Laboratory and Pathology Test Menu and Specimen

Laboratory and Pathology Test Menu

and Specimen Collection Guide

ARHS-SC-19.User Field Version = 13

Title Page

Policies and Procedures

Laboratory and Pathology Test Menu and Specimen

Collection Guide

ARHS-SC-19 . 13

LABORATORY SERVICES

Current Version Approved By: ARHS Policy Committee , Aubree Robinson, Bethany Vallangeon

Current Version Approved Date: 06/18/2020

Last Reviewed: 06/18/2020

ARHS-SC-19.User Field

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Approvals - Table of Contents 2

Introduction

3

Laboratory Telephone Numbers

4

Venipuncture Collection

5

Capillary Collection

9

Specimen Labeling Policy

11

Clean Catch Urinalysis Collection Instructions

12

24 Hour Urine Collection Forms/Instructions

13

Stool Collection Instructions

16

Swab Collection

19

Therapeutic Drug Monitoring

22

Test Menu Guide

23


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Thank you for allowing ARHS Laboratory and Pathology Services to serve as your resource for laboratory testing. In this collection guide, you will find the pertinent information relating to all tests performed by an ARHS Laboratory, as well as, instructions for the collection of common specimens. Each test in this guide lists which ARHS Laboratory that has the ability to perform the test. For any test requested that is not listed in this collection guide, please contact the ARHS Laboratory you are using to obtain reference laboratory specific information/specimen requirements.

As noted above, ARHS Laboratory and Pathology Services have the ability to perform thousands of tests not listed in this collection guide. However, this requires the need to use multiple reference laboratories to supplement testing not performed in our own laboratories. Each reference laboratory has their specific specimen collection requirements; so again, please contact your ARHS Laboratory to obtain the correct collection information.

This directory is available to all ARHS Laboratory Services users either in print, on

the ARHS Intranet or via the Laboratory Services website (www.apprhs.org)

How to use the guide: Test/Panel Name

Basic Metabolic Panel (BMP)

Lab: WMC/CMH Chemistry Availability: 24 hours TAT: Routine, 4 hours Stat, 1 hour CMH ED - 44 min Test Includes: glucose, BUN, creatinine, sodium, potassium, chloride, CO2, calcium

Specimen: Serum , heparinized plasma Tube: SST, Plain red or Green (Li hep.) Minimum volume: 5 ml Collection: Routine venipuncture Causes for rejection: Gross hemolysis, improper labeling, contamination with IV fluids, serum/plasma not removed from cells within 2 hours, wrong anticoagulant.

Use: to evaluate metabolic status, fluid/electrolyte balance.

1. Lab – Facility performing test 2. Availability – When testing is

performed 3. TAT – average turnaround time for

results 4. Test Includes – tests included in a

panel 5. Special Instructions/Notes

1. Specimen requirements 2. Collection container required 3. Minimum Volume required 4. Pertinent collection information

5. 10. Reasons a sample may be

rejected

6. Uses – background on test use 7. Test limitations if present 8. 13. Additional test information

http://www.apprhs.org/


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Watauga Medical Center Telephone Numbers

Main Laboratory 262-4150

Transfusion Services 262-4146

Chemistry 262-4296

Hematology 262-4149

Microbiology 262-4148

Laboratory Fax 262-4147

Pathology Office 262-4106

Pathology Laboratory 268-9401

Histology 265-5028

Cytology 268-8923

Outpatient Laboratory 266-2495

LIS/IT 266-1163

Cardiopulmonary 262-4176

Cannon Memorial Hospital Telephone Numbers

Laboratory 737-7500

Laboratory Fax 737-7501

Pathologists Diagnostic Services

Main Office 336-999-8888


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Venipuncture Collection Procedure

Principle

A patient's veins are the main source of blood for laboratory testing as well as a point of entry for IVs.

Since only a few veins are easily accessible to both laboratory and other medical personnel, it is

important that everything be done to preserve their good condition and availability. Correct collection

procedures are the first step to accurate laboratory testing. Collection must be performed on the

correct patient, drawn in the correct tubes, and handled properly after collection to ensure accurate

results.

Procedure

1. Review the request form(s) or labels. See what test(s) have been ordered and that you have the appropriate tubes.

2. When collecting an inpatient, be sure to knock on the patient's door before you enter the room.

3. Cordially greet the patient. Let them know your name, which department you’re from, and the purpose of your visit.

4. Access the patient’s ability to understand. Each inpatient has a Learning Readiness Assessment. If' needed, you may review the nursing assessment found in the patients room chart. You may find it necessary to seek additional assistance before attempting to obtain the sample.

a. What is the patient's primary language? b. What is the patient's education level? Your communication needs to be at a level that the

patient can understand. If the patient asks you questions, keep your response at a level that the patient can understand.

c. Does the patient have any learning impairments? i. Hearing ii. Sight iii. Speech iv. Cognitive Abilities

5. Identify the patient using the two unique identifiers detailed on ARHS-SC-02.

6. Sanitize hands before and after patient contact.

7. If a fasting specimen is required, verify that the patient has not eaten. Food trays are a good sign that the patient has eaten. If you believe that the patient is capable of understanding and answering the question, you may ask the patient if they have eaten within the specified fasting time. In some cases you may need to consult with the nursing department regarding the patients fasting status.

