in the I V line of the arm that you have chosen If there is choose the other arm Then you may proceed by either using the Vacutainer unit to draw a discard tube first and then draw the specimen that is to be used for testing afterwards or you can use a butterfly unit and a syringe and draw approximately 3 5 ml In a syringe and discard the syringe with the discard blood in it leaving the butterfly unit still in the vein Obtain another syringe and hook it to the end of the butterfly tubing and draw back enough blood for the testing to be done on that specimen When the v
128. edure written_6 30 2004 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 CRITERIA FOR REJECTION OF SPECIMENS PRINCIPLE It is important for the quality of results that all specimens received in the laboratory meet the requested test s specific specimen requirements and the laboratory s identification standards It is not the intent of this laboratory to cause inconvenience to the patient and every effort will be made to correct the problem without affecting patient care and satisfaction A signed order from the physician is required for all tests Any deviation from this policy may only be made at the discretion of the medical director laboratory administrative director or in their absence a laboratory supervisor If collections from an Outpatient Outreach Dr Office location need to be rejected and recollected refer to the Outreach Outpatient Follow up On Rejected Specimens or Tests That Need Redrawn procedure for instructions PROCEDURE FOR REJECTING SPECIMENS DUE TO LABELING ISSUES gt For purposes of determining if a specimen should be rejected due to labeling issues the different specimen types i e retrievable irretrievable those collected by non UVMC personnel need to be considered See below for rejection guidelines for different sample types gt A problem log must be generated for all unusual identification issues and all mislabeled specimens If the test is cancelled be
129. en in house test Min 30mL urine in urine container To be ordered by Miami County Mental Health ONLY 114 OCCUPATIONAL HEALTH Quest send Test Description auei Specimen Instructions Tube Shipping indicated Hepatitis B Virus Surface Antibody 1 full tube blood in red top tube or gold top tube E greenback top tube AND a i bleos in lasedder or be AND OCH BETA 2 Microglobulin QU 19521E A EN a da OP MDE ar BienyiZee OCH Blood Alcohol Industrial Special Collection Procedure 2 gray top tubes OCH Drug Screen DFWP 8 10 Panel 50 mls random urine minimum Hepalis B Surface A ALTISGPTS E a Hepatitis C Ab OCH Drug Screen 8 10 Panel 50 mls random urine in sterile container minimum OCH Drug of Abuse Panel 5 50 mls random urine in sterile container minimum OCH Drug Screen Collection 50 mls random urine in sterile container minimum OCH Drug Screen 9 Panel Employee 50 mls random urine in sterile container minimum OCH Drug Screen Split See Special Instructions for DOT collection OCH DOT Drug Screen See Special Instructions for DOT collection OCH DOT Drug Screen Bus Driver See Special Instructions for DOT collection OCH DOT Panel Post Accident See Special Instructions for DOT collection OCH Fireman Panel Refer to OCH Collection Procedure ODH Occult Blood Stool 1 In house 1 ml stool on Hemoccult card ODH Occult Blood Stool 2 In house 1 ml stool on Hemoc
130. en Identification 1 Label specimen with a Routine Label specimen s with barcode sticker from accession label for T amp Rh or T amp S with same accession number as on the armband On the specimen label write the patient s birthdate Also put the name of person collecting the specimen first initial and last name and the time of the draw on the specimen s b Downtime Label specimen with the following Patient s name last first and initial Patient s medical record number Patient s date of birth Date time of draw Name of person collecting the specimen first initial and last name 6 Mandatory unique I D number 2 As a second identification check have the patient look at the specimen tube and initial the tube showing that they have looked at the tube and checked the name on it for proper identification During situations when the patient is not able to identify their specimen ask another person familiar with the patient family member or friend present in room when the specimen was collected to look at the specimen A nurse or other lab employee can be asked to watch the collection and initial the specimen if needed They can look at the specimen and information for correctness and initial the specimen During Traumas or Massive Transfusion Protocols follow procedures for those situations there are other steps in place for the safety of the patient such as transfusing type O blood AR WN gt
131. en top tube No gel barrier Manone rough oe State time of last dose 10ml aliquot of urine from a 24hr urine collection containing 6N HCL A 24hr collection without preservative is acceptable if ph is below 6 and the sample is Wanillviamandelie Acid 24 hour Urine shipped frozen Record the volume on the requisition and the specimen vial VMA e creatinine i QU 934X It is preferable for the patient to be off medications for three days prior to collection Call lab for exceptions Patient should avoid alcohol Lab Use Only coffee tea tobacco and strenuous exercise prior to collection See 24 Hour Urine Collections Procedure VAP Cholesterol Test QU 10270X 1 full tube blood in gold top red black top or red top tube Fasting is not required for this testing Varicella Zoster AB IGG QU 54031E 1 full tube blood in gold top or red top tube Grossly lipemic and hemolyzed specimens will be rejected Refrigerate serum a Zoe Min amibas le Uo QU 1347N 1 full tube blood in red top tube or gold top tube IgM Herpes zoster virus VDRL CSF also see RPR CSF QU 52902P 1 mI CSF in sterile container Special Instructions 1 full red top or gold top tube Wrap tube in Vitamin A Retinol QU 921X aluminum foil to protect from light Overnight fasting is preferred Centrifuge within 1 hour of collection QUEST send out Test Description ae abet Specimen Instructions Tube indicated ABCDEFG KLMNOPQRSTUVW
132. end to Lab ASAP Genital Culture gram stain incl In house Microbiology transport media red or blue cap DO NOT REFRIGERATE Send to Lab ASAP GI Stool Culture See Stool Culture Group B Strep Screen See Strep Screen Group B 108 Test Description Cultures QUEST send out test QU if indicated Specimen Instruction Tube Herpes Culture Rapid HSV Rapid Method QU 2692E Collect specimen from a suspected lesion using a swab of cotton rayon or Dacron with a plastic or metal shafts Do not use calcium alginate swabs with wooden shafts Place swab in M4 transport medium Refrigerate Do not Leave at room temperature Indicate source on requisition Other acceptable specimens are urogenital nasopharyngeal eye and throat swabs CSF or tissue in viral transport or M4 transport medium Herpes Culture Rapid HSV VZV Rapid Culture QU 17495X Collect lesion aspirate or swab from sources such as oral skin or conjuntiva and place in M4 media Sterile swabs with plastic shafts and rayon or Dacron tips may be used Do not use swabs made with cotton or wood Other acceptable specimens are body fluids CSF and tissues as well as respiratory specimens such as sputum bronchial washing lavage and tracheal aspirates trasport in M4 media Note For genital rectal and peri rectal specimens order HSV Rapid Method 2692E Refrigerate Do not leave at room temperature
133. ending to a reference laboratory NOTE A container that does not have a secure closure cannot be sent to a reference laboratory the specimen must be transferred to a container with a secure closure before sending Tubing on mucus traps suction containers should be secured against straightening before the lid is removed this tubing loosens from the lid readily and tends to straighten abruptly rapidly expelling any specimen remaining in the tubing Proper barrier precautions and PPE must be used when handling these specimens barrier precautions must protect both the person handling the specimen and anyone present to the sides and opposite that work station To prevent possible contamination of another specimen container resulting from re use the bag that contained the specimen must be discarded the bag may be used for storage of the specimen then discarded with the specimen 14 Zip closure plastic bags used as secondary containers for the transport of specimens for laboratory analysis may be re used by laboratory personnel only if they are known not to be contaminated such as the outer bag from double bagged specimens transported through the pneumatic tube system These bags should not be re used by non laboratory departments such as nursing floors and doctors offices Bags that have been in contact with specimen containers that are to be handled as if contaminated on the outside respiratory fecal and CSF specimens must not be re use
134. enipuncture is completed inform the patient s Nurse right away so that they may restart the I V Make sure to note on the barcode that the specimen was drawn above an I V and how many minutes that the I V was shut off prior to drawing the patient Communicate any special situation or information about the draw on the barcode so the technician can use the information accordingly 137 5 Doctor patient Relationship The Doctor has priority in seeing the patient If the Doctor is seeing the patient the Phlebotomist should ask politely if the Physician would like to have the sample drawn now or at another time 6 Tips for successful Geriatric Patient venipuncture A The patient interview will determine how to proceed with the venipuncture Many times older patients are confused or may be very much like dealing with a small child B Explain to the patient exactly what you are going to do in order to gain the confidence of your patient C If the patient appears confused or uncooperative in any way get assistance D In some diseases like arthritis or other degenerative conditions assistance will be needed in order to maintain a stable arm position during venipuncture E Many older patients have lost muscle tone and have rolling veins modify equipment and use a syringe or a winged infusion set butterfly F Watch for and be prepared for unexpected movement and swinging of the patient s arms G Be prepared to spend time tal
135. eparin or lithium heparin green top tubes are also acceptable Angiotensin Converting Enzyme ACE QU 18572E 1 full tube blood in red top tube Centrifuge separate and refrigerate within 1hr Angiotensin Coverting Enzyme CSF QU 34692N 1 ml frozen CSF is a sterile screw top container Antibody Screen Indirect Coombs 7 mls blood in lavender top tube Blood Bank Tube o Test Description ABCDEFG HIJ KLMNOPQRSTUVW Antibody Titer Blood Bank SO AntiCardiolipin Antibody IgG and IgM Anti DNA DS Double Stranded Anti DNA SS Single Stranded Anti HU Anti Jo 1 Anti La Antimitochondrial Antibody Antimicrosomal Antibody Thyroid Peroxidase TPO Abs Antineutrophil Cytoplasma Abs ANCA Vasculitides Antinuclear Antibodies Screen EIA w reflex titer IFA Antipancreatic Islet Cells Antiplatelet Platelet Antibodies IgG Direct QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ 5 ml whole blood in yellow top ACD A or ACD B perfered starting Nov 9 QU 4005 2009 EDTA Lavender top also acceptable Draw 2 15ml red top prior to Nov 9 2009 QU 10793A 1 full tube min 3mls blood in red top tube or gold top tube QU 51300E 1 full tube min 3mls blood in red top tube or gold top tube QU 14857X 1 full tube min 3mls blood in red top tube or gold top tube QU 9175N See Neuronal Nuclear HU Antibody QU 52340E
136. er a T uptake amp T4 In house 1 full tube min 3 mls blood in green black top tube or gold top tube Must have physician order for both Ke amp QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG KLMNOPQRSTUVW T Treponema Pallidum Antibodies or Quy 53934R 1 full tube blood in red top tube or gold top tube FTA ABS Tacrolimus Level FK06 QU 112532P 1 full tube whole blood in 3 ml EDTA Lavender top tube Room Temp l 1 full tube blood in red top tube or green top tube No gell barrier tubes State Tegretol Level Carbamazepine Hine ot act dose 1 full tube 3mls min in a red top or green top lithium heparin tube no gel Testosterone Total In house Do not remove stopper specimen will be spun at lab Refigerate Grossly lipemic specimens will need to be ultracentrifuged Testosterone Free Serum QU 36170X 1 full tube min 3mls blood in red top tube no SST tubes Specify age and Includes Total Testosterone sex on test form Grossly Hemolyzed specimens are unacceptable See Maternal Serum Screen IV f 1 full tube min 3 mls blood in red top tube or green top tube lithium Shop hy line eines ine heparin No gell barrier tubes State time of last dose Therapeutic Phlebotomy se See Phlebotomy Therapeutic Tetra Screen See Vitamin B1 Plasma Thin Prep PAP When ordering MUST m house Special Media Cytology Pre
137. er device unit is discarded intact in the sharps containers mounted on the walls of the patient rooms outpatient drawing rooms and emergency rooms or in the nearest sharps container designated for that purpose HAZARDOUS CHEMICALS Solvent Recycling Used xylene absolute alcohol and 95 alcohol are recycled for reuse with the CBG BIOTECH Solvent Recycler Refer to ALCOHOL AND XYLENE RECYCLING MANUAL located in the Histology department for details Disposal of hazardous reagents Flammable or toxic reagent waste is not to be dumped down the drain These waste reagents include alcohol formalin strong acids pH less than 5 5 strong alkali pH greater than 11 0 or any other toxic reagent such as B 5 and Bouins used in the Histology department These reagents must be poured into the appropriate chemical waste containers designated for flammable or non flammable chemical waste or designated one gallon containers for B 5 and Bouins and held for disposal by a qualified outside waste contractor Reagents containing sodium azide as a preservative in quantities typically used in this laboratory may be discarded into the sanitary sewer system followed by flushing with large volumes of water to prevent azide build up Accumulated build up of azides can react with copper and lead used in some plumbing systems to form highly explosive metal azides and must be avoided Small amounts of alcohol and formalin may be discarded into the sanitar
138. er transfusion Place the chart copy of the Blood Transfusion Record on the chart Post Transfusion A Return the completed Blood Transfusion Record Blood Bank Lab copy to the Laboratory This can be B returned by nursing staff or the pneumatic tube system Discard the empty blood bag and tubing using proper hospital guidelines for biohazards 165 VII Blood Release and Return A Blood release for transfusion and not used must be returned to the Blood Bank within 20 minutes to assure that blood has not been warmed above 10 C B Blood may not be released to be stored in another area because constantly monitored refrigerators are not available outside of the Blood Bank New Procedure Supersedes 2 22 06 Prepared by jas 3 12 07 166 UPPER VALLEY MEDICAL CENTER te BLOOD PRODUCT ORDER FORM PRODUCT CIRCLE TO INDICATE PRODUCT INDICATIONS FOR TRANSFUSION CHECK AT LEAST ONE Leuko reduced packed RBC s One 1 Two 2 Three 3 Four 4 units Transfusion Instructions Rate Meds Other Fresh frozen plasma Two 2 Three 3 Four 4 units Transfusion Instructions Platelets One 1 Two 2 units Single donor apheresis leuko reduced 1 apheresis unit 6 random units Transfusion Instructions Acute Blood Loss O Estimated blood loss gt 1000 mL or 30 of volemia O Hgb lt 8 g dl or Hct lt 23 O Hgb lt 10 operative trauma or head injury pt with evidence of significan
139. essful Change the position of the needle If the needle has penetrated too far into the vein pull it back a little bit If it has not penetrated far enough advance it further into the vein The tube may not have vacuum try another tube Loosen the tourniquet and reapply it more loosely Probing for a vein is not recommended as it is painful for the patient Never attempt a venipuncture more than twice Have another competent person attempt to draw the patient 7 Do not draw above an l V site If you have no other choice draw approximately three inches below the site Document specimen was drawn below the IV site on the barcode If there are not other alternate sites for venipuncture and the patient has an I V refer to the Special Situation section below 8 Label specimens directly after collection at the patient s bedside drawing chair Never ore label tubes SPECIAL SITUATIONS 1 Timed Intervals 136 Specimens should be obtained at the precisely specified timed interval For example glucose tolerances Cardiac Panels or any therapeutic drug levels These timed interval draws are usually scheduled ahead of time and it is very important to collect them at the specified time 2 HIV Tests A consent form must be signed before an HIV test can be drawn Refer to the HIV protocol in the Phlebotomy Procedure Manual 3 Non Venipuncture Specimen Collection Please refer to the procedure in the Phlebotomy Proc
140. etone 1 full tube min 3 mls blood in green black top tube or gold top tube Ketones Urine Inhouse 1 ml urine in urine container keep refrigerated KOH Smear Genital nous gia swabs in 1ml sterile saline or Microbiology culture transport medium red or blue cap Red top swab or swab in 1 cc of sterile saline PREFERRED SPECIMEN Raw specimen any source other than blood or raw stool specimens are acceptable Submit stool in stool culture transport medium Collect oral nose nasopharynx ear eye wound or urethral specimens using culture swab transport system liquid medium Use sterile plastic container for respiratory secretions body fluid tissue CSF urine contact lens or contact lens fluid For tissue samples add a small amount or KOH Smear Non Genital Must state source In house saline to sample Transport raw specimens refrigerated transport swab specimens at room temperature Special Instructions Call Lab Do Not Use Tourniquet 1 full tube in Lactate Lactic Acid In house gray top tube Deliver to lab on ice Centrifuge within 15 min of draw then separate plasma oO QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW inhouse Lactate CSF In house 0 5mls CSF in a sterile container 1 full 10ml red top No additive tube Special Instructions Draw 1 Lamotrigine QU 69484P _ hour before d
141. f collection and witnessed the collection See step C 2 A Patient Identification NOTE For Home Health Nurses certain nurses have been trained to collect blood bank specimens with armband system If they are in the hospital prior to collection and pick up Blood Bank labels they will follow the routine operation Otherwise they will collect using the downtime procedure All patients will come to the hospital for transfusion 1 a During routine operation the armband ID will be the accession number assigned by computer for the patient s Type and Rh or Type and Screen This number can be found on the accession label b During downtime the armband ID will be a unique number preprinted for Blood Bank Obtain numbered sheet with numbered stickers and a Blood Bank armband from the Blood Bank The number on the sticker sheet will be the patient s unique Blood Bank armband number 2 Properly identify patient by comparing the request information with the patient s hospital identification armband Ask patient to give his ner name and birthdate If there is no hospital armband or the patient is unable to communicate have a nurse from that floor identify the patient and verify patient s birthdate If there is any doubt of the patient s identity do not draw specimen until the problem is resolved 168 B Sample Collection Obtain needed specimen one 7 ml EDTA purple top tube following proper specimen collection protocol C Specim
142. fields For example a patient has a critical BUN K and Na Under one result note document BUN K and Na called along with the date time caregiver s name etc Outpatient results including outreach facilities The critical result should be called to the physician msp or physician s office immediately not to exceed 10 minutes upon discovery If unable to reach the physician msp immediately document the date time you paged the physician msp and your initials under result notes and release the results After the physician msp has returned the page document all information by using the CR template in Order Notes See above under Inpatient results for documenting more than one critical per accession number Nursing Homes Dettmer Home Health or Hospice results If the critical result that needs to be called involves a resident of a nursing home or Dettmer Hospital call the nursing station where the patient is located If unable to reach the nursing station at Dettmer or the Nursing Home immediately not to exceed 10 minutes document the date time of the first call and your initials under result notes and release the results if able Continue attempting to reach them until successful Document all subsequent calls in Order Notes if the test is already released or in Result Notes if not released Once the result has been given to the caregiver finish the documentation of date time called to called and read back by using the CR
143. for any unusual noise or vibrations if anything out of the ordinary please 11 Clean spillage as needed interior and exterior Weekly check off done in each dept NOTE DO NOT EVER OPEN THE LID WHEN CENTRIFUGE IS ROTATING O re NOTE Centrifuge spills broken tubes Shut off instrument and leave centrifuge shut for 30 minutes allow for aerosols to settle Always wear gloves when cleaning up broken glass and spilled liquids Always use forceps or hemostat to remove the broken glass Always put the broken glass in an approved sharps disposal container Never operate the centrifuge in this condition The centrifuge must be disinfected before operation can resume Use 10 Bleach when cleaning centrifuge interior and or exterior After using the 10 Bleach on any part of the centrifuge thoroughly rinse with water Dry all parts as much as possible ALWAYS STOP THE CENTRIFUGE IMMEDIATELY IF IT DOES NOT SOUND OR OPERATE RIGHT Twice yearly January and July GE Service will do preventative maintenance checks REFERENCE Operating manual for Clinifuge or Medifuge or VanGuard or Horizon Revised procedure prepared by dss date _ 04 24 08 Supersedes procedure written __ 07 31 06 Centrifuge Procedure PG 2 04 24 08 dss 193 Upper Valley Medical Center Clinical Laboratory 3130 North Dixie Highway Troy Ohio 45373 CENTRIFUGE OPERATION AND MAINTENANCE PROCEDURE For Doctor s offices and Nursing Home Facilities PRINCIPLE
