clinical laboratory sample collection manual

Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC. Please follow this link for the addresses and hours of operation of these facilites. Urine containers requiring special preservatives are not stocked on the floors, but can be obtained from the specimen processing desk at each hospital laboratory. This information is also available via the individual test entries in our test menu. Other collection tubes may be rejected. While the minimum volume necessary for testing is stated in the test menu, when clinically possible it is advisable to collect the preferred volume, as this will allow for repeat testing when necessary. We recognize that this is not always possible, and will make every effort to provide a result on the sample submitted If it is necessary to draw proximal to an IV it is important that the IV be stopped and the vein allowed to clear (minimum 1 minute) before the sample is drawn. Laboratory phlebotomists have been instructed not to collect samples proximal to an IV, and will ask nursing personnel to stop the IV prior to phlebotomy and restart it after the samples have been collected. Short filling a citrate tube (Blue top) will alter the required 9:1 plasma:citrate ratio and may result in erroneously prolonged coagulation test results. This will ensure that an adequate blood volume is collected. If a patient's hematocrit is above 55%, contact the Hematology laboratory and request a tube adjusted to contain the appropriately decreased amount of citrate anticoagulant. There is no standard at present for adjusting the amount of anticoagulant for specimens with low hematocrits. Check the expiration date of all tubes prior to collecting samples and discard any expired tubes. DO NOT use expired tubes for sample collection.

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Click to login or enroll. Visit our Help Center Click to login or enroll. Visit our Help Center This Specimen Collection Manual is a professional service that gives our teams the information they need to ensure your tests are collected correctly. This reduces the chance of an incorrect test result. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit About Us. Quality specimens must be collected in order to provide the most clinically relevant microbiology results for our patients ( The instructional information should be made available to your clinicians, clinical laboratory scientists, nursing staff, patients, or other clients. Specimens are to be labeled with the patient name and medical records number. The last preanalytical consideration before processing the specimen is to ensure that the specimen is processed in accordance with the test ordered and the organism suspected. The tables in this section are meant to be used as a guide for these important preanalytical steps. Leber A (ed),ASM Press, Washington, DC.ASM Press, Washington, DC. ASM Press, Washington, DC. ASM Press, Washington, DC. American Public Health Association, Washington, DC. Star Publishing Co., Belmont, CA. Elsevier Inc., Philadelphia, PA. ASM Press, Washington, DC. J Infect Dis 141: 531. Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.Leber A (ed),ASM Press, Washington, DC.

If one is not available, a screw-top container or extra padding is acceptable. Be aware that dry ice is a dangerous good and must always be declared by marking, labeling and documentation. If there are no other dangerous goods in a shipment with dry ice, a formal Shipper’s Declaration is not required. Refer to IATA packing instruction 904. If this is not possible, specify antibiotic in the request. Contamination can usually be evaluated by the number of epithelial cells seen on gram stain examination. It is preferable to obtain specimens bypassing normal flora whenever possible. For urines, single catheterized specimens are cleaner than midstream clean catch specimens. Deep wounds collected by aspiration are preferable to superficial swab collection. For sputum specimens, having the patient rinse their mouth before expectorating may reduce oral-pharyngeal contamination. Follow instructions for proper use of specimen collection devices provided with each unit. Use no fixatives or bacteriostatic agents for cultures. View guidelines for choosing the correct swab or container for the test. Deliver immediately if results are needed STAT. Urine can be refrigerated if delivery is delayed.Please contact the laboratory for provision of required transport tubes or, if necessary, STAT pickup. Note: Due to the instability of Neisseria gonorrheae, specimens for GC culture from off-site clinics should be collected in transport media. Anaerobic transport media is usually not necessary if the specimen is delivered to the laboratory immediately. Do not inoculate blood culture media except for peritoneal fluid and also send uninoculated fluid in a sterile container. This occurs periodically for routine preventive maintenance, reprogramming procedures and back-up of the system.This may be temporary, lasting as little as a few minutes or more severe, lasting hours.

