Proper sample collection and handling is an integral
part of obtaining a valid and timely laboratory test result. Specimens must be
obtained using proper phlebotomy techniques, collected in the proper container,
correctly labeled (in the presence of the patient) and promptly transported to
the laboratory. It is the policy of the laboratory to reject samples when
there is failure to follow these guidelines. All specimens should be
handled with universal precautions, as if they are hazardous and infectious.
Prior to each collection, review the appropriate
test description, including the specimen type to be collected, the volume, the
procedure, the collection materials, and the storage and handling instructions.
Specimen Collection Timing
The basal state (the early morning approximately 12
hours after the last ingestion of food) is recommended for determining the
concentration of body constituents such as glucose, cholesterol, triglycerides,
electrolytes, and proteins.
Blood composition is significantly altered after
consuming food, and consequently alters many clinical chemistry tests. If a
patient has eaten, and the physician still wants the test, then "non-fasting" is
written on the request so the laboratory can make a notation on the report as to
why some of the test values may be different than expected. For
outpatients, provide the patient in advance with appropriate collection
instructions and information on fasting, diet, and medication restrictions when
Specimens for Coagulation Testing
Specimens obtained for Coagulation testing must be
collected and transported to the laboratory according to strict guidelines in
order to assure accuracy of results. Refer to Coagulation Collection
and Handling Guidelines for further instructions concerning requirements for
- Knock before entering the patient's room.
- Introduce yourself
- Identify patient using two patient identifiers.
- Explain the procedure you will be performing.
All patients from whom clinical specimens are
obtained must be positively identified prior to specimen collection.
Positive identification is the responsibility of the person collecting the
Identify the patient prior to sample collection,
using at least two patient identifiers. Verify the patient's name,
unit history number on the identification armband (inpatients and ER), or
drivers' license or other ID (outpatients) with the information on the
Precaution: Maintain awareness for sound-alike names and suffixes during patient
identification. (i.e. Gonzalez and Gonzales; Sr. and Jr.)
Inpatients: Patients in the hospital should
be wearing an identification bracelet that includes their last and first name,
date of birth and a unique hospital number. Proper identification should
include a three-way match using information on the ID bracelet and the test
requisition, and the patient's stating of his or her name. If the patient
does not have an ID bracelet, ask the nurse responsible for the patient to
positively identify the patient and to place and ID bracelet on the patient.
For unconscious or unidentified patients, it is important a unique number or
identification system be used.
Outpatients: For an outpatient or ambulatory
setting, there is no ID bracelet, but the patient should have been given
identification labels when he/she registered. This label can be used along
with asking the patient his/her name. If there is no label, then another
means of identification should be used. Use at least two patient
identifiers whenever taking blood samples.
DO NOT collect any specimen unless at least two
positive identifications can be made.
All specimens should be regarded as potentially
hazardous or infectious. Universal Blood and Body Fluid precautions should
The test requisition must include:
the patient's name
a unique identification number which assures
positive patient identification (e.g., UH number)
the unit / clinic location
The name(s) and signature of the authorized provider
requesting the test(s)
UTMB physician identification number if applicable
the test(s)/procedure(s) being ordered
the date and time of specimen collection is
required on all requisitions
name or initials of person collecting specimen
pager/ phone number of appropriate contact person
office address of requesting physician if not part
of the UTMB enterprise
diagnosis: ICD9 code or narrative description
Additional information may be required as necessary to comply with specific
regulatory requirements or to meet clinical needs. These will be defined
in divisional policies.
Specimen Identification and Labeling
All specimens submitted to
Pathology Clinical Services for testing must be appropriately labeled to assure positive identification and optimum
integrity of patient specimens from the time of collection until testing is
completed and the result reported. In accordance with standards
issued by the College of American Pathologists (CAP), American Association of
Blood Banks, and The Joint Commission, all specimens
must be labeled at the time of collection; in the presence of the patient,
to maintain identity throughout the pre-analytical, analytical, and
post-analytical processes. Refer to
PCS Policy 7.01.03 Specimen Labeling Requirementfor additional requirements.