8. Reassure the patient. Be confident and display a positive attitude.

9. Properly position the patient: a. Inpatients should lay on their back in a comfortable position. Add support under the arm

with a pillow if needed. Extend the arm to form a straight fine from the shoulder to the wrist.

b. Outpatients should be comfortably seated in a venipuncture chair. The arm should be positioned on an armrest in a straight line from the shoulder to the wrist. The arm should not be bent at the elbow.

c. Make sure the patient does not have anything in his/her mouth. d. Never perform a venipuncture on a patient who is standing.

https://apprhs.policytech.com/docview/?docid=18537


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10. Prepare your equipment. Assemble your tube(s) and venipuncture supplies, alcohol prep, gauze, tape and tourniquet. Do not place the phlebotomy tray on the patient's bed. Determine the order of tube collection:

1. Blood Cultures 2. Discard tube (necessary if drawing only light blue top tube with a butterfly) 3. Royal blue 4. Light blue (Sodium citrate) 5. Red (no additive) 6. SST 7. Light green (Lithium heparin) 8. Green (Sodium heparin) 9. Lavender (EDTA) 10. Pink (EDTA) 11. White (gel EDTA) 12. Gray (Sodium fluoride) 13. Yellow (ACD)

11. Select site for venipuncture:

a. Do not draw blood above an Intravenous (IV) Infusion. If the patient has an IV in one arm, look for a vein in the other arm. If IV's are located in both arms, blood may be drawn from ABOVE the IV site if the nurse can turn the IV fluids off for at least 2 minutes. Tourniquet use should be avoided in this situation and a discard of 3-5 ml of blood should be drawn before drawing the specimen(s) for testing. Discard waste tube in the biohazard waste.

b. In most cases blood can be drawn from the median cubital vein, located in the Antecubital Fossa. The Cephalic, Basilic, Accessory Cephalic, Median Ante brachial and Radial veins in the arm or the Dorsal Hand Veins may be used. Do not use veins in the Ventral Wrist area. Leg and foot veins should be used only as a last resort and when we have a physician’s written order to draw from the foot or leg. A tourniquet should not be used in these cases.

c. A tourniquet may be applied to help in locating a vein; however it should be left on no longer than 1 minute.

d. You may ask the patient to make a fist to help make the vein more prominent, however in no case should the patient be allowed to pump the fist. Some laboratory results could be altered by the pumping action.

e. Avoid scarred or bruised areas and if possible, the side on which a mastectomy was performed should be avoided.

12. Cleanse the venipuncture site with an alcohol prep using a circular motion from the center to the periphery. For blood cultures, cleanse site in a circular motion for 60 seconds using a chloroprep pad. Allow the area to air dry. While the site is drying, put on a clean pair of gloves. Gloves must always be donned in the presence of the patient.

13. Apply a tourniquet 3 to 4 inches above the venipuncture site. Hold one end taut and tuck a portion of the other end under to form a loop.

14. Perform the Venipuncture - Note, do not attempt to perform more then two venipuncture attempts on a patient. There should be no more than five attempts to collect blood from a patient. If the lab has been unable to collect a specimen, notify the nursing department and document in the LIS.


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Vacutainer

a. Holding the vacutainer barrel in your dominant hand, remove the needle cap and position the needle with the bevel up.

b. Pull the skin just below the puncture site tight using either the thumb or index finger of your non-dominant hand. Do not make a "window."

c. Align the needle with the puncture site, keeping the needle at a 15° angle. Use a small quick thrust, puncture the skin and enter the vein in one smooth motion, if possible.

d. Holding the barrel securely, push the first tube fully onto the needle assembly. Blood should flow when the needle punctures the tube cap. If it does not, the needle is either too far in the vein or not in the vein. Back the needle and reposition needle until you feel the needle is in the vein. If blood still does not flow, try another tube.

e. Remove the tube when the blood flow ceases. If multiple tubes are needed, insert them in the order listed above.

f. When all the blood necessary has been collected, release the tourniquet, remove the needle quickly and immediately apply a cotton ball or gauze pad on the puncture site. At the same time, make the needle safe by activating the protective device. Hold pressure to the cotton/gauze. Discard the needle in the sharps container.

Syringe

a. Holding the syringe in your dominant hand, remove the needle cap. Position the needle with

the bevel up.

b. Grasp the patient's arm just below the puncture site with your non-dominant arm and pull the

skin tight with your thumb.

c. Align the needle with a 15-degree angle to the skin. Use a quick, but small, thrust to

penetrate the skin and enter the vein in one motion, if possible.

d. Holding the barrel of the syringe securely, pull back on the syringe plunger until a sufficient

amount of blood fills the syringe.

e. Release the tourniquet, remove the needle quickly and immediately apply a cotton ball or

gauze pad on the puncture site. At the same time, make the needle safe by activating the

safety device. Hold pressure to the cotton/gauze. Discard needle in the sharps container.

f. Using a transfer device, transfer the blood from the syringe to the appropriate tubes

immediately. Fill tubes containing anticoagulants first. Discard of the transfer device and

syringe in the sharps container.

Butterfly

a. Holding the butterfly by the "wings" in your dominant hand, remove the needle cap.

b. Position the needle with the bevel up.

c. Grasp the patient's arm just below the puncture site with your non-dominant arm and pull

the skin tight with your thumb.

d. Align the needle with a 15-degree angle to the skin. Use a quick, but small, thrust to

penetrate the skin and enter the vein in one motion, if possible.

e. Blood will enter the tubing attached to the needle once the needle is in the vein. The

opposite end of the tubing can be attached to a syringe or an adapter can be used and

it can be attached to a vacutainer barrel.

f. When all the blood necessary has been collected, release the tourniquet, remove the

needle quickly and activate the safety mechanism. Immediately apply a cotton ball or

gauze pad on the puncture site. Hold pressure to the cotton/gauze. Discard the butterfly

assembly in the sharps container. Using a transfer device, transfer the blood from the

syringe to the appropriate tubes immediately. Fill tubes containing anticoagulants first.

Discard of the transfer device and syringe in the sharps container.


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15. Apply a bandage to the site and advise the patient to leave it on for 1 to 2 hours.

16. In the presence of the patient, label tubes according to ARHS-SC-05.

17. For inpatients, return the patient area to the condition in which you found it - raise side rails,

dispose of trash, lower the bed, etc.

18. Remove gloves and sanitize hands prior to leaving the room.

Adverse Reactions to Phlebotomy

To ensure that any patient that has an adverse reaction such as fainting, seizure, or injury to

phlebotomy will receive immediate care:

Inpatients:

1. The phlebotomist will call the nurse’s station for immediate assistance. 2. The patient’s nurse will be notified. 3. An occurrence report will be completed.

OPIC Outpatients:

1. Basic first aid will be administered. 2. Ammonia and a recliner are available when needed. 3. When indicated 911 will be called per EMTALA Policy.