144. for details Patient should avoid tobacco tea and coffee for three days prior to testing 24 hr Urine Microalbumin In house 10 ml of urine from a 24hour collection with no preservative Record total volume Pick up container from lab Keep refrigerated 24 hr Urine Oxalate Quant QU 11318X 10 ml aliquot from 24hour urine collection with 25ml 6N HCL as preservative Record volume Keep refrigerated Patient should refrain from taking excessive amounts of ascorbic acid or oxalate rich foods i e spinach coffee tea chocolate rhubarb for at least 48 hours before the collection period 24 hr Urine Phosphorus In house 10 ml aliquot from 24hour urine collected with no preservative Record total volume Pick up container from lab Keep refrigerated 24 hr Urine Porphyrins Quantitative Fractionated QU 68437N 12mls urine from a 24hr collection Do not use preservatives Protect from light Collect urine in a dark or wrapped container Keep refrigerated 24 hr Urine Potassium In house 10 ml aliquot from 24hour urine collected with no preservative Record total volume Pick up container from lab Keep refrigerated 24 hr Urine Protein In house 10 ml aliquot from 24hour urine collected with no preservative Record total volume Pick up container from lab Keep refrigerated 103 Test Description i QUEST send RO iki out test
145. fore being received a problem log must be generated If there are any unusual circumstances associated with a cancellation a problem log must be written Tests cancelled on doctor s office collections or OPT collections need a problem log for documentation and follow up gt Aproblem log is not necessary for unlabeled clotted or hemolyzed specimens as long as the accession is received with the correct collector ID and then cancelled as unlabeled clotted etc and the patient is not an outpatient doctor s office collection gt Ifthe specimen arrives on an off shift when the collecting personnel cannot be contacted i e physician office that is closed and specimen stability is an issue run the tests and hold the results until clarification is received SPECIMEN IDENTIFICATION Two patient identifiers are to be used at the bedside when collecting specimens Name and date of birth are those acceptable identifiers at UVMC For every specimen that is hand labeled ie not labeled with a Cerner barcode label the following information must be on the label If not refer to the subsection below for different specimen types for direction on how to handle the rejection First and last name of patient Date of birth is the first choice as a second form of patient identifier Medical record number is acceptable if using a pre printed barcode label Date Time specimen was collected Initials of person collecting specimen if nota UVMC
146. gency where an armband is cut off before Lab is notified the lab must be called immediately The lab staff will bring or send a new green armband If the person who cut it off still has the armband and can positively identify the patient from whom the armband was cut they can remove identification materials from the armband They can insert the identification materials in the new green armband and attach it to the patient s arm A Blood Bank Identification Transfer Record should be completed by the person who removed the armband signing the record This will be kept on file in the Blood Bank until that specimen has outdated 2 Ifthe actions listed in No 1 above do not occur it will necessitate a restick of the patient and a repeat of the type and crossmatches The patient can not be charged again Redraws will be necessary in cases where armbands are found taped to beds or are missing The most frequent cause of fatal transfusion reactions is clerical identification errors a greater risk than AIDS NOTES 1 In downtime a Save unused stickers b If four or more units are ordered or in an emergency to speed up the process the identification number can be written on the BLOOD TRANSFUSION RECORD and the large unit sticker of the BLOOD TRANSFUSION RECORD The ID number should transfer through all copies of the slip 171 UPPER VALLEY MEDICAL CENTER 2130 N DIXIE HWY TROY OH 45373 BLOOD RECIPIENT S TRANSFUSION
147. h wil come to pick up the specimen If the specimen is not picked up or processed within 15 minutes of collection place tube in a cup of ice water Specimen Instructions Tube Lab Use Only XYZ Phenobarbital Luminal In house 1 full tube min 3mls blood in red top tube or green top tube lithium heparin No gell barrier tubes State time of dose Special instructions Call lab for specimen information There will special PhenosurenEM Eomp CUA ACAIN patient information that needs to be submitted with specimen Teer 1 full tube min 3mls blood in red top tube or green top tube lithium Ehrenyioini Dilantin heparin No gel barrier tubes State time of dosed a optimal time to collect sample is 4 hours post oral dose Phlebotomy Therapeutic ee through Central Scheduling or CCC Cancer Care Phosphorus blood 1 full tube min 3mls blood in green black top tube or gold top tube 10 ml aliquot from a 24hour urine collected with no preservative Pick up Phosphorus Urine 24 hour In house container from lab Record total volume Keep refrigerated See 24 Hour Urine Collections Procedure Photo Gross Surgical a Call Histology x4638 Use pinworm collection kit Apply sticky side of paddle to perianal area before Pinworms In house child awakes in early am Refer to Pinworm Collection Procedure Phenvtoin F Dilantin F 1 full tube min 4mls of blood in red top tube DO NOT USE GEL TUBE at Bhs Dilantin
148. h will remove the scheduled frozen section printout from the printer she will then log the frozen section onto the large desk calendar The frozen section printout will then be given to the Pathology secretary she will then look up any previous testing Histology or Cytology The Pathology secretary will return the frozen section print with any additional patient information to the Histology department and place the Frozen Section Patient information in the wall FS pocket These will be filed in order of date of surgery REPORTING OF FROZEN SECTIONS A Surgical Pathology requisition slip is to be completed with all appropriate data and submitted along with the specimen at the time of frozen section A Frozen Section Report Form must also be completed at the time of frozen The Pathologist doing the frozen will complete the Gross Pathology and Frozen Section Diagnosis section and sign the form The histologist assisting may need to complete the top half of the form The white copy will be given to surgery to be shown to the surgeon and then attached to the patient s chart The yellow copy will be filed with the final Pathology Report in the Pathology Secretary s office The histology tech will charge the appropriate charge s The Frozen Section QA sheet needs to be completed at the time of the frozen section listing all required information this will be filled either by the Pathologist or the Histo tech assisting with the frozen section 186 SCHED
149. he collection date and time be the Oligoclonal Bands CSF and Serum QU 674X same for both specimens Serum can be drawn with in 48 hours of the CSF but this is not recommended Client may submit CSF only to be run with control serum with client s approval Osmolality Serum Inhouse 1 full tube min 3 mls blood in red top tube or gold top tube Occult Blood Submit Hemoccult card Cards should be stored at Room Temp Protect from Stool light heat amp chemicals DO NOT use cards after expiration date Apply thin NOTE If more than 1 Occ Blood is to n house smear of stool inside box A Using other end of stick apply thin smear from E E EA E LUCENTE REN ERE ee Oa different area of stool to box B Label card with patient s name date and time QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW Osmolality Urine 10 ml random urine no preservative Random stool specimen placed into 2 preservative vials formalin amp PVA Ova and Parasites PVA Smear included In house within one hour of collection Add Stool to fill lines on vial do not overfill For specimens other than stool contact lab for instructions 10 ml aliquot of 24 hour urine collection with 25ml of 6N HCL preservative Oxalate Quantitative Urine 24 h Keep refrigerated Record volume on form Patients should refrain from aae Ranae Sne i QU 11318X taking excessive amounts of ascorbic acid or oxalate rich foods i e
150. hospital at 3130 North Dixie Highway Telephone Laboratory Call Center 937 440 4025 Pathology Office Coordinator 937 440 4637 Hours of Operation Upper Valley Medical Center Clinical Laboratory is a full service laboratory Staffed 24 hours a day 7 days a week UVMC Clinical Laboratory Medical Director Carlos Machicao MD UVMC Clinical Laboratory Administrative Director Shelly Buehler MT ASCP 8 2009 Upper Valley Medical Center Clinical Laboratory 3130 N Dixie Highway Troy Ohio 45373 INFECTION CONTROL BIOLOGICAL SPECIMEN HANDLING TRANSPORT AND STORAGE DISCUSSION Due to their biohazardous nature specimens submitted for laboratory analysis must be handled transported and stored in a manner that minimizes the possibility of inadvertent employee contact with blood or other potentially infectious materials This procedure provides guidelines for safe handling of such specimens during processing transport within or between UVMC facilities testing and storage by volunteers couriers laboratory personnel or other hospital staff in accordance with NCCLS OSHA DOT and EPA regulations Special requirements to insure specimen stability after collection during storage and transport to the laboratory can be found in the Laboratory Services Manual under the test directory for each test that is being collected GENERAL GUIDELINES FOR HANDLING OF BIOLOGICAL SPECIMENS 1 Gloves and other appropriate personal prote
151. hould be on a diet including 100 grams of fat per day for three days prior and during the collection period 1 full tube min 3mls blood in red top tube 12 hour fast is required Lipoprotein a QU 108357P_ Centrifuge within 1 hour of collection Avoid hemolysis Grossly lipemic samples are unacceptable Lithium Inhouse f full tube min 3mls blood in red top tube State time of last dose Liver Profile sl See Hepatic Function Panel Liver Kidney Microsomal Antibodies QU 15038X 1 full tube min 3mls blood in red top or gold top tube Special Instructions Call Lab 2 full tubes blood in Lt blue tube 3 2 Lupus Anticoagulant Evaluation Sodium Citrate is the only acceptable sample type Separate plasma into Includes Russell s viper venom time QU 7079N 2 1ml aliquots and ship frozen 20C Submit 1additional plasma aliquot Partial Thromboplastin time Lupus anticoag for repeat and or test additions Prolonged tests will reflex an additional test charge Hemolyzed specimens are not acceptable Frozen Luteinizing Hormone LH QU 25791E 1 full tube blood in red top or gold top tube 1 full tube min 3mls of blood in red top tube or gold top tube A positive Lyme Disease Antibodies IgG and IgM QU 1529T jor equivocal result will reflex a western blot confirmation with an additional charge Hemolyzed and lipemic samples will be rejected 1 ml CSF ina sterile CSF tube Synovial fluid is also an acceptabl
152. hyrin EN See Lead amp Zinc Protopophorin 101 Test Description i QUEST send ete RU rea out test QU if Specimen Instructions Tube Click here to access 24 hour urine indicated Collection Procedure Follow UVMC Instructions for Laboratory Specimen Collection 24 HOUR URINES in Lab Services Manual for 24hour collection procedure 10 ml aliquot of 24hr urine Use 25ml of 6N HCL as gt preservative or no preservative if PH of less than 6 is a aE Soe OUR EN maintained and specimen is shipped frozen See 5 HIAA for dietary restrictions Record volume 24 hr Urine Amv RRoUsE 10 ml aliquot from 24hour urine with no preservative Record g Vids total volume Pick up container from lab Keep refrigerated 54 hr Urine Calcium mhos 10 ml aliquot from 24hour urine with no preservative Record total volume Pick up container from lab Keep refrigerated 54 nr Urine Catecholamines Une 10mls of urine 24hour collection using 25ml of 6NHCL or Fr i j QU 4168N 15gm of boric acid as preservative Record total volume date ae amp time Keep refrigerated 54 nr Uine Catecholamine Urine 10mls of urine 24hour collection using 25ml of 6NHCL or Fr l QU 4168N 15gm of boric acid as preservative Record total volume date SS amp time Keep refrigerated 10 ml aliquot from 24hour urine with no preservative Record coi TES CUMS ieee total volume Pick up container from lab Keep refrigerated 2ml urine al
153. ide Trough Immediately prior to next dose Steady state levels should be obtained after 4 7 days of therapy in children ZARONTIN 60 and even longer in adults Gentamycin IV Trough 15 30 minutes prior to infusion Trough could be obtained just prior to dose administration Peak will be GARAMYCIN Peak 15 30 minutes after dose infused affected by a short distribution phase A pair of peak and trough levels 1 7 Random Anytime during dose interval should be obtained around the 3rd dose in most patients Two random levels usually 1 1 5 half lives apart on the same dosage interval can be Trough 15 minutes before next dose drawn on a loading dose Verify with the RN or MAR that dosing interval or Peak 60 minutes after IM dose administration time is as expected Document exact draw times on pharmacokinetic dosing service records Lidocaine IV 4 8 hours after start of therapy Levels obtained 4 8 hours after initiation or change in therapy should 1 5 approximate steady state concentrations Lithium Trough Immediately prior to first morning Steady state lithium levels should be obtained 3 5 days after initiation of 14 30 dose and approximately 12 hours after therapy or change in dose v last evening dose 27 GENERIC BRAND NAME HALF LIFE hrs SUGGESTED SAMPLE TIMES COMMENTS Trough Immediately prior to next dose or Trough levels are preferred Routine samples should be monitored 2 to 3 Phenobarbit
154. ie Highway Troy Ohio 45373 Insulin Resistance Challenge 2 Hour Principle This test is used in the assessment of anovulatory women who are hyperandrogenic through measurement of 2 hour glucose and insulin levels after a 75 g glucose load Procedure 1 2 3 Identify the patient using standard operating procedures Confirm that the patient is fasting prior to specimen collection If the patient is not fasting the test will need to be re scheduled Collect a fasting glucose and insulin specimens from the patient making sure to label the insulin tube SST as the fasting specimen with the collection date and time The glucose tube GRNBLK Gel is to be labeled with the barcode from the fasting glucose order identify the collection date and time Administer 75 g of glucose beverage Instruct the patient to consume the entire amount within 5 minutes Record the time glucose beverage consumption is completed The second collection will be two hours after ingestion Ask the patient to remain in the outpatient testing area for the duration of the test Patient may consume only water during the 2 hours between collections Food and smoking are not allowed during this time Instruct the patient to notify the collection personnel if at any time they experience nausea faintness dizziness headache or vomiting After the two hours have elapsed collect the 2 hour glucose and insulin specimens Label the 2 hour glucose with the barcode labe
155. igerate Ultracentrifuge grossly lipemic samples 1 full tube min 3mls blood in red top tube Draw AM specimen between Cortisol AM serum inhouse 07 00 and 10 00 AM preferably within 1 hour of awakening Mark specimen with date and time drawn Plasma is not acceptable Refrigerate Ultracentrifuge grossly lipemic samples 1 full tube min 3mls blood in red top tube Draw specimen at 4 00 pm Cortisol PM serum In house 16 00 Mark specimen with the date and time drawn Plasma is not acceptable Refrigerate Ultracentrifuge grossly lipemic samples Cosyntropin Challenge ooo See ACTH Stimulation Test Test Description Coxsackie A Titer Coxsackie Viral B 1 6 Antibodies Coxsackie B Titer CPK Creatine Kinase CK Creatine Kinase Isoenzymes Isoenzymes CPK Creatinine Urine 24 hour If Protein Creatinine Ratio is needed see Protein Creatinine Ratio Creatinine Urine Random CRP CRP Cardio CRP Wide Range or High Sensitivity Cryoglobulin Cryocrit Serum Cryoprecipitate CRYO Cryptococcal Ag EIA CSF ABCDEFG HIJ KLMNOPQRSTUVW QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ QU 2324 1 Full tube blood in red top tube Room Temp QU 3210N 1 full tube blood in red top tube or gold top tube Identify as acute or convalescent CSF is also an acceptable specimen ETTE full tube min 3 mls blood in red top gold top or geen blac
156. ign take a verbal response and note Verbal in patient signature area Read the second statement on the T P record for the person collecting the specimen and sign stating that you have properly identified the patient labeled specimen properly and correctly armbanded the patient On the bottom of this T P record note who initialed the specimen as the identification verifier Mark as patient friend or famly member of patient or the Cerner sign in of the UVMC employee Deliver specimen slip with remaining stickers and paperwork to Blood Bank Also send a copy of the physician s orders to Blood Bank so the Blood Bank tech can confirm what is ordered 1 EMERGENCY REMOVAL OF ARMBAND AND REPLACEMENT Occasionally circumstances may require removal and replacement of the green Blood Bank Identification Armband When this becomes necessary the laboratory should be notified PRIOR to the armband removal A laboratory staff member SHOULD be present for the transfer see note below The lab staff will bring a new green armband and will remove the identification materials from the armband removed from the patient IN THEIR PRESENCE Lab staff will insert the identification materials in the new green armband will attach it to the patient s arm Lab personnel will fill out a Blood Bank 170 2 Identification Transfer Record which will be kept on file in the Blood Bank until that specimen has become outdated NOTE In an emer
157. ile urine container 91 Test Description ABCDEFG HIJ KLMNOPQRSTUVW Somatomedin C IGF I insulin like growth factor Somatostatin QU 34480X 1 full tube 7 ml tube blood in Pre chilled lavender top EDTA tube Separate and freeze plasma immediately Special Stains Histology Specific Gravity SPEP Sperm Post Vas Stone Analysis Stool Fat Qualitative Stool Fat Quantitative Stool pH Stool WBC Stool Reducing Substance Stool Rotavirus Stool Staph Yeast QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ 1 full tube min 3 mls blood in red top tube or gold top tube Centrifuge QU 24844P within 1 hour of collection and transfer to a plastic vial Freeze specimen Plasma is no longer an acceptable specimen Call Histology to order x4638 Fill out Surgical Pathology Form AFB Alcian Blue Congo Red Giemsa Helicobacter GMS fungus Iron Mucicarmine PAS Pneumocystis Trichrome 10 mls Random Urine no preservative in a sterile urine container See Protein Electrophoresis See Semen Analysis Post Vasectomy a QU 5022X Collect 10 30 grams stool in a plastic container Seal container in a plastic bag before shipping Store and ship frozen TT See Rotavirus Antigen Order Gram Stain 92 er QUEST send out F p Test Description r an mi Specimen Instructions Tube Lab Use Only indicated gt
158. imen Instruction Tube Culture Fungus w stat KOH In house PREFERRED SPECIMEN Raw specimen any source other than blood hair skin or nail Raw stool specimens are unacceptable Submit stool in stool culture transport medium Collect oral nose nasopharynx ear eye wound or urethral specimens using culture swab transport system liquid medium Use sterile plastic container for respiratory secretions body fluid tissue CSF urine contact lens or contact lens fluid For tissue samples add a small amount or saline to sample Transport raw specimens refrigerated transport swab specimens at room temperature Culture Fungus Misc QU 5801E PREFERRED SPECIMEN Raw specimen any source other than blood hair skin or nail Raw stool specimens are unacceptable Submit stool in stool culture transport medium Collect oral nose nasopharynx ear eye wound or urethral specimens using culture swab transport system liquid medium Use sterile plastic container for respiratory secretions body fluid tissue CSF urine contact lens or contact lens fluid For tissue samples add a small amount or saline to sample Transport raw specimens refrigerated transport swab specimens at room temperature Fungus Culture Blood QU 6015P Special tube 10ml Sodium Heparin whole blood plain green rubber stopper GC Screen Culture In house Microbiology transport media red or blue cap DO NOT REFRIGERATE S
159. in a sterile container without fixative Transport the specimen immediately to the Labs Histology department for processing Calling the Histology department at 4638 as soon as the specimen has been collected informing them of the specimens pending arrival into the lab MUSCLE BIOPSY Quadriceps are preferred because they are easily oriented gastrocnemius biceps deltoid or any site are acceptable A 1 x 0 5 x 0 5 cm minimum muscle biopsy needs to be place on sterile telfa pad moisten with sterile saline and placed in a sterile specimen transport container do not add any other type of fixative Note DO NOT clamp suture or affix muscle to tongue blade Transport the specimen immediately to the Labs Histology department for processing Calling the Histology department at 4638 as soon as the specimen has been collected informing them of the specimens pending arrival into the lab Notify the Histology department at 4638 the day before collection this will alert the histology personnel and pathologist of the collection The histology department can then make any additional arrangements that are needed SURAL NERVE BIOSPY A 3 cm piece of nerve is required one segment 2 6 cm in length is to be placed on a sterile telfa pad moisten with sterile saline and placed in a sterile container do not add any other type of fixative Transport the specimen immediately to the Labs Histology department for processing Calling the Histology de