If there is a question as to the integrity and/or
identification of a sample, the laboratory will reject the sample and request
recollection. If extenuating circumstances exist that prevent recollection
of the sample, and the physician or nurse requests that the test be performed on
a sample that cannot be positively identified, the laboratory will analyze the
sample with the following conditions:
The ordering nurse or physician must come to the
laboratory to personally identify and relabel the request slip and patient
The Inappropriate Sample Identification Release form must be completed and be
legible. The correction must be dated and signed. Delegating this to another person will not suffice for medico-legal purposes.
"STAT" means special turnaround time and must
be collected immediately. It may involve a patient whose medical condition has
suddenly become very critical and must be treated as a medical emergency.
Fasting: Requests for "fasting" specimens are performed before routine requests, so patients can
eat meals on schedule.
Order of Draw
Blood collection tubes must be drawn in a specific
order to avoid cross-contamination of additives between tubes. The
recommended order of draw for plastic vacutainer tubes is:
First - blood culture bottle or tube (yellow
or yellow-black top)
Second - coagulation tube (light blue top).
If just a routine coagulation assay is the only test ordered, then a single
light blue top tube may be drawn. If there is a concern regarding contamination
by tissue fluids or thromboplastins, then one may draw a non-additive tube (red
top) first, and then the light blue top tube.
Third - non-additive tube (red top)
Last - additive tubes in this order:
SST (red-gray or gold top): Contains a gel separator
and a clot activator.
Sodium heparin (dark green top)
PST (light green top): Contains lithium heparin
anticoagulant and a gel separator.
EDTA (lavender top)
ACDA or ACDB (pale yellow top): Contains acid
Oxalate/fluoride (light gray top)
Note: Tubes with additives must be
filled to their stated volumes and thoroughly mixed. Erroneous
test results may be obtained when the tube is not filled to the stated volume
and blood is not thoroughly mixed with the additive. Mix all tubes with
anticoagulant by gentle inversion for 15 seconds.
(This is meant to be a guide and is not
all-inclusive, if you have any questions, call the lab.)
|Stopper Color (Plastic Tubes)
|1. Blood Culture
|2. Light Blue *
|4. SST (Red-Gray, or Gold stopper)
||Gel separator + clot activator
|5. Dark Green
|6. Light Green
||Lithium Heparin + gel separator
|8. Pale Yellow (ACDA or ACDB)
||Acid citrate dextrose
|9. Light Gray
*Red Stopper color tube (no additive) should be used as "waste tube" if just a routine coagulation assay is the only
test ordered or if there is a concern regarding contamination by tissue fluids or thromboplastins.
Reference: CLSI H3-A6 Procedures for the
Collection of Diagnostic Blood Specimens by Venipuncture
Specimen Transport and Storage
All laboratory specimens shall be placed in
leakproof containers (i.e., culturettes, vacuum tubes), then bagged in single,
biohazard specimen bags. Place the requisition slip in the outside pocket of the
biohazard specimen bag.
Specimens may be sent through the tube system as follows:
Place and seal the specimen in a biohazard bag, with
the request slip in outside pocket.
Place the biohazard bag into a Zip N' Fold pouch;
completely sealing the pouch.
Load the Zip N' Fold pouch into a pneumatic tube and
send to the lab.
To ensure the validity of test results and the
safety of laboratory personnel, specimens that leak in transit will be
discarded, and the sender notified to resend another sample.
If a pneumatic capsule is received that appears grossly wet or soiled, wear
gloves before handling the capsule and removing the contents. Be aware that
there may be broken glass or plastic inside! Remove sharp objects (broken glass
or plastic) using forceps. Discard any wet or soiled padding as infectious
waste. Clean the inside and outside surfaces of the pneumatic capsule with a
hospital-grade disinfectant. Call the physical plant dispatcher and notify them
of the contamination of the tube system.
DOT and IATA requirements will be followed when shipping specimens for reference
testing. Refer to PCS policy 3.18.16 - Packaging and Shipping of
Infectious Substances and Diagnostic Samples for guidelines.
Reviewed 11/08/12 Anthony Okorodudu, PhD