Main Lab Outpatients:

1. Basic first aid will be administered. 2. Ammonia and a recliner are available when needed. 3. An intercom system is available to obtain assistance. 4. When indicated a CODE Blue will be called.

The following steps can be taken to assist the patient during adverse events:

Fainting:

1. If the patient is sitting, lower head and arms. If lying down, elevate feet. 2. Try to revive patient with ammonia inhalant (draw trays and in draw rooms). 3. Loosen any tight clothing. 4. Apply cold compress to patient’s forehead and back of neck.

Nausea

1. Situate patient comfortably with head lowered. 2. Instruct patient to breathe deeply and slowly. 3. Offer water.

Vomiting

1. Roll prone patients on their side. 2. Give patient a basin. 3. When vomiting ceases, assist patient with towels and water.

Extensive bleeding

1. Apply direct pressure to venipuncture site and note time it takes to cease bleeding.

ORIGINAL AUTHOR: Wendy R. Williams

ORIGINAL EFFECTIVE DATE: 12/30/2010

Venipuncture Collection Procedure



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Capillary Collection Procedure

Principle

Capillary blood specimens are especially important for hard to stick patients such as pediatric, obese,

or geriatric patients. This procedure is also used for obtaining blood for bedside glucoses and PKU

newborn screenings. Correct collection procedures are the first step to accurate laboratory testing.

Collection must be performed on the correct patient, drawn in the correct tubes, and handled properly

after collection to ensure accurate results.

Procedure

1. Review the request form(s) or labels. See what test(s) have been ordered and that you have the appropriate tubes.

2. When collecting an inpatient, be sure to knock on the patient's door before you enter the room. 3. Cordially greet the patient and/or patient’s family. Let them know your name, which

department you’re from, and the purpose of your visit. 4. Access the patient’s ability to understand. Each inpatient has a Learning Readiness

Assessment. If' needed, you may review the nursing assessment found in the patients room chart. You may find it necessary to seek additional assistance before attempting to obtain the sample.

a. What is the patient's primary language? b. What is the patient's education level? Your communication needs to be at a level that

the patient can understand. If the patient asks you questions, keep your response at a level that the patient can understand.

c. Does the patient have any learning impairments? i. Hearing ii. Sight iii. Speech iv. Cognitive Abilities

5. Identify the patient using the two unique identifiers detailed on the Patient Identification procedure.

6. Sanitize hands before and after patient contact. 7. If a fasting specimen is required, verify that the patient has not eaten. Food trays are a good

sign that the patient has eaten. If you believe that the patient is capable of understanding and answering the question, you may ask the patient if they have eaten within the specified fasting time. In some cases you may need to consult with the nursing department regarding the patients fasting status.

8. Reassure the patient. Be confident and display a positive attitude. 9. Prepare your equipment. Assemble your tube(s) and collection supplies, alcohol prep, gauze,

and Band-Aid. Do not place the equipment on the patient's bed. 10. Finger stick collections:

a. The preferred site is the middle or ring finger. Stick the palmar surface of the distal phalanx; do not stick the side or tip of the finger.

b. Wash hands and put on gloves. c. If patient’s hand is cold, warm with a heel warmer or a warm wash cloth. d. Clean site with an alcohol pad and let it dry. e. Hold finger to prevent movement and perform puncture with appropriate safety lancet. f. The first drop of blood should be wiped away with gauze. g. To enhance blood flow hold finger downward and apply intermittent pressure. h. Touch collection device to 2nd drop of blood and allow blood to flow into microtainer

tube or place drop on BSG strip. i. Gently tap tube if blood becomes lodged at top of tube.




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j. Fill tubes appropriately and invert tubes with anticoagulant. 11. Heel stick collections:

a. The baby should be in a supine position. b. Puncture should be performed on the most medial or most lateral portion of the plantar

surface of the heel. Do not puncture the posterior curvature or the central area of the heel.

c. Wrap the heel in a heel warmer or a warm washcloth for 5 minutes. d. Clean the puncture site with an alcohol pad and allow to air dry. e. Open the tenderfoot blister pack and remove the safety clip from the device. f. Raise the foot above the baby’s heart level and carefully select a safe incision site. g. Place the blade slot surface of the device flush against the heel; both ends should

make light contact. h. Depress the trigger and immediately remove the device. i. Gently wipe away the first drop with a gauze pad. j. Touch collection device to 2nd drop of blood and allow blood to flow into microtainer

tube. k. Gently tap tube if blood becomes lodged at to top of tube. l. Fill tubes appropriately and invert tubes with anti coagulant. m. For PKU screens, allow blood to flow onto the circles on the form. Fill all circles

completely. 12. Apply a bandage to the site and advise the patient to leave it on for 1 to 2 hours. 13. In the presence of the patient, label tubes or PKU form according to Specimen Labeling . 14. For inpatients, return the patient area to the condition in which you found it - raise side rails,

dispose of trash, lower the bed, etc. 15. Remove gloves and sanitize hands prior to leaving the room.



Capillary Collection Procedure



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Specimen Labeling

Principle

To ensure that all specimens are labeled in the same manner by all staff and that all necessary

information is supplied with each sample.

Procedure

The primary specimen container for all specimens must be labeled with the following:

1. Patient name (first and last) 2. Patient date of birth 3. Date of collection 4. Time of collection 5. Initials or ARHS employee number of person collecting specimen

Specimens may also include the location of the patient and the facility patient specific identification

number.

Specimens received without date of birth on the label must be accompanied with a requisition or

demographics sheet that includes the required patient identifiers.

Specimens are to be labeled in the presence of the patient at the time of collection.

LIS generated labels are to be placed on specimen tubes with the test names on the left and the

patient name on the right. Labels are also to be placed over the manufacturer label in such a way

that allows the sample to be seen. Specimen cups and tubs may have the label placed over supplied

labeling area. Blood culture tubes should have the label placed at the bottom of the tube making sure

not to cover up the barcode on the bottle. If tubes are labeled with labels other than those generated

by the LIS, the LIS labels should be placed on the tubes in the same manner as above with care

given to keeping the name on the original label visible.