If, by contrast, the venipuncture is difficult with much searching for the vein, the blood flow is slow, or the collection is made into a large syringe, the coagulation cascade may become activated; in that case, an initial blue top tube should be filled, discarded and a second filled tube should be collected for testing. The anticoagulants and clotting activators in each tube are specific for the type of sample necessary for testing. Transferring sample between tubes results in adulteration of the sample and will produce spurious test results. If blood is to be obtained from a catheter, it must be collected by nursing staff. If unavailable, a plastic vial with a black screw top cap is acceptable. Each vial should be labeled with patient information (full name and medical record number are minimum requirements) and also list the name of the person who collected the specimen and the date it was collected.In this circumstance cell counts should be interpreted with caution. Go to the UCD Pathology page. This will provide enough sample to perform multiple tests with adequate volume for repeat analysis and add-on tests. To ensure the best patient care, if at all possible, CSF samples should be submitted in this manner. This often provides sufficient sample to perform chemical tests, cell counts and culture though, depending on the exact volume submitted, the laboratory cannot guarantee the ability to perform every ordered test. Tests ordered for which there is not enough CSF to perform the test will be resulted as “quantity not sufficient for analysis” (QNS). In addition, submitting fewer than four tubes will necessitate that a single sample be shared among multiple laboratory departments which may increase the result turnaround time. Note: specimens known to originate from patients with a Risk Group II or II pathogen should be shipped as Biological Substances. A 95 kPa bag or container is recommended.

Use at least two patient identifiers when collecting blood samples and other specimens for clinical testing. See Specimen Labeling section of this web page. Using the wrong container often leads to erroneous results. See the test catalog for exact requirements. Specimens must be submitted to the laboratory in the container used originally for collection. See Test Catalog for storage and transport requirements. When red cells are hemolyzed, there is a release of these analytes and dilution of plasma, resulting in erroneous laboratory values. Then draw the syringe for the desired tests. The “flush” may be given back to the patient if needed. Time is measured from receipt of the specimen in the laboratory to release of results. The following policy for unacceptably labeled specimens will be enforced: If a specimen is placed in a plastic bag, it is not adequate to place a label on the bag rather than on the tube. Whenever the specimen itself is not labeled, the label will be considered unacceptable. There are no exceptions. Click here to view UCHealth “Blood Administration” policy. Labels must be straight, wrinkle-free, and oriented as follows: Refer to “Specimen Labeling” section of this document. Prompt transport of fresh specimens is expected. If unable to transport within this guideline, the specimen must be refrigerated until delivery. 24-hour specimens are unacceptable for urinalysis testing. Catch midstream specimen in a sterile urine container. Collection containers must not have been cleaned using detergents or have contained any liquid other than distilled water previous to the collection. The laboratory does not supply collection containers. Please refer to the individual test listings for details of preservative requirements. Dietary restrictions are required for some procedures and are specified in the individual test listings. Add this specimen to the collection container. Write this time and date on the bottle.

Depending on the length of the downtime and the anticipated time to start up, critical values will be called and STAT results will be faxed, tubed, or hand-delivered to the ordering unit until computer operations are restored. The distance from the nose to the ear gives an estimate of the distance the swab should be inserted.Immediately place swab into the M4 Transport media. Leave swab in transport media. Swab should be entirely enclosed in tube, no wire should extend past lip of tube. Replace lid to transport media, tighten to prevent leakage during transport. Transport same day, refrigerated or on ice. If delivery is not expected within 24 hours, freeze at -70 degrees C and ship on dry ice. Base syringe size and tubing length on age and size of patient. Amount depends on size and age of patient. Attach tubing to syringe tip. NOTE: Recovery must occur rapidly or instilled fluid will rapidly drain down the throat. Repeat with other nostril and inject specimen into same container. Discard syringes and tubing or bulb in biohazard waste. Mark with thumb and forefinger. Adjust suction to appropriate pressure. NOTE: Don’t use lubricants other than saline to aid tube insertion. Hold trap upright to prevent loss of secretions from trap. NOTE: Catheter should remain in nasopharynx no longer than 10 seconds Label trap and place in biohazard bag. Ensure that lids of containers are secure. The secondary container is a securely sealed zip lock plastic bag labeled with the biohazard symbol pictured below. Exception: Blood, blood components, or blood products that are labeled as to their contents and have been released for transfusion or other clinical use are exempted from this requirement. Specimens must be obtained in the proper tubes or containers, correctly labeled, and then promptly transported to the laboratory. Obtaining reliable and accurate laboratory test results The following are essential safeguards for your patients.

