Laboratory Specimen Collection and Labeling Guidelines · Synovial Fluid Crystals • Syn Crystal...

2019

Rutland Regional Medical Center

1/2/2019

Laboratory Specimen Collection and Labeling Guidelines

Table of Contents

LABORATORY SPECIMEN LABELING GUIDELINES ..................................................... 1-2

GENERAL LABORATORY ........................................................................................................................... 1 BLOOD BANK ............................................................................................................................................. 1 CYTOLOGY AND PATHOLOGY ................................................................................................................... 1 ACCEPTABLE & UNACCEPTABLE LABELING FOR LABORATORY SPECIMENS ...................................... 2

HEMATOLOGY, COAGULATION, AND URINALYSIS ..................................................... 3-6

BODY FLUID CELL COUNT (NON CSF) ................................................................................................. 3 COMPLETE BLOOD COUNT ....................................................................................................................... 3 COMPLETE BLOOD COUNT WITH AUTO-DIFFERENTIAL ........................................................................ 3 CORRECTION STUDIES (PT OR PTT) ..................................................................................................... 3 CSF CELL COUNT...................................................................................................................................... 4 D DIMER .................................................................................................................................................... 4 FETAL MEMBRANE RUPTURE (ROM)…………………………………………………………………………4 FIBRINOGEN .............................................................................................................................................. 4 MONONUCLEOSIS SCREEN ....................................................................................................................... 4 PARTIAL THROMBOPLASTIN TIME ......................................................................................................... 4 PLATELET FUNCTION ASSAY ................................................................................................................... 5 PROTHROMBIN TIME ................................................................................................................................ 5 SEDIMENTATION RATE ............................................................................................................................ 5 SYNOVIAL FLUID CRYSTALS ..................................................................................................................... 5 URINALYSIS REFLEX MICROSCOPIC AND CULTURE, IF INDICATED ...................................................... 5 URINALYSIS REFLEX MICROSCOPIC, IF INDICATED ............................................................................... 6 XA ............................................................................................................................................................... 6

I

TRANSFUSION TESTING ...................................................................................................... 7-9

ABO/RH AND ANTIBODY SCREEN ......................................................................................................... 7 ABO/RH CONFIRMATORY TYPE….…………………………………………………………………………….7 ABO/RH TYPE ......................................................................................................................................... 7 ANTIBODY SCREEN ................................................................................................................................... 7 CORD BLOOD TESTING ............................................................................................................................. 7 CRYOPRECIPITATE .................................................................................................................................... 7 DIRECT ANTIGLOBULIN TESTING ............................................................................................................ 8 FETAL SCREEN .......................................................................................................................................... 8 FRESH FROZEN PLASMA .......................................................................................................................... 8 HOLD CLOT ................................................................................................................................................ 8 MICRHOGAM ............................................................................................................................................ 8 PLATELET .................................................................................................................................................. 8 RED BLOOD CELLS .................................................................................................................................... 9 RH TYPE ................................................................................................................................................... .9 RHOGAM .................................................................................................................................................. 9 TRANSFUSION REACTION ......................................................................................................................... 9

CHEMISTRY ....................................................................................................................... 10-14

BODY FLUIDS .......................................................................................................................................... 10 CARDIAC MARKERS ............................................................................................................................... 10 CREATININE CLEARANCE ...................................................................................................................... 10 CRITICAL CARE MARKERS .................................................................................................................... 11 DRUG LEVELS (SERUM ONLY) ............................................................................................................. 11 DRUG LEVELS (SERUM/PLASMA) ....................................................................................................... 11 DRUG SCREEN (URINE) ........................................................................................................................ 11 GENERAL CHEMISTRIES ........................................................................................................................ 12 HORMONES ............................................................................................................................................. 13 INFECTIOUS DISEASE…………….……………………………………………………………………………...13 RANDOM URINE TESTING ..................................................................................................................... 13 TUMOR MARKER…………………………………………………………………………………………………14 24 HOUR URINE .................................................................................................................................... 14

II

MICROBIOLOGY ............................................................................................................... 15-20

ABSCESS, WOUND, ROUTINE CULTURE ............................................................................................... 15 AFB CULTURE ....................................................................................................................................... 15 ANAEROBIC CULTURE ........................................................................................................................... 15 BLOOD CULTURE.................................................................................................................................... 16 BODY FLUID CULTURE .......................................................................................................................... 16 C-DIFF .................................................................................................................................................... 16 CSF CULTURE ........................................................................................................................................ 16 CRYPTOCOCCAL ANTIGEN - CSF .......................................................................................................... 16 FUNGUS CULTURE .................................................................................................................................. 17 FUNGUS CULTURE SKIN, HAIR, NAILS ................................................................................................. 17 GARDNERELLA, TRICHOMONAS AND YEAST PROBE .......................................................................... 17 GI PATHOGEN ........................................................................................................................................ 17 GROUP A STREP CULTURE .................................................................................................................... 17 GROUP B STREP CULTURE .................................................................................................................... 18 LACTOFERRIN……………………………………………………………………………………………………. 18 MRSA/STAPH SCREENING .................................................................................................................. 18 RAPID FLU A/B ..................................................................................................................................... 18 RAPID RSV ............................................................................................................................................. 18 RAPID STREP .......................................................................................................................................... 19 SPUTUM CULTURE ................................................................................................................................. 19 STOOL GIARDIA AND CRYPTO ............................................................................................................... 19 STOOL OCCULT BLOOD ......................................................................................................................... 19 STOOL O&P ............................................................................................................................................ 19 TISSUE CULTURE ................................................................................................................................... 20 URINE CULTURE..................................................................................................................................... 20 VIRUS DETECTION ................................................................................................................................. 20