Place the label on the correct tube as indicated on the label. Failure to place the correct labels on the

correct tubes may result in delayed testing. Extra labels may be used to label extra tubes.

In the event of errors/discrepancies in specimen labeling, the best practice is to recollect the sample

and ensure proper specimen labeling at time of recollection. For irreplaceable or difficult-to-obtain

samples, corrections in labeling may be made by the original collector. In addition to the labeling

correction, a Specimen Labeling Discrepancy Form must be completed by the original collector with a

laboratory staff member witnessing the correction.

Cannon Memorial Hospital PKU Labeling

1. Log onto Hearing Link site (wcs.ncpublichealth.com) 2. Choose patient by clicking on patient name in hospital queue. 3. In the green box, click New Specimen.



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4. Scan or enter the barcode on the metabolic screening (PKU) form. 5. Fill in

a. Specimen Status b. Date and time of collection c. Collector initials d. Facility

6. Click Submit Data. 7. Return to patient record and click Print Label. 8. Click OK to confirm patient information. 9. Click File then Page Setup then Landscape 10. Set margins at 0.5” for all sides (top/bottom/left/right) 11. Click Printer then Properties then select Labels as the paper type 12. Click OK to print. 13. Inspect label for accuracy. Place one label on each page of the PKU form taking care not to

cover the barcode or the patient medical record number.

ORIGINAL AUTHOR: Wendy R. Williams, MT (AMT)


Specimen Labeling



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Clean Catch Urine Collection

Principle

To ensure proper collection from patients for clean catch specimens, the following

instructions are provided to the patient.

Procedure

When presented with an order for a test that requires a clean catch urine specimen,

provide the patient with a specimen cup and a sterile antiseptic pad. If the patient is taking

the container home to collect the specimen, also provide them with a specimen bag to

transport the specimen in. Review the following instructions with the patient or direct them

to the posted instructions in the collection restroom.

Instructions for the female patient:

1. If you are menstruating, first insert a fresh tampon or use cotton to stop the flow. 2. Separate the skin folds around the urinary opening then wash the urinary opening and

its surroundings from front to back with a sterile antiseptic pad. 3. Begin urinating in the toilet, making sure to keep the skin fold apart with the fingers of

one hand. 4. Wait until the urine stream is well established before moving the container to the

genital area but do not touch container to genital area. 5. Replace lid when done collecting sample. 6. Label the container with your name, date of birth and the date and time of collection

and place in the specimen window or deliver to laboratory as soon as possible. Refrigerate specimen if transport to the laboratory will be delayed.

Instructions for the male patient:

1. Wash the end of the penis well with a sterile antiseptic pad and allow to dry. 2. Begin urinating into the toilet. Wait until the urine stream is well established before

moving the container into the path of the stream to catch the rest of the urine. Do not touch the container to the genital area.

3. Replace lid when done collecting sample. 4. Label the container with your name, date of birth and the date and time of collection

and place in the specimen window or deliver to laboratory as soon as possible. Refrigerate specimen if transport to the laboratory will be delayed.

ORIGINAL AUTHOR: Wendy R. Williams, MT (AMT)


Clean Catch Urine Collection



Clinical/Anatomic Pathology Laboratory

Facility/Department: ARHS Laboratory Services

24 Urine Collection Instructions For Use with Boric Acid

Tests Included: Aldosterone, C-peptide, Glucose, Human Growth Hormone (HGH), Hydroxycorticosteriods (17 OHCS), Ketosteriods (17-KS)

Special Patient Preparation:

Aldosterone Avoid diuretics, antihypertensives, estrogen, and licorice. Patient

should be on restricted sodium diet prior to collection (consult MD).

C-peptide Do not collect within 8 hours of last biotin dose.

17 OHCS (Hydroxycorticosteriods) Avoid all medications for 72 hours prior to collection if possible

(Consult MD prior to stopping any medications).

17-Ketosteriods Avoid all medications for 72 hours prior to collection if possible

(Consult MD prior to stopping any medications).

Collection Instructions: *Do Not Urinate Directly into Urine Container*

CAUTION– The container contains a strong acid. Please read precaution instructions on

container.

1. Label urine container with your name and date of birth if not already done.

2. On the first morning when you start collection, urinate as normal in the toilet and discard.

3. Write down the date and time this was done in the space provided below. This is the start of the

collection.

4. Collect all urine your pass for the next 24 hours including the first specimen of the second

morning. All of the urine passed must be added to the container. If any specimens are missed, the

collection must be started over with a new container.

5. Write down the date and time of the last specimen added in the space provided below. This will be the date and time of the first urination on the second morning and is the end of the collection.

6. Take care not to touch the urine with a bowel movement or toilet paper.

7. The urine in the container should be kept cool during the 24 hour collection period. This may be done

by putting the container in a pan with ice.

8. Once collection is completed, bring the container and this sheet to the laboratory.

Questions: Cannon Memorial Hospital 828-737-7500 Watauga Medical Center 828-262-4150

Patient Name:

Date/Time Collection Started:

Date/Time Collection Ended:

Patient Date of Birth:

FA-SC-03.01 Printed: 3/14/2011

Page 1 of 1 Effective Date: 3/14/11



24 Urine Collection Instructions For Use with No Preservative

Tests Included: Protein Electrophoresis, Porphyrines, Porphobilinogen (PGB), Immunofixation, Creatinine Clearance, Sodium, Potassium, Total Protein, Creatinine, Chloride, Heavy Metals*, Amylase, Cadmium*, Chromium*, Cobalt*, Copper*, Histamine, Lead*, Lysozyme, Mercury*, Microalbumin, Nickel*, Osmolality, Selenium*, Urea Nitrogen, Uric Acid, Zinc*, Hydroxyindoleacetic Acid (5-HIAA),

Special Patient Preparation: Calcium Patient should be on low calcium diet for 72 hours prior to collection.

Avoid antacids, phosphates, diuretics, glucocorticoids, carbonic

anhydrase inhibitors, and anticonvulsants (Consult MD before stopping

any medications).

All Heavy Metals* Avoid seafood and red wine for 72 hours prior to collection

Uric Acid Maintain standard diet 24 hours prior to collection.