160. ination of the patient sample during venipuncture and inoculation into the culture bottles since contamination could lead to a specimen being determined positive when a clinically relevant isolate is not actually present Blood cultures must be collected from peripheral venipuncture sites If the patient is currently receiving a transfusion the blood cultures may be collected from the other arm Use of indwelling intravenous or intra arterial catheters line draws should be avoided unless 1 The patient s blood cannot be obtained with a venipuncture Prior to using a line draw have the nurse on charge notify physician and obtain permission to obtain the blood culture from the line Documentation of this order is required in the patient s chart 2 The patient s physician specifically orders the blood to be collected from the line source to rule out infection of the access device itself Note If possible obtain specimen prior to initiating antibiotic therapy If this is not possible blood cultures should be drawn immediately before administration of the next dose 1 Locate vein to be used Use a sterile 70 alcohol prep to cleanse skin over venipuncture site rubbing briskly 2 Remove iodine or ChloroPrep disinfectant ampule With the tip in downward position pinch center to crush ampule Pump lightly until tip is saturated flow of antiseptic can be regulated by finger pressure Apply iodine Chloroprep to 145 venipuncture
161. iners If the specimen is liquid or loose a portion of unpreserved stool is also requested but not required Keep all containers at room temperature The stool in the pink and gray capped containers is stable for 14 days The specimen can be returned to the outpatient department at UVMC or to one of the outreach facilities Hyatt Stanfield Medical Services North or Medical Services South Collection of Stool for Clostridium Difficile White capped container with no liquid inside 1 Collect the specimen in the clean over the toilet container that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine 2 Transfer the stool specimen into the white capped container This container should not have a preservative in it Recap the container and label with your name and date time of collection Refrigerate this container Transport to the hospital within 24 hours for testing Collection of Stool for Occult blood Follow directions from your physician regarding drug or diet restrictions Diet and Drug Guidelines Eat a well balanced diet including fiber such as bran cereals fruits and vegetables For three days before and during stool collection period avoid red meats beef lamb and liver For seven days before and during the stool collection period avoid non steroidal anti inflammatory drugs such as ibuprofen Motrin Advil naproxen or aspirin more than one adult aspirin a day Acetomi
162. ines plasma Catecholamines Urine 24 hour Fractionated QUEST send out test QU if Lab Use Only Specimen Instructions Tube indicated XYZ MENEE 1 ml of random urine collected in a plastic container Keep refrigerated No preservative OO esemme OOOO a e QU 10793A 1 full red or gold top tube Centrifuge and separate serum from cells Ship Refrigerated A full Lt Blue top tube is also acceptable 1 full tube blood in redtop tube or gold top tube Protect from light by QU 20537P wrapping tube in aluminum foil Centrifuge within 1 hour of collection No vitamin supplements 24hours prior to testing Frozen Special Instructions Call Lab 2 full green or green black tubes Tube should be chilled prior to drawing patient Plasma should be separated in a refrigerated centrifuge within 30 minutes of collection and frozen immediately QU 314X at 20C Patients should be relaxed in a supine or an upright position before blood is drawn Indicate on requisition if the patient is supine or upright Patient should avoid alcohol coffee tea tobacco and strenuous exercise prior to collection Overnight fasting is required Frozen 10 ml aliquot of urine from a 24hr collection Collect urine using 25ml of 6N HCL or 15gm of boric acid as a preservative It is preferable for the patient to QU 4168N be off medications for three days prior to testing Call lab for details Patient should also avoid alcohol coffee
163. into other containers aliquot specimens for each testing department or reference laboratory Procedure If when specimens are received into the laboratory and need a aliquot due to only receiving a minimum amount of specimen for different testing departments reference laboratory or to meet specimen requirements specimen needs separated from cells specimen needs sent frozen in plastic container mix specimen with additive extra specimen saved each secondary specimen needs patient name and a unique identifier to ensure that the container is labeled correctly Refer to the policy Specimen Labeling for further information The original container is refrigerated and stored for seven day The laboratory barcode sticker can be placed on the secondary container or can be hand written with a permanent marker An aliquot sticker from the barcode is acceptable Each aliquot specimen is labeled with the specimen type i e plasma serum csf fluid urine ect to ensure the original specimen type that was collected New procedure prepared by T Cheney Date 1 28 03 Revised procedure prepared by 1 Cheney Date 11 5 08 Supercedes procedure written 12 28 04 117 Glucose Tolerance Testing 2 Hour 3 Hour 4 Hour and 5 Hour Phlebotomy Procedure Procedure 1 7 Properly identify the patient by using two identifiers and make certain that the patient is fasting Make sure that there are no other conflicting procedures ordered i e X ray
164. ion ODH send out Submit specimen in clean dry urine container Call lab to schedule an examination Exams are done only on First Shift a O Ab QU 53702E 1 full tube min 3 mls blood in gold top tube or red top tube Aspirin Salicylate inhouse f full red top tube AST SGOT inhouse f full tube min 3 mls blood in green black top tube or gold top tube Autoclave Indicator Check Call Lab Autologous Blood inhouse Order Crossmatch 1 unit Autologous CBC Patient must have donated unit prior to admission Aventyl QU 38729W 1 Full red top green top or lavender top tube Do not use sst serum separator tubes Call Lab 2 swabs collect nasopharyngel specimen using a calcium alginate B Pertussis Culture w Smear Qu 2246F Dacron swab Place 1 swab in Bordetella Regan Lowe transport Bordetella Pertussis medium Use the second swab to prepare two slides Allow slides to air dry Room Temp Collect 1 nasopharyngel swab or aspirate using mini tip calcium alginate or QU 34966X Dacron swabs Use swab to prepare 2 slides Air dry Do not fix slides Label slides and keep at room temperature Room Temp Bacterial ID Anaerobic QU 84830N Pure culture isolate on swab in anaerobic transport tube or plate in anaerobic bag Do not refrigerate or freeze Indicate source on test requisition Basic Metabolic Panel BMP Sodium Potassium Chloride CO2 Gluc In house 1 full tube min 3 mls blood in green black top tube or go
165. ion label is available as in downtime label the specimen with the following a Patient name first and last b Patient medical record number c Date and time drawn d Collector name first initial and last name e Test ordered Send the specimen and paperwork to Blood Bank NOTE Specimen labeling must occur at the same time that the patient is identified and the specimen is collected to eliminate errors in identification Cord blood specimens can be labeled with mom s or baby s identification plus cord blood so the Blood Bank personnel know what type specimen it is IN BLOOD BANK When the specimen arrives in Blood Bank compare the request form and the specimen label If there is any discrepancy or doubt resolve the problem before performing any tests with the specimen Another specimen should be collected if there is any doubt of patient identity Supersedes _03 01 06 176 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N Dixie Hwy Troy OH 45373 CRITERIA FOR UNACCEPTABLE BLOOD BANK SPECIMENS LABELING All specimens received must have adequate labeling see procedures on Blood Bank Identification with armband or without armband If specimens received are not adequately labeled consult with the specimen collector about labeling or recollection before performing the requested tests IDENTIFICATION DESCREPANCY Before a specimen is used in Blood Bank the Blood Bank employee will confirm that all
166. iquot from a 24hour urine collected with no preservative Urines collected with 6N HCL glacial acetic acid 24 hr Urine Cortisol Free QU 11280X or boric acid are acceptable Record 24hour urine volume on requisition and urine vial Random urine specimens are also acceptable there are no reference ranges for random urines 10 ml aliquot from 24hour urine collected with no 24 hr Urine Creatinine In house preservatives Record total volume Pick up container from lab Keep refrigerated 20ml aliquot from a 24hour urine collection Place 10gm of 24 hr Urine Hydroxycorticosteriods QU 15202X boric acid into container at the start of collection Record total volume Pick up container from lab Keep Refrigerated 102 Test Description 24 Hour Urines Click here to access 24 hour urine Collection Procedure QUEST send out test QU if indicated Specimen Instructions Tube 24 hr Urine Magnesium QU 6213N 10 ml aliquot from a 24hour collection Collection container must contain 25ml 6N HCL Call lab for collection container Record total volume 24 hr Urine Metanephrine QU 14962X 25ml aliquot of 24hour urine collected with 25ml 6N HCL or 25ml or Acetic Acid Urine without preservative is acceptable if PH is below 6 and the Sample is shipped frozen It is preferable that patients to be off all medications for three days prior to and during collection however there are some exceptions call lab
167. issue Wound abscess aspirate material and bone Mycobacteria Culture Tissue QU 1313A marrow Place aspirated materials into a sterile screw capped container Refrigerate Collect Bone Marrow in a heparinized tube 50 mls urine in sterile container Collect first morning urine by midstream or catheterization after appropriate cleansing of area Mycobacteria Culture amp Stain Urine QU 10355F Send entire specimen no preservative needed Specimen is stable three days refrigerated Do not collect urine from drainage bag when an indwelling catheter is in place Refrigerate Lab Order Only Call Lab for ordering and collections Test to Single Organism culture In house be used in event of suspected outbreak or following consultation with Infection Ctrl Dept Sputum Culture Gram stain incl house Sputum in sterile container To LAB within 1 hour or refrigerated Lower respiratory for up to 24 hours Strep A throat Culture In house Microbiology transport medium double swab red cap Strep screen Group B Culture or i house Microbiology transport medium swab red or blue cap Group B Strep Screen or Culture Acceptable specimens Vaginal introitus and or Anorectum Group B Strep Special Instructions Stool in sterile container Send to Lab ASAP specimen must be processed within 1 hour or place Stool Culture or GI Stool Culture sample into orange topped Cary Blair preservative which has In house Room Temp or Culture Stool stabil
168. issue fluid that may contaminate the specimen Do not use a cotton ball because fibers from the cotton ball may accidentally be put into the microtainer and can cause problems while testing the specimen 8 Using moderate pressure let blood drip into the correct microtainer tube Make sure to release pressure between blood drops This allows for re circulation of new blood If collection blood sample in an anticoagulant additive microtainer tube make sure to turn the tube as you collect the specimen to make sure the blood catches the additive on the way 141 9 down the tube this will help avoid a clotted specimen Do not squeeze the finger or heel excessively as this will cause dilution or hemolysis of the specimen After collection seal the specimen container and hold gentle pressure on the puncture site until bleeding has stopped then apply a Band Aid or a spot Band Aid 10 If an insufficient sample has been obtained because the blood stopped flowing repeat the puncture at a different site using a fresh lancet 11 Make sure to dispose of the lancet into the sharps container 12 Label tubes appropriately with all pertinent information including your Cerner user ID TIPS FOR SUCCESSFUL HEEL DRAWS 1 2 3 4 Heel punctures should be performed on infants less than 12 months old unless the child is walking or the heel is too big to hold effectively Pre warming the heel increases capillary circulation Know the am
169. ith no liquid inside 1 Collect the specimen in the clean over the toilet container that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine If the collection is done on a 24 diaper wearing child the diaper can be lined with plastic wrap to prevent absorption of the stool into the diaper Be certain not to contaminate the stool with urine 2 Transfer a small amount approximately a teaspoon of the stool specimen into the white capped container This container should not have a preservative in it Recap the container and label with your name and date time of collection Refrigerate this container Transport to the hospital within 24 hours for testing Collection of Stool for WBC White Blood Cells White capped container with no liquid inside 1 Collect the specimen in the clean over the toilet container that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine 2 Transfer a small amount approximately a teaspoon of the stool specimen into the white capped container This container should not have a preservative in it Recap the container and label with your name and date time of collection Refrigerate this container Transport to the hospital within 24 hours for testing Collection of Stool for Reducing Substances White capped container with no liquid inside 1 Collect the specimen in the clean over the toilet co
170. ity up to 96 hours Prior use of purgatives may interfere with testing If patient has been medicated with bowl evacuation test only with physician approval DO NOT Refrigerate 110 Test Description Cultures QUEST send out test QU if indicated Specimen Instruction Tube Stool Culture with Yersinia workup or Culture Stool with Yersinia Workup In house Special Instructions Stool in sterile container Send to Lab ASAP specimen must be processed within 1 hour Or place sample into orange topped Cary Blair preservative which has stability up to 96 hours DO NOT Refrigerate Room Temp Surgical Culture smear incl In house Microbiology transport media red or blue cap Throat Culture Upper Respiratory In house Microbiology transport media double swab red cap Urine Culture In house Urine in sterile container CC or cath specimen which is stable 1 hour at room temp and 24 hours refrigerated or 4 10 mls of urine in a grey top urine device which is stable for 48 hrs at room temp Viral Culture QU 689X Submit swabs lavages fluids urines 3ml biopsy CSF 1ml amniotic fluid or seminal fluid 3ml in M4 transport media For stool samples add 1 gm of stool to 3ml of M4 media Refigerate If specimen is blood or bone marrow order the individuarl viral PCR rest Refrigerate Wound Culture gram stain incl In house Microbiology transpo
171. ium Heparin anticoagulant Contains a gel barrier Contains Buffered Sodium Citrate anticoagulant Does not contain a gel barrier Contains Potassium Oxalate anticoagulant Does not contain a gel barrier Contains K2 EDTA anticoagulant Contains a gel barrier 130 VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio 45373 VENIPUNCTURE PROCEDURE PURPOSE Proper collection of a blood specimen for laboratory analysis is essential for the correct diagnosis and care of the patient PROCEDURE 1 Verify the patient by using the two patient identifiers name and date of birth Fig 1 If there are any discrepancies notify the patient s nurse right away If an inpatient does not have an armband do not draw their blood Have a nurse identify the patient for you and have them place an armband on the patient If the patient is incoherent verify the patient by the armband If you are drawing an outpatient ask their name and date of birth Verify these against the orders NOTE Blood Bank requires special armbands to be placed on the patient by you if you are drawing for any Blood Bank procedures This includes inpatients and outpatients see the Blood bank procedures if you are unsure of any issues Please refer to the procedure Specimen labeling to ensure you have identified the patient correctly and follow UVMC s guidelines for specimen labeling Verify the test requisition by checking the barcode label The barco
172. k top tube QU 4451X 1 full tube red top tube or gold top tube Separate and Freeze serum immediately in a plastic vial Hemolyzed samples not acceptable 10 ml aliquot of urine from a 24hr collection with no preservative Call lab for In house container Keep refrigerated Record total volume See 24 Hour Urine Collections Procedure 1ml random urine in a sterile container na See C Reactive Protein ees See C Reactive Protien Cardio See C Reactive Protein Wide Range Special Instructions Call Lab for Special Preparations Test must be QU 36562X drawn at UVMC Out Patient Lab Draw 10 ml red top tube Deliver tube immediately Place tube immediately in a 37C water bath for 1 hour to clot Centrifuge and separate serum Ship specimens at Room Temperature in house Call Blood Bank Special Order Specimen is associated with Type amp Rh May need to order Type amp Rh 3 QU 11197X 1ml CSF in sterile screw cap container Freeze and do not thaw Positive results will prompt a reflex test Oo oO QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW 1 ml body fluid State fuid source Transport in sterile container at room Graci BEeninciar Ih neues temperateure ASAP For bile samples only send to lab immediately For off site y collections Centrifuge in a sterile screw top tube pour off supernatent and freeze sediment Transport frozen sediment via courier CSF FLUIDS E
173. king to patients since many times these patients are lonely H Good communication skills are essential Have patience because many times older patients do things in slow mode J Examine your own feelings about death and dying since many older patients are in the terminal stages of disease K Show compassion and understanding L Remember that gravity is your friend and hang the hand or arm over the edge of the bed or table 7 Tips for successful pediatric venipunctures A Always try to explain exactly what you will be doing to a child B Be honest with the child if they ask questions about the procedure or if it will hurt them C Let them participate by holding a sticker or Band Aid D Make sure all equipment is ready ahead of time E Know the quantity of blood needed for the tests to be drawn and stick to the minimum recommended amount needed F Talk to children in a reassuring manner G Some children will try to stall the procedure and you may have to be firm in dealing with these children H Understand that some children will not be reassured or calm at all and you may just have to go ahead with the procedure without explaining everything in detail as with these type of children this will just make it worse and they will just become more upset 138 z aN f BICEPS MUSCLE X PN y yy ZF BASILIC VEIN CEPHALIC VEIN EICEFS TENDON per 4Z Uy Mz ARTERY Z MEDIAN MEDIAN CUBITAL VEIN VEIN
174. l CSF in sterile container 2 full tubes blood in red top or gold top tube Fasting specimen is preferred QU 5077 Hemolysis lipemia and plasma specimens may be rejected Samples that have been left uncapped are unacceptable due to evaporation 1 full tube min 3 mls blood in red top tube or gold top tube Fasting QU 687T specimen is preferred Hemolysis lipemia and plasma specimens may be rejected Samples that have been left uncapped are unacceptable due to evaporation 10ml random urine no preservative in urine container Cs ESS First morning specimen preferred 10mls of urine from a 24hour collection No preservative Discard first QU 750X morning specimen before starting the 24hour collection Random first catch morning urine sample are also acceptable See 24 Hour Urine Collections Procedure 50mls of urine from a 24hour collection Random urine is also acceptable PUE IEA Ie See 24 Hour Urine Collections Procedure inhouse 1 full tube of blood in lavender top tube 1 ml min draw on 3 ml tube or 3 ml min draw on a 7 ml tube QU 22376R_ 1 full tube of blood in a red top or gold top tube QUEST send out Test Description ia a if Specimen Instructions Tube Indicated Epstein Barr Virus AB Panel EBV Nuclear Ag IgG Epstein Barr VCA IgG QU 6421X l full eed of blood in oe tube mee top tube Grossly lipemic and Ab and Epstein Barr VCA IgM Ab gmo ee Se hore WOS aera gt z 1 full tube min 3mls of blood i
175. l be associated with Type amp Screen May need to order Type amp Screen Patient must have armband Ordered from 7 Ordered from 1 full tube whole blood in preferred EDTA lavender top or sodium heparin Rapamune Sirolimus QU 36712P_ green top or Royal Blue EDTA tube Optimal time to draw specimen is 30 to 60 minutes before the next oral dose 87 QUEST send out Test Description test QU if Specimen Instructions Tube Lab Use Only indicated ABCDEFG HIJ KLMNOPQRSTUVW 5 Ordered from RBC Leukoreduced In house test See Above Call blood bank for Stat or ASAP ORDERS RBC Leukoreduced Irradiated CMV Ordered from See Abeve Neg CBC XYZ Collect 10 30 grams of stool in a plastic container Seal container in a plastic bag before shipping Store and ship frozen Do not ship in metal cans P duem DE ANTE ECA tea QUR oza Specimens greater than 4 hrs old at room temperature or greater than 24 hrs old refrigerated will be rejected Reducing Substance Urine E See Urine Reducing Substance Renal Panel Sodium Potassium Chloride CO2 Gluc In house 1 full tube blood in green black top tube or gold top tube BUN Creat Calcium Albumin amp Phosphorus Renal Panel minus glucose 1 full tube blood in green black top tube or gold top tube 00 0 0 Test Description ABCDEFG HIJ Renin Activity Plasma Reticulocyte Count Retinol Rheumatoid Factor Rho Gam Worku
176. l be transported to the Laboratory immediately after collection Package the specimen in a red transport bag which indicates stat and send the specimen to the Laboratory with the courier 5 Observe the specimen for the presence of a dense clot after the 30 or 60 minute clotting time Samples from certain populations of patients including coumadin and heparin drug therapy and impaired coagulation may require longer clotting times If a dense clot is not observed do not centrifuge specimen allow the specimen to clot for an additional 30 minutes Serum must be separated from the red blood cells as soon as possible with a maximum time limit of 2 hours Once a dense clot is visualized the specimen can then be centrifuged for 15 minutes at 3500 RPM Refer to Centrifuge Operation and Maintenance Procedure for additional centrifuge directions Notify Laboratory personnel immediately if specimens cannot be centrifuged due to equipment failure or other reasons these specimens must be delivered to the Laboratory within 2 hours of collection to be centrifuged by Laboratory personnel 125 7 Visually check specimen to ensure proper centrifugation It is extremely important that the serum is completely separated from the red blood cells See figure 1 a The gel barrier in SST tubes adequately separates the serum from the cells once the specimen is properly centrifuged b The no gel barrier tubes must have the serum aspirated off the red blood
