Timed Specimen Collection

All Lab Publications, Specimen Collection & Handling

Frequently, physicians order laboratory procedures that require the collection of testing samples at specific times. These are referred to as ‘timed’ tests. Due to the importance of the time the specimen is collected in relationship to the drug dosing, it is very important that the laboratory be contacted a minimum of 12 hours prior to the desired collection time, though 24 hours lead time is preferred, to assure that personnel are available to collect the specimen.

Certain antibiotic levels such as Amikacin, Gentamicin, Tobramycin and Vancomycin are often ordered at specific times before and/or after the administration of the drug to monitor the drugs peak and trough levels. Trough levels are drawn prior to the drug administration, and peak levels are drawn after the drug has been administered. Since drug administration should occur at specific times, laboratory personnel do their best to work around the administration schedule.

When contacting the laboratory, please ensure that the time of the dose administration is provided to the dispatcher.

COLLECTION GUIDELINES

In the event that facility staff are collecting the timed specimens, strict adherence to the following guidelines is essential to ensure appropriate reporting:

Complete a separate laboratory requisition for each timed specimen
Indicate clearly on each requisition the type of drug being monitored (ex. Amikacin, Vancomycin)
Indicate in the box provided, the dose quantity, dose time, and the type of administration (IV, IM, etc.)
Indicate the type of level, peak, trough or random
Obtain the blood sample as near to the requested time as possible (collection times are noted in the NICL Laboratories LTC manual)
Label each specimen with the following: Patient Name, Patient’s date of birth, collection date and time
Place each specimen in a separate collection bag accompanied by the corresponding laboratory requisition

Failure to follow these collection guidelines may result in rejection of the specimen as unsuitable for testing.

Consult your Customer Service Representative with any questions on this topic.

March 5, 2020/by NICL

Specimen Rejection Criteria for Facility Collected Samples

All Lab Publications, Specimen Collection & Handling

Purpose

The Laboratory can provide accurate results only if the specimens provided are fresh, properly obtained, labeled and transported. Specimens must also be from sites appropriate for the test ordered and accompanied by a physician’s order and supporting diagnosis for the testing. On occasion it becomes necessary to reject a specimen. This notice outlines some of the problems that can occur and the Laboratory’s rejection criteria for Facility obtained samples.

Rejection Criteria

There are four basic factors that serve as a foundation for accepting or rejecting specimens:

Specimen labeling and collection problems
Requisitioning difficulties
Specimen integrity problems
Results integrity problems

Blood Collection Problems

Clotted samples for whole blood or plasma tests
Gross hemolysis
IV fluid contamination
Incorrect collection tube or container
Improperly labeled or unlabeled sample
Date and time of collection absent on the order and sample

Urine Collection Problems

Urine contaminated with stool
Improperly labeled or unlabeled sample
Date and time of collection absent on the order or sample

Culture Collection Problems

Specimen received damage or leaking
Grossly contaminated specimen
Improper culture collection materials submitted Improperly labeled or unlabeled sample
Date and time of collection absent on the order or sample

When it is necessary for the Laboratory to reject a sample, the Laboratory will notify the Facility of the reason for rejection and request a proper recollection of the sample.

March 5, 2020/by NICL

Collection Devices for Chlamydia / GC / Trichomonas by Nucleic Acid Amplification

All Lab Publications, Specimen Collection & Handling

FOR GENITAL SPECIMENS

Aptima Unisex Swab Specimens Collection Kit (White Label)

FEMALE:

Endocervical specimen collected on Aptima Unisex Swab submitted in transport tube. NOTE: Prior to female endocervical specimen collection, excess mucus must be removed with white cleaning swab provided in unisex swab collection kit. Discard white cleaning swab.

MALE:

Urethral swab collected on Aptima Unisex Swab submitted in transport tube. Discard white cleaning swab.

FOR URINE SPECIMENS

Aptima Urine Specimen Collection Kit (Yellow Label)

FEMALE/MALE:

The patient should not have urinated for at least one hour prior to specimen collection.
Collect first 20 – 30 ml of voided urine (not midstream) in sterile, plastic preservative-free container. Minimum volume is 20ml. Maximum volume 60ml (NOTE: collection of larger volumes may result in dilution which may, in turn, reduce test sensitivity).
Transfer approximately 2 ml of urine into the Aptima Urine Specimen transport tube using the disposable pipette provided. Ensure fluid level is between the black lines on the urine specimen transport tube label. Do not overfill or underfill (testing will not be performed if the urine fluid level is not in between the two black lines on the transport tube). Urine specimens must be transferred into the Aptima Urine Specimen transport tube within 24 hours of collection and before being tested.

NOTE: Neisseria gonorrhoeae and chlamydia by nucleic acid amplification and trichomonas vaginalis naa testing are performed on the same Aptima tube and urine replicates are not required. The unisex swab cannot be used for testing males for trichomonas vaginalis. Please submit the urine swab.

NOTE: If other urine tests are requested, they must be submitted in separate plastic containers according to their individual requirements.

September 3, 2019/by NICL

Your Patient May NOT Need a Transfusion

All Lab Publications, Clinical & Diagnostic Topics, Specimen Collection & Handling

Understanding Postural Pseudoanemia

Simple changes in posture can cause wide fluctuations in hemoglobin (Hgb) and hematocrit (Hct), due to the redistribution of fluid between the intravascular and interstitial spaces. Plasma volume shifts significantly when a person changes position; after a postural change, restoration of equilibrium may take as long as 20 minutes⁽¹⁾. Standing up from a seated or supine position leads to rapid hemoconcentration as gravity causes blood to pool in the lower extremities, causing a hydrostatic shift of plasma fluid into the surrounding tissues. However, variations in lab values also occur with more moderate positional changes, such as going from sitting to a supine position. When a person is lying down, Hgb and Hct values can decrease by approximately 10%, as there is more volume in the intravascular space, leading to an apparent hemodilution. The changes occur in the fluid fraction and not in the red cell mass; therefore, the term postural pseudoanemia is used, as this state does not represent a true pathologic anemia.

