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Specimen Collection & Preparation

Blood Collection

Blood Gas Analysis

Specimen Collection Tubes

Lab Recommendations for Blood Collections from Lines

Specimen Handling & Transportation

24-Hour Urine Collection

Random Urine Drug Screen Collection with Chain of Custody

Minimum Pediatric Volume of Whole Blood Required for Commonly Ordered Procedures

Ambient Specimens

Refrigerated Specimens

Frozen Specimens

Courier Services

Priority Codes

SPECIMEN COLLECTION INFORMATION

Specimen Collection and Preparation
Laboratory test results are dependent on the quality of the specimen submitted. It is important that all specimens and request slips be properly labeled in the presence of the patient. Specimens should be labeled with the name of the patient, collection date and time, and the origin (source) of the specimen, when applicable.
If there is any doubt or question regarding the type of specimen that should be collected, it is imperative that Deaconess Hospital Laboratory be called to clarify the order and specimen requirements.

Blood Collection

Most laboratory tests are performed on anticoagulated whole blood, plasma or serum. In general, specimens should be refrigerated until placed in the courier box for transport to the laboratory. Please see our individual User’s Guide section for specific requirements.

• Plasma: Draw a sufficient amount of blood with the indicated anticoagulant to yield the necessary volume. Gently mix the blood collection tube by inverting 6-10 time immediately after draw. If required, separate plasma from cells by centrifugation within 20 minutes.
• Serum: Draw a sufficient amount of blood to yield the necessary volume. Gently invert tubes immediately following collection. Allow blood to clot at ambient temperature and then, separate serum from clot by centrifugation within 20-30 minutes of collection. Hemolyzed samples may compromise the test results.
• Whole Blood: Draw a sufficient amount of blood with the indicated anticoagulant. Gently mix the blood collection tube by inverting 6-10 times immediately after draw.

Blood Gas Analysis
Capillary
Absolute minimum collected in a special heparinized collection device is 125 mL.

Heparinized Syringe Collection
Absolute minimum in a special heparinized syringe is approximately .5m

Specimen Collection Tubes
The following is a list of tubes referred to in the Laboratory User’s Guide specimen requirements:

Grey top tube (Potassium Oxalate/Sodium Fluoride):   This tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative.

Note:  After the tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation.

Lavender top tube (EDTA):   This tube contains EDTA as an anticoagulant.

Note:  After the tube has been filled with blood, immediately invert the tube several times in order to prevent coagulation.

Light blue-top tube (Sodium Citrate):  This tube contains sodium citrate as an anticoagulant – used for drawing blood for coagulation studies.

Note:  It is imperative that the tube be completely filled.  The ratio of blood to anticoagulant is critical for valid prothrombin time results.  Immediately after draw, invert the tube 6-10 times in order to activate the anticoagulant.

Red top tube:  This tube is a VACUTAINER® containing no anticoagulant – used for drawing serum for selected tests.

Royal blue top tube:  there are two types of royal blue-top Monoject® tubes – one with the anticoagulant EDTA and the other plain.  These are used in drawing whole blood or serum for trace element analysis.  Refer to the individual metals in the individual test listing to determine the necessary tube type.

Gold top tube:  this tube contains a clot activator and serum gel separator – used for various laboratory tests.

Note:  Invert the tube to activate the clotting.  Let stand for 20-30 minutes before centrifuging for 10 minutes.  If frozen serum is required, pour off serum into plastic vial and freeze.  Do not freeze VACUTAINER(S) ®.

Special collection tubes:  Some tests require specific tube for proper analysis.  Please contact Deaconess Hospital Laboratory prior to patient draw to obtain the correct tubes for metal analysis or other tests as identified in the individual test listing.

Yellow top tube (ACD):  This tube contains ACD, used for drawing whole blood for special tests.

Order of Draw

Note:  Please use the clear discard tube prior to collecting coagulation testing (Blue), especially when drawing with a butterfly needle.  This is very important to ensure there is a correct blood to additive ratio and prevents contamination by additives from previous tubes.

Lab Recommendations for Blood Collections from Lines

Drawing blood for routine testing below an IV:

1. Turn fluid off
2. Wait 2 minutes
3. Discard 5 ml of blood
4. Collect blood tubes according to the “Order of Blood Draw” instructions.