Refer to the Online Testing Guide For timed collections, patients should be given two containers and Patients should receive Specimen containers should be labeled with the type of preservative added. DISCARD THIS VOIDING since the urine was formed prior to the collection COLLECT ALL SUBSEQUENT VOIDINGS UNTIL THE SAME TIME ON THE SECOND DAY, emptying Preservative may have been added to the container; this may As a guideline, START THE COLLECTION Submit only the required aliquot of a Refer to the Online Testing Guide to determine the appropriate pH adjustment. Carefully following instructions The specimen should be labeled and refrigerated until pick up. A clean catch or The patient should void a small amount of urine before collecting in a clean container. Make sure the swab is fully immersed in the UTM, and that Send to the laboratory as soon as possible. This specimen is appropriate for PCR or culture for many In cases of mumps, swab the inflamed orifices of Stenson's ducts. Swabs should Break or cut swab making sure that the swab shaft doesn't extend beyond the top of the vial, secure Break swab off immediately into universal transport media.Swabbing pus collection in corner of eyes is not adequate. First morning voids usually contain the highest titers of virus.PCR is a much more sensitive method for diagnosing viral infections from CSF. 0.2 mL per PCR test ordered is Do not dilute in universal transport media (UTM).Macular lesions do not yield high titers of viruses. Vesicular lesions should be opened with a The swab should be placed in a vial of universal transport. Lesion specimens collected in this manner provide material both for PCR or viral Do NOT add the flocked swab to the transport media. Large pieces may be Tissues for PCR testing do not need to be placed in transport media. Heparin is inhibitory to PCR reactions and should be avoided.

Specimens should Laboratory procedures are performed ONLY upon a physician's written CLIA-88, the Joint Commission, and Fold completed request form and place in the outside If submitting multiple specimens with different storage temperature requirements, use separate bags and requisitions for each sample. Be sure label or tag is secure. For these rare Any questions should be directed to Client Support All specimens must be bagged for handling. The request forms must be in a Please follow the appropriate directions whether you intend to use our All specimens should be Containers for shipping Shipping containers should be filled with dry ice to prevent samples Specimens should be shipped in containers Do not ship frozen specimens in glass containers Mark the outside of the container with label: FROZEN MATERIAL - DO NOT THAW. Place on a coolant pack and fill the vacant space with any type of Mark the outside of the container: REFRIGERATED However, safe specimen Such options will be The courier route includes bus and air freight depots. Stops are made at Sea-Tac Stops are made at the Greyhound Bus Terminal in the morning and afternoon, See Transport and Packaging of Specimens. Routine specimens At times outside of these hours, please call the For information, assistance, or for pre-addressed labels, call (206) 520-4600 or. All internal and frequently ordered send out tests can be found in this section. A test can be selected from the list, or the list can be searched by test name. The Quest test code can also be included, if known. Lab staff will research the requested test and contact the ordering provider if there are any issues. Following are general guidelines for blood and urine (urinalysis) specimen processing and handling at this facility. Use good laboratory working practices when handling specimens. Follow all bio-safety practices established by OSHA. All tests requested by the physician should be properly identified with a written or electronic order.

Indicate collection start date and time and stop date and time in the request. The laboratory will measure and report the total volume on all timed urines. Alternatively, it is acceptable to submit an aliquot of a well-mixed, accurately measured urine specimen. The total volume must then be included in the request. By continuing to use this site you are giving us your consent. Learn how cookies are used on our site. Accept terms. Separate plasma as soon as possible, Transfer plasma to a plastic vial and indicate the anticoagulant used on the label. Avoid hemolysis, as Let specimens clot at room temperature unless otherwise specified, and Transfer serum to a plastic vial unless otherwise specified. Avoid hemolysis, Indicate the anticoagulant used on the label. Do not allow to freeze. Do not substitute the yellow top (SPS) Do not allow to freeze. This tube must be accompanied by Please see test guide or contact Transfusion Support Lab (TSL). After drawing specimen, invert the tube to If frozen plasma is required, pour off plasma into plastic vial and freeze. This is used for Immediately after filling the tubes, shake them ten (10) times just firmly enough to make sure the entire This will dissolve antigens on the tube walls. They are used for serum The tube is used for the collection of serum for selected chemistry tests and special An SST tube should never be substituted as the gel barrier can interfere with analysis. Please contact Client Support Services before collection. This tube is a serum separator tube with clot activator and barrier gel to separate This tube is used for common chemistry panels such as the Basic and Comprehensive Metabolic Panels, This tube should not be used for drug Cell-Free DNA BCT stabilizes cell-free Tube must be accompanied with requisition specific to this test.