177. l body fluid in EDTA or Heparin to prevent clotting State Body Fluid In house Source 0 5 ml body fluid in a sterile container State source of fluid In house Sterile container state source 0 5 mls body fluid in a sterile container State Source of fluid 0 5 mls body fluid in a sterile container State Source of fluid A QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABER ENG Hii KLMNOPQRSTUVW Body Fu LDH Fluid aspirated anaerobically into a syringe rinsed with heparin and sent to Body Fluid pH Lab ASAP on ice State Source Body Fluid Protein Total 1 ml fluid in a sterile container State Source Body Fluid Triglycerides 0 5 ml fluid in a sterile container State Source Body Fluid Uric Acid 1 ml body fluid in a sterile container State Source Bone Marrow amp Biopsy Collection and In house Call Histology x4638 to schedule a time for procedure Preparation Bordetella Pertussis culture QU 5260X See B Pertussis culture w Smear Collect 1 nasopharyngeal swab or aspirate specimen using mini tip calcium Bordeiaila Penuesic GmeabES QU 34966X alginate or Dacron swab Use swab to prepare 2 slides Allow slides to air dry Do not fix slides Label slides and keep at room temperature Room Temp Borrelia burgdorferi a See Lyme Disease Antibodies 1 full 3 5 ml tube blood in Dark Purple Black tube Draw separate specimen for this test
178. l from the order Use the second barcode on the insulin label to label the 2 hour collection making sure to label the tube as the 2 hour specimen with the collection date and time New procedure prepared ala_ date 3 12 07 H labsuper lis computer manuall insulin resistance challenge 2 hr 122 CLEANING AND SUPPLYING THE BLOOD COLLECTION TRAY The drawing tray used by Phlebotomist and Technicians should be kept clean at all times Many people and patients see our trays and the laboratory should maintain a neat clean and professional appearance Items kept on the trays should be arranged in a logical sequence and must be well stocked Each drawing tray should be cleaned with at least 10 bleach to 90 water solution every week and all expiration dates of items on each tray will be checked at the same time Each phlebotomist is responsible for maintaining this schedule Every tray should contain these items Serum Separator Tubes Lavender Top Tubes Blue Top Tubes 2 7rnl and 4 5rnl Red Top Tubes Green Top Tubes lithium and sodium Lancets for finger sticks and heel sticks 21 22 23 and 25 ga Safety Needles for syringes 21 and 22 ga Safety Vacutainer Needles Butterfly Safety Needles various sizes Alcohol Prep Pads Gauze or Cotton Balls Two Tourniquets Vacutainer Holders Vacutainer Transfer Device Betadine Band Aids Tape Sharps Container Pen An adequate supply of all these items should be checked before going to
179. last first and initial 2 Patient s medical record number if available 3 Patient s birthdate 173 4 Date time of collection 5 Name of person collecting the specimen first initial and last name 6 Mandatory unique ID number D Blood Bank Armbanding 1 Label armband insert with the following Patient s name last first and initial Patient s birthdate Date time of collection Name of the person collecting the specimen first initial and last name Mandatory unique ID number Dango 2 Place insert into the green Blood Bank armband Securely fasten the Blood Bank armband around the patient s wrist Put the armband on so that it is comfortable for the patient but tight enough that it will not slide off over the wrist NOTE The Blood Bank armband should be placed on the patient s wrist with other identification bands In accordance with nursing policies the armband should never be removed unless the patient s welfare necessitates such removal In this event another green Blood Bank should be securely affixed immediately to the same or a different part of the patient s body The Blood Bank band and a Blood Bank Identification Transfer Record form can be obtained from Blood Bank The transfer record must be completed and sent to the Blood Bank as documentation of the band switch See below for details 3 As a second identification check have the patient look at the specimen tube and initial the tube sho
180. ld the heel gently but firmly This can be done in one of these two ways A Place the forefinger over the arch of the foot and the thumb below the puncture site at the ankle or B Place the forefinger around the ankle and the thumb over the arch of the foot When holding for a finger stick make sure to hold the finger to that the patient does not pull away at the last minute before the puncture is fully done Make sure that your thumb is well away from the puncture site 6 Using only laboratory approved safety lancets perform the heel puncture in one smooth continuous motion and perpendicular to the puncture site Punctures should be made on the medial or most lateral portion of the plantar surface the shaded areas in the illustration It is also recommended that you do not perform heel sticks on the posterior curvature of the heel The depth of the skin puncture in the heel is important in infants particularly neonates It must not exceed 2 4 mm Penetration of the calcaneous bone osteomyelitis and sepsis have all been reported as potential complications For a finger stick the puncture should be made into the pulp of the finger as shown in the shaded area of the illustration in one continuous smooth motion It should not be directed toward the bone AAA 1 gt te 1 yi tll pas ncorres z Corres 7 Wipe away the first drop of blood using the gauze Wiping away the first drop of blood removed any t
181. ld top tube BUN Creat amp Ca B Pertussis Smear DFA Bordetella Pertussis oO 00 QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ Ae rece Panel minus glucose 1 full tube min 3 mls blood in green black top tube or gold top tube Bence Jones Oooo See Immunofixation Urine Beta 2 Microglobulin CSF QU 5500X 1mIl CSF collected in a sterile container Beta 2 Microglobulin Serum QU 19521E 1 full tube min 3 mls blood in red top or gold top tube Hemolyzed specimens are unacceptable 1ml random urine Frozen Special instructions Patient should void bladder then drink at least 500ml of water A urine sample should be Betara Microdobulin Unne QU 4944X collected within 1 hour and ph adjusted to PH 6 8 with 1M NaOH Notify lab when sample has been collected Frozen Bicarbonate CO2 or Carbon Dioxide 1 full tube min 3mls blood in redtop tube or gold top tube Bilirubin Cord Blood j tntouse full red top tube Protect specimen from light Bilirubin Direct inhouse 1 full tube min 3 mls blood in green black top tube or gold top tube gel Protect specimen ru light Bilirubin Fractionated See Indirect bilirubin Bilirubin Indirect Please order both Direct and Total Bilirubin Sirab Tol EE 1 full tube min 3 mls blood in green black top tube or gold top tube Protect specimen from light
182. leanse the site again 11 Perform the venipuncture Always wear gloves during the entire venipuncture procedure Use appropriate needle size and always inspect needle and tubes for any defects or flaws Hold the patient s arm approximately 1 2 inches below the venipuncture site 133 Anchor the vein by pulling the skin tight or taut with your thumb Press down on the arm and at the same time pull the skin toward the hand The fingers of the hand should be around the underneath grasping the arm as the thumb stretches and holds the vein taught See Fig 9 Make sure the bevel of the needle is upward and in line with the vein Puncture the vein in one smooth quick motion at a 15 degree angle Fig 11 Do not hesitate As the needle enters the vein a little give will be noted Hold the syringe or vacutainer firmly with one hand at a 15 degree angle Fig 11 With the opposite hand either pull back on the plunger of the syringe slowly or push the tube as far as it will go the gt bottom of the vacutainer holder Fill the appropriate NEEDLE BEVEL UP tubes The order is as follows Blood Culture Light Blue second Red or tiger top mottled red gel separator tube Green and light green heparin tubes Purple Pink or white Gray Dark Blue Royal Blue last Have the patient release their fist FIG 13 and release the tourniquet GAUZE PAD OR dul L Position the gauze or cotton ball S GOER
183. lease call Outpatient testing at 440 4568 Monday thru Friday 6 30 am to 6 00pm or on Saturday 07 00 am to 12 00 pm You may call the laboratory 440 4645 at anytime Please note that you will need to go through the registration process when bringing the specimens to the hospital for testing Note Warning on container labels that the fluids in these containers are harmful if swallowed and should not be ingested If you cannot fill all the required containers from one stool collection it is acceptable to add stool from another collection if it is within the same day as the first sample Collection of Stool for Culture Orange Cap Container Directions for placing the stool sample into the preservative must be followed carefully Stool samples for culture testing must be put into preservative solutions within 1 hour of collection 1 Collect the specimen in the clean over the toilet container that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine 2 Transfer enough stool specimen into the orange cap container to raise the level of the liquid to the red line Do this slowly and in small increments if possible to avoid overfilling the container DO NOT ADD AN EXCESSIVE AMOUNT OF SPECIMEN WHICH CAN CAUSE THE LIQUID TO GO OVER THE RED LINE Overfilling or under filling will be reason for rejection of the specimen and recollection will be necessary 3 Recap the container tightly
184. lood specimens There are three acceptable types of blood specimens used for clinical testing whole blood serum and plasma Whole Blood A whole blood specimen is collected using a tube that contains an anticoagulant A whole blood specimen is never centrifuged for testing This means that the cells in the blood are not separated from the serum plasma Thus the specimen remains in whole blood form When drawn from a vein a whole blood specimen usually appears dark red purple in color Serum A serum specimen is collected into a tube that does not contain any anticoagulant This means that eventually the blood will clot in the tube Once the blood has clotted the specimen is centrifuged Centrifugation separates the cells from the serum Thus serum is the product that remains after the blood has clotted and been separated from the cells Serum usually appears as light yellow in color and translucent in consistency depending on the amount of hemolysis and lipemia Plasma A plasma specimen is collected into a tube that contains anticoagulant This means that the blood will not clot in the tube The specimen is immediately ready to be centrifuged Centrifugation separates the cells from the plasma Thus plasma is the product that contains anticoagulant and has been separated from the cells Like serum plasma usually appears as light yellow in color and translucent in consistency depending on the amount of hemolysis and lipemia The O
185. lp with any explanation that is needed After the patient signs the form print the patient s name and Medical Record number next to the signature The HIV consent from needs to be placed with the patient s chart or scanned in the system There is no age limit for HIV testing and anyone may sign for themselves After the patient has signed the HIV consent form see attached the specimen can be drawn and sent to the lab for testing New procedure prepared by 1 27 97 tmc Superseded procedure written 1 22 99 tmc Revised procedure prepared by T Cheney 1 03 07 154 Ohio Department of Health 246 N High Street P O Box 118 Columbus Ohio 43266 0118 CONSENT FORM FOR HIV ANTIBODY TEST What is HIV The Human Immunodeficiency Virus HIV is the virus that causes AIDS Acquired immune Deficiency Syndrome How Do People Get HIV People may be infected by 1 By having sex with someone whom is HIV infected and not using a condom Vaginal anal and oral sex can spread HIV 2 Sharing the same needle while using drugs with someone who is HIV infected 3 Having a blood transfusion before 1985 4 Being born to a mother who is infected with HIV How is an HIV Test Done A sample of your blood or other body fluid is tested for antibodies If the test is positive more tests are done on the same sample to make sure the first test was right If the other tests come back positive you are considered to be infected What Does A Positive Te
186. lts that were not called upon release documenting time called and to whom in Cerner in Order Notes Then document on check off list in Chemistry initial printouts and place them in designated space in Chemistry CALLING PROCEDURE FOR OUTPATIENT CRITICAL RESULTS When calling an outpatient s critical results to the physician use the following options for locating the physician A lf the physician msp has given a telephone number where he she may be reached dial that number first Otherwise call the physician office during normal business hours B Attempt to contact the physician msp by pager through the UVMC operator Make sure you tell the operator to page the physician msp stat If the operator does not get a response back from the physician msp and they have used all available methods of contact they will inform the original person requesting the page that the physician msp has not called back Proceed to step C and or D C If the physician msp does not call back in a timely manner inform the immediate supervisor and or the Laboratory Administrative Director or Laboratory Medical Director D The Laboratory Medical Director or designee should contact the section chief through the UVMC operator FOR NON UVMC PHYSICIANS Call the number provided or the one we have on record If the physician msp cannot be located by page within 30 minutes contact the pathologist on call If needed the pathologist will contact the patient advisi
187. marcations on the bottle label indications sufficient blood volume 5 10 ml Do not overfill Volumes greater than 10 cc do not maintain the optimal blood to medium ratio 4 After obtaining the required volume of blood in the aerobic bottle move the Adapter Cap from the aerobic bottle to the anaerobic bottle if required and collect 5 10 ml of blood into the bottle do not overfill Do not remove the needle from the patients vein during this process 5 After blood collection is complete remove the Adapter Cap form the blood culture bottle If additional blood is required for other tests place the Adapter Insert into the Adapter Cap and lock into place This makes the cap compatible with vacuum collection tubes When all blood has been collected remove the needle from the patient s vein 146 Always notify the care giver after collecting the last set of blood cultures because they are most often waiting to start or change antibiotic therapy Transport all bottles promptly to the microbiology laboratory If bottles cannot be loaded into the instrument at once hold at 35 C or room temperature until loading occurs Do not refrigerate inoculated bottles at any time If inoculated culture bottles have been delayed in their receipt into the laboratory or have been incubated prior to entry into the BacT Alert instrument visually inspect them for indications of microbial growth If microbial growth is evident treat the bottles as positive and
188. men Forms that accidentally do get contaminated must be discarded in proper waste containers and replaced Fig 15 16 Ice or warm specimen if appropriate i e Ammonia Cyclosporine etc kkkkkkkkkkkkkkkkkkkkkk kkkkkkkkkkkkkkkkkkk You may now remove your gloves 17 Wash your hands 18 Before leaving the room make certain all used equipment has been properly disposed of and that the bed rails have been put back up if moved 19 Leave the patient in a courteous manner QUALITY ASSURANCE 1 Do not attempt to draw a patient more than twice Per phlebotomist Either have another Phlebotomist or Technician try to obtain the specimen or notify your supervisor of the difficult draw If more than three people have been unsuccessful in obtaining the specimen notify the patient s nurse and explain the situation Ask the nurse to notify the ordering Physician The ordering Physician will have the option of collecting the specimen himself having the Respiratory Therapy obtain an arterial specimen or having an Anesthesiologist attempt the draw If anyone outside of the laboratory collects the specimen make sure that they have the correct tubes and know the specimen requirements Contact the Medical Director for guidance if all other options fail 2 Mastectomy Side The use of the arm on the mastectomy side for venipuncture should be avoided If you are unable to locate another acceptable venipuncture site have the patient s nurse
189. mens A disclaimer will then be attached to the report stating the specimen was received unlabeled or mislabeled The disclaimer will be added to the test result under Result Comments in order to be visible to the clinician The disclaimer forms for documentation of the information are located in the Registration room and in the processing department D SPECIMENS COLLECTED BY NON UVMC PERSONNEL Unlabeled specimens collected by non UVMC personnel i e doctor s offices or nursing homes will be accepted if the collector can positively identify them A disclaimer will be added to the test result under Result Comments stating that the specimen was received unlabeled and was identified by the collector The registration processor handling the specimen will attach the disclaimer slip listing all the relevant information to the specimen barcode so that the resulting technologist can enter the information into Result Comments If the specimen arrives on an off shift when the collecting personnel cannot be contacted i e physician office that is closed and specimen stability is an issue run the tests and hold the results until Clarification is received Mislabeled specimens that are collected by non UVMC personnel will need to be reviewed on a case by case basis Most would be cancelled and recollected but if extenuating circumstances exist discuss the issue with the laboratory medical or administrative director In the event of their absence a depar
190. mple If a volume larger than 10 ml can be obtained from an older pediatric patient the volume may be divided between a FAN and an anaerobic bottle References BacT Alert Culture bottles product alert August 2006 BacT Alert Blood Culture adapter procedure April 2004 Principles and Procedures for Blood Cultures Approved Guidelines CLSI M47 A May 2007 Revised procedure prepared by clb 08 02 2009 supersedes procedure written 04 2707 05 07 2009 147 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY North Dixie Highway Troy Ohio COLLECTION OF BLOOD CULTURES FOR MYCOBACTERIA AFB OR FUNGUS DISCUSSION Patients infected with systemic mycobacteria or fungi especially those who are immunocompromised may have acid fast bacteria or yeast fungi in the bloodstream Ordinary blood cultures use media and procedures designed for recovery of routine bacteria Some of the more hardy yeasts may grow inadvertently in these bottles but the more fastidious yeast and fungal organisms or any mycobacteria need special handling with different media and monitoring over a longer period of time Blood cultures for mycobacteria AFB or Fungus will be sent to Quest Diagnostics Reference Laboratory for processing MATERIALS REQUIRED 7 5 ml green top heparin collection tube Materials for drawing blood culture see separate procedure COLLECTION OF SPECIMEN NOTE Often blood cultures are ordered in multiple sets of two or three per series Each
191. n green f f top Lithium heparin green top no additive red top and royal blue top PabapaHn Near QU 97386P tubes are also acceptable Draw sample 2 hours after last dose at steady state Contact lab for special Quest instructions GAD 65 QU 34878X See Glutamic Acid Decarboxylase 65 Antibody Gamma GGT foe See GGT Ganglioside GM 1 Antibodies IgG IgM QU 7997N 1 full gold top or red black top tube Overnight fasting preferred EIA Refrigerate 3 1 ml Gastric contents in container Sample need to be sent to Lab Gastric Fluid occult blood immediately for testing Special Instructions 1 full tube min 3mLs blood in red top tube or Gastrin QU 478X gold top tube Overnight fasting required Centrifuge with in 1 hour of collection Separate and freeze immediately Frozen TAT Collect specimen using the chlamydia trachomatis Neisseria gonorrhoeae Ne e a ae ENE tole QU 50286R Pace DNA Probe collection kit Swabs must be submitted in the Gen Probe collection container QUEST send out Test Description test QU if indicated BCDEFG HIJ Gentamicin Peak Se Ue etccs in red top tube or green top tube Gentamicin Trough Cues Si in red top tube or green top tube Gentamicin Random ee es in red top tube or green top tube Gentamicin Random snr oe eee in red top tube or green top tube Genital Herpes Specimen Instructions Tube Lab Use Only XYZ See Herpes Culture
192. n red top tube or gold top tube Grossly ee pean QU 4066 lipemic and hemolyzed specimens will be rejected Avoid extremes of heat Lab Use Only XYZ and cold Room Temp ay 1 full tube min 3mls of blood in red top tube or gold top tube Grossly SOSH eby VACATE adi tca ee lipemic and hemolyzed specimens will be rejected 1 full tube min 3mls of blood in red top tube or gold top tube Use for the Epstein Barr VCA IgM Antibody QU 8426X diagnosis of an acute or recent infection Grossly lipemic and hemolyzed specimens will be rejected Avoid extremes of heat and cold ERA PRA Assay Erythropoietin EPO QU 22376R 1 full tube min 5mls of blood in red top tube or gold top tube 4 Submit pure culture of the organism to be confirmed on Agar slant Must be BoeD ar lumen QUi 364704 transported in a Double Walled container ESR See Sedimentation Rate Estradiol serum inhouse 1 full tube min 3 mls blood in red top tube or gold top tube 1 full tube blood in red top tube or gold top tube serum Plasma from EDTA Estrogen Total QU 22541P lavender or royal blue top Sodium or lithium heparin green top tubes are also acceptable Call Histology x4638 1 full red black top sst tube Specify age and sex on test requisition Ql o QUEST send out Test Description ia abet Specimen Instructions Tube ABCDEFG HIJ KLMNOPQRSTUVW Need 2 full Tubes 2 lavender top tubes 7 mls whole blood Sp