Drawing blood for routine testing from central lines, implanted ports, and central venous catheters:

1. Turn all fluids off
2. Flush (all Ports) with 5 mL of normal saline (if there was fluid in the line/s).
3. Wait 2 minutes.
4. Discard first 5 mL of blood
5. Collect blood tubes according to the “Order of Blood Draw” instructions

Drawing blood for coagulation testing through any lines that have been flushed with heparin should be avoided if possible.  But if unavoidable, for collection from central lines implanted ports, and central venous catheters:Turn all fluids off

1. Flush (all Ports) with 20 mL of normal saline (if there was fluid in the line/s).
2. Wait 2 minutes.
3. Discard first 10 mL of blood
4. Collect blood tubes according to the “Order of Blood Draw” instructions

Specimen Handling and Transportation
Serum and plasma samples - Unless specific handling instructions are listed in the alphabetical listing (to follow); samples need to be processed within 2 hours of collection.

After centrifugation, samples should be refrigerated or frozen or testing performed within 8 hours unless other specific instructions are listed in the alphabetical listing.

Samples should be maintained at the same temperatures as required for sample stability whether samples are handled and processed in the building or whether samples are transported from other locations.

The correct sample type and special instructions are listed in the alphabetical test listing.

The collection of urine specimens is the responsibility of the nursing unit or client office except for those collected in the Laboratory Outpatient collection centers. 

Specimens for routine urinalysis and cultures should be freshly collected specimens.  All urines should be collected utilizing clean catch, sterile technique.

The nursing unit, attending physician or office staff will collect specimens for culture.  See the Microbiology / Infectious Disease Specimens collection section of this User’s Guide

Random Urine Drug Screen Collection with Chain of Custody

1. Obtain a Chain of Custody form the Chemistry Section of the laboratory. Only use an approved Chain of Custody form as provided by Deaconess Regional Laboratory.
2. Observe collection or put dye in toilet and turn off hot water and seal around shut off valve.
3. Let patient choose a urine cup and instruct that you need a minimum of 50 cc.
4. Take specimen from patient and note temperature and color on Chain of Custody form.
5. Seal container and label with patient’s name and an additional patient identification (date of birth or hospital number), date/time and collector’s initials.
6. Complete the Chain of Custody form.
7. Keep the top copy of the Chain of Custody form and place on the patient’s chart.
8. Take the back copy of the Chain of Custody form and the urine sample to the laboratory.

Minimum Pediatric Volume of Whole Blood Required for Commonly Ordered Procedures

Hematology Procedures
CBC with diff - 500 ul - one lavender microtainer filled to the top

Chemistry Procedures
The following listing states the absolute minimum sample required for commonly ordered tests. This listing reflects just enough sample to perform the procedures once, and assumes no instrument problems or dilutions that require the sample to be repeated.

General Chemistry Assays

SPECIMEN PACKAGING & COURIER SERVICE

Ambient Specimens
Small biohazard bags are designed to transport serum and urine specimens that do not require special temperature or handling.

Refrigerated Specimens
Couriers have the necessary equipment to transport refrigerated specimens to Deaconess Hospital Laboratory. Cooler bags are utilized to assure the specimen remains refrigerated. Place the specimen and accompanying request in a tightly sealed plastic biohazard bag.

Frozen Specimens
Our couriers have the necessary equipment to transport frozen specimens to Deaconess Hospital Laboratory. Dry ice is utilized to assure the specimen remains frozen. Send each frozen specimen in a vial not more than ¾ full and use plastic (not glass) vials. Place the specimen and accompanying request in a tightly sealed plastic biohazard bag.

Courier Services
The Deaconess Regional Laboratory, Outreach section provides courier services to client physician offices. Contact the Outreach section at 812-450-2740 or additional information. Pick up frequency is determined by location and referral volume.

LABORATORY TEST ORDER ENTRY

Priority Codes

STAT – Need it drawn and tested ASAP

STAT2 – Need it drawn at a specific time and tested ASAP

TIMED – Need it drawn at a specific time, but tested routinely

ROUTINE – Routinely drawn and tested at the top of every hour

Remember : Use TIMED priority code for all tests requiring the specimen to be drawn at a specific time except:

• AM rounds are always ordered with a ROUTINE priority code unless STAT results are required.
• If STAT results are required for AM rounds (or any other specimen to be drawn at a certain time during the day), then the STAT2 priority code should be ordered. The TIMED priority code should rarely, if ever, be used for AM rounds.

Frequently Asked Questions

Q. Does ordering tests STAT speed up the process of downtime?

A. No, this actually delays the accessioning and testing of specimens during a downtime. Use priority codes appropriately as you would during normal operating procedures.

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