While not always feasible, specimens should be Specimens should be collected in a manner which minimizes contamination When multiple tests are ordered, sufficient samples or volume should be submitted in order to provide for the Do not add fluid to the container. Larger pieces of tissue are ideal and Remove the needle and replace it with a stopper. Alternately, collect the fluid in an empty Do not remove the liquid transport media in the ESwab as this is Alternatively, samples may be collected using Amies gel transport swabs for culture, however they may Dry swabs are not acceptable for bacterial culture testing. On request form, clearly indicate site of the body Note: See below for more information on Virology swab collection. Obtain specimen from the most active site of the wound. Take care not to swab Each set contains one aerobic (Redox1) and one anaerobic (Redox2) bottles. Ideally add 10 mL of Note the original volume of media in the bottle before inoculating and add to a 10 mL mark above. Do not overfill For infants the minimum volume is 0.5 mL in one aerobic bottle. For UW Medicine only: If unable to draw directly into a blood culture bottle, draw into a SPS tube (not ACD) The Isolator tube must be filled to the line on the side. If the tube is not filled completely In cases of Catheter tips specimens should be the segment near the skin and tip end and must not Longer tip segments can be cultured but will not be given a colony count. Note: Foley catheter tips Instruct patient on the need for Collect specimen in a sterile container. A good specimen will show purulent material. If the specimen is watery and almost Transport in Cary-Blair for bacterial culture and Enteric Pathogen For fecal leukocytes or C. difficile testing transport fresh stool in a clean container. Submit in an approved For Viral culture, clean catch Morning voids have highest titers.Urine collection containers are available on request.

These are requirements for acceptable specimens. These requirements may also be found in the Specimen Handling sections of individual assay procedures. The Lab Supervisor will notify the Medical Director, or their designee, who will message all clinicians potentially afffected by the discarded specimen. If the specimen is collected in a plain red top tube, carefully separate the serum from the clot, and transfer it to a specimen container that can be capped and labeled. Label it with complete patient information. Store at conditions recommended by the reference lab. Specimens collected in these tubes may be stored without transfer, as long as the gel creates a complete separation between serum and red cells. Separate plasma from cells. Follow reference lab instructions for storing and sending plasma. If plasma is frozen, it should be frozen rapidly (-20 degrees C or lower). The ICSH (International Committee for Standardization in Hematology) defines fresh blood specimens as processed within four hours after collection. Whole blood collected in EDTA provides accurate results for all parameters within eight hours of collection. Gently invert the collection tube several times just prior to sample transfer. Do not shake the collection tube; shaking may cause hemolysis. Glucose concentrations are affected by the length of time since the patient has eaten and by the type of sample collected from the patient. To accurately determine glucose results, samples should be obtained from a patient who has been fasting for at least 12 hours.If analysis of the specimen is to be delayed, carefully separate the plasma from the red blood cells, and transfer it to a specimen container that can be capped and labeled. Store at conditions recommended by the method manufacturer. Bring the sample to room temperature before testing. If urine is not tested immediately, mix the specimen before testing. Do not centrifuge before performing the chemical portion of the analysis.

Take care not to touch the inside lip of the container or the underside of lid. At the end of this time, void one last time and add this sample to the container. Separate two aliquots of urine and label both adequately. Include the 24 urine volume on the labels. Send one to the reference laboratory and keep one in the facility laboratory refrigerator until completed results from the reference laboratory are received. There are also very specific instructions in the restrooms. Remove the cap. Gently rotate for 10 seconds. Screw the cap tightly on the tube. There are also very specific instructions in the restrooms. Remove the cap. Gently rotate for 10 seconds. Screw the cap tightly on the tube. For patients checking in after 4:30, the Lab staff reviews the orders and consults with the ordering clinician or charge nurse, as necessary, to determine testing urgency. This is necessary to allow for adequate clotting and spinning time prior to the daily reference lab pick up at 5pm. However, if the in-house labs are ordered STAT, the Lab staff will draw the in-house labs that day. A late blood draw will be done, the blood processed, and the Lab will request a STAT pick up from our reference lab. In these cases, the outdoor lock box is used to secure the specimen until the reference lab courier arrives. Because the lock box is located outside, temperatures are variable and specimen quality may be compromised. The UF College of Nursing continually attracts and retains the highest caliber of nursing students and faculty with a passion for science and caring. Ranked among the top schools of pharmacy nationally, the college supports research, service and educational programs enhanced with online technologies. We offer a a four-year Doctor of Veterinary Medicine programs as well as M.S. and Ph.D. degrees in Veterinary Medical Sciences. Our state-of-the-art medical center serves an urban population of 1 million from north Florida to south Georgia.