193. n to verify rescheduled test 9 The patient should be encouraged to drink as much water as they want Provide the patient with a pitcher of ice water and a cup 10 After the test has been completed the patient can eat or drink whatever diet the physician has ordered CONTACT THE LAB STAT IF THE PATIENT STARTS TO FEEL VERY ILL OR HAS ANY COMPLICATIONS Special Note Make sure the patient does not have dextrose running through an V before starting the tolerance The I V will need to be shut off before starting the test Advise the patients nurse if this applies Keep the lines of communication open between lab and nursing to ensure the test is being completed correctly Revised 07 16 2003 Supersedes procedure written 12 2000 119 DOSAGE OF GLUCOSE FOR ORAL GLUCOSE TOLERANCE TEST ON PEDIATRIC PATIENTS 1 75gm kg Use the 50gm Bottle Body weight Glucose Volume Ib kg gm 50 Solution ml 10 4 5 7 9 16 0 11 5 0 8 8 18 0 12 5 5 9 6 19 0 13 5 9 10 3 21 0 14 6 4 11 2 22 0 15 6 8 11 9 24 0 16 7 3 12 8 26 0 17 7 7 13 5 27 0 18 8 3 14 6 29 0 19 8 7 15 3 31 0 20 9 1 16 0 32 0 21 9 6 16 9 34 0 22 10 0 17 5 35 0 23 10 5 18 4 37 0 24 10 9 19 1 38 0 25 11 4 20 0 40 0 26 11 8 20 6 41 0 27 12 3 21 5 43 0 28 12 7 22 2 44 0 29 13 2 23 1 46 0 30 13 7 24 0 48 0 31 14 1 24 7 50 0 32 14 5 25 4 51 0 33 15 0 26 3 53 0 34 15 5 27 2 54 0 35 15 9 27 9 56 0 36 16 4 28 7 57 0 37 16 8 29 4 59 0 38 17 3 30 3 61 0 39 17
194. nd Cardiac Cath Lab For outpatient testing the ASAP priority will be used to alert the laboratory that the results need called faxed when complete When a physician notates call results or fax results the ordering employee will create an expedite report to be generated upon verification of results to the number given on the order The ordering employee will apply a sticker stating expedited and or call results and will include the phone number to be called 157 TIMED This priority should be used when tests are desired to be drawn at a specific time and date The most common timed test order is used for therapeutic drug monitoring in order to appropriately assess the peak and trough levels These tests will be drawn within 15 minutes of the stated date and time and will be performed within 2 hours from time drawn These results will NOT print automatically nor will they be called ROUTINE Tests ordered as routine will be collected within 2 hours from time ordered except for routine Blood Bank orders Blood Bank orders should be drawn as soon as possible Routine orders will be resulted within an 8 hour time span Exception Some specialty tests are performed only several times a week takes greater than 24 hours to report cultures or are referred to a reference lab and will fall outside the 8 hour time span Routine results will not be called unless they have critical values Revised procedure prepared by pjr 12 4 07 supercedes
195. nd it is determined that the specimen is labeled with the correct patient s name but the order was in error the tests should not be received until clarification is made If the specimen label is correct but the orders are wrong new orders must be obtained before receiving the specimen 12 gt If the specimen arrives on an off shift when the collecting personnel cannot be contacted i e physician office that is closed and specimen stability is an issue run the tests and hold the results until clarification is received F SPECIMEN REJECTION PROCEDURES FOR SPECIFIC DEPARTMENTS gt Refer to Microbiology Department for specific specimen rejection procedure gt Refer to Cerner Specimen Rejection procedure for the computer process of rejecting a specimen Refer to the Procedure for Laboratory Specimen Rejection for additional instructions on specimen rejection New Procedure prepared by Pam Rader date_9 6 96 Revised procedure prepared by SMW date 07 14 09 supercedes procedure written 11 14 08 3 22 07 5 08 06 3 28 06 2 27 06 1 27 2003 2 1 01 11 6 98 9 6 96 13 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N Dixie Highway Troy Ohio 45373 UVMC LABORATORY CRITICAL VALUES TESTS MICROBIOLOGY CRITICAL VALUES Positive CSF results culture gram stain increased WBCs on stain India Ink HEMATOLOGY CRITICAL VALUES D Dimer Hemoglobin Platelets Protime PTT WBC gt 1 000 ng mL Adults Neonates
196. ndards for generators of infectious waste 10 UVMC Chemical Waste Management Plan V3 Environmental Services Hazmat Manual 11 UVMC Hazardous Waste Management Plan V3 Environmental Services Hazmat Manual 12 UVMC Infectious Waste Management V3 Environmental Services Hazmat Manual 13 Murex Biotech Limited Murex Streptex rapid latex test package insert 14 Office of Commissioners of Miami County Sanitary Engineering Department Updated Procedure 02 07 06 Supersedes Procedure 01 26 04 153 Upper Valley Medical Center 3130 N Dixie Highway Troy Ohio 45365 Procedure for HIV Specimen Collection and Consent Form Purpose The State of Ohio and UVMC require that every person having HIV testing done sign and HIV consent form before testing is performed The UVMC Outpatient testing staff and the Outreach Facility staff are responsible for obtaining the Outpatient HIV consent form Nursing is responsible for all Inpatient and Emergency room patients When Nursing placed an order for and HIV test to be drawn they are assuming responsibility for making sure the consent form is signed by the patient Procedure If the patient to be drawn is an outpatient give the patient the consent form Have the patient read the entire form and ask the patient if they any questions about the form or the test If he she has not questions have the patient sign the form If the patient has questions that you cannot answer call a laboratory technician to he
197. nder top tube 2ml minimum draw O amp QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ 1 full 10 ml green top Sodium or lithium heparin Draw sample using a Hemoglobin plasma QU 7211P 19gauge needle to avoid hemoysis Separate plasma from cells immediately and refirgerate AT 1 full tube min 3mls Whole blood in lavender top tube Invert tube 6 times to Ao Sealy sie decal GU ones prevent clotting Absolute minimum specimen requirement 50ull sample Hemoglobinopathy Evaluation Includes Hbg A1 Hbg A2 Hbg F Abn Hbg1 Abn Hbg 2 Abn Hbg 3 RBC Hbg Hct MCV MCH RDW with interpretation Specimen Instructions Tube Lab Use Only QU 35489X 1 full 7ml lavender top EDTA tube Hemoglobin Fetal See Fetal Hemoglobin k Compunet 2 Full It blue tubes 3 2 sodium citrate tubes Separate plasma and freeze Heparin udute TPEIaralet ANIHOdy HIRA 70488 Specimen is sent to Compunet for testing 2 full It blue top 3 2 sodium citrate tubes Centrifuge 1500g 15min Heparin Low Molscilar weight CUR S029AA Respin plasma 1500g 15min Freeze plasma immediately No hemolysis Hepatic Function Panel Albumin Bilirubin Total amp Direct Alk Phos T Protein AST SGOT amp ALT SGPT Liver Hepatis A Total Antibody Qui 51830w Heras A Antibody aM QU 51813E Hepatis B Core Antibody 9M Qui 518648 Hepatitis B Core Total Antibody QU 5
198. ng him her to go to the ED The pathologist may designate a tech supervisor to contact the patient in their place If the patient or physician msp can t be reached immediately continue to attempt to reach both until you are successful After the patient is contacted the critical result will still need to be called to the ordering physician msp during normal office hours This may include several shifts A problem log and occurrence monitor must then be generated by the tech that attempted the calls NOTE Critical values MUST be called to a caregiver Never leave a critical uncalled 20 After successfully calling the results to the physician document date time called to called by and read back of all criticals in the computer under Result Notes or Order Notes NOTE Critical test results may not be left on an answering machine Messages regarding critical results should not be left on an answering machine either Follow the process for paging a caregiver Revised procedure prepared by sab smw 1 31 08 supersedes revision on 9 14 06 supersedes revisions 5 8 06 2 6 06 and 10 11 05 supersedes procedure by pjr 4 5 04 also 1 29 03 1 12 99 9 9 96 21 UVMC Instructions for Laboratory Specimen Collections 24 Hour Urine Specimen Collection 1 Obtain 24 hour urine specimen container from the laboratory Note Different tests require different preservatives Be sure to notify the laboratory of all tests that are to be collected for thi
199. nophen Tylenol can be taken as needed For three days before and during stool collection period avoid Vitamin C in excess of 250 mg a day from supplements and citrus fruits and juices Collecting the stool sample For accurate test results collect each stool sample before contact with the toilet bowl water You may use any clean dry container Do not collect sample if blood is visible in your stool or urine e g menstruation active hemorrhoids urinary tract infection Patients using the Hemoccult II screening test should collect stool specimens from bowel movements on three different days Samples should be collected from two different sections of each fecal specimen Using the Hemoccult Card Label the front of the card with your name date of birth and date and time of sample collection Using the applicator provided collect small fecal sample Open the front of the card the side to be filled out with your name Apply a thin smear covering Box A Reuse applicator to obtain a second sample from a different part of the stool Apply thin smear covering Box B Close cover flap Dispose of applicator in waste container Return the completed card to the UVMC outpatient testing department or one of the outreach facilities Hyatt Stanfield Medical Services North and Medical Services South Testing should be completed no later than 14 days after the first sample collection Collection of Stool for Rotavirus Antigen White capped container w
200. notify the ordering Physician to see if it would be acceptable to use the mastectomy arm For public relation reasons draw from the other arm if the patient requests this 3 Fistulas or Shunts An arm with a fistula should not be used for blood collection When possible the specimen should be drawn from the opposite arm Collection from the arm with the fistula should only be done under the direction of the Physician 135 4 Prevention of hematoma Puncture only the uppermost wall of the vein Remove the tourniquet before removing the needle Use only the major veins see Fig 7at the end of the procedure not the superficial ones if possible Make sure the needle fully penetrates the uppermost wall of the vein Apply a small amount of pressure to the area with the gauze pad when bandaging the arm 5 Prevention of hemolysis Mix anticoagulated blood thoroughly by inverting each tube gently at least 5 times Avoid drawing blood from an area of hematoma Avoid drawing the plunger back too forcefully when using a needle and syringe Avoid Using a needle that is too small smallest gauge needle is a 25 g Do not force blood from a syringe with a needle into a tube instead take needle off or use a larger needle to transfer blood from syringe into tube Make sure the needle is fitted securely on the syringe to avoid frothing of the blood Ascertain that the venipuncture site is dry without touching it 6 If Venipuncture is unsucc
201. nsport bags must be transported in a crush resistant container with a positive closure at the appropriate temperature for specimen stability Acceptable containers include Playmate type coolers with latching lids thermal beverage type containers with screw tops and Styrofoam containers with 6 secure closures Each approved container must be clearly labeled to indicate contents Patient Specimens or Biological Substances Category B When transported by a local contract courier lab courier a sealable secondary container such as a sealed biohazard transport bag is required either the specimen container or the secondary container must be labeled with the international biohazard symbol and the secondary container must contain absorbent material in a quantity sufficient to absorb any and all liquid specimens being transported in case of leakage The outer container may not contain more than a total of 4 liters of liquid specimens or 4 kilograms of solid specimens No single specimen container may contain more than 1 liter of liquid When transported by persons other than couriers laboratory nursing or security personnel for example a sealable secondary container is optional the specimen container secondary container or the outer container must be labeled with the international biohazard symbol The outer container must contain absorbent material in a quantity sufficient to absorb any and all liquid specimens being
202. nt The HP collection priority will be used to indicate a patient s life is in immediate jeopardy and will signify to the lab that this testing must take top priority The physician orders must be written stating that the tests are to be ordered as High Priority Collection and testing of high priority specimens is to take precedence over all other collections and testing As with stat testing specimens should be collected within 5 10 minutes of time ordered and tested immediately It is our ultimate goal to release all high priority stat results with 30 45 minutes of time ordered not to exceed 1 hour High priority test results will print automatically to the nursing stations and the Emergency Department The following tests have been identified by the Laboratory Medical Director as being appropriate to order high priority CBC Protime CKMB Troponin BNP Basic Metabolic Panel Electrolytes Sodium Potassium Chloride Bicarbonate Glucose BUN Creatinine Calcium Lactate ASAP For inpatient testing all tests ordered as ASAP will be drawn within 15 minutes and will be performed and called within 2 hours of time ordered All ASAP orders will take priority over all other testing with the exception of stats and high priority testing ASAP orders will automatically print to all inpatient locations and to the following outpatient locations CCC TAH HPR PAT SDS OPS Dialysis Nursing Homes Home Health Occupational Health Dettmer a
203. ntainer no preservative Keep refrigerated 10ml aliquot from a 24hour urine collected with no preservative Pick up Potassium 24 hour Urine In house container from lab Keep refrigerated Record total volume See 24 Hour Urine Collections Procedure Potassium amp Sodium Random Urine 10 mls random urine in urine container no preservative Keep refrigerated Porphyrins Fractionated Quantitative 12mls urine from a 24hr collection Do not use preservatives Protect from sae ie i QU 68437N light Collect urine in a dark or wrapped container Keep refrigerated See i 24 Hour Urine Collections Procedure 82 QUEST send out Test Description test QU if indicated 10ml aliquot from a 24hour urine collected with no preservative Pick up Potassium amp Sodium 24 hour Urine In house container from lab Keep refrigerated Record total volume See 24 Hour Urine Collections Procedure Prealbumin 1 full tube min 3mLs blood in green black or gold top tube Pregnancy Test blood Quantitative 1 full tube min 3mLs blood in gold top tube or green black top tube Age 1 full tube min 3mLs blood in gold top tube green black top tube EDTA Peete een aero leah Lavender top tube or green top tube Prenatal Type and Screen 7 mls blood in lavender top tube Blood Bank tube bee i 1 full tube blood in red top tube Do not use a serum separator tube Primidone Mysoline Serum QU 40751 dicate lime onlact dose Prist IgE QU
204. ntainer that you were given by your doctor or Outpatient Testing Services Do not contaminate the container with urine If the collection is done on a diaper wearing child the diaper can be lined with plastic wrap to prevent absorption of the stool into the diaper Be certain not to contaminate the stool with urine 2 Transfer a small amount approximately 1 2 teaspoons of the stool specimen into the white capped container This container should not have a preservative in it Recap the container and label with your name and date time of collection Refrigerate this container Transport to the hospital within 24 hours for testing Collection of Specimen for Pinworms Pinworm collection kit Because pinworms generally come out at night to deposit their eggs specimens are best obtained a few hours after the patient has retired for the night or in the morning before the patient has awakened It is recommended that a special collection device available from the Laboratory be used Warning Discard any devices whose package is not intact Hold the device paddle by the cap and remove it from the tube Separate the patient s buttocks and press the sticky surface of the paddle against several areas of the perianal around the anus Wash hands to prevent spread of infection Label the container with the patient s name date of birth and the date and time collected Return specimen to the outpatient department at UVMC or to one of the
205. ntification label area If the specimen could puncture the primary container the primary container must be placed within a secondary container that is puncture resistant 3 Refer to the Laboratory Services Manual under the test directory for each test that is being collected for specific instructions and storage requirements of the specimen to ensure specimen stability 4 All specimens should be packaged in zippered specimen transport bags bearing the biohazard symbol sealed securely and stored according to appropriate temperature and handling requirements to await pick up by the lab courier 5 Respiratory specimens such as sputums and nasal washings stool specimens and CSF must be placed individually in separate bags for transport not in the same bag with other specimens unless with the same type specimens from the same patient Multiple specimens contained in a single bag dropped off by a patient may remain in that bag together provided they have the same storage transport requirements Multiple vials of CSF from one patient should be placed into one bag each vial must be properly labeled 6 All applicable specimen routing slips transport lists or written orders are to be placed in the outside pocket of the specimen transport bag Do not place paperwork of any kind inside the zippered compartment with the specimen container as this increases the possibility of contamination 7 When transported off site sealed biohazard tra
206. o a plastic Overnight fasting is preferred Special Instructions 2 Different Specimens 2mls CSF AND 1 full tube s blood in red top or gold top tube Blood specimen should be drawn after CSF walee eE EE is collected Collection date must be same for both specimens CSF must be clear IgM Serum Immunoglobulin Quantitative QU 24729W 1 full tube min 3mls blood in red top tube or gold top tube Immunoelectrophoresis Oooo See Electrophoresis and or Protein Electrophoresis Immunoelectrophoresis amp Fixation See Electrophoresis and or Protein Electrophoresis Immunofixation IgG IgA IgM QU 992A 1 full red top or gold top tube Refrigerate serum O oe QUEST send out Test Description ae a if Specimen Instructions Tube indicated Immunofixation Urine 5 eee n i ae 50ml urine from a 24hour collection is preferred Random urine sample is cane R OU tease also acceptable See 24 Hour Urine Collections Procedure Immunoglobulin CSF IgA IgG IgM QU 7104N 2 mls CSF in sterile CSF tube Overnight fasting is preferred Immunglobulin E IgE Serum QU 24620E 1 full tube min 3 mls blood in gold top or red black top or red top tube Immunoglobulins Quant Serum IgA IgG amp IgM QU 1370A 1 full tube blood in red top tube or gold top tube Immunoglobulins Serum Quant IgA IgE IgG amp IgM QU 5111 1 full tube blood in red top tube or gold top tube Immunoglobulins IgM eee See IgM Nas
207. o not collect specimen Ferritin blood 1 full tube min 3 mls blood in green black top tube or gold top tube Special Kit Call Lab Adeza Biomedical specimen collection kit swab Provided by the Lab Fetal Hemoglobin stain for quantitation 7 mls blood in lavender top tube Blood Bank tube FFP See Fresh Frozen Plasma Fibrin Degradation Products FDP See FDP or D Dimer Or D Dimer ror of U Vimer Fibrin Split Products iS See Fibrin Degradation Products above Finanoaen inhouse 1 full tube blood in It blue top tube 3 2 citrated plasma Must be filled to g the indicated line Specimen is stable only 4 hours Fine Needle Aspiration Oooo Call Histology x4638 NON GYN Fetal Fibronectin In house 57 QUEST send out Test Description ae abet Specimen Instructions Tube Lab Use Only Indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ 1 3 mls bone marrow or whole blood in a sodium heparin green top dark blue top or lead free tan top tube Ship at room temperature Provide the FISH CML ALL bcr abl Blood QU 12070N following information specimen type volume clinical indication prior therapy transplant referring physician phone client phone client accession and patient ID Flow Cytometry Folate RBC QU 1768T Folate and Vitamin B12 See Leukemia Lymphoma Evaluation See Folic Acid serum 1 full tube min 1 ml blood in Lavender top EDTA tube Whole blood specimen Minimize exposure to light
208. ocedure Collection of Blood Cultures Collection of Blood Cultures for AFB or Fungus Waste Disposal Procedure for HIV Specimen Collection and Consent Form Policy on Laboratory Priority Levels Quick Reference For Specimen Stability eee BANK General Guideline for Maximum Surgical Blood Orders Nursing Instructions for Requesting Blood for Transfusion Identification for Blood Bank With Armband Brief Outline on Specimen Identification for Blood Bank with Down Time Numbers Blood Bank Identification of Patient Specimen No Armband Required Criteria for Unacceptable Blood Bank Specimens OE CYTOLOGY Procedure for Handling Specimens for Histology Cytology Procedure for Handling Fresh Tissue Specimens Collection of Non Gyn Cytology Specimens ThinPrep PAP Test Procedure Scheduling and Reporting of Frozen Sections Scheduling Autopsies and Reporting of Surgical Specimens Gross Only Specimens To Be Dictated By The Pathologist UVMC Policy For Surgical Specimens Excluded From Submission To The Pathology Department For Examination CENTRIFUGE Centifuge Operation and Maintenance Procedures MISCELLANEOUS List of Commonly Used Medications Known to Induce Temporary Platelet Dysfunction New Test Listing UVMC CLINICAL LABORATORY Upper Valley Medical Center 3130 North Dixie Highway Troy Ohio UVMC Laboratory Hours and Staffing Location Upper Valley Medical Center Clinical Laboratory is located on the lower level of the