5-HIAA (Hydroxyindoleacetic acid) Avoid bananas, avocados, plums, eggplant, tomatoes, plantains,

pineapple, and walnuts. Avoid all medications for 72 hours prior to

collection if possible (Consult MD prior to stopping any medications).

Collection Instructions: *Do Not Urinate Directly into Urine Container* 1. Label urine container with your name and date of birth if not already done. 2. On the first morning when you start collection, urinate as normal in the toilet and discard. 3. Write down the date and time this was done in the space provided below. This is the start of the

collection. 4. Collect all urine your past for the next 24 hours including the first specimen of the second

morning. All of the urine passed must be added to the container. If any specimens are missed, the collection must be started over with a new container.

5. Write down the date and time of the last specimen added in the space provided below. This will be the date and time of the first urination on the second morning and is the end of the collection.

6. Take care not to touch the urine with a bowel movement or toilet paper. 7. For all tests ordered other than metals, the urine in the container should be kept cool during the 24

hour collection period. This may be done by putting the container in a pan with ice.

*Collections for metal testing should be maintained at room temperature.

8. Once collection is completed, bring the container and this sheet to the laboratory. Questions:

Cannon Memorial Hospital 828-737-7500 Watauga Medical Center 828-262-4150

Patient Name: Patient Date of Birth: _

Date/Time Collection Started: __________________ Date/ Time Collection Ended:

FA-SC-02.01 Printed: 3/14/2011




24 Urine Collection Instructions For Use with 6N HCL

Tests Included: Calcium, Catecholamines, Citric Acid, Cortisol (Free), Cystine, Homovanillic Acid (HVA), Hydroxyproline, Magnesium, Metanephrines/Normetanephrine, Oxalate, Phosphorus, Vanillylmandelic Acid (VMA), Ketosteriods (17-KS)

Special Patient Preparation:

17-Ketosteriods Avoid all medications for 72 hours prior to collection if possible (Consult MD prior to

stopping any medications).

Calcium Patient should be on a low calcium diet for 72 hours prior to collection. Avoid antacids,

phosphates, diuretics, glucocorticoids, carbonic anhydrase inhibitors, and

anticonvulsants (Consult MD prior to stopping any medications).

Catecholamines Avoid stress and caffeine. Avoid all medications for 14 days prior to collection if

possible (Consult MD prior to stopping any medications).

Homovanillic Acid

(HVA)

Avoid aspirin, disulfiram, reserpine and pyridoxine for 48 hours and Levodopa for 14

days prior to collection (Consult MD prior to stopping any medications).

Hydroxyproline Patient should be on a collagen-free diet for 24 hours prior to collection. Avoid foods

containing gelatin and meats. Avoid all aspirin-containing drugs (Consult MD prior to

Metanephrines Avoid caffeine before and during collection. Avoid taking monamine oxidase inhibitors

for 7 days prior to collection (Consult MD prior to stopping any medications).

Oxalate Avoid Vitamin C supplements and Vitamin C enriched foods (fruits, broccoli, tomatoes,

peppers, potatoes) for 48 hours prior to collection.

Vanillylmandelic Acid

(VMA)

Avoid all medications for 72 hours prior to collection if possible. Avoid caffeine, tea,

chocolate, fruit (especially bananas) and any vanilla containing substance for 72 hours

prior to collection (Consult MD prior to stopping any medications). Collection Instructions: *Do Not Urinate Directly into Urine Container*

CAUTION– The container contains a strong acid. Please read precaution instructions on container. 1. Label urine container with your name and date of birth if not already done. 2. On the first morning when you start collection, urinate as normal in the toilet and discard.

3. Write down the date and time this was done in the space provided below. This is the start of the

collection.

4. Collect all urine your past for the next 24 hours including the first specimen of the second morning. All of the

urine passed must be added to the container. If any specimens are missed, the collection must

be started over with a new container.

5. Write down the date and time of the last specimen added in the space provided below. This will be the date and

time of the first urination on the second morning and is the end of the collection.

6. Take care not to touch the urine with a bowel movement or toilet paper.

7. For all tests ordered other than metals, the urine in the container should be kept cool during the 24 hour collection

period. This may be done by putting the container in a pan with ice.

8. Once collection is completed, bring the container and this sheet to the laboratory.

Questions: Cannon Memorial Hospital 828-737-7500 Watauga Medical Center 828-262-4150

Patient Name: Patient Date of Birth:

Date/Time Collection Started: Date/Time Collection Ended:

FA-SC-04.01 Printed: 3/14/2011


Stool Collection

Principle To ensure proper collection from patients for stool specimens, the following instructions are provided to the patient. Two important aspects of collection that must be emphasized are the collection of the specimen before the administration of antimicrobial agents and the prevention of specimen contamination with externally present organisms or normal flora of the body.

Procedure

The following collection and transportation guidelines should be followed in order to

produce the best specimen for microbiology testing:

1. Apply strict aseptic techniques throughout the procedure.

2. Collect the specimen at the appropriate phase of the disease.

3. Make certain that the specimen is representative of the infectious process and is

adequate in quantity for the desired tests to be performed.

4. Collect or place the specimen aseptically in a sterile container.

5. Label and date the container appropriately and complete the requisition with the

patient’s clinical history when appropriate. Place the label on the container, not

the lid.

6. Specify the specimen site or source.

7. Arrange for immediate transportation of the specimen to the laboratory, preferable

within 2 hours of collection.

Outpatients must be given the appropriate sterile collection containers and a biohazard bag for transport of the collection specimen. The patient should also be instructed to label the containers with their name, date of birth and date and time of collection. Para Pak containers should be filled with stool up to the fill line located on the container. Instruct the patient not to overfill.

GI Panel This requires a fresh random stool. Stool specimens should be collected before the patient receives any oil laxative or barium. Specimen must not be contaminated with urine, barium, bismuth or mineral oil. Do not submit in a diaper. Stools collected in sterile containers must be partially transferred to an orange topped Para Pak Enteric container within 2 hours of

collection. S u b m i t b o t h s a m p l e s f o r t e s t i n g .

