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 minimum volume required, 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. 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
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 full first and last name
a unique identification number which assures
positive patient identification (e.g., medical record 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: ICD10 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
Laboratory 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
LS I.1.02.01 Specimen Labeling and Requests for Testingfor additional requirements.
"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 is demonstrated below:
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. . When using a winged blood collection set for venipuncture and a coagulation (citrate) or lavender (EDTA) tube is the first specimen to be drawn, a discard tube should be drawn first. The discard tube (a non-additive or coagulation tube) must be used to displace the air in the collection set’s tubing, but does not need to be filled completely. Mix all tubes with anticoagulant by gentle inversion according to the chart above. Mix all tubes with
anticoagulant by gentle inversion according to the chart above.