209. oglobin QUEST send out test QU if Specimen Instructions Tube indicated Lab Use Only XYZ Used for Health Fairs Fireman Panel Call Lab 10ml aliquot from a 24hour urine collected in an acid wash metal free container Do not use a preservative Loo JON Patient should refrain from eating seafood 3 days prior to collection Do not measure total volume Send aliquot in trace element free container See 24 Hour Urine Collections Procedure Used for Health Fairs Fireman Panel Call Lab 10ml aliquot from a 24hour urine collected in an acid wash metal free container Do not use a preservative Shoo ON Patient should refrain from eating seafood 3 days prior to collection Do not measure total volume Send aliquot in trace element free container See 24 Hour Urine Collections Procedure 1 full tube min 3mls blood in red top tube or gold top tube Plasma QU 51763E _ specimens will be rejected Specimens that contain hemolysis lipemia or are icteric are not acceptable 35079X See Hereditary Hemochromotosis in house 3mls Whole blood in lavender top tube 1 ml minimum draw in a 3 ml tube or 3 ml minimum draw in a 7 ml tube enone 3mls Whole blood in lavender top tube 1ml min draw in a 3 ml tube or 3 ml min draw in a 7 ml tube Ee See Hemoglobinopathy Evaluation inhouse 3mls Whole blood in lavender top tube 1ml minimum draw in a 3 ml tube or 3 ml minimum draw in a 7 ml tube in house 2 3 mls whole blood in lave
210. ollection Room Temp Allergen Profile Zone 8 QU 20201 1 full red top or red black tube Refrigerate ENET 7 1 full tube min 3 mls blood in red top tube or gold top tube Spin and Alpha 1 Antitrypsin Quant QU 67710E separate immediately Specimen Instructions Tube Lab Use Only Special Instructions 1 full tube blood in gold top tube or red black top Alpha fetoprotein Maternal 3 QU 224F tube Must fill out Alpha Fetoprotein Maternal Serum Screening form AFP Maternal Screen III completely Physicians Office to supply needed information Call Lab for extra forms Alpha Fetoprotein Serum QU 41434 1 full tube min 3mls blood in red top tube or gold top tube For males or Tumor Marker AFP Tumor non pregnant females No hemolysis Alpha Melanocyte Stimulating Hormone QU 38830X 1 full Lavender tube Spin and separate plasma and refrigerate ALT SGPT 1 full tube min 3 mls blood in green black tube or gold top tube Special Tube Call Lab 2ml serum collected using a Royal Blue No Aluminum Serum QU 55764P Additive Tube Patient should not take antacids containing aluminum compounds at least three days prior to testing Refrigerate pike Trough ee te on al pik Peak te ee epee asta pik Random RG cece eS ee ee oe ere Aminophylline Theophylline 1 full green top or red top tube A er QUEST send out p Test Description r oni Specimen Instructions Tube Lab Use Onl
211. ology Department must work closely with nursing staff surgery physician offices to make sure that 1 Specimens are processed as soon as possible 2 Non routine specimens are handled properly 3 Autolysis does not occur 4 Specimens are labeled properly 5 Requisitions are filled out completely 6 Specimens are accurately grossed and charged DISCUSSION All specimens that require only surgical pathology testing are to be considered as routine specimens and are to be submitted in 10 formalin It is important that the volume of formalin be adequate In general the volume should be 10 times the size of the specimen Those specimens for special studies for example specimens that have other testing such as cultures etc are to be handled by specific guidelines found in procedure The Collection of Non Routine Pathology Specimens Procedure These could include muscle biopsy sural nerve biopsy product of conception and lymph nodes to be received as fresh tissue For further information on how to submit a specimen please call the Histology Department at 4638 Monday Friday 6AM to 4PM After hours call the Lab at 4639 Some specimens are excluded from submission to the pathology department see procedure UVMC Policy for Surgical Specimens Excluded from Submission to the Pathology Department for Examination Please note that for very large specimens the specimen must be covered with formalin or autolysis will compromise the patholog
212. or gold top tube 1 full tube min 3 mls green black or gold top tube T See arthropod 1D QU 90209T 1 full tube min 3 mls blood in red top or gold top tube in house 1 full tube min 3 mls blood in red top tube or gold top tube No gel barrier tubes State time of last dose im house 1 full tube min 3 mls blood in red top tube or gold top tube No gel barrier tubes State time of last dose Ko o QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW 1 full red top tube Do not collect gel barrier tube Refrigerate Specimens Topiramate Eade IU that are grossly hemolyized are unaccepatable Total Complement ESZ See CH50 Complement Total Protein See Protein Total PEREA 1 full tube blood in red top tube or gold top tube Specimens that are grossly T p Antibodies Ca BIOS hemolyzed or lipemic are not acceptable Transferrin QU 30346R 1 full tube min 3 mls blood in red top tube Transiusion Reaction Works fatness 2 Different Specimens 7mls blood in lavender top tube Blood Bank tube p and 10mls urine Must fill out Report of Blood Transfusion Reaction form Treponema Pallidium Antibodies See FTA ABS or T Pallidium Trichomonas Wet Prep Moe swab in 1 cc sterile saline tube or Microbiology red top transport TSH 3rd Generation Thyroid Stimulating Hormone 1 full tube blood in green black top tube
213. or gold top tube tTG IgA QU 90209T 1 full red top or gold top tube See Tissue Transglutaminase Tylenol Acetaminophen inhouse f full red top tube 96 Test Description Type amp Screen or ABO amp Screen UCG Urine Pregnancy UPEP Uric Acid blood Uric Acid Body Fluid Uric Acid 24 Hour Urine Urine Tests Random Urine Amylase Urine Blood Urine BUN Urine Calcium Urine Chloride Urine Creatinine Urine Culture ABCDEFG HIJ KLMNOPQRSTUVW QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ inhouse 7 mls blood in lavender top tube Blood Bank tube Follow arm banding procedures See D for Blood Bank procedure under Blood Bank Section Inhouse f ml random urine in sterile container E See Urine Electrophoresis 1 full tube min 3mls blood in green black top tube or gold top tube 1 ml body fluid in sterile container Please State Source a Call Lab for 24 hr urine container 24 hour urine no preservative Refrigerate In house throughout collection See 24 Hour Urine Collections Procedure P see via Testnome aso O wose pmen invoice memene O S 1 ml random urine in sterile container CC or cath specimen which is stable 1 In house hour at room temp and 24 hours refrigerated or 4 10 mls of urine in a grey top urine device which is stable for 48 hrs at room temp Urine Glucose In house 1 ml random urine in sterile cont
214. ormation Separate serum within 1 hour of draw FROZEN Patient should be fasting Methylmalonic acid urine QU 44131N 5 mls random urine FROZEN No Preservative 1 full blood tube in red top tube Do not use gel barrier tube Centrifuge Mexiletine Mexitil QU 4934X within 1hour of collection Plasma from lavender top EDTA tube is also acceptable MHA TP Microhemagglutinin Test 4 See FTA ABS or T Pallidum Abs or FTA Abs For Treponema Pallidum Antibodies 10 ml of Urine 24 hour container No preservative Keep refrigerated Record total volume See 24 Hour Urine Collections Procedure Microalbumin Random Urine 10 mls urine random No preservative Keep refrigerated pee IM tea a Rote In house 10 mls urine random No preservative Keep refrigerated Random Urine Microalbumin 24 hour Urine In house Microscopic Only Urinalysis See Urinalysis Microscopic Only o Test Description ABCDEFG HIJ KLMNOPQRSTUVW Mitochondrial Antibodies Mixing Study PT or PTT MMA serum MMA urine Mono Test Heterophile MTHFR Mumps Antibody Panel IgG and IgM Mumps Virus AB IgG Mumps Skin Test Muscle Biopsy Mycoplasma Pneumoniae IgG Antibody QU 659X 1 full tube min 3mls of blood in red top tube or gold top tube Mycoplasma Pneumoniae IgM Antibody QU 21130X 1 full tube min 3mls of blood in red top tube or gold top tube Myeline Associated Glycoprotien Sulfated Glucuronic i 1
215. orresponds to the trough of the quinidine dosing interval and which avoids the distribution phase of digoxin at least 6 hours post dose PO and 4 hours post dose IV Digoxin levels will not reach a new steady state for 7 14 days ocd Hunter Russell Director of Pharmacy orig 7 92 Revised by Stephen Pawloski Clinical Pharmacst rev 7 94 8 96 7 98 T Zaug 3 00 Reviewed 1 2 2007 Pharmacy 28 Comprehensive Metabolic Panel Sodium Potassium Chloride Carbon Dioxide Glucose BUN Creatinine Calcium Albumin Bilirubin Total Alkaline Phosphatase Total Protein ALT SGPT AST SGOT Electrolytes Sodium Potassium Chloride Carbon Dioxide Lipid Panel Cholesterol Triglycerides HDL Effective 1 1 2002 pjr 12 06 tmc UVMC PANEL DEFINITION Renal Function Panel Sodium Potassium Chloride Carbon Dioxide Glucose BUN Creatinine Calcium Albumin Phosphorus Hepatic Function Panel Albumin Bilirubin Total Bilirubin Direct Alkaline Phosphatase Total Protein ALT SGPT AST SGOT Acute Hepatitis Panel Hepatitis A Ab IGM Hepatitis B Core Ab IGM Hepatitis B surface Ag Hepatitis C Ab Basic Metabolic Panel Sodium Potassium Chloride Carbon Dioxide Glucose BUN Creatinine Calcium Obstetric Panel CB auto diff Hepatitis B surf Ag Rubella Antibody RPR Antibody Screen Blood Type ABO Blood Type RH 29 Upper Valley Medical Center Clinical Laboratory 3130 N Dixie Highway Troy Ohio 45373
216. ose at steady state Centrifuge within 1 hour of collection Do no use gel barrier tubes Refrigerate serum Latex specific IgE Quant K82 QU 8927X 1 full tube min 3 mls blood in red top tube or gold top tube LAP Score A See Alkaline Phosphatase Leukocyte LDH blood inhouse y full tube min 3 mls blood in green black top tube or gold top tube LDH Body Fluid 1 ml fluid in a sterile container State Source LDL Direct inhouse 1 full tube min 3 mls blood in red top tube or green black top tube Spin and pour off immediately Lead Heavy Metal Profile Mercury See Hea Metal Profile neavy Metals Frome 1 Heavy Metal Lead Industrial fa See Lead level Adult 1 full tube of whole blood drawn in a Royal blue top EDTA tube Capillary Lead Level Adult QU 56713E_ collections are only acceptable from physicin offices 0 5mI sample in lavender top microtainer Clotted or viscous samples will be rejected 1 full tube whole blood drawn in a Royal blue top EDTA tube For capillary Lead amp Zinc Protoporphyrin QU 6904 collections provide 0 5ml sample in lavender top microtainer Clotted or viscous samples will be rejected re Pneumophia Anikadien QU 52365R 1 full tube min 3mis blood in red top tube or gold top tube N Test Description ABCDEFG Legionella Pneumophilia Urinary Antigen EIA Legionella Species Culture Leukemia Lymphoma Evaluation Leukocyte Alkaline Phosphatase Leukoreduced
217. otein Total Body Fluid Inhouse 1 ml fluid State Source Protein Total Blood Inhouse 1 full tube min 3 mls blood in green black top tube or gold top tube QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW Hane ee mee inhouse Urine 24 hour no preservative Refrigerate throughout collection see Protein Creatinine Ratio See 24 Hour Urine Collections Procedure Protein Creatinine Ratio 24 hour Urine Mhosg Call Lab Urine 24 hour no preservative Keep refrigerated Includes 24hr Protein amp 24hr Creatinine See 24 Hour Urine Collections Procedure ayer Prothrombin Time PT or Protime Lae of blood in Lt Blue top tube 3 2 citrated sodium must fill to top Need 2 Full Tubes 2 lavender top tubes 7mls whole blood Specimens Prothrombin Gene Mutation Analysis QU 30326X drawn in EDTA royal blue top sodium heparin lithium heparin and ACD Factor II DNA Analysis solution B yellow top tubes are also acceptable Do not centrifuge Specimen Instructions Tube Lab Use Only XYZ specimens Keep at room temperature Protime PT Mixing Studies Guest 2 3 full tubes of blood in Lt Blue top tube 3 2 citrated sodium must fill to Coagulation top of label Need a minimum of 3mls of citrated plasma Freeze plasma PSA See Prostatic Specific Antigen PSA Free See Prostatic Specific Antigen Free PTH Intact Serum Parathyroid 1 full tube
218. ount of blood that you need for the required testing taking too much blood may cause bruising No more than 2 ml is recommended per collection Stay within safe boundaries of the heel in order to avoid unnecessary damage to underlying bone or blood vessels Do not puncture any deeper than 2 4 mm 5 6 Avoid excessive squeezing or pressure to the heel 7 8 9 1 Always wipe away the first drop of blood Avoid any scraping of the microtainer against the heel Avoid swollen or bruised areas of the heel 0 Know when to restick TIPS FOR SUCCESSFUL FINGER PUNCTURES 1 2 3 4 9 6 7 8 9 1 Always try to explain exactly what you will be doing to a child Talk to children in a soft and reassuring manner Let children participate by holding a sticker or special Band Aid Make sure that you have all your equipment ready ahead of time Try to have the child sit on the parent s lap so they can help hold the child Make sure to warn the child prior to puncturing the finger Recommended sites are the middle finger or ring finger Use a puncture device appropriate for the size of the child s finger Always wipe away the first drop avoid milking 0 Know the quantity of blood needed no more than 2 ml is recommended per collection PROCEDURAL NOTES 1 Drawing during the transfusion of blood products Blood products that are being transfused immediately mix with the patients own blood supply Therefore capill
219. outreach facilities Hyatt Stanfield Medical Services North or Medical Services South In order for UVMC laboratory to provide quality results for our patients we must reject samples that do not provide the optimum conditions for testing We realize that recollection of samples are inconvenient for patients and delay getting results to physicians but our first consideration is providing accuracy and value to our clients for each of the tests we perform Please contact UVMC outpatient testing 440 4568 or laboratory 440 4625 for any questions concerning specimen collection requirements Current revision 5 2 08 supersedes revision on 12 14 07 7 25 04 25 SEMEN ANALYSIS INSTRUCTIONS AND COLLECTION DATA SHEET UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 North Dixie Highway Troy Ohio 937 440 4025 Instructions for the Collection of a Semen Analysis Obtain a container from your doctor or Outpatient Testing This specimen must be brought directly to Upper Valley Medical Center Outpatient Testing between 6 30 am and 6 00 pm Monday through Friday Saturday 7 00 am to 11 00 am Remain sexually inactive for 3 days before collection the specimen 2 Collection containers may be glass or plastic similar to those used for urine collection They must be clean and free of chemical or soap residue 3 The specimen should be obtained by masturbation without the aid of any lubricants taking care to include the entire specimen c
220. oves Fig 2 Exe i PER Hien Ny Bosse If the patient refuses to have their blood drawn attempt to courteously and professionally persuade the patient to have the test done NEVER ARGUE WITH THE PATIENT If the patient still refuses notify the patient s nurse The patient has a right to refuse any test The patient s nurse will record this information on the patient s chart and will inform the ordering Physician or will try to persuade the patient to have the procedure done the test Notate the nurse s name on the barcode and check later to make sure the test has been canceled 6 Proceed if the Patient agrees If the test s ordered is required to be fasting or is a medication level check to make sure patient is fasting and document appropriately on the requisition Make certain to document date and time of the last dose when entering the test in the Cerner system 7 Properly position the patient Have bed patients lay on their back in a comfortable position If necessary add support under their arm with a pillow or a rolled up towel etc Fig 4 Outpatients should be comfortably seated in the appropriate drawing chair Fig 5 Do not draw blood from the patient if they are standing up 8 Have supplies close at hand Assemble necessary equipment needed for the venipuncture procedure 132 The collection tray and assembled venipuncture equipment should
221. p Rotavirus Antigen RPR Serum RPR CSF VDRL RSV Antigen Rubella Antibody Qualitative IgG Rubeola IgG AB Salicylate Serum Saturation Scabies Scraping QUEST send out test QU if Specimen Instructions Tube indicated Lab Use Only KEMNOPQRSTUVW XYZ of each sample at the ordering lab Frozen omoa tube Whole blood in 3ml Lavender top tube Min 1 ml blood drawn in the 3 In house ml tube or min 3 ml blood drawn in the 7 ml tube Refrigerate up to 36 hours or Room Temp for 6 hrs o wma o O Oo ema O O Order both TIBC amp IRON 1 full 7ml or 3ml lavender tube Centrifuge and separate blood at room temperature Do NOT refrigerate Patient should refrain from taking QU 10537N medications 3 weeks prior to draw Patient should be ambulatory for 30minutes prior to draw Patient should be on a moderate sodium diet during collection When submitting catheterization studies retain a portion 53348W o QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW gt Min 3mls whole blood in lavender top tube Stable for 4 hrs at room temp Sedimentation Rate ESR Westergren or 12 hrs refrigerated Anti Scleroderma See Instructions for semen analysis collection 2 hour stability for motility Semen Analysis Post Vasectomy In house at room temperature 24 hour stability for
222. p S T amp S T amp S T amp S T amp S T amp S T amp S T amp S T amp S T amp S T amp S 1 T amp S T amp S 162 General Guidelines for Maximum Surgical Blood Order Otolaryngologic Surgery Angiofibroma resection Branchial cleft cyst Caldwell Luc Caratoid body tumor resection Ethmoidectomy Jaw neck tongue dissection Laryngectomy with radical neck Mandibulectomy Mastoidectomy Otolaryngologic Surgery Orbital exploration Radical neck dissection Septoplasty Tumor of palate Plastic Surgery Flap reconstruction Otoplasty Reduction Mammoplasty Repair of cleft palate lip Repair of decubital ulcer Skin flap Skin graft References T amp S T amp S T amp S NNANA T amp S T amp S T amp S T amp S T amp S T amp S Pg 2 Urologic Surgery Adrenalectomy Bilateral reimplantation ureters Cystotomy Fulgeration of bleeding bladder tumor Hydrocolectomy Ileal condiut Meatotomy Nephrectomy Open prostate biopsy Orchiectomy Orchiopexy Prostatectomy Transurethral Suprapubic Perineal Pyelolithotomy Radical cystectomy Radical penectomy Transurethral resection bladder Tumor TUR Ureterolithotomy 1 Clinics in Laboratory Medicine W B Saunders Company March 1982 pg 172 3 2 Technical Manual American Association of Blood Banks Bethesda 1996 12th Ed Pg 58 Prepared by js revised 1 4 99 T amp S T amp S T amp S 163 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130
223. p tubes 6 5mls Includes Androstenedione Dehydroepian QU 36707x Serum min Specify age and sex on requisition Early morning specimen is Heterophile drosterone Sulfate Testosterone free preferred and total Histoplasma Antibodies QU 526X 1 full tube min 3mls blood in red top tube or gold top tube 5 mLs urine in screw cap container or 3 full red top or gold top tubes CSF Histoplasma Antigen QU 19994X and Bronchial Lavage washings are also acceptable specimens Indicate specimen type and date collected on test request HIT Heparin Induced Thrombocytopenia Oooo Call lab for assistance 1full tube min 3 mis blood in red goldor red black top tube Refrigerate 2 full lavender top tubes Separate plasma within 2 hours of collection QU 83600N Transfer to plastic transport tube Ship Frozen There are other acceptable specimens for this test call lab with questions RER 1 full lavender top EDTA tube Separate plasma within 6 hours of a Quantitative PCR QU 40085X collection Transfer to plastic transport tube Ship Frozen iral Load Ultra Sensitive HIV 1 Genotype HIV Genosure There are other acceptable specimens for this test call lab with questions HLA DR2 DQ1 EA See Narcolepsy Profile HLA Typing Call Lab Human Leukocyte Antigen Q O Test Description ABCDEFG HIJ KLMNOPQRSTUVW paserna ar Special tube 1 10ml yellow top tube ACD Solution A or B Do not HLA B27
224. partment at 4638 as soon as the specimen has been collected informing them of the specimens pending arrival into the lab 181 Notify the Histology department at 4638 the day before collection this will alert the histology personnel and pathologist of the collection The histology department can then make any additional arrangements that are needed CHROMOSOME STUDIES Tissue submitted for Chromosome Studies is to be placed in a sterile container Transport the specimen immediately to the Labs Histology department for processing Calling the Histology department at 4638 or 4198 as soon as the specimen has been collected informing them of the specimens pending arrival into the lab Revised 11 25 08 cmw 182 COLLECTION OF NON GYN CYTOLOGY SPECIMEN S Principle The collection of NON GYN specimens is primary for the purpose of examination of the fluid to detect malignancy the method is also used for the detection of inflammatory or infectious disorders These samples may include but not limited to e Respiratory specimen s e Gastrointestinal specimen s e Serous Effusions e Urine e Cerebrospinal fluid s e Fine Needle Aspirates Procedure 1 NON GYN sample s to be processed on the ThinPrep processor should be collected fresh in sterile container s or in CytoLyt fixative solution That can be obtained by calling the histology department at 4638 2 All specimen s should be labeled with the patient s name medical record num
225. ransport tube red C aCA NS eure ODA HBR or blue cap Other acceptable specimens Cytobrush post hysterectomy specimens REJECTION CRITERIA Wooden shaft and calcium alginate swabs dry swabs Refrigerate Collect specimen using the correct collection kit Female collections use the pink kit Males use the blue kit Female kits contain two swabs one to Chlamydia DNA Probe QU 49932E Temove excess mucus from the cervical area and the second to collect the Female endocervical Male urethra actual specimen Male kits contain only one swab for specimen collection Collection swabs must be transported in a GEN_PROBE transport tube For conjunctiva collections use Male Blue kit A ol QUEST send out Test Description test QU if indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ Genital Specimens Separate kits are available for male and female Chlamydia GC Neisseria Gonorrheae DNA QU 20027 specimens Eye conjunctive specimens are not acceptable for this Probe orderable by Laboratory staff only testing Please refer to Chlamydia DNA Probe Genital specimens BD ProbeTec ET CT GC kit Separate kits are available for male and female specimens amyn e Neisseria Comerica BIN Urine specimens Collect 10 to 15ml of first catch urine first part of the SDA Female endocervical Male urethral QU 17305X f stream into a clean polypropylene container Patient must not have urinated Specimen Instructions T
