Specimen Collection | ihealthdiagnostic

SPECIMEN COLLECTION INFORMATIONAL

 

Order of Draw

 

Avoiding Common Problems

  • Examine the specimen supplies for expired containers.

  • Label the specimen correctly.

  • Provide all pertinent information on the order form.

  • Submit sufficient quantity of the specimen to avoid QNS (quantity not sufficient), as indicated by the individual test requirements. See QNS information.

  • Use the appropriate containers/tubes as indicated in the individual test requirements.

  • Carefully tighten specimen containers to avoid leakage and/or potential contamination of specimens. Note: Leaked specimens will be rejected.

General Specimen Collection

Serum Preparation

  • Invert tube 5 times immediately after collection.

  • For clot to form allow the tube to sit at room temperature for a minimum of 30 minutes. Do not exceed 60 minutes.

  • Separate serum from red cells within two ours of collection.

  • Spin for 10-15 minutes.

  • Avoid hemolysis.

  • Avoid lipemia.

  • Invert tube 8-10 times immediately after collection.

  • Avoid hemolysis.

  • Fill the tube completely to avoid a dilution factor excessive for total specimen volume (QNS).

  • When indicated in the individual test requirements, separate the plasma from cells within two hours after collection.

    • Label transport tube as "plasma"​.

  • Indicate type of anticoagulant (eg, "EDTA", "Citrate, etc).

Plasma Preparation

Urine Collection

  • Obtain a clean-catch, midstream specimen.

  • Store unpreserved specimens refrigerated or in a cool place until ready for transport.

  • Provide sufficient quantity of sample to meet the minimum fill line on preservative transport container.

  • 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.

 

Hemolysis

Preventing Hemolysis

During Specimen Collection

  • Use a 20-22 gauge needle for routine collection; too small a needle results in excess vacuum force, while too large a needle can cause shear stress on the cell walls. 

  • Draw the sample from the antecubital region of the arm; drawing from other sites—sometimes a necessity in the emergency room—has been shown to result in a higher degree of hemolysis.

  • Warm up the puncture site; warming increases the blood flow and prevents the need to “milk” the site, a significant cause of hemolysis.

  • Do not leave the tourniquet on for longer than one minute; prolonged tourniquet time causes the interstitial fluid to leak into the tissue, promoting hemolysis.

  • Alcohol damages cell walls; allow the venipuncture site to completely air dry after cleaning it with alcohol.

  • Place the needle correctly in the vein; if the bevel of the needle is crowded by the inner wall of the vein, the partial occlusion exerts a dramatic shear force on the cells. This is typically indicated by too slow a blood flow.

  • When using a syringe, pull the plunger gently; pulling too quickly exerts excess pressure—well beyond that of a standardized evacuated tube—and will shear the cell walls.

  • Similarly, pushing hard on the syringe plunger while transferring blood to another tube exerts a destructive level of pressure, and can also cause loss of the sample if the stopper comes off.

  • Avoid drawing from catheters and lines; these are designed to deliver fluids to the patient, not drawn from the patient. Drawing blood samples from these systems involve shear forces and turbulence that makes hemolysis unavoidable.

  • Fill tubes to correct volume; under-filling of tubes containing anticoagulant results in a higher than recommended concentration of the additive, which promotes hemolysis. Use a smaller tube for difficult draws.  

  • When there is difficulty accessing a vein or when a vacuum tube fills too slowly due to a difficult venipuncture, damage to the red blood cells may result. Address this problem by collecting a fresh tube when blood flow is established or select another puncture site and, using sterile/unused equipment, collect a second specimen. Also, use of a blood pressure cuff, in lieu of a tourniquet, will reduce trauma to fragile red blood cells.

  • Do not remove the needle from the vein with the vacuum tube engaged. This applies to both the last tube collected during a routine venipuncture and to tubes collected during a difficult procedure.

  • Premature removal of the tube causes a rush of air to enter the tube, which may result in damage to the red cells.

  • Be as gentle as possible, drawing the blood evenly. Too much pressure in drawing blood into a syringe or forcefully ejecting blood into a collection tube from a syringe may damage red cells.

  • Allow collection site to dry after cleaning with the alcohol pad. Alcohol used to clean the puncture site may cause contamination in a tube.

  • Do not collect a specimen from or through a hematoma.

  • Allow specimen to clot completely (for 30 to 60 minutes) before centrifuging.

  • Do not centrifuge the specimen for more than 10 minutes unless otherwise specified by the collection instructions.

Preventing Hemolysis

Vacuum Tubes With Additives

  • 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 centrifuging.

 

Lipemic Serum or Plasma (Turbidity)

Specimen Collection

Preventing Serum or Plasma Lipemia

Normal serum or plasma is a clear and light yellow to straw in color. Turbid serum or plasma appears cloudy or milky

Serum or plasma may be cloudy due to bacterial contamination or chronic or transient high lipid levels in the patient's blood.

The primary dietary sources of lipids (fatty substances) are meats, butter, cream, and cheese. Patients who consume these foods within the 24-hour period immediately preceding collection of a blood specimen may have temporarily elevated lipid levels, which may be manifested by cloudy or lipemic serum. Lipemic serum or plasma may not be a true indicator of the patient's physiologic state. Regardless of diet and length of fast, some patients may produce cloudy specimens.

 

To avoid dietary-induced high lipid levels prior to testing, many physicians require patients to exclude the high-fat foods from their diets or to fast for 12 to 14 hours prior to specimen collection. For morning specimen collection, the laboratory recommends that the patient be required to fast from 6 PM on the previous evening.