A patent’s measured hematocrit may seem to have decreased significantly from a prior value, but this may simply be due to a change in the patient’s position between the two time points of the blood draw. This may alarm the physician, causing them to be concerned for acute anemia. They may then order an unnecessary ancillary tests as well as unnecessary blood transfusions. Therefore, it is important to understand when and how the phlebotomy occurred during each setting in order to better assess the need for a transfusion in a patient based largely on hemoglobin and hematocrit lab values, especially in the absence of other clinical signs or symptoms pointing to a need to transfuse.

Nurses and phlebotomists should aim to standardize patient position before venous blood collection, to minimize spurious lab test results. Because this may not always be possible, patient posture should be stabilized to one position for about 20 minutes before a blood draw. Physicians should take care to consider pre-analytical and other variables when receiving test results that do not match with the patient conditions, and communication between healthcare providers can help mitigate the alarm caused by unexpected laboratory findings.

Nurses and phlebotomists should include the following important parameters in their notes:

Time of day the specimen was drawn
The patient’s position
Any other significant details related to the phlebotomy

References:
(1) Jacob G et al. Postural Pseudoanemia: Posture-Dependent Change in Hematocrit. Mayo Clin Proc. 2005. 80(5):611-614.
(2) Lippi G, et al. Postural change during venous blood collection is a major source of bias in clinical chemistry testing. Clinica Chimica Acta. 2015. 440: 164–168.
(3) Lima-Oliveira G et al. Patient posture for blood collection by venipuncture: recall for standardization after 28 years. Rev Bras Hematol Hemoter. 2017;3 9(2):127–132.

Clinica Chimica Acta. 2015. 440: 164-168

Rev Bras Hematol Hemoter. 2017;3 9(2):127–132

June 14, 2018/by NICL

Specimen Collection Cups/Devices

All Lab Publications, Specimen Collection & Handling

NICL Laboratories provides two types of specimen collection cups/devices:

URINALYSIS and URINE CULTURE AND SENSITIVITY

One device (shown to the left) is a combination collection and transport kit. This kit should be used only for Urinalysis testing and for the preservation of a quality specimen for Culture and Sensitivity. The urine is collected in the sterile blue capped cup and using the integrated transfer device, transferred to red/yellow top tube for urinalysis and if required, the gray top for culture. The transfer to the gray top tube should also be performed if a Urinalysis with Reflex to Culture and Sensitivity is requested. Please remember to properly label all specimens. Specimens transferred into the tubes are stable for 48 hours.

When requesting supplies from the lab, please refer to this device as the Complete UA Kit.

STOOL, SPUTUM and URINE CHEMISTRY TESTS

The second specimen collection device is the orange capped sterile cup. This device (shown to the left) should be used for the collection of stool, sputum or urine chemistry tests including urine microalbumin. Please remember to properly label the container.

When requesting supplies from the lab, please refer to this device as Sterile Cups.

October 12, 2017/by NICL

STAT Eligible Testing

All Lab Publications, Specimen Collection & Handling

In consideration of the increased acuity of patients now seen in our facilities and in our ongoing efforts to ensure prompt response and quality patient care, NICL Laboratories is providing the following information regarding STAT testing.

By definition, STAT laboratory tests and services are those that are needed immediately in order to manage medical emergencies. STAT test requests are given the highest priority for processing, analysis and reporting. In order to effectively apply resources to meet the needs of genuine medical emergencies, only the test listed below will be offered for STAT priority. All requests for STAT eligible tests must be substantiated by appropriate medical necessity. All results for STAT eligible tests will be called and faxed to the ordering facility. In accordance with Joint Commission requirements the laboratory requires the full name of the individual who receives the STAT test results.

Only the following tests can be ordered STAT:

Chemistry	Hematology
Basic Metabolic Panel Comprehensive Metabolic Panel Renal Function Panel BUN Creatinine Electrolytes Glucose Potassium Magnesium Amylase BNP (B-type natriuretic peptide) Troponin I	CBC w/o differential CBC w/differential Hemoglobin and Hematocrit Platelets PT/INR PTT D-dimer
Therapeutic	Other
Digoxin Dilantin Phenobarbital Valproic Acid	Blood Culture (draw only)

Tests not listed as STAT eligible may be scheduled for routine early AM collection. Please contact the laboratory to schedule these collections and have a requisition prepared and/or specimen collected for the phlebotomist’s arrival.

Be advised that facilities requiring same day collection will incur a handling charge. You will be notified of any future modifications to our procedure for STAT services. If you have any questions, please do not hesitate to contact your Customer Service Representative or contact the Laboratory.

June 1, 2016/by NICL

Timed Specimen Collection

COLLECTION GUIDELINES

Specimen Rejection Criteria for Facility Collected Samples

Purpose

Rejection Criteria

Blood Collection Problems

Urine Collection Problems

Culture Collection Problems

Collection Devices for Chlamydia / GC / Trichomonas by Nucleic Acid Amplification

FOR GENITAL SPECIMENS

FEMALE:

MALE:

FOR URINE SPECIMENS

FEMALE/MALE:

Your Patient May NOT Need a Transfusion

Understanding Postural Pseudoanemia

Specimen Collection Cups/Devices

URINALYSIS and URINE CULTURE AND SENSITIVITY

STOOL, SPUTUM and URINE CHEMISTRY TESTS

STAT Eligible Testing

Information

Resources

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