Ova and Parasite Examination

This requires a fresh random stool. Stool specimens should be collected before the

patient receives any oil laxative or barium. Specimen must not be contaminated with

urine, barium, bismuth or mineral oil. Do not submit in a diaper. Stools collected in sterile

containers must be transferred to a pink topped and a gray topped Para Pak container

(formalin and PVA) within 2 hours of collection.

C. difficile Examination


patient receives any oil laxative or barium. Specimen must not be contaminated with

urine, barium, bismuth or mineral oil. Do not submit in a diaper. Specimen must be

refrigerated or frozen within 2 hours of collection.

Hemoccult



patient receives any oil laxative or barium. Specimen must not be

contaminated with urine, barium, bismuth or mineral oil. Do not submit in a diaper.

Hemoccult cards may be submitted for testing with stool already placed in the testing

areas.

Test Container to Provide to Patient

GI Panel Sterile container and/or Orange Para Pak container

Ova and Parasite Sterile container or Pink and Grey Para Pak container

C. difficile Sterile container

Hemoccult Sterile container

Notes

1. No more than 2 bacteriology specimens and 3 parasitology specimens per

patient are recommended.

2. With the exception of Clostridium difficile, enteric cultures should not be performed after 3 days of hospitalization.

3. Parasitology exams should not be done after 4 days of hospitalization.

4. Physicians are encouraged to increase testing for Clostridium difficile in

appropriate clinical settings (diarrhea and prior antibiotic

administration). ORIGINAL AUTHOR: Wendy R. Williams


Stool Collection




Outpatient Stool Collection Instructions

Your physician has ordered the tests marked below. Please follow the collection instructions below for each test ordered. Bring collected samples back to an ARHS Laboratory or the Outpatient Imaging and Laboratory Center located at 1200 State Farm Road in Boone. The Outpatient Imaging and Laboratory Center is open from 7:00am to 5:00pm Monday through Friday. Watauga Medical Center and Cannon Memorial Hospital Laboratories can accept samples 24 hours a day, 7 days a week.

□ GI Panel Container Color: Orange/White

□ Ova and Parasite (O&P) Container Color: Pink/Gray

Collect stool specimen in a clean, dry container. Do NOT mix urine with the stool sample. Open the Para Pak vial(s). Using the spoon attached to the lid of the vial, place small scoopfuls of stool from areas which appear bloody, slimy, or watery into the vial until the contents reach the red line on the label that reads “Add Specimen to this Line.” DO NOT OVERFILL. If the stool is liquid, carefully pour into the vial until contents reach the red line. If the stool is solid, add portions from the middle and ends to the vial. Replace lid and close tightly. Shake the vial vigorously until the contents are mixed. Label the vial with your name, date of birth, and date and time of collection. Repeat if more than one vial is provided. The sample(s) may remain at room temperature and must be delivered to the laboratory within 24 hours of collection.

*If more than one O&P is ordered, do not collect more than one set of vials per day.

□ C. difficile Toxin/Stool for WBCs/ Container Color: White/Clear

Reducing Substances/Fecal Fat Collect stool specimen in a clean, dry container. Do NOT mix urine with the stool sample. If not collected in the sterile container that was provided, transfer the stool specimen to the sterile container. Label container with your name, date of birth, and date and time of collection. If sample cannot be delivered to the laboratory within an hour, sample must be refrigerated. The sample must be delivered to the laboratory within 24 hours.

FA-SC-01.01 Printed: 3/14/2011


ARHS-SC-19.03 20

1/24/2022 6:01 a1/p1

Name Color Storage/

Transport Purpose Testing

Method Site

UTM-RT Purple top Pink media

Refrigerate 2-8° Viruses (including

Herpes),

Chlamydia

(including child

abuse) &

Mycoplasma

Culture All

Copan CultureSwab

(red top)

Red Top/ Sponge

Room Temperature

Aerobic bacteria Culture All

BBL CultureSwab

(green top)

Green Top/ Sponge

Room Temperature

Nasopharyngeal Cultures

Culture Nasopharyngeal

fFN White top transport/

swab

Room Temperature

Fetal Fibronectin Immunoassay Posterior formix Vaginal

Cepheid GC (Female)

Pink print Room Temperature

Chlamydia/GC DNA Vaginal/Cervical only

Genprobe (Male)

Blue print Room Temperature

Chlamydia/GC DNA Urethral only

BBL Vacutainer Anaerobic

Collector

Glass collection

kit

Room Temperature

Anaerobic and aerobic bacteria

Culture Anaerobic sites

Swab Collection for Microbiology Principle To ensure proper collection of cultures requiring swab collection, the following procedure is used. Two important aspects of collection that must be emphasized are the collection of the specimen before the administration of antimicrobial agents and the prevention of specimen contamination with externally present organisms or normal flora of the body.

Procedure

The following collection and transportation guidelines should be followed in order

to produce the best specimen for microbiology testing:

1. Apply strict aseptic techniques throughout the procedure.

2. Collect the specimen at the appropriate phase of the disease.

3. Make certain that the specimen is representative of the infectious process and

is adequate in quantity for the desired tests to be performed.

4. Collect or place the specimen aseptically in an appropriate container.

5. Label with two patient identifiers and date and initials of collector. Place the

label on the container, not the lid and complete the requisition with the

patient’s clinical history when appropriate.

6. Specify the specimen site or source.

7. Arrange for immediate transportation of the specimen to the laboratory,

preferable within 2 hours of collection.

8. Refer to the Swab Selection Chart below for collecting a particular specimen for microbiological analysis

9. Swabs are not recommended for collection of sample from significant

infectious process.

10. Swabs must only be touched to the area of collection to avoid contamination.

Swab Type and Usage


Steps for collecting a swab specimen (all except BBL Vacutainer Anaerobic

Collector):

1. Check for expiration date of swab.

2. Peel open the sterile package if required. 3. Remove swab from packaging.

4. Collect sample.

5. Remove lid to transport container and place swab inside. Close container.

6. Label properly with patient’s name, date of birth, date and time of

collection and collector’s initials.