226. re achieved at approximately 24 hours Quinidine Trough Immediately prior to next dose Trough levels are more reproducible Steady state levels are achieved at 4 7 approximately 24 hours See note on co administration of digoxin below Theophylline IMMEDIATE RELEASE Routine monitoring of theophylline plasma levels can usually begin Aminophylline Trough Immediately prior to next dose approximately 24 hours after initiation of therapy or 24 hours after a change 6 14 Peak 2 hours after dose in therapy Levels obtained within the first 18 hours of therapy should be SUSTAINED RELEASE interpreted cautiously Outpatients taking sustained release preparations Trough Immediately prior to next dose must be treated cautiously as levels obtained 12 24 hours after admission Peak 4 6 hours after dose may represent an unknown rate of theophylline absorption from all doses taken prior to admission Steady state Anytime approximately 24 Aminophylline 80 theophylline hours after start of infusion Trough Immediately prior to next dose Peak 15 minutes after dose infused THEODUR SLOBID UNIPHYL IVPB Tobramycin NEBCIN 1 7 Trough 15 30 minutes prior to infusion Trough could be obtained just prior to dose administration Peak will be Peak 15 30 minutes after dose infused affected by a short distribution phase A pair of peak and trough levels Random Anytime during dose interval should be obtained around the 3rd
227. re to take priority over all other testing with the exception of High Priority stats see below The physician orders must be written stating that tests are to be ordered stat Stat orders will be collected within 10 minutes of time ordered Every effort will be made to complete and report results within 1 hour of time ordered At anytime the laboratory has equipment failure staff shortage or any other situation that may negatively affect a stat turnaround time the use of a backup piece of equipment method or facility should be identified as a temporary solution The main priority must be to deliver results in an immediate fashion Stat orders print as soon as the results are verified to both inpatient and outpatient fax or printer Outpatient results must be called immediately upon release The majority of testing in the laboratory is offered as stat The exceptions have been identified by the Medical Director and the medical staff and are as follows HDL Vitamin B12 CEA All serologies except Mono testing O amp P Cultures will be plated immediately but due to testing requirements will not be Available for 24 48 hours after plating Rotavirus HIV C Difficile Semen Analysis 156 All Reference Lab Testing Quant HCG will be offered stat but may take longer than 1 hour if dilution is Required HIGH PRIORITY HP STAT The High Priority HP stat is to be used only for inpatients including patients in the Emergency Departme
228. room temp Centrifuge within 1 hour Refrigerate serum 1 full tube whole blood 5 mis lavender top tube Draw as late as possible Acid Hemolysis Ham s Test QU 135335P_ in day due to specimen stability of only 24 hours Room Temp 1 full tube min 3 mls blood in red top tube no gel or gold top tube Acid Phosphatase Total QU 17152P Specimen should be spun and separated immediately freeze serum promptly Frozen Acid Phosphatase Prostatic QU 208X full tube 2 0ml serum blood in gold top SST tube or red top tube Separate serum and freeze Frozen w Z QUEST send out Test Description test QU if indicated Specimen Instructions Tube ABCDEFG HIJ KLMNOPQRSTUVW 5 full tube 2 0ml serum blood in gold top SST tube or red top tube Acid Phosphatase Prostatic QU 208X Separate serum and freeze Frozen ACTH QU 211X See Adrenocorticotropic Hormone for special instructions Contact Central Scheduling to arrange appointment Test to be collected in Cancer Care Department Special Handling Instructions If any of the specimens ACTH Stimulation Test are hemolysed continue with testing until the ordering physician can be contacted to determine whether to run test or recollect Hold specimens frig up to 7 days if necessary Activated Partial Thromboplastin Inhouse 1 full light blue top tube Fill tube to the indicated line Acute Leukemia Profile e e 7 See Leukemia Lymphoma Eval
229. rpm for 15 min separate plasma and freeze immediately Submit separate frozen vials for each special coagulation assay ordered Coagulation Factor IX Activity QU 352X Special Instructions Call Lab 1 Full 4 5m Lt blue top tube 3 2 or 3 8 Sodium Citrate Centrifuge for 15 minutes at 3500 rpm separate and freeze plasma immediately Submit separate frozen vials for each special coagulation assay ordered Coagulation Mixing Studies APTT amp PROTIME Quest See Prothrombin Mixing Study or PTT Mixing Study or Mixing Study 105 Test Description QUEST send out C test QU if Specimen Instruction Tube oagulation Studies iadiedied Special Instructions All of the following conditions must be met 1 The veinipuncture should be performed using a 21 gauge needle 2 The specimen needs collected via vacutainer collection Do not use a syringe or butterfly to collect The specimen needs to go directly into the anticoagulant tube 3 Draw 2 Light blue black center 3 2 Na Citrate plastic tubes Discard sample if the vein collapses or blood flow stops Platelet Function Screen In house 4 Hemolysis is not acceptable 5 Sample is stable only 4 hours at room temperature 6 Do not refrigerate or centrifuge Do not allow the specimen to be come chilled by courier transit Specimens cannot be rewarmed or remixed 7 Do not send through the pneumatic tube system Call the
230. rt media red or blue cap 111 Test Description QUEST send out Sine es a if Specimen Instruction Tube CYTOLOGY TE a ss ce see SL Breast Aspirate In house Cytology Non Gyn Request Breast Cancer Profile Paraffin Block Call Histology x4638 Bronchial Brushings In house Cytology Non Gyn Request Bronchial Washings In house Cytology Non Gyn Request Cervical Pap diagnostic In house Cytology GYN Request Cervical Pap screening In house Cytology GYN Request Chromosome Study Bone Marrow Call Histology x4638 DNA Ploidy Paraffin Block In house Call Histology x4638 ER PR Receptors Paraffin Block Call Histology x4638 Esophageal Brushings In house Cytology Non Gyn Request Esophageal Washings In house Cytology Non Gyn Request Estrogen Level In house Call Histology x4638 Fine Needle Aspiration In house Call Histology x4638 Cytology Non Gyn Request ea S piraton Wall yet CULES Call Histology x4638 Cytology Non Gyn Request Fluids In house Call Histology x4638 Cytology Non Gyn Request Gastric Brushings In house Cytology Non Gyn Request Gastric Washings In house Cytology Non Gyn Request Photo Gross Surgical In house Call Histology x4638 Sputum In house Cytology Non Gyn Request Thin Prep PAP When ordering MUST ia hoise Special Media Preserve CYST Solution for use with Thin STATE diagnostic or screen Prep GYN Request 112
231. s Trough Immediately prior to next dose Suggest three serial levels each 2 3 hours apart For toxicity 4 12 hours after ingestion Trough Immediately prior to next dose Trough levels are most reproducible and should be obtained whenever For toxicity ASAP and 6 hrs later possible Levels obtained within one week of a dosage change should be viewed with caution Acetaminophen TYLENOL Aspirin Salicylate 5 10 Carbamazepine TEGRETOL 5 35 Digoxin LANOXIN 28 48 Trough Immediately prior to next dose Levels obtained within the first few weeks of therapy may be useful to establish a relationship to clinical response This data should be interpreted cautiously if attempting to predict long term dose response relationship Dosage adjustments should be made in small increments AM 8 9am Dexamethasone Suppression Test Administer 1 mg dexamethasone at PM 4 5pm 11pm evening prior to test gt 6 hours after dose or immediately prior Steady state levels can be obtained 7 14 days after instituting or changing a to next dose dose in patients with normal renal function In the presence of renal insufficiency the time to achieve steady state levels may be 3 weeks or gt 4 hours after dose or immediately prior more See note on co administration of quinidine below to next dose Disopyramide Trough Immediately prior to next dose Steady state levels should be obtained after 3 4 days of therapy NORPACE Ethosuxim
232. s cat scan and etc If there are notify the ward secretary or nurse to reschedule other test per physician swishes Inform nursing to have the patient collect a fasting urine sample and label properly After the fasting urine has been collected collect a fasting blood sample from the patient and label properly For a non pregnant adult Administer 75 grams of glucose beverage and record amount ingested on the barcode For pregnant adult Administer 100 grams of glucose beverage and record amount ingested on the barcode Pediatric patient consult the diagram given for amount of glucola to be administered and record the amount ingested on the barcode Instruct the patient to consume the entire amount within 5 minutes Start timing process when patient has finished the entire glucose beverage Make two lists of the times that blood and urine samples are to be collected from the patient Give one list to the patients nurse explaining the procedure Nursing is responsible for obtaining the urine specimens from the patient Provide nursing with the urine containers labeled with the barcodes including 1 hr 2 hr 3 hr etc documented on the urine container Place the other list with the scheduled collection times and barcodes in the lab processing area as a reminder of the times the specimens need to be collected Blood and urine samples are to be collected at the following times 2 hour tolerance test Fasting glucose and urine
233. s specimen Label the patient container Instruct the patient to empty bladder and discard specimen before beginning collection in the morning If the patient is catheterized the bag should be emptied before beginning the timing of the collection 4 Save all urine for the next 24 hours including the next morning specimen in the laboratory container provided Do not include stool fecal matter or toilet paper in the container Store the container on ice or in the refrigerator Submit to the laboratory along with the HIS routing slips for all tests ordered within one hour of the end of specimen collection Urine for Culture Urinalysis Cytology Mid stream clean catch Note For CYTOLOGY specimens early morning specimens are preferred 1 Instruct patient to wash hands thoroughly and to cleanse the penis or vulva with down strokes using moistened cleansing towelettes 2 Instruct patient to hold the container on the outside to collect the urine and not to touch the inside of the lid or container 3 Patient should begin to urinate directly into the toilet or bedpan stop urinating position container and collect a midstream specimen Screw cap securely on container Label the container and submit to the laboratory along with the HIS routing slips or requisition The urine must be processed in the laboratory OR refrigerated within one hour of collection Note For infants and young children clean as above and attach a pediatric
234. servative solution for use with Thin Prep STATE diagnostic or screen NON GYN Request Thin Prep with HPV reflex When ordering MUST STATE diagnostic Special Media Cytology Preservative solution for use with Thin Prep Or screen NON GYN Request Thiamine i i A Test Description ABCDEFG HIJ KLMNOPQRSTUVW Special Instructions 1 full It blue top tube Must fill to the indicated line Immediately centrifuge for 10 minutes Separate and freeze plasma immediately Thrombin Ill Antigenic Thyroid ABS ATA TPO Graves Test Thyroglobulin Antibody Anti Thyroglobulin AB Thyroglobulin Quantitative Thyroid Peroxidase Ab TPO Antimicrosomal Antibody Thyroid Stimulating Hormone TSH 3rd generation High Sensitivity Thyroxine Thyroxine Binding Globulin TBG TIBC or Iron Binding Capacity Total Saturation order TIBC amp Iron Tick Identification Tissue Transglutaminase IgA Tobramycin RANDOM Tobramycin Trough QUEST send out test QU if indicated Specimen Instructions Tube Lab Use Only XYZ LC See Antithrombin III QU 7302A 1 full red top or gold top tube QU 80986R 1 full tube blood in red top tube or gold top tube QU 30130E 1 full tube blood in red top or gold top tube QU 80994R 1 full gold top tube inhouse hi full tube blood in green black top tube or gold top tube ee QU 870X 1 full tube min 3 mls blood in red top tube
235. sible patient treatment PROCEDURE The following list is a guideline for the Histology department to follow on which specimens will receive a gross description only Whenever there is a request by an attending physician or at the discretion of the Pathologist when indicated by the clinical history or gross findings microscopic examination will be done on any of the following Bone without pathology Calculus Renal and bladder calculi are sent out for chemical analysis after Gross description Histology department will send out Foreign body example splinter needle glass tick fishhook Hardware Hernia sac Hydrocele Implants Teeth Toenail Soft tissue following debridement Tonsils age 16 and under unless enlarged or microscopic examination requested Varicose veins revised 10 13 08 cmw 188 UPPER VALLEY MEDEICAL CENTER CLINICAL LABORATORY 3130 N DIXIE HWY TROY OHIO 45373 UVMC POLICY FOR SURGICAL SPECIMENS EXCLUDED FROM SUBMISSION TO THE PATHOLOGY DEPARTMENT FOR EXAMINATION PURPOSE This policy is in place to insure the continuance of patient care PROCEDURE See UVMC Organization Functions of the Medical Staff section E EXAMINATION OF TISSUE BY PATHOLOGIST All pertinent clinically relevant materials and tissues removed during operative and invasive procedures shall become the property of the hospital and shall be examined by the hospital pathologist whose report shall be a part of the patient s clini
236. st Mean A positive test does NOT mean you have AIDS It means that you have the virus that can lead to AIDS which can take up to 10 years to develop It also means you could pass the virus to someone else through sex or sharing needles If your test is positive you should e See a doctor to find out what medicines you can take to help keep you healthy e Talk with an expert about how to keep from passing the virus to others The person who gives you the test can help you e Work with staff from the Ohio Department of Health to tell anyone you have had sex or shared needles with that they need to get an HIV test Your name will NOT be used What If The Test Is Negative It means no antibodies to the virus were found However you may need to take another test if you have had unsafe sex or shared needles in the last three months It can sometimes take as long as six months for antibodies to show up on a test You Have A Choice You can choose NOT to take this test at any point during your clinic visit by simply leaving the clinic site If you are in a hospital or other health care facility you need to let someone know within one hour after blood is drawn that you have changed your mind e If you choose to take this test you can take a confidential test This means you may have a written copy of your results This means your name is on the results Your test results can not be given to anyone unless you sign a paper giving consent The law requires
237. t B HCG amp Unconj Estradiol specimen See Maternal Screen above Quest recommends that client keep a duplicate sample frozen at the requesting lab 1 full tube blood in red top or gold top tube The Obstetric Gynecology Maternal Serum Screen IV QU 30294X Requisition Form or equal information MUST be complete and sent with the Tetra specimen See maternal Screen above Quest recommends that client keep a duplicate sample frozen at the requesting lab Maturation Index in house Estrogen level collect from posterior vaginal wall Smear onto slides and spray fix or drop into 95 alcohol immediately Must supply GYN request F 1 full tube blood in a red top or gold top tube Specimens that are grossly Medeles furibody AJG Ou hemolyzed or lipemic will be rejected Metabolic Panel Basic ooo See BMP or Basic Metabolic Panel Metabolic Panel Basic minus Glucose SF See BMP minus glucose A QUEST send out Test Description test QU if Specimen Instructions Tube indicated Lab Use Only XYZ ABCDEFG HIJ KLMNOPQRSTUVW Metabolic Panel Comprehensive AE See CMP minus alucese Glucose wR TIDES aa Methadone See DRUG SCREENS Methylenetetrahydrofolate Reductase QU 36165X_ 1 full tube blood in 7ml lavender top EDTA tube Room Temp 1 full tube blood in red top tube Place specimen in refrigerator or ice bath for Methylmalonic acid serum QU 34879X 30 minutes after collection Centrifuge after complete clot f
238. t the patient s physician will be notified immediately Components could be crossmatched prior to surgery or need It will take longer to find compatible components C Components Blood Products The number of components ordered are prepared and made available for transfusion Units must be reordered and crossmatched on a fresh patient specimen every 72 hours on patients who have been pregnant or have received blood within the past three months The number of requested units must be indicated UVMC has only leukoreduced RBCs at this time If the components are ordered or needed STAT the order should be called to Blood Bank so there can be verbal communication with Blood Bank and the order is received promptly Red blood cells of all Type and Rhs are stored at UVMC Fresh frozen plasma FFP and Cryoprecipitate CRYO are stored frozen at UVMC and must be thawed to be prepared Due to short shelf life platelets are stored at Community Blood Center in Dayton Platelets are shipped upon order for transfusion It is UVMC policy to use apheresed platelets Apheresed platelet units are from one donor and are equal in size to 5 to 6 random donor units They are better for the patient than transfusing multiple random units Alternatives Donors to Transfusion A Autologous Transfusion 1 Useful for select patients and is most valuable when major blood loss can be anticipated 2 Four to six units of blood may be drawn safely within a 40 day period
239. t risk for ischemia by the following criteria O Systolic BP lt 90 mmHg O Lactic acid gt 2 meq L O Base excess lt 0 at least 2 consecutive times O O2 consumption index lt 170mL min sq m O MVO2 mixed venous O2 sat lt 65 Chronic Blood Loss O Transfusion dependent patient with Hgb lt 8 6 g dl O Severe anemia Hgb lt 7 g dl or Hct lt 21 O Symptomatic anemia O Anemia of chronic kidney disease Other O Coagulation factor deficiency Protime gt 18 sec APTT gt 55 sec INR gt 1 5 O Massive transfusion with active bleeding O Reversal of Warfarin Coumadin in bleeding or surgical pt O Plasmapheresis TTP HUS etc O Dilutional coagulopathy O Protein C or S deficiency complication Prophylaxis O Platelet ct lt 10 000 mL or lt 20 000 mL in bleeding or surgical patient O Pre operative count lt 75 000 mL or 100 000 mL in neurosurgical or ophthalmic patients Hemorrhage O Quantitative lt 50 000 mL or qualitative platelet defect O Intra or post operative count of lt 75 000 mL or 100 000 mL in neurosurgical or ophthalmic patients O Massive transfusion Thrombocytopathy O Congenital drug related ASA Other Other blood products O Fibrinogen deficiency lt 100 mg dL in bleeding or surgical patient _ O Factor VIII deficiency with no Factor VIII concentrate available O Cryoprecipitate O Von Willebrand s disease or uremic pt unresponsive to DDAVP O Massive transfusion O Factor VII O Factor XIII deficienc
240. tape or equivalent The bag must be capable of being held in an inverted position with the closed end at the bottom for a period of five minutes without leakage A bar coded label bearing the date and point of generation lab or morgue is then applied near the top of the box in the area marked CUSTOMER LABEL Biohazard waste to be incinerated such as identifiable body parts limbs etc requires a special label color coded yellow available from Histology The packaged biohazardous waste is taken from the lab by Environmental Services to be removed for disposal by a qualified off site waste contractor currently Stericycle 3 REGULAR WASTE Clear lined waste containers are designated for non biohazardous waste as defined in the UVMC Waste Management Policy Biohazardous materials including any items or materials dripping or caked with blood or body fluids or items that may release blood or body fluids if compressed are not to be placed in the clear lined containers as this could present an environmental hazard Items or materials lightly stained with blood or body fluids that are not dripping or caked with blood or body fluids and will not release blood or body fluids if compressed or not visibly stained may be discarded in clear lined containers Regular waste is removed by Environmental Services 4 CHEMICAL WASTE Flammable and non flammable chemical waste drums are located in the lab storage room off the receiving
241. te which are not crossmatched the type and Rh only have to be performed once per admission This armband must remain on the patient s arm for transfusions during the admission I WHEN COLLECTING A SPECIMEN NOTE When identifying and collecting a specimen from a patient another person other than the collector needs to be able to verify that the specimen was collected from the patient This other person the verifier can be the patient a family member or friend of the patient a nurse or other lab person who was in the room at the time of collection and witnessed the collection See step D 3 A Patient Identification 1 The armband ID will be a unique number preprinted for Blood Bank Obtain a packet with numbered stickers Blood Bank armband etc The number on the sticker sheet will be the patient s unique Blood Bank armband number 2 Properly identify patient a Check armband to confirm the correct patient is being drawn Ask patient to give his her name and birthdate If there is no armband or the patient is unable to communicate have RN from that floor identify the patient and verify patient s birthdate b If there is any doubt on patient identity they problem must be resolved before the specimen is collected B Sample Collection Obtain needed specimen one 7 ml EDTA purple top tube following proper specimen collection protocol C Specimen Identification Label specimen with the following 1 Patient s name