19

III

ANATOMIC PATHOLOGY ............................................................................................... 21-26

ANAL-RECTAL CYTOLOGY (ANAL PAP) .............................................................................................. 21 BODY FLUID CYTOLOGY ........................................................................................................................ 21 BONE MARROW SPECIMEN EVALUATION ........................................................................................... 21 BREAST LUMPECTOMY OR RESECTION ................................................................................................ 21 BRUSH/SCRAPING CYTOLOGY .............................................................................................................. 22 CHLAMYDIA GONORRHOEAE TESTING – NON-UROGENITAL SITES…………………………………….22 CHLAMYDIA GONORRHOEAE TESTING - UROGENITAL SITES…………………………………………….22 CORE NEEDLE BIOPSY ............................................................................................................................ 23 CSF CYTOLOGY ...................................................................................................................................... 23 CYTOGENETICS ON BONE MARROW SPECIMEN…………………………………………………………….23 CYTOGENETICS ON NON BONE MARROW SPECIMEN…………………………………………………….23 EOSINOPHIL EVALUATION .................................................................................................................... 23 FLOW CYTOMETRY ON BONE MARROW SPECIMEN ........................................................................... 23 FLOW CYTOMETRY ON NON BONE MARROW SPECIMEN ................................................................. 24 FNA CYTOLOGY (FINE NEED ASPIRATION) ....................................................................................... 24 FRESH SPECIMEN ................................................................................................................................... 24 FROZEN SECTION ................................................................................................................................... 25 GYN PAP TEST WITH REFLEX HPV-DETECTION ............................................................................... 25 HEMOSIDERIN EVALUATION ................................................................................................................. 25 HPV DETECTION WITH REFLEX TO GYN PAP TEST CYTOLOGY……………………………………….25 NASAL CYTOGRAM………………………………………………………………………………………….……26 PJP (PNEUMOCYSTIS JIROVECI EVALUATION).................................................................................... 26 SPUTUM CYTOLOGY ............................................................................................................................... 26 TISSUE SPECIMEN .................................................................................................................................. 26 TZANCK PREP ......................................................................................................................................... 27 URINE CYTOLOGY .................................................................................................................................. 27 WASH CYTOLOGY ................................................................................................................................... 27

1

Laboratory Specimen Labeling Guidelines:

ALL SPECIMENS MUST BE LABELED WITH PATIENT NAME AND AT LEAST 1 OTHER SIGNIFICANT IDENTIFIER (DOB/MRN)

General Laboratory (Chemistry, Hematology, Coagulation, Urinalysis, Microbiology, Reference)

• Labeled with a Cerner Accession Label or Patient Chart Sticker

• If labeled by hand, must have 2 patient identifiers (NAME and DOB/MRN)

• Labels placed so they are not covering any other patient identification

• Labels placed so the contents of the tubes/sterile containers are visible

• Cerner Accession labels must be as straight as possible for instrument reading

• Labels must be flat to tube, and not go over the bottom, or placed on the cap

• For microbiology, place the source and type of specimen on label

Blood Bank

DO NOT REMOVE A BLOOD BANK BRACELET WITHOUT VERIFYING WITH THE BLOOD BANK FIRST 1. Patient must be asked to verbally verify their full name (spell it) and date of birth, if possible, before collection or completion of the Blood Bank Bracelet. 2. Use a blue or black permanent ink pen (no gel pens) to legibly complete the Blood Bank Bracelet. 3. RRMC policy states that there must be at least 2 identifiers on the band. If possible, Blood Bank requests full completion of the information on the band, i.e.

Name/DOB/MRN. 4. Place the label vertically on the patient’s tube. 5. Place the bracelet on the patients arm before leaving the bedside. 6. Remove the tail of the bracelet and return it to the blood bank along with the tube.

Criteria for rejection: write overs, incorrect spelling, smudged or illegible writing.

Cytology and Pathology • Labeled with a Cerner Accession Label or Patient Chart Sticker

• Labels placed so they are not covering any other patient identification

• Labels placed so the contents of the tubes/sterile containers are visible

• Specimen type/source on label

2

Acceptable Labeling for Laboratory Specimens: Unacceptable Labeling for Laboratory Specimens:

3

Hematology, Coagulation, and Urinalysis

Cerner Order Name Useful for Specimen Stability

Expected TAT

What to Collect Collection Device

Body Fluid Cell Count (NON CSF)

• Body Fluid Cell Count

• Cell Count Body Fluid

• Synovial Fluid Cell Count

Providing the WBC in all fluids tested. A differential will indicate which WBC cells are present and how many of each type of cells are in the fluid being tested

Send to Lab STAT • ST - 1 hour

• TS - 1 hour

• RT - 1 hour

1 of the following Lavender K2 EDTA:

• 4.0ml

• 2.0ml Number of Inversions: 8-10

Complete Blood Count

• CBC Monitoring or detecting any of the following:

• Infection

• Anemia

• Bleeding disorder

• 48 hours @ 2-8°C

• 24 hours @ Room Temp

**For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 4.0ml (min 1ml)

• 2.0ml (min 1ml)

• 500µl- *must filled to top line

Number of Inversions: 8-10

Complete Blood Count with

auto-differential

• CBC Auto Diff reflex Manual Diff

• CBC-D

Monitoring or detecting any of the following:

• Anemia

• Infection

• Inflammation

• Bleeding disorder

• Leukemia

• 48 hours @ 2-8°C

• 24 hours @ Room Temp


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 4.0ml (min 1ml)

• 2.0ml (min 1ml)



Correction Studies (PT or PTT)

• Corr PT

• CorrPTT

Determining whether a prolonged PT/PTT are due to an inhibitor or factor deficiency

1 hour @ Room Temp **For best results, send all samples to lab ASAP**

• ST - 2 hour

• TS - 2 hour

• RT - 4 hours

SPECIAL REQUIREMENTS - CALL LAB

CSF Cell Count

• Body Fluid Cell Count

• CSF Cell Count

Provided the WBC and RBC count in CSF. If indicated, a differential will indicate what WBC cells are present, and how many of each type of wells are in the fluid tested.