 

Quantity Not Sufficient (QNS)

Quantity Not Sufficient For Testing

Common Root Causes

As a reference laboratory, Innovative Health Diagnostic (IHD) a MD Tox Laboratories, Corp. service, receives specimens from across the United States daily. Quality is of utmost importance at IHD. Accuracy and clarity of laboratory reports, appropriateness of samples, labeling, transport conditions, and assay precision are continually monitored. Only a small percentage of tests are cancelled. Whenever a specimen volume is deemed unsuitable for testing, IHD will immediately notify clients of the problem. Listed below are some of the common reasons why IHD may not be able to perform an ordered test on a particular specimen.

  • Compromised specimen: Specimen received was compromised during shipping, receiving, or test preparation process.

  • One or more of the following events occurred:

  • Specimen was shipped in a non-approved container.

  • Specimen leaked during delivery or thaw.

    • Cap was not tightly seated (e.g., cap was not tightened; specimen was shipped in a vacutainer whose stopper had been removed and reseated; or incorrect cap was placed on the tube).

    • Sealed tube cracked (e.g., because heavy contents cracked or broke the specimen tube during shipping).

    • In some cases it may not be clear why the specimen leaked.

See individual test requirements for the appropriate container type, volume, and special handling requirements. Specimens may be rejected if any of the requirements for these processes are not met.

 

Insufficient specimen volume: Specimen received was less than the minimum published volume.

  • The volume listed in the IHD Test Directory is the minimum volume required. If less than the minimum volume is received, IHD may reject the specimen for testing.

 

Depleted specimen volume: IHD received the published minimum volume; however, that volume was depleted during the testing process. One or more of the following events occurred:

  • IHD needed to repeat the test to ensure that the results were correct.

    • A technical error may have occurred during the first round of testing, which required that the test be run again.

    • The clinical picture, including the results of related tests, did not match the initial result of this test, and the test was repeated to verify the results.

  • The client ordered a group test.

    • A group test requires several component tests be performed. The specimen volume sent was insufficient to perform all of the component tests.

  • The client requested that several different tests be performed on one specimen.

    • To meet this requirement, the specimen is divided among test tubes and sent to different sections of the lab. However, in the process of dividing the specimen, the volume can be decreased and at times depleted.

  • The specimen was sent to a referral laboratory that required a larger specimen volume.

    • When IHD cannot perform a test due to temporary instrumentation or reagent difficulties, IHD sends the specimen to another laboratory to be performed. Sometimes, the referral laboratory requires more specimen volume than IHD does.

  • Due to an IHD handling error, insufficient sample volume remained to complete the correct test.

 

TROUBLESHOOTING

IHD will:

  • Immediately notify clients of insufficient or depleted specimen volumes.

  • Attempt to locate additional specimen collected on the same day at the same time.

    • Sometimes, IHD will dilute a specimen to increase the usable volume; however, dilution is not a viable option for all tests.

  • Continually monitor assay performances and recommend changes in laboratory processes when indicated.

 

Critical Values

Reporting Critical Values

The Process

Innovative Health Diagnostics (IHD) a MD Tox Laboratories service defi­nes critical values as any test result which indicates a pathophysiological state which is life-threatening unless something is done promptly and for which some clinical decision could be taken by the physician or care-giver. It is the policy of MD Tox Laboratories to adhere to all pertinent CLIA and CAP regulations. Laboratories are mandated by federal regulations (CLIA 493.1291) to “immediately alert the individual physician or entity physician office who ordered the test and, if applicable, the individual responsible for using the test results when any test result indicates an imminent life-threatening condition or Critical Values.”

In compliance with HIPAA, test results are communicated verbally only to a member of the healthcare team responsible for the patient and authorized to take patient results. For authentication, client contacts are asked for:

  • Their full name (­first and last).

  • Their position or title.

In addition to the critical test result(s), and any accompanying information, the following information is provided by MD Tox Laboratories:

Patient name, spelled out.

  • Full test name.

  • Date and time of collection.

  • The client contact receiving the verbal information is asked to?

The following information is requested to be read back:

  • The test results.

  • Read any other information provided.

  • Correctly spell the patient’s full name.

Test results and protected health information (PHI) are not left in a voice mail. All verbal critical value notifications are documented, and records stored by MD Tox Laboratories.

 

Lockboxes

Outdoor Specimen Lockboxes

General

Recommendations

Clients using specimen lockboxes outdoors should be prepared to use gel packs during warm weather to help provide a moderate temperature inside the lockbox until the specimens are collected by the courier.

​Note: Gel packs should be frozen solid prior to being placed in the lockbox. 
 

*This is the number of ice packs that are to be placed with the samples in the lockbox.

Refrigerated Samples

1. Follow the steps listed above.

Ambient Samples

1.       If samples need to be kept ambient during transportation, please contact the laboratory

          (800) 820-8803.

2.       Clearly notate the specimen bag(s) to differentiate from refrigerated samples.

Frozen Samples

1.       Clients requiring frozen samples to be transported should use appropriate Blue Frozen Pouches.

                 a.       Place an order (800) 820-8803 (Limit 3 per client).

2.       If samples require freezing and a Blue Pouch is not available please contact the laboratory

          (800) 820-8803 prior to your scheduled pick-up.

                 a.       Clearly notate the specimen bag(s) to differentiate from refrigerated samples.

 

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