242. ted from cells within 2 f hours Store Refrigerated UVMC has successfully correlated out in house a Inhouse CRP Wide Range with CRP High Sensitivity As a result all CRP wide Quantitative High Sensitivity Cardiac 7 mls whole blood in EDTA Royal Blue top tube Must complete Heavy Cadmium Blood QU 56093P_ Metals Form Restrict patient from eating shellfish for 3 days prior to testing Room Temp 7ml aliquot of a 24hour urine collected in an acid washed metal free Cadmium 24 hr Urine QU 89722N container Do not measure 24hour volume Send aliquot in a trace element free container Restrict patient from eating shellfish for 3 days prior to testing Calcium Blood 1 full tube min 3mls blood in green black tube or gold top tube Special Instructions 1 full tube blood in gold top sst tube Tube must Calcium lonized serum In house not be opened at any time Centrifuge specimen 30 minutes after drawing and refrigerate immediately Send unopened tube to lab transport refrigerated Calcium Urine 24 hour mouss 10ml aliquot from a 24hour urine collected with no preservative Pick up container from lab Keep refrigerated Record total volume 43 Test Description ABCDEFG HIJ KLMNOPQRSTUVW Calcium Random Urine Calculus Analysis Candida Albicans Skin Test Carbamazepine Level Carbohydrate Antigen 19 9 Carbon dioxide Carcinoembyronic Antigen Anti Cardiolipin Abs IgG IgM Carotene Catecholam
243. termine the proper collection tube i e serum separator tube SST or no gel barrier and the quantity of serum needed for testing Collect sample using proper veinipuncture techniques Refer to the Laboratory Service Manual for assistance Make every effort to fill the SST tube to the stated draw volume to ensure the proper blood to additive ratio Mix the serum tube by 5 complete inversions Proper mixing of the clot activator is critical to achieving appropriate clotting times and clot formation Allow SST specimens to clot for a minimum of 30 minutes and the no gel barrier tubes to clot for a minimum of 60 minutes in a vertical upright position at room temperature Note For the following scenarios at outreach collection sites instruct the courier to transport the specimen to the Laboratory at room temperature in a vertical upright position for proper clot formation e If the serum in the no gel barrier tube cannot be aspirated off and separated from the red blood cells for any reason there is no need to centrifuge or wait for the specimen to clot send the specimen to the Laboratory with the courier within 2 hours e Ifa courier is present in the outreach collection sites to transport the specimen to the Laboratory before clotting time is complete package the uncentrifuged specimen in a yellow transport bag which indicates immediate attention required and send the specimen to the Laboratory with the courier e All Stats wil
244. the centrifuge should be symmetrical before operating the unit This is essential for safety in operating the unit and also prolongs the life of the centrifuge Please mix plasma and serum tubes appropriately when collected and follow the UVMC Laboratory s procedure titled Processing Blood Specimens for Serum Testing for proper clot formation before centrifugation of all serum specimens 1 Set the unit on a flat sturdy surface A centrifuge does need space for air circulation around it 2 Plug into power supply 3 Turn on the main power switch 4 Doa visual check rotor is in place and locking nut is tight and that tube holders are in appropriate positions 5 Load the centrifuge with tubes Balance the tubes symmetrically and by fluid levels and by identical tube types Properly balanced loads will improve sample separation and extend the life of the centrifuge 6 Close the lid 7 Each centrifuge will have a timer All blood specimens are to be centrifuged for 15 mins unless it is noted otherwise per UVMC Laboratory please see list for centrifuge exceptions If you are using a VanGuard please turn the timer clockwise all the way to 60 and then back to the time needed to centrifuge blood tubes 8 Some centrifuges have a place to set speed RPM s please refer to your specific centrifuge manual for this step 3500 is the recommended speed 9 Clean spillage as needed interior and exterior 192 10 Listen
245. tinine 14 days at 2 8 C or frozen 7CSF Urine Protein 72 hours at 2 8 C 8C Reactive protein 8 hours at Room temperature 2 days at 2 8 C and frozen 14 days 9Digoxin 8 hours at room temperature 7 days at 2 8 C and 14 days frozen 159 10Estradiol 48 hrs at 2 8 C or 6 months frozen 11Ferritin 48 hrs at 2 8 C or freeze 12Folate 48 hrs at 2 8 C or 30 days frozen 13FSH 24 hrs at 2 8 C or freeze 14Gentamicin 8 hrs at room temp 48 hrs at 2 8 C or freeze 15GGT room temperature or 2 8 C for 7 days and frozen for 14 days 16Glucose 8 hrs at room temperature and for 3 days at 2 8 C 17HBAIC 1 week at 20 25 C 2 weeks 2 8 C 18HBSAb aliquoted specimen 3 days 2 8 C 365 days frozen 19HDL 4 days at 2 8 C and frozen for 14 days 20HIV 5 day at 2 8 C 365 days frozen 2lIonized Calcium 4 hours at 2 8 C 22Iron 4 days at room temperature 7 days at 2 8 C and 4 days frozen 23Lactic acid 30 minutes room temp 14 days at 2 8 C or frozen 24LDH 2 days at room temperature or 2 days at 2 8 C 25LH 24 hrs at 2 8 C 26LDL 4 days at 2 8 C and frozen for 14 days 27Lithium 8 hours at room temperature 24 hours at 2 8 C and 14 days frozen 28Lipase 14 days at 2 8 C or frozen 29Magnesium 7 days at 2 8 C and 14 days frozen 30Microalbumin 3 days at 2 8 C 310smolality refrigerate or freeze if not run within 4 hrs 32Phenobarbital 48 hours at room temperature 7 days at 2 8 C and 14 d
246. tment supervisor can be consulted Any tests resulted from a mislabeled or unlabeled specimen must have a disclaimer added to the test result under Result Comments If stability is an issue tests may be run and results held until approval is obtained PROCEDURE FOR REJECTION OF SPECIMENS DUE TO REASONS OTHER THAN IDENTIFICATION ERRORS A DATA INFORMATION gt If the test requisition does not have all the required information i e source test s requested the results will not be released until this information is obtained B SPECIMEN CONTAINER 11 E gt If the specimen container is not appropriate for the test s ordered i e anticoagulant the specimen will be rejected and a new specimen must be obtained If a specimen is received broken or has leaked in transit and it is a retrievable specimen the specimen will be rejected If an irretrievable specimen has leaked in transit consult the laboratory medical director or administrative director or in their absence a department supervisor for guidance on how to handle the specimen SPECIMEN CONDITION If incorrect specimen material is submitted the specimen will be rejected and a new specimen will need to be obtained If a line draw specimen yields questionable results the redraw to check the specimen should be via venipuncture if possible If improper preservative or fixative has been used the specimen will be rejected and a correct specimen must be collected
247. ts Crossmatched General Surgery Abdominal perineal resection Amputation A K B K Aneurysm resection Breast Biopsy Cholecystectomy and CD exploration Colon Resection Total large colon Hemicolectomy Sigmoidectomy Anterior Resection Small Bowel Resection Colostomy gastrostromy Exploratory laparotomy Femoropopliteal bypass Hemorrhoidectomy Hernia Mastectomy Simple Radical Radical with immediate reconstruction Pancreatectomy Paarathyroidectomy Parotidectomy Splenectomy Thyroidectomy Vein Stripping Cardiopulmonary Surgery Bronchopleural fistula Esophagectomy Thoractomy Tracheotomy T amp S 6 T amp S T amp S Gynecologic Surgery AP repairs combined incontinence Conization D amp C Ectopic Pregnancy Hysterectomy Vaginal Abdominal Radical Wertheim Hysterectomy with repair Hysterectomy C section Laparoscopy and bilateral tubal ligation Oophorectomy Pelvic lymphadenectomy Tuboplasty Uterine suspension with presacral neurectomy and fulgeration of endimetrial implants Urethral diverticulum Neurosurgery Carpel Tunnel procedures Cranioplasty Nerve Repair Scalp and skull lesions no intercranial communication Orthopedic Surgery Arthroscopy Arthotomy Dupuytren s contracture release Hip Nailing Leg Amputation Medial Menisectomy Open Reduction Osteotomy biopsy Removal of hip pin Replacement prothesis Total hip or resurfacing hip Total knee Laminectomy Spinal Fusion T am
248. turette type sleeves inoculating loops and any object that may penetrate intact skin or a waste bag The Ohio EPA defines anything meeting Webster s definition of syringe as a sharp LOOSE NEEDLES OR SHARPS THAT MAY PUNCTURE A WASTE BAG OR INTACT SKIN MUST NEVER BE PLACED IN RED OR CLEAR LINED RECEPTACLES 151 Contaminated needles must never be clipped bent or broken prior to disposal Do not recap contaminated needles refer to ENGINEERING AND WORK PRACTICE CONTROLS Contaminated Vacutainer needles are to be discarded without disengaging from the holder the needle holder unit is discarded intact after activation of the safety feature in the sharps containers mounted on the walls of the patient rooms outpatient drawing rooms and emergency rooms or in the nearest sharps container designated for that purpose Needle and syringe units are to be discarded intact after activation of the safety feature in the sharps containers mounted on the walls of the patient rooms outpatient drawing rooms and emergency rooms or in other sharps containers designated for that purpose When necessary for transfer of specimens safety needles are to be removed from syringes by use of a removal device found on portable sharps disposal containers and on some bench top sharps disposal containers after activation of the safety feature A transfer device may then be attached to the syringe after transfer of the specimen the syringe transf
249. uation z Call Lab Nasopharyngeal aspirate wash throat swab or bronchial lavage AdeneMlUsiEES Lakai specimens in M4 media Refrigerate Adrenocorticotropic Hormone ACTH 3ml blood in plastic EDTA tube lavender top tube Maintain collection Plasma p QU 21410P_ tube in an ice bath before and after blood collection Mix Well Separate plasma by centrifugation at 4C within 1hour of collection Refrigerate AFB Acid Fast a See Culture Mycobacteria AFB 1 full tube blood in red top gold top tube Maternal date of birth weight race insulin dependant diabetic status gestational age 14 22 weeks EDD AFP Maternal QU 729T method of determining EDD and date of collection MUST be provided for the interpretation of results see Obstetric Gynecology Requisition Form Quest recommends that clients keep a duplicate frozen specimen at requesting lab Refrigerate AFP Maternal III Se See Maternal Screen III AFP Maternal IV 7 See Maternal Screen IV 32 QUEST send out Test Description ae a if Specimen Instructions Tube indicated ABCDEFGHIJ KLMNOPQRSTUVW DEPUNA QU 41434F 1 full tube min 3 mls blood in red top tube or gold top tube For males or non pregnant females Refrigerate Albumin blood 1 full tube min 3mls blood in green black tube or gold top tube Albumin Body Fluid 1 ml body fluid State source of body fluid Albumin 5 Call Pharmacy 1 full tube Min 3mLs blood in each tube gray top tu
250. ube Lab Use Only during the previous two hours This method had a 2 day TAT Eye conjunctive specimens are not acceptable for this method Chloride Blood CL inhouse f full tube min 3 mls blood in green black top tube or gold top tube Chloride Urine 24 Hour ae for 24 hr container 1 ml aliquot of 24 Hour Urine See 24 hr Urine Chloride Urine Random 1 ml random urine in a sterile container Cholesterol blood 1 full tube min 3mls blood in green black tube or gold top tube Special Instructions 2 full tubes whole blood in EDTA lavender top or Cholinesterase Plasma amp RBC QU 338X royal blue top tube Spin one tube and separate plasma into a plastic aliquot tube Ship both whole blood and plasma samples refrigerated 2ml aliquot from a 24hour urine collected in an acid washed metal free Chromium 24 hr Urine QU 10944 container Call lab for container Record total volume on test request and urine container See 24 hour Urine Collections Procedure Chromogranin A Qu 34468X 1 full red black top sst tube Refrigerate serum Chromosome Analysis Karyotyping QU 14596X 5mls whole blood in green stopper sodium heparin Keep at room temperature DA O QUEST send out Test Description test QU if Specimen Instructions Tube Lab Use Only indicated ABCDEFG HIJ KLMNOPQRSTUVW XYZ Chromosome Analysis Hematologic Special Instructions Call Histology x4638 3 ml bone marrow or whole QU 8
251. uge manual for this step 3500 is the recommended speed 20 Clean spillage as needed interior and exterior 21 Listen for a unusual noise or vibrations if anything out of the ordinary please 194 22 Clean spillage as needed interior and exterior Weekly check off done in each dept NOTE DO NOT EVER OPEN THE LID WHEN CENTRIFUGE IS ROTATING O NOTE Centrifuge spills broken tubes Shut off instrument and leave centrifuge shut for 30 minutes allow for aerosols to settle Always wear gloves when cleaning up broken glass and spilled liquids Always use forceps or hemostat to remove the broken glass Always put the broken glass in an approved sharps disposal container Never operate the centrifuge in this condition The centrifuge must be disinfected before operation can resume Use 10 Bleach when cleaning centrifuge interior and or exterior After using the 10 Bleach on any part of the centrifuge thoroughly rinse with water Dry all parts as much as possible ALWAYS STOP THE CENTRIFUGE IMMEDIATELY IF IT DOES NOT SOUND OR OPERATE RIGHT Twice yearly January and July GE Service will do preventative maintenance checks REFERENCE Operating manual for Clinifuge or Medifuge or VanGuard or Horizon Revised procedure prepared by dss date __04 24 08 Supersedes procedure written __07 31 06 Centrifuge Procedure PG 2 04 24 08 dss 195 List of Commonly Used Medications Known to Induce Temporary Platelet Dysfun
252. wing that they have looked at the tube and checked the name on it for proper identification During situations when the patient is not able to identify their specimen ask another person familiar with the patient family member or friend present in the room when the specimen was collected to look over the specimen and information for correctness If family or friends are unavailable a nurse or other lab employee can be asked to watch the collection They can look at the specimen and information for correctness and initial the specimen During Traumas or Massive Transfusion Protocols follow procedures for those situations there are other steps in place for the safety of the patient such as _transfusing type O blood 4 Have the patient read and sign the Transfusion Pregnancy Record T R circling Yes No or Not Sure to the question of them having been transfused or pregnant within the past 3 months This will help determine if the specimen outdates in 72 hours or 10 days If the patient can t sign take a verbal response and note Verbal in patient signature area Read the second statement on the T P record for the person collecting the specimen and sign stating that you have properly identified the patient labeled specimen properly and correctly armbanded the patient On the bottom of this T P record note who initialed the specimen as the identification verifier Mark as patient friend or family
253. xpected turn around time is no longer than 2 hours ASAP results print automatically to inpatient locations Outpatient Testing will only use the order priority of ASAP when ordering blood work on organ transplant patients who need their test results by 2 00pm It is not necessary for techs to call the physicians msp office to report that ASAP testing is complete Distribution printing of completed Outpatient reports will be increased to every three hours between 7 00 and 19 30 Timed results print automatically to the floors CRITICAL RESULTS Technologists should be aware of the critical values found listed elsewhere in the department procedure manual All critical values should be called immediately not exceeding 10 minutes With all verbal notification of critical test results the person receiving the information must write it down or have the hard copy report available They must read back the result to the reporting tech This will be documented in Result Notes or Order Notes using the F2 template CR Critical Results and filling in all required information Inpatient results Call the nursing station immediately Critical inpatient test results can only be given to an RN or physician msp The date time called person called to called by and read back of all criticals should be documented in the computer using the F2 template of CR If multiple criticals exist on one accession number document what was called in one of the Result Note
254. y O Factor VIII Other O Factor IX Transfusion Instructions Product Modifications circle all needed Irradiated CMV Negative Donor HLA Matched Platelet Crossmatching Internal Fax for Blood Bank 4393 Physician sign Prepared 2 27 2007 167 UPPER VALLEY MEDICAL CENTER CLINICAL LABORATORY 3130 N Dixie Highway Troy OH 45373 IDENTIFICATION FOR BLOOD BANK WITH ARMBAND The Upper Valley Medical Center Transfusion service is using an armband system for identification of all patients who have specimens collected for Type and Screens crossmatches or transfusion of blood components platelets FFP etc This armband will serve as verification that the numbered specimen was drawn from this patient for Blood Bank purposes Green is the official color for Blood Bank armbands in Ohio At Upper Valley Medical Center Blood Bank armbands are green For platelets fresh frozen plasma and cryoprecipitate which are not crossmatched the type and Rh only have to be performed once per admission This armband must remain on the patient s arm for transfusions during the admission I WHEN COLLECTING A SPECIMEN NOTE When identifying and collecting a specimen from a patient another person other than the collector needs to be able to verify that the specimen was collected from the patient This other person the verifier can be the patient a family member or friend of patient a nurse or other lab person who was in the room at time o
255. y indicated 1 full tube min 3 mls blood in red top tube no gel or green top tube Do Amiodarone Cordarone QU 36721X Not use a serum separator tube Special Instructions Call Lab 1 full tube blood in EDTA lavender top Ammonia NH3 iw bouse tube Place on ice immediately Centrifuge and separate plasma from cells within 15 minutes keep plasma on ice Call Lab immediately and send STAT Amylase Blood 1 full tube min 3 mls blood in green black top tube or gold top tube Amylase Body Fluid 0 5 ml body fluid in sterile container State source of fluid Amylase Random Urine 1ml random urine in urine container 10 ml aliquot from a 24hour collection with no preservative Pick up container Amylase 24 hour Urine In house from lab Keep refrigerated Record time and volume See 24 Hour Urine Collections Procedure ANA Anti Nuclear Antibody Screen EIA QU 249X 1 full tube min 3 mls blood in red top tube or gold top tube Positive Titer w reflex IFA samples will reflex to a titer ANCA Vasculitides C ANCA amp P ANCA QU 4044F 1 full tube blood in red top or gold top tube Specimens that are grossly Antineutrophil Cytoplasma Antibodies hemolyzed lipemic or contain heavy visible particulates are not acceptable 1 full tube min 3 mls blood in red top tube serum separator is unacceptable Morning specimen preferred Do not submit glass tubes Androstenedione nents UE Plasma from EDTA lavender top and blue top or sodium h
256. y of the specimen Specimen for Frozen Section should be taken to the frozen section room immediately without formalin The Histology department needs to be called at 4198 or 4638 as soon as the specimen has been collected Once a frozen section is completed the remainder of the tissue is brought to the histology department and additional tissue is submitted for permanent sections These sections will be collected at the discretion of the pathologist With tissue results being incorporated into the final report confirming the frozen section result report REMINDER OSHA requires that all specimens of blood or other potentially infectious material shall be placed in a container which prevents leakage during transport Bags that zip close and are labeled with the 178 biohazard code are acceptable for transporting specimens If the specimen could possible puncture the primary container it should be placed in a puncture resistant container and labeled as bio hazardous PROCEDURE 1 Submit specimen according to specimen type example routine special studies frozen sections 2 Specimen container must be labeled with patient name medical record number hospital account number specimen s type date and time specimen collected Containers must also be numbered if more that one specimen to a surgical case Label must be legible 3 Specimen requisition must contain all relevant information a Pre op and Post op diagnosis b Surgeon and all
257. y sewer system followed by large volumes of water one part chemical to 100 parts water UNCONTAMINATED WASTE Non sharp uncontaminated materials are discarded into clear lined containers Unbroken clean blood collection tubes that are to be discarded because they have expired or are otherwise unacceptable must first be securely packaged in sturdy boxes to prevent breakage All sharps such as broken glass are to be packaged in puncture resistant containers of appropriate size sharps containers specimen containers etc not plain cardboard which are then securel closed and placed in biohazard boxes bearing the words may contain sharps 152 Non biohazardous waste containing information of sensitive nature relative to patient confidentiality is to be shredded before disposal REFERENCES 1 NCCLS GP5 A Clinical Laboratory Waste Management Approved GuidelineNCCLS GP17 A Clinical Laboratory Safety Approved Guideline 2 OSHA Standard 29CFR 1910 1030 Bloodborne Pathogens 3 OSHA Standard 29CFR 1910 1450 Occupational exposure to hazardous chemicals in laboratories 4 OSHA Standard 29CFR 1910 1048 Formaldehyde 5 DOT Standard 49CFR 178 Specifications for Packagings 6 DOT Standard 49CFR 173 196 Infectious Substances etiologic agents 7 DOT Standard 49CFR 173 197 Regulated Medical Waste 8 DOT Standard 49CFR 173 199 Diagnostic specimens and used health care products 9 Ohio Administrative Code 3745 27 30 Sta

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