• TS - 1 hour

• RT - 1 hour

• Sterile CSF Collection containers

* Containers must be number according to order of fill.

4


Expected TAT


D Dimer

• D Dimer Investigating/ruling out the presence of inappropriate blood clots seen in deep vein thrombosis, pulmonary embolism, or DIC (Disseminated Intravascular Coagulation)

8 hours @ Room Temp **For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

1 of the following Blue Sodium Citrate:

• 2.7ml


Tubes must be filled to line on tube for proper dilution

Fetal Membrane Rupture (ROM)

• ROM PLUS Detecting the Rupture of membrane in pregnant women

Send to Lab STAT *Testing must be completed within 30 minutes of collection

• ST - 15 minutes

• ROM Plus collection kit

Fibrinogen

• Fibrinogen Measuring the amount of fibrinogen and its ability to be converted into fibrin


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 2.7ml



Mononucleosis Screen

• Mononucleosis Screen

• Monospot

Detecting, or ruling out, if patient has Mononucleosis

24 hours @ 2-8°C **For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 4.0ml (min 1ml)

• 2.0ml (min 1ml)



Partial Thromboplastin

Time

• Partial Thromboplastin Time

• PTT

Diagnosing unexplained bleeding or clotting

• 4 hours @ Room Temp- Patient not on Heparin

• 2 hours @ Room Temp- Patient on Heparin


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 2.7ml



5


Expected TAT


Platelet Function Assay

• PFA

• Platelet Aggregate

• Platelet Function

Detecting platelet dysfunction induced by intrinsic platelet defects, von Willebrand disease, or exposure to platelet inhibiting agents.


• ST - 1 hour

• TS - 1 hour

• RT - 1 hour

PHLEB DRAW ONLY - CALL LAB

Prothrombin Time

• Prothrombin Time

• Protime, PT/INR

Monitoring or diagnosing bleeding or clotting disorders


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• 2.7ml



Sedimentation Rate

• Sedimentation Rate

• Sed Rate

Used to monitoring inflammation

24 hours @ 2-8°C **For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT -4 hours


• 4.0ml (min 2ml)

• 2.0ml- must be to the line Number of Inversions: 8-10 * Cannot be collected in a Microtainer

Synovial Fluid Crystals

• Syn Crystal examination

• Crystal Examination Synovial

Looks for the presence of uric acid or CPPD crystals in synovial fluid


• TS - 1 hour

• RT - 1 hour


• 4.0ml


Urinalysis Reflex Microscopic and

Culture, if indicated

• UA Rflx Mic/Clt Detecting urinary tract infections or kidney disease. If certain criteria are met, a culture can be indicated based on microscopic findings. A culture will help identify the type of bacteria that may be the cause of the UTI.

• UA: 8 hours @ 2-8°C

• Culture: 24 hours @ 2-8°C


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

• Sterile Container *For best results, collect at least 5ml of urine

6


Expected TAT


Urinalysis Reflex Microscopic, if

indicated

• UA Microscopic Detecting urinary tract infections or kidney disease

• 8 hours @ 2-8°C

• 1 hour @ Room Temp **For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

• Sterile Container *For best results, collect at least 5ml of urine

Xa

• Anti-XA (LMWH)

• Anti-Xa (UFH)

• Anti-Xa (UFH)-Heparin

Monitoring heparin therapy. It can be used to monitor unfractionated heparin (UFH) or low molecular weight heparin (LMWH).

1 hour @ Room Temp **For best results, send all samples to lab ASAP**

• ST - 1 hour

• TS - 1 hour

• RT - 1 hour SPECIAL REQUIREMENTS - CALL LAB

7

Transfusion Testing

Cerner Order Name

Orders Needed to Process Request

Specimen Stability

Expected TAT TAT depends on workflow,

e.g. traumas, massive bleeds, and OR patients.


ABO/Rh and Antibody Screen

• Type and Screen Gel

• T&S Gel

Type and Screen 72 hours • ST - 1 hour

• TS - 1 hour

• RT - 2 hours

1 Pink EDTA Number of Inversions: 8-10 Patient must be banded with Blood Bank bracelet.

ABO/Rh

Confirmatory Type

• ABO/Rh Confirmatory

ABO/Rh Confirmatory

72 hours • ST - 20 minutes

• TS - 20 minutes

• RT - 1 hour SPECIAL REQUIREMENTS - CALL LAB

ABO/Rh Type

• ABO/Rh ABO/Rh 72 hours • ST - 20 minutes

• TS - 20 minutes

• RT - 1 hour


Antibody Screen

• Antibody Screen Gel

• ABSCR Gel

Antibody Screen 72 hours • ST - 1 hour

• TS - 1 hour

• RT - 2 hours

*if clinically significant antibodies are identified, workup will be longer.


Cord Blood Testing

• DAT Cord

• Infant DAT

• ABO/Rh Cord

• Infant ABO/Rh

• Cord Blood Workup

• DAT

• ABO/Rh * Tests may be ordered individually or as a full workup that includes both.