7. Transport to laboratory.

Steps for collecting anaerobic specimen (BBL Vacutainer Anaerobic Collector):

1. Check for expiration date of swab.

2. Peel open the sterile package and remove plunger with sterile swab

attached.

3. Collect sample.

4. Replace swab through holes and into inner tube.

5. While holding at a 45° angle, press down on disc portion of plastic

plunger forcing the inner tube into the outer tube.

6. Gently rotate tube in a swirling motion to facilitate mixing of air in inner tube

and hydrogen in outer tube.

7. Label properly with patient’s name, date of birth, date and time of

collection and collector’s initials.

8. Transport to laboratory.

Ear

Using a sterile swab, gently enter the ear canal, rotate swab before removing.

Avoid contact with other areas of the ear.

Eye

Obtain purulent material from the conjunctiva or cornea. Avoid contact with other

areas of the eye.

Nasal

Gently insert swab into nostril until resistance is met (less than 1 inch). Rotate the

swab then remove it.

Nasopharyngeal

Pass a swab gently through the nostril until it passes the nasopharyngeal wall.

Rotate the swab then remove it.

Throat The swab should be taken from the back of the throat. Keep swab free of saliva; do not touch teeth or tongue. If the isolation of C. diphtheriae is required, please contact the laboratory so that the appropriate transport media/container will be used. If testing for N. gonorrhoeae is desired, please inform the laboratory on the requisition so that the appropriate media can be inoculated.

Wound– Deep

Most often these are specimens from surgical sites; less frequently puncture

wounds and some decubiti may contain anaerobes. These specimens are

suitable for aerobe/anaerobe cultures.

Wound – Surface

Debride area if necessary. Care should be taken not to touch surrounding skin

surface. This is suitable for aerobic culture only.

Sterile Body Fluids

Body fluids for culture should be placed in a sterile container. Do not put fluid into

a swab.



Swab Collection for Microbiology


Therapeutic Drug Monitoring

Recommended collection times for common therapeutic medications:

Drug

Peak

(time after end of

infusion/dose)

Trough

(time before next

dose)

Therapeutic

Range

Aminoglycosides –

Conventional dosing

IM – 1-1.5 hours

IV – 30 min < 30 min

Peak: 4-10

Trough: <2.0

Aminoglycosides –

Extended interval dosing N/A <90 min

Peak: 4-10

Trough: <2.0

Vancomycin IV - 60 min < 30 min Peak: 30-40

Trough: 5-20

Chloramphenicol IV/PO – 2 hours < 30 min Peak: 10-20

Trough: 5-20

Carbamazepine N/A < 30 min 4-12

Phenobarbital N/A < 30 min 10-40

Phenytoin N/A < 30 min 10-20

Valproic Acid N/A < 30 min 50-100

Digoxin N/A < 30 min 0.8-2.0

Lithium N/A < 30 min 0.6-1.2

Theophylline N/A < 30 min 10-20

ABO & Rh

Lab: WMC/CMH Transfusion Service

Availability: 24 Hours

TAT: Routine:, 4 Hours

Stat, 1 Hour

Specimen: Whole Blood Tube: EDTA (lavender/pink)

Minimum Volume: 5ml Collection: Routine venipuncture

Causes For Rejection: Improper labeling of sample,

wrong sample type, hemolysis.

Use: To determine blood type

and Rh.

Limitations: Certain clinical

conditions may interfere with

typing.

Acetaminophen

Lab: WMC/CMH Chemistry


TAT: Routine, 4 hours

STAT, 1 hour

Specimen: Serum or heparinized plasma

Tube: SST, Plain red or Green (Li Hep)

Minimum Volume: 2 ml

Collection: Routine venipuncture



Use: monitor therapy, evaluate

toxicity

Additional info: hepatic toxicity

may appear 3-5 days after

ingestion of a toxic dose.

Albumin




STAT, 1 hour


Tube: SST, Plain red or Green (Li hep.)



Causes for rejection: Improper labeling, wrong tube,

gross hemolysis, contamination with iv fluids, or

bacteria.

Use: evaluation of nutritional

status, blood osmotic pressure,

renal disease with proteinuria,

and other chronic diseases.

Limitations: hemolysis and high

triglycerides can interfere with

testing.

Alcohol (ETOH, Ethanol)


Availability: 24 hours


STAT, 1 hour



Minimum volume: 2 ml

Collection: Routine venipuncture. Do not clean

venipuncture site with alcohol. Transport specimen to

laboratory immediately.

Causes for rejection: Collected from site cleaned

with alcohol.

Storage: transport sample to

laboratory immediately. Keep

tightly closed and store at 4˚C if

testing is delayed.

Use: evaluation of apparently

intoxicated or comatose

patients.

Alkaline Phosphatase (Alk Phos)




STAT, 1 hour





Causes For Rejection: Mislabeled tube, wrong tube,

gross hemolysis, contamination With IV Fluids, or

bacteria.

Use: Evaluation of liver function

and bone disease.

Limitations: Bilirubin,

Methotrexate, & Nitrofurantoin

can interfere with testing.

ALT (SGPT)




STAT, 1 hour

Specimen: Serum or heparin zed plasma

Tube: SST, Plain red Or Green (Li hep.)


Collection: Routine Venipuncture

Causes For Rejection: Mislabeled sample,

wrong tube, gross hemolysis, or

contamination with IV fluids or bacteria.

Use: evaluation of liver function.

Limitations: ALT is less

sensitive to alcoholic liver disease

than AST. High total protein can

interfere with testing.

AmniSure

Lab: WMC/CMH

Microbiology


TAT: STAT, 30 hour

Specimen: Vaginal Swab

Collection: non-speculum collection

Causes For Rejection: Mislabeled sample, wrong

swab, specimen not mixed with solvent vial within 1

minute following collection

Use: evaluation for rupture

of fetal membranes

Limitations: Gross hemolysis may

impair tests ability to detect PAMG-1

Ammonia, Venous




STAT, 1 hour

Specimen: Heparinized plasma

Tube: Green (Li hep.)


Collection: Routine venipuncture. Fill tube

completely; keep tightly stoppered; place in an ice

slurry; spin and separate within 15 minutes of

collection. If testing is delayed place sample in

refrigerator. Sample may be used up to 3 hours after

collection if collected on ice, centrifuged immediately

and kept on ice or refrigerated.

