Introduction to Specimen Collection

Dr. M.FERN
• Laboratory tests contribute vital information
about a patient's health.
• Correct diagnostic and therapeutic decisions
rely, in part, on the accuracy of test results.
• Adequate patient preparation, specimen
collection, and specimen handling are
essential prerequisites for accurate test
results.
• The accuracy of test results is dependent on
the integrity of specimens.
• Safety and Disposal Considerations in Specimen Collection
• In all settings in which specimens are collected and
prepared for testing, laboratory and health care personnel
should follow current recommended sterile techniques,
including precautions regarding the use of needles and
other sterile equipment.
• Treat all biological material as material that is potentially
hazardous as well as contaminated specimen collection
supplies.
• For all those who are involved in specimen collection and
preparation, the responsibility to adhere to current
recommendations designed to maintain the safety of both
patients and health care workers does not end when the
patient is dismissed.
• There are four steps involved in obtaining a
good quality specimen for testing:
• (1) preparation of the patient,
• (2) collection of the specimen,
• (3) processing the specimen, and
• (4) storing and/or transporting the specimen.
• Preparation
• Prior to each collection, review the appropriate
test description, including the specimen type
indicated, the volume, the procedure, the
collection materials, patient preparation, and
storage and handling instructions.
• Preparing the Patient. Provide the patient, in
advance, with appropriate collection instructions
and information on fasting, diet, and medication
restrictions when indicated for the specific test.
• Preparing the Specimen. Verify the patient's
identification.
• Proper identification of specimens is extremely
important.
• All primary specimen containers must be labeled with
at least two identifiers at the time of collection.
• Submitted slides may be labeled with a single
identifier, but two identifiers are preferred.
• Examples of acceptable identifiers include patient's
name (patient's first and last name exactly as they
appear on the test request form), date of birth,
hospital number, test request form number, accession
number, or unique random number.
• A location such as a hospital room number is
not an appropriate patient identifier.
• If chain of custody documentation is necessary
for the procedure, follow the appropriate
protocol.
• All specimens should be labeled in the
presence of the patient.
• Process and store the specimen(s) as required.
Appropriate storage and handling are
necessary to maintain the integrity of the
specimen and, consequently, the test results.
• Avoiding Common Problems
• Careful attention to routine procedures can
eliminate most of the potential problems related
to specimen collection.
• Materials provided by the laboratory for specimen
collection can maintain the quality of the specimen
only when they are used in strict accordance with
the instructions provided.
• To collect a sufficient quantity of each type of
specimen indicated for the procedures to be
performed, please consult the volume
requirements published in this Directory.
• General Specimen Collection. Some of the common
considerations affecting all types of specimens:
• Please examine specimen collection and transportation
supplies to be sure they do not include expired containers.
• Label a specimen correctly and provide all pertinent
information required on the test request form. (See
Blood Specimens: Chemistry and Hematology − Blood Coll
ection/Transport Containers
.)
• Submit a quantity of specimen sufficient to perform the
test and avoid a QNS (quantity not sufficient), as indicated
in the test requirements. (See Quantity Not Sufficient.)
• Use the container/tube indicated in the test requirements
for appropriate specimen preservation.
• Follow patient instructions prior to specimen
collection Including the proper order of blood draw
when multiple tubes are required.
• (
See Blood Specimens: Chemistry and Hematology – Co
nsideration for Single and Multiple Sample Collection.
)
• Carefully tighten specimen container lids to avoid
leakage and/or potential contamination of specimens.
• Maintain and transport the specimen at the
temperature indicated in the test requirements.
• Mix specimen with additive immediately after
collection by inverting 5-10 times.
• Serum Preparation. The most common serum preparation
considerations:
• Separate serum from red cells within two hours of venipuncture.
• Mix by inverting specimen with additive immediately after
collection.
• Allow specimens collected in a clot tube (eg, red-top or gel-
barrier tube) to clot before centrifugation.
• (See
Blood Specimens: Chemistry and Hematology − Preparing Serum
on clotting and gel-barrier tubes and red-top tubes.)
• Avoid hemolysis: red blood cells broken down and components
spilled into serum. Causes and prevention are discussed under
the section on hemolysis.
• Avoid lipemia: cloudy or milky serum sometimes due to the
patient's diet (discussed under the section on lipemia).
• Plasma Preparation. The most common considerations in
the preparation of plasma:
• Collect specimen in additive indicated in the test
requirements.
• Mix specimen with additive immediately after collection
by inverting 5-10 times.
• Avoid hemolysis or red blood cell breakdown.
• Fill the tube completely, thereby avoiding a dilution factor
excessive for total specimen volume (QNS).
• Separate plasma from cells within two hours of
venipuncture or as indicated in the test requirements.
• Label transport tubes as “plasma”
• Indicate type of anticoagulant (eg, “EDTA,” “citrate,” etc)
• Urine Collection. The most common urine collection
considerations:
• Obtain a clean-catch, midstream specimen.
• Store unpreserved specimens refrigerated or in a cool
place until ready for transport.
• Provide patients with instructions for 24-hour urine
collection(s).
• Add the preservative (as specified in the test
requirements) to the urine collection container prior
to collection of the specimen if the preservative is not
already in the container.
• Provide sufficient quantity of specimen to meet the
minimum fill line on preservative transport container.
• Provide the proper mixing of specimen with urine preservative
as specified in the test requirements.
• Use the collection container as specified in the test
requirements, and refrigerate the specimen when
bacteriological examination of the specimen is required.
• Carefully tighten specimen container lids to avoid leakage of
specimen.
• Divide specimen into separate containers for tests with such
requirements.
• Provide a complete 24-hour collection/aliquot or other timed
specimen.
• Provide a 24-hour urine volume when an aliquot from the 24-
hour collection is submitted.
• Preservatives vary for each test; refer to test information for the
required preservative.
• Collection Procedures
• Collection of Vacuum Tubes Containing Additives (eg,
anticoagulants, preservatives, clot activators, gel-barrier).
When using vacuum tubes containing an additive:
• Tap the tube gently at a point just below the top to release
any additive adhering to the tube or top.
• Permit the tube to fill completely to ensure the proper ratio of
blood to additive. There will be some dead space at the top of
the tube.
• To allow for adequate mixing of blood with the anticoagulant
or preservative, use a slow rolling wrist motion to invert the
tube gently four to eight times. Failure to invert tubes may
lead to the formation of microscopic clots.
• Rapid wrist motion or vigorous shaking may contribute to
hemolysis.
• Check to see that all the preservative or anticoagulant
is dissolved.
• If any preservative powder is visible, continue inverting
the tube slowly until the powder is dissolved.
• If multiple samples are being drawn, invert each
specimen as soon as it is drawn.
• Do not delay. Place the tube upright in a rack as quickly
as possible after collection.
• The gel-barrier tube is an additive tube and should be
inverted five to six times after collection.
• Allow the tube to stand for 30 to 60 minutes for
complete clotting to occur prior to centrifugation.