Students rotate through the various clinical settings on the campus, and primary care centers and specialty care centers located throughout Jacksonville. Also offered on campus is an American Society of Health-System Pharmacists-accredited pharmacy residency program at Shands Jacksonville. That is why we provide online Continuing Medical Education (CME) courses for you to complete for CME credits. These courses share the latest in medical knowledge, teach new patient-relationship skills and help providers deal with relevant current issues. You may find the information you were looking for by browsing through the navigation menus above and below or via the search box in the upper right corner of this page. If you believe that you have reached this destination due to an error on our part, please let us know. Together we teach. Together we care for our patients and our communities. Together we create unstoppable momentum. All over the world the laboratories use GCLP to improve the quality of their work, to improve patient care given by clinicians and also to improve safety of staff who work in the laboratories. Implementation of GCLP is a step wise process of meticulous planning, perfect execution with involvement by the whole team of laboratory personnel. Even though many laboratories in India do follow some measures of good laboratory practices, I feel there is a big need to repeatedly remind about GCLP in as many fora as possible. Therefore first of all I would like to thank and acknowledge the ICMR team which brought out the GCLP booklet. The laboratories in our country can be brought under three categories: primary care, secondary and tertiary level laboratories. In addition there are also reference laboratories and research laboratories. Therefore each laboratory should align themselves with the category they belong to. Depending upon the scope of work the laboratories should have the following facilities according to their needs.

Infrastructure Infrastructure of laboratories should be planned according to the services provided by the laboratory. Personnel, Training and Development Every laboratory should have properly qualified staff at various levels depending upon the nature of the work. Every staff member should be given a job description and should be trained to do the job that they are assigned to perform. There are well accepted promotional avenues and polices and these should be made available to all the staff of the laboratory. Equipment The laboratories should be appropriately equipped for the task that they are going to perform. Unnecessary fancy equipments should be avoided and only appropriate technology and instruments should be installed. Care should be taken to install the instruments in suitable locations to facilitate smooth flow of samples. Regular maintenance and cleaning should be performed. The operating manual should be available for all the staff members. Maintenance contract, contact telephone number of service engineers and good log book should be provided for the trouble shooting and maintenance of the equipment. Equipment should be properly calibrated and the performance should be verified by running internal and external quality control samples. All calibrations of equipments including pipettes and thermometers should be performed only by authorized personnel and documented. Accreditation agencies, such as NABL, require that calibration certificates are issued at prescribed intervals (to see NABL 112 (2007)). Reagents, Chemicals and Consumables All reagents used in the laboratory should be of certain certified standards. The reagents, chemicals and consumables should be stored under appropriate environmental conditions. The water used by the laboratory should be of prescribed quality. Specimen Collection The patient should be properly counselled before the specimen collection and consent should be taken whenever needed.

A lot of pre analytical errors can happen if care is not taken during the specimen collection. The phlebotomist, nurses and doctors who collect samples should be trained periodically in sample collection. The lab should prepare a “Primary specimen collection manual” containing information on patient preparation, methodology for specimen collection, labeling and transporting the samples. Necessary instructions on the preservative to be used, storage and transportation conditions should be provided. Requisition Form The requisition form for testing should be written only by the doctor and sent along with the sample. This should contain patient identity, age, sex, date and time of sample collection and investigation requested. A brief clinical history of the patient would be helpful to the laboratory. Registration of Samples When samples for analysis are received by the laboratory, the laboratory should note down the time of specimen receipt and all details like name, age, sex, location in the hospital or medical unit the patient is attached to, name of physicians, investigation requested and date. There should be a column for remarks where the condition of specimen can be recorded. The laboratory should assign a unique registration number and then the process of analysis can start. Work Sheet Nowadays many analysers can read barcode labels and the ID number, tests requested etc could be printed and stuck on the tube. Every laboratory should also provide a work sheet to the analyst wherein the test requested, with a column for signature of the person analyzing the sample and other relevant data can be entered. The request form and the work sheet can also be combined and made into a single form. The laboratory should not deviate from the standard operating procedure (SOP) which is already prepared by the laboratory for the parameter. There is no room for any errors or corrections, in the reporting. On line transfer of results will avoid the transcriptional errors.