Causes for rejection: Sample not on ice, wrong

anticoagulant, hemolyzed specimen, mislabeled

sample.

Use: Elevated in liver disease,

inborn errors of metabolism,

indicated in neonates with

neurological deterioration.

Antibody ID (Panel)

Lab: WMC Transfusion Service Availability: As needed TAT: Routine, 4 Hours

Stat, 1 Hour

Note: This test cannot be ordered

individually. It is performed only as a

reflex to a positive antibody screen.

Specimen: Whole blood Tube: EDTA (lavender/pink)

Minimum Volume: 10ml

Collection: Routine venipuncture. Labeling: must have complete patient identification, including full name and MR number.

Causes for rejection: Improper labeling of sample, wrong sample type, hemolysis.

Use: To identify clinically significant unexpected antibodies detected in a positive antibody screen. Limitations: Antibodies to high or low incidence antigens may require referral to a reference lab. A delay in providing compatible blood may occur.

Antibody Screen

Lab: WMC/CMH Transfusion Service

Availability: As needed TAT: Stat: 1 Hour

Routine: 4 Hours


Minimum Volume: 5ml Collection: Routine venipuncture

Causes for rejection: Improper labeling of sample,


Use: To detect unexpected

clinically significant antibodies.

Antibody Titer

Lab: WMC Transfusion Service Availability: As needed TAT: Stat: 1 Hour

Routine: 4 Hours


Minimum Volume: 5ml

Collection: Routine venipuncture Causes for rejection: Improper labeling of sample,


Use: To determine the titer of clinically significant identified antibodies.

Aspirations Of Various Sites for Cytopathology

Lab: Cytopathology

Availability: Mon. – Fri. 5:00 am –

5:00 pm

TAT: 24-48 hours.

Special instructions: please indicate on

requisition if patient has a history of

carcinoma.

Storage: If collected after hours place in

Pathology rack in refrigerator in the main

lab.

Specimen: Aspirates from thyroid, breast, lymph

nodes and other palatable masses.

Minimum volume: Collect as many slides as a

specimen will allow up to 4. Aspirate remaining

aspirate in Cytolyt® solution pull 5 ml of solution back

into syringe and wash out remaining aspirate. Submit

to cytopathology.

Container: Syringes are available from central

supply. Cytolyt available in surgery suite or

Cytopathology lab.

Collection: Label slides w/patient name. Place pea

size aspirate on slide and spread evenly. Let slides air

dry.

Causes for rejection: Improper fixation. Unlabeled

slides or specimen. Coverslips on smears.

Use: To establish the presence

of primary or metastatic

neoplasm. To aid in the

diagnosis of infection.

AST




Stat, 1 hour

Specimen: Serum , heparinized plasma




Causes for rejection: Mislabeled sample, wrong

tube, gross hemolysis, or contamination with IV

fluids or bacteria.

Use: Increased AST activity

commonly follows myocardial

infarction, pulmonary emboli,

skeletal muscle trauma,

alcoholic cirrhosis, viral

hepatitis, and drug-induced

hepatitis.

Basic Metabolic Panel (BMP)




Stat, 1 hour

CMH ED - 44 min

Test Includes: glucose, BUN, creatinine,

sodium, potassium, chloride, CO2, calcium





Causes for rejection: Gross hemolysis, improper

labeling, contamination with IV fluids, serum/plasma

not removed from cells within 2 hours, wrong

anticoagulant.

Use: to evaluate metabolic

status, fluid/electrolyte

balance.

Bilirubin, Direct




Stat, 1 hour


Tube: SST, plain red or Green (Li hep)



Causes for rejection: Gross hemolysis, prolonged

exposure to light.

Use: Liver function test, useful in

diagnosing and monitoring

hepatobiliary obstruction

Bilirubin, Neonatal




Stat, 1 hour


Tube: SST, Plain red or Green (Li hep)


Collection: Heelstick


exposure to light.

Use: Increased in hemolytic

disease of the newborn.

Bilirubin, Total




Stat, 1 hour


Tube: SST, Plain red, or Green (Li hep)




exposure to light.

Use: To evaluate hepatic

function

Blood Gases, Arterial

(with or without CO-Oximetry analysis)

Lab: CMH Lab/WMC Cardiopulmonary lab



Stat, 1 hour

Test includes: pH, PCO2, PO2,

bicarbonate, base excess, total CO2, O2,

(total hgb, CO saturation, methhgb, and

vol %02, - only measured with co-ox

order).

Specimen: arterial blood

Container: heparinized syringe

Minimum volume: 1ml

Collection: gently agitate syringe to mix the heparin.

Label with the patient’s name and date and deliver

immediately to the cardiopulmonary lab.

Causes for rejection: specimen not aerobic, not

properly labeled, blood clots, air bubbles, insufficient

sample.

Use: evaluate respiratory function

and acid/base balance.

Blood Gases, Venous




Stat, 1 hour

Test includes: pH, pCO2, pO2, O2

saturation

Specimen: Venous blood

Container: heparinized syringe

Minimum volume: 1ml


Label with the patient’s name and date and deliver

immediately to the cardiopulmonary lab.


properly labeled, blood clots, air bubbles, insufficient

sample.

Use: Evaluate respiratory

function, acid/base balance and

estimate cardiac output

Blood Gases, Umbilical Cord Blood




Stat, 1 hour

Specimen: Umbilical cord blood

Minimum volume: 0.3 ml


Label with patient’s name and date and deliver to

the cardiopulmonary lab immediately.


properly labeled, blood clots, air bubbles, and

insufficient sample.

Use: To evaluate respiratory

status and acid/base balance of

the neonate.

Blood Urea Nitrogen (BUN)

Lab: WMC/CMH Clinical chemistry



STAT, 1 hour


Tube: SST, Plain red or Green top (Li hep)

Minimum Volume: 2mL

Collection: Routine venipuncture or capillary

collection

Causes For Rejection: Improper labeling, gross

hemolysis.

Use: Evaluate