72 hours • ST - 1 hour

• TS - 1 hour

• RT - 2 hours

1 Red Top tube Number of Inversions: 5

and 1 Lavender K2 EDTA:


Tube must be labeled with infant information

Cryoprecipitate

• Blood Bank Cryoprecipitate

ABO/Rh * Full workup recommended but not required


• TS - 40 minutes

• RT - 1 hour


8

Cerner Order Name


Specimen Stability

Expected TAT • TAT depends on workflow,



Direct Antiglobulin

Testing

• DAT Poly

• Direct Antiglobulin Testing-Polyspecific

DAT Poly 72 hours • ST - 30 minutes

• TS - 30 minutes

• RT - 1 hour

SPECIAL REQUIREMENTS - CALL LAB

Fetal Screen

• Fetal Screen

• ABO/Rh

Fetal Screen and ABO/Rh * Commonly ordered on Rh negative females within 72 hours after birth. Also used for Fetal/Maternal Bleeds.


• TS - 1 hour

• RT - 2 hours

1 Pink EDTA Number of Inversions: 8-10 Must be labeled with patient identification and 1 red sticker off Blood Bank Bracelet and placed on tube. Do NOT cut off current Blood Bank Bracelet

Fresh Frozen Plasma

• Blood Bank Plasma

ABO/Rh * Full workup recommended but not required


• TS - 40 minutes

• RT - 1 hour


Hold Clot

• Hold Clot Hold Clot 72 hours • Not Applicable 1 Pink EDTA Number of Inversions: 8-10 Patient must be banded with Blood Bank bracelet.

micRhoGAM

• Blood Bank MicRhoGAM

ABO/Rh 72 hours • ST - 30 minutes

• TS - 30 minutes

• RT - 1 hour


Platelet

• Blood Bank Platelet

ABO/Rh- if no previous history * Full workup recommended but not required


• TS - 15 minutes

• RT - 30 minutes


9

Cerner Order Name


Specimen Stability

Expected TAT • TAT depends on workflow,



Red Blood Cells

• Blood Bank RBC ABO/Rh + Antibody Screen Gel

or Type and Screen Gel


• TS - 1 hour

• RT - 1 hours


Rh Type

• Rh Type

• Rh Only

Rh Type 72 hours • ST - 20 minutes

• TS - 20 minutes

• RT - 1 hour


RhoGAM

• Blood Bank RhoGAM

ABO/Rh 72 hours • ST - 30 minutes

• TS - 30 minutes

• RT - 1 hour


Transfusion Reaction

• Transfusion Reaction Workup

• Trxn Workup

Transfusion Reaction Workup

72 hours All transfusion reactions will be worked up as soon as they are ordered. The length of the workup depends on the type of reaction.

1 Pink EDTA Number of Inversions: 8-10 Must be labeled with patient identification and 1 red sticker off Blood Bank Bracelet and placed on tube. Do NOT cut off current Blood Bank Bracelet

10

Chemistry

Testing

Specimen Stability

Expected TAT

What To Collect Collection Device

Body Fluids

• CSF Glucose

• CSF Protein

Send to Lab STAT

• ST - 1 hour

• TS - 1 hour

• RT - 1 hour

• CSF Collection Tubes

• BF LDH

• BF Glucose

• BF Protein

• BF Albumin

• BF Amylase

• BF BUN

• BF Creatinine

• BF Triglycerides

• BF Uric Acid

Send to Lab STAT

• ST - 1 hour

• TS - 1 hour

• RT - 1 hour

At least 1 full: Light Green Lithium Heparin Tube

Number of Inversions: 8-10 Or

Gold SST Tube Number of Inversions: 5

Or Sterile Container

• BF pH

Send to Lab STAT

• ST - 1 hour

• TS - 1 hour

• RT - 1 hour

1 Dark Green Lithium Heparin Number of Inversions: 8-10

Cardiac Markers

• CK

• CKMB

• hsCRP

• Troponin

Specimens must be spun within 2 hours of Draw. For best results send to lab ASAP.

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

At least 1 full: Green Lithium Heparin Tube Number of Inversions: 8-10

Or Gold SST Tube

Number of Inversions: 5

* Green Lithium Heparin Tube Preferred

Creatinine Clearance

Creatinine Clearance:

• Must record duration of collection (usually 24 hours)

• Must have creatinine Blood test collected within 24 hours of Creatinine Clearance.

All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample.

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

Call Lab for Instructions

11

Testing

Specimen Stability

Expected TAT


Critical Care Markers

• Critical Care Panel

• Ionized Calcium

• Lactate

• pH

• Carboxyhemoglobin

• VBG

• Cord Blood Gas

Specimens must be drawn, placed on ice, and sent

to the lab IMMEDIATLEY

• ST- 30 minutes

• TS- 30 minutes

• RT- 30 minutes

1 Dark Green Lithium Heparin Tube Number of Inversions: 8-10

Or Heparinized Syringe

• Needle must be removed, and end capped before sending the sample to the lab

• ABG



• ST- 30 minutes

• TS- 30 minutes

• RT- 30 minutes

1 Heparinized Syringe-needle must be removed, and end capped before sending the sample to the lab *Respiratory usually collects these specimens Lab cannot collect these specimens

*Lab does not provide arterial draw kits.

Contact Respiratory Therapy for arterial kits.

• Capillary Blood Gas



• ST- 30 minutes

• TS- 30 minutes

• RT- 30 minutes

1 full capillary tube with flea inside. All items for collection of this test are located within the lab. Call the lab when this test is ordered.

Drug Levels (Serum Only)

• Lithium Specimens must be spun within 2 hours of Draw. For best results send to lab ASAP.

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

At least 1 full Gold SST Tube Number of Inversions: 5

Drug Levels (Serum/Plasma)

• Acetaminophen

• Digoxin

• Phenobarbital

• Salicylate

• Carbamazepine

• Ethanol

• Phenytoin

• Valproic Acid

• Gentamicin (Random, Trough, Peak)

• Vancomycin (Random, Trough, Peak)


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


Or Gold SST Tube



Drug Screen (Urine)

• Urine Drug Screen (ordered as a panel) All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample.

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

• Sterile Container

*Lab does not provide

arterial draw kits.

Contact Respiratory

Therapy for arterial kits

12

Testing

Specimen Stability

Expected TAT


General Chemistries

• Acetone

• Albumin

• Alk Phos

• Amylase

• ALT

• AST

• Bun

• CO2

• CRP

• GGT

• Magnesium

• Uric Acid

• Sodium

• Protein

• Potassium

• Calcium

• Chloride

• Cholesterol

• Creatinine

• Ferritin

• Phosphorous

• Triglycerides

• LDL

• HDL

• Bilirubin (Direct, Total, Total & Direct)

• Glucose (Fasting, Diabetic Screen, 2hr PP, 2hr GTT, 3GTT)

• Panels: o CMP o BMP o Liver Function o Renal Function, o Lipid Profile


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


Or Gold SST Tube



• C3

• C4

• Folate

• Iron

• Rheumatoid Factor

• IgA

• IgG

• IgM

• TIBC

• Vitamin B12

• Vitamin D


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

At least 1 full Gold SST Tube


13

Testing

Specimen Stability

Expected TAT


Hormones

• TSH,

• T4, Free

• T4, Total

• T3 Free


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


Or Gold SST Tube



• TSH Cascade

• Cortisol, Random

• Cortisol, Baseline, 30 min., 60min (ACTH)

• FSH

• Prolactin

• T3 Total

• PTH


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


Infectious Diseases

• Hepatitis A/B/C Panel

• HIV Antibody

• Syphilis

• Lyme

• Measles

• Mumps

• Rubella

• Procalcitonin

• Varicella Zoster


Hepatitis, HIV, and Syphilis samples are only run M-F between 8am-1pm.

At least 1 full Gold SST Tube for Syphilis

2 full Gold SST Tubes for Hepatitis Testing


Random Urine Testing

• Phosphorous

• Protein

• Urea Nitrogen

• Microalbumin

• Calcium

• Creatinine

• Glucose

• Potassium

• Sodium

• Uric Acid

All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample.

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


14

Testing

Specimen Stability

Expected TAT


Tumor Marker

• Ca125

• CEA


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours


• PSA, Diagnostic

• PSA, Screening


• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

At least 1 full: *Green Lithium Heparin Tube

Number of Inversions: 8-10 Or

Gold SST Tube Number of Inversions: 5


24 Hour Urine

• Phosphorous

• Protein

• Urea Nitrogen

• Uric Acid

• Microalbumin

• Calcium

• Creatinine

• Glucose

• Potassium

• Sodium

All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample

• ST - 1 hour

• TS - 1 hour

• RT - 4 hours

Call Lab for Instructions * All 24-hour urines MUST be refrigerated on kept on ice during the whole collection process

15

Microbiology

Cerner Order Name Useful For

Specimen Stability

Expected TAT


Abscess, Wound, Routine Culture

• C Abscess

• C Wound

• C Routine

• *Orders require a source.

Identifying bacteria responsible for infections

Sterile Container:

• 2 hours Room Temperature

• 24 hours Refrigerated

Swab:

48 hours Room Temp

**For best results, send all samples to

lab ASAP**

3 days

*Gram stain completed within 1 shift


• ESwab-White Cap (Most Common)

• ESwab-Green Cap( small sources)

Collect material from actual infection site with minimal contamination from adjacent areas.

AFB Culture

• C AFB

• AFB Culture *Orders require body fluid type or source

Detect the presence of Acid Fast Bacilli in a specimen

Sterile Container:



• Negative: 6 weeks

• Positive: Reported when become positive


Anaerobic Culture

• Anaerobic with Aerobic Scr. Culture

• C Anaerobe *Orders require a source.

• *Note difference in collection containers for tissues and body fluids.

Detection of bacteria only capable of surviving in oxygen lacking environments

Send to lab Immediately

3 days


Tissues All anaerobic tissues MUST be collected in the small anaerobic jar and CANNOT be placed in the tall, skinny anaerobic vial for fluids.

Body Fluids

All body fluids for anaerobic testing MUST be collected in the tall, skinny anaerobic vial, and should not be placed in the small anaerobic jar meant for tissues.

*Note: Tissue samples

should be in contact

with the media in the

vial

*Do NOT pierce gel.

***Swabs are

not acceptable

collection devices

for anaerobic

cultures

* Do not remove cap.

Open sterile pack,

then pierce rubber

stopper on cap with

syringe to add fluid.

***Swabs are not

acceptable

collection devices

for anaerobic

cultures

16


Specimen Stability

Expected TAT


Blood Culture

• Blood Culture Testing for septicemia and bacteremia

Bring to Lab ASAP

• Negative: 5 days

• Positive: Called to floor when bottle becomes positive

• Green BacT Alert Aerobic Bottle

• Orange BacT Alert Aerobic Bottle

• Yellow BacT Alert Pedi Bottle (12 yrs. and under ONLY)

Adult: Aerobic: 8-10ml

Anaerobic: 8-10 ml

Pediatric: 0.5-4 ml

Body Fluid Culture

• C Body Fluid

• Body Fluid Culture *Orders require body fluid type

Detect the presence of bacteria in normally sterile body fluids Send to lab

immediately

3 days *Gram stain completed within 1 shift


• Red Top Tube

• Syringe with no needle *Swabs are unacceptable*

C- Diff

• C Diff Toxin

• Clostridium Difficile Toxin

Detection of toxogenic C- Diff DNA in liquid fecal specimens

3 days Refrigerated


1 day


• White Para-Pak Vial *Formed stools not accepted

CSF Culture

• CSF Culture

• C CSF

Detect bacterial infection or presence in CSF. Often seen in cases of meningitis

Send to lab immediately.

3 days

*Gram stain completed within 1 hour


Cryptococcal Antigen - CSF

• CSF Crypt Ag

• Cryptococcal Antigen Scr

Detection of the capsular polysaccharide antigens of Cryptococcus species in CSF

Send to lab immediately

1 hour • Sterile Container

17


Specimen Stability

Expected TAT


Fungus Culture

• C Fungus

• Fungus Culture *Orders require body fluid type or source

Detect the presence of fungi in a specimen

Sterile Container:



• Negative: 6-8 weeks



Fungus Culture

Skin, Hair, Nails

• Fungus Culture Skin, Hair, Nails

Detect the presence of fungi in a specimen

Sterile Container:



• Negative: 6-8 weeks



Gardnerella, Trichomonas

and Yeast Probe

• GTY Probe Useful for the detection of Candida, Gardnerella, and Trichomonas in vaginal fluid specimens

72 hours • 1 day

• STAT: 1 hour

• Affirm GTY Kit

GI Pathogen (Previously Stool Culture)

• GI Pathogen PCR

• Stool Pathogen PCR

Detection of:

• Campylobacter

• Salmonella

• Shigella

• Yersinia Enterocolitica

• Vibrio

• Norovirus

• Rotavirus

• Shiga Toxins

Sterile Container: 1-hour Room Temperature

Orange Para-Pak:

48 hours refrigerated


24 hours


Orange Para-Pak Vial (preferred)

Group A Strep Culture

• C Strep A

• Group A Strep

Detect the presence of Group A Step

48 hours Room Temperature


3 days • White Cap (Flocked) ESwab

Collect from inflamed throat and/or tonsil area

18


Specimen Stability

Expected TAT


Group B Strep Culture

• C Strep B

• Group B Strep

Prenatal Screening for Group B Strep colonization


**For best results, send all samples

to lab ASAP**

3 days • Green Star Swab II

Collection from vaginal introitus and anorectum

Lactoferrin

• Lactoferrin Screen for fecal leukocytes

Sterile Container or White Para-Pak: Refrigerated within 1 hour of collection. Acceptable 14 days refrigerated

1 day • Sterile Container

• White Para-Pak Vial

MRSA/Staph Screening

• C MRSA

• C Pre-op Staph Screen

Detection of MRSA from anterior nares, groin, and or axilla. Detection of MRSA or MSSA from pre-op anterior nares specimen only. Not intended to monitor treatments

Swab: 48 hours Room Temperature


3 days • White Cap (Flocked) ESwab Only

Rapid Flu A/B

• Rapid Influenza A/B PCR

• Vir Rapid Flu PCR

Rapid detection of Influenza A & B in respiratory specimens

72 hours Refrigerated


1 hour • NP swab only

Rapid RSV

• Rapid Flu/ RSV PCR

• Rapid Influenza A/B and RSV PCR

Rapid detection of RSV in respiratory specimens

72 hours Refrigerated


1 hour • NP swab only

19


Specimen Stability

Expected TAT


Rapid Strep

• Rapid Strep Strep A Ag

Rapid detection of the Group A Antigen



1 hour

• Green Star Swab II

Sputum Culture

• C Sputum

• Sputum Culture *Required source: Endotrach, Sputum Induced, Sputum, Sputum Aspirate, Trach Aspirate

Identifying bacteria responsible for respiratory tract infections




3 days


• Sterile Container Expectorated or induced sputum: Collect a deep, vigorous cough, directly into sterile container

Stool Giardia and Crypto

• Giardia/ Cryptosporidium Ag

Detecting Giardia or

Cryptosporidium antigen in feces

Sterile Container: 1-hour Room Temperature

Black Para-Pak:

96 hours


2-3 days • Sterile Container

• Black Para-Pak Vial *Collection kit available upon request from lab

Stool Occult Blood

• Fecal Occult Blood Diagnostic or Screening

• Occ Bld Fec, Dgn, or Scr

• Detection of Hemoglobin in stool samples.

• Often seen in GI Bleeds.

Sterile Container: 1-hour Room Temperature Occult Card:

14 Days Room Temperature


1 day • Sterile Container

• Occult Card

Stool O&P

• O&P Exam

• Ova and Parasite Exam

• Identifying parasites and/or ova in feces

Sterile Container: Fresh stool in

white top must be transferred to black top within

1 hour of collection

Black Para-Pak:

96 hours


2-3 days • Sterile Container

• Black Para-Pak Vial *Collection kit available upon request from lab

20


Specimen Stability

Expected TAT


Tissue Culture

• Tissue Culture

• C Tissue *Orders require a source.

Detection of bacteria on or in body tissues

• Send to lab Immediately

• Refrigerate only if there is a delay


3 days



* DO NOT SEND SWAB OF TISSUE.

Urine Culture

• C Urine

• Urine Culture *Orders require collection type: Clean Catch, Mid- Stream, Cystoscopy, Kidney, Pedi Bag, Suprapubic Asp, Ureteral, NOS

Detection of UTI 24 hours Refrigerated


3 days • Sterile urine container

Virus Detection

• Virus Adenovirus Detection

• Virus Cytomegalovirus Detection

• Virus Influenza & RSV Detection

• Virus Herpes Simplex Detection

• Virus Metapneumovirus Detection

• Virus Parainfluenza Detection

• Virus Varicella Zoster

• Virus VTDH Flu Detection

*Requires Specimen Type

Rapid (qualitative) detection of viruses through PCR

Return to lab within 24 hours

refrigerated


3-5 Days

• NON-Nasopharyngeal/ Body Fluid sites: Adult Virology FloqSwab Collection Kit

• Nasopharyngeal: Wire shaft, polyester tipped swab in Copan sleeve

• Body Fluids: Sterile Container

21

Anatomic Pathology


Specimen Stability

Expected TAT


Anal-Rectal Cytology (Anal Pap)

• Pathology NON-GYN Request

Evaluation of HPV related lesions in upper anal-rectal mucosa.

Send to lab in timely manner.

Specimen is stable

at room temperature.

1 Day Swab/brush above the anal transformation zone, and swish or clip the brush into NONGYN PreservCyt vial. Single-use Anal-Rectal kits available through the lab.

Body Fluid Cytology


Evaluating the presence or absence of malignant cell populations in effusions.


1 Day NO FIXATIVE. Tap effusion. Submit ALL fluid regardless of volume.

Bone Marrow Specimen Evaluation

• Pathology Bone Marrow Request

• Must contact Cytology Dept for assistance x1786

• One order for the aspirate and one order for the core biopsy

Evaluating disorders involving blood and bone marrow.

24-48 hours refrigerated

1-2 Days

(2)-1 mL Sodium Heparin Green (1)- 1 mL K2 EDTA (1)- Formalin container with clot specimen (1)- Formalin container with filter specimen 6 to 9 prepared slides

Breast Lumpectomy or Resection

• Pathology TISSUE Request

Refer to lab with any questions. Extension 1786.

Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "fresh specimen.”

24-48 Hours Fresh specimen. NO FIXATIVE.

22


Specimen Stability

Expected TAT


Brush/ Scrapping Cytology


Evaluating possible malignant cell populations in brush/scraping of bronchial tree, gastric mucosa, oral mucosa, tongue scraping, or other surface lesions.

Transport as soon as possible or

refrigerate with Cytolyt.

1 Day Submit as 2 fixed slides made by rolling the brush across the slide, and rapidly submersing slides in Coplin Jar with 95% ethanol or fix with spray fix. Vigorously swish then clip the brush tip into the Cytolyt tube. Submit slides and Cytolyt tube containing brush tip.

Chlamydia Gonorrhoeae

Testing - Non-

Urogenital sites

• Misc Mayo

• GOKEY MCTGC

Diagnosing Chlamydia trachomatis & Neisseria gonorrhoeae infections in Throat, Oral, Rectal or Eye specimens

Swab: 30 days at 2-30°C

1-3 Days Blue Swab Only: Discard White Swab. Use Blue Swab Only. Swab site and place in transport tube. Snap off swab at score line to fit inside tube. Securely fasten cap.

Aptima Swab Collection Kit

Chlamydia Gonorrhoeae

Testing - Urogenital

sites

• CT PCR

• NG PCR

• Chlamydia Gonorrhea PCR Panel

Diagnosing urogenital Chlamydia trachomatis & Neisseria gonorrhoeae infections in male and female.

1. Urine: 24 hours refrigerated (male or female) 2.Vaginal swab: 60 days at 2-30°C (female only) 3. PreservCyt Pap Test Co-collection: 60 days at 2-30oC (female only)

1-2 Days 1. Urine: (male or female) Collect first 30 mL of NON-Clean Catch (Dirty) urine, at least 2 hours post previous urination. 2. Vaginal swab: (female only) Use Uni-swab PCR Collection Kit, swab vaginal canal without prior cleaning. Submit swab in the collection tube, snapping it off at the demarcation line. 3. PreservtCyt Pap Test: (female only) Collect as for Pap test with

an endocervical broom/spatula, vigorously swish into ThinPrep vial, discard collection device.

Vaginal Swab Collection Kit

PreservCyt ThinPrep Urine Collection Vial Cup

23


Specimen Stability

Expected TAT


Core Needle Biopsy:

Breast, Liver, Kidney, etc.


Routine Pathology. Transport specimen as soon as possible to the

lab

24-48 Hours • Tissue Sample added to container with formalin.

• Record time specimen enters container on patient label.

CSF Cytology


Evaluating the presence or absence of malignant cell populations in Cerebrospinal Fluid.


1 Day Tapped CS Fluid. Submit as fresh.

Cytogenetics on Bone Marrow

Specimen

• Bone Marrow Request Must contact Cytology Dept for assistance x1786

Evaluating genetic abnormalities associated with various diseases.


> 5 Days

Testing Performed at Mayo Medical

Labs

(2)-1 mL Sodium Heparin Green

OR

(2)- 2 mL bone marrow OR

Tissue in RPMI (RPMI located

in Histology refrigerator).

Cytogenetics on NON Bone

Marrow Specimen

• Cytogenetics

Evaluating genetic abnormalities associated with various diseases.


> 5 Days

Testing Performed at Mayo Medical

Labs

(1)-1 mL Sodium Heparin Green Peripheral Blood only

Eosinophil Evaluation


*Please specify in Order Comments tab whether testing request is for "eosinophils only" or "eosinophils and cytology"

Detection of eosinophils in fluid specimens.



1 Day Submit as fresh or with Cytolyt fixative.

24


Specimen Stability

Expected TAT


Flow Cytometry on Bone Marrow

Specimen

• Bone Marrow Request

• Must contact Cytology Dept for assistance x1786



1-2 Days

Testing done at UVMMC.

(2)-1 mL Sodium Heparin Green AND

(2)-2 mL EDTA Lavender

OR

Tissue in RPMI (RPMI located in Histology refrigerator)

Flow Cytometry on

NON Bone Marrow

Specimen

• Flow Cytometry



1-2 Days

Testing done at UVMMC.

6 mL Sodium Heparin Green for Peripheral Blood

OR 1.5 mL CSF

OR 5 mm3 or larger tissue biopsy in RPMI

(RPMI located in Histology refrigerator Must call to obtain)

FNA Cytology (Fine Needle Aspiration)

• Pathology FNA Request

Evaluating the presence or absence of malignant cell populations in palpable or imaged lesions.


Specimen is stable


1 Day Generally, 1-3 needle passes, submitted as fixed material. Cell Blocks can be made from generous sampling for confirmation/typing stains (specimen material should be visible in the Cytolyt tube). Each pass should contain Preferred: 1. One Labeled, direct-smear slide dropped, while wet, into a Coplin Jar filled with 95% alcohol. 2. One labeled, direct smear, spreader slide allowed to air dry. 3. Needle rinse material in CytoLyt collection tube. Acceptable: 1. One Cytolyt tube with contents of each pass expressed directly into media.

Fresh Specimen:

Lymph Node

Suspicious for

Lymphoma


Anything other than Routine Pathology. Example: lymph nodes, looking for lymphoma.

Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "fresh specimen.”

24-48 Hours Fresh specimen. NO FIXATIVE.

25


Specimen Stability

Expected TAT


Frozen Section


*Place order in Cerner stating frozen section needed BEFORE the specimen is sent to pathology. * Must Include Form #1275 Intraoperative Consultation Request

Immediate diagnosis.

Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "frozen specimen.”

20 Minutes Fresh specimen. NO FIXATIVE.

GYN Pap Test Cytology with HPV Detection

• Pathology GYN Request

HPV reflex testing options include:

• HPV if ASC/LSIL

• HPV Co-testing Reflex Genotype

Screening detection for squamous cancer or precursors and molecular detection of HPV in cervical, endocervical, and vaginal brushings.

60 Days from collection at Room

Temperature

3 to 5 Days Endocervical brush/spatula, vigorously swished into ThinPrep PAP Test vial, discard brush/spatula. Single-use collection kits available through the lab.

Hemosiderin Evaluation


*Please specify in Order Comments tab whether testing request is for "hemosiderin-macrophages only" or "hemosiderin- macrophages and cytology".

Detection of hemosiderin-laden macrophages in fluid specimens.



1 Day Submit as fresh or with Cytolyt fixative.

HPV Detection with Reflex to

Pap Test Cytology

• HPV Primary Screen Alternative screening algorithm for detection of squamous cancer or precursors and molecular detection of HPV. For women >25 yr. Cytology is performed only if HPV result is HPV HR Other Positive.

60 days from collection at 2-

30oC

1-3 days Endocervical brush/spatula in a ThinPep Vial, discard brush/spatula.

26


Specimen Stability

Expected TAT


Nasal Cytogram


Differentiation of allergic, non-allergic, infectious, inflammatory, and non-inflammatory forms of rhinitis


Specimen is stable


1 Day 1 air-dried slide in a slide holder and 1 CytoLyt tube containing the Rhino-probe.

PJP (Pneumocystis

Jiroveci Evaluation)


*Please specify in Order Comments tab whether testing request is for "PCP only" or "PCP and cytology".

Detection of PJP (formerly PCP) in respiratory specimens.



1 Day Submit as fresh or with Cytolyt fixative

Sputum Cytology


Evaluating the presence or absence of malignant cell populations in sputum.



1 Day Deep cough expectorate. Do not have patient spit. Submitted as fresh or with Cytolyt fixative.

Tissue Specimen:

• Temporal artery

• Wound biopsy

• Skin Biopsy

• Vasectomy


Routine Pathology.

Transport specimen as soon as possible to the

lab

24-48 Hours • Tissue Sample added to

container with formalin.

• Record time specimen enters container on patient label.

27


Specimen Stability

Expected TAT


Tzanck Prep or Varicella

Zoster


Detection of cellular change associated with varicella virus in surface lesions/blisters.


Specimen is stable


1 Day Directly scrape the blister/lesion base, spread onto 1 air dried slide, vigorously swish the collection device in the PreservCyt vial, discard collection device. Submitted slides AND PreservCyt vial. Single-use Tzanck Prep kits available through the lab.

Urine Cytology


*Must Specify voided urine, catheterized urine or bladder wash

Evaluating the presence or absence of malignant cell populations in voided urine, catheterized urine, and bladder washes.



1 Day Clean-catch midstream urine, or catheterized-urine, or wash collection. Make sure to specify the collection type on the label. Can be submitted as fresh or with up to 30mL of Cytolyt fixative.

Wash Cytology


Evaluating the presence or absence of malignant cell populations in washes (bronchial, abdominal, etc.).



1 Day Submit as fresh wash collection or mixed with Cytolyt fixative.

Laboratory Specimen Collection and Labeling Guidelines · Synovial Fluid Crystals • Syn Crystal...

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Transcript of Laboratory Specimen Collection and Labeling Guidelines · Synovial Fluid Crystals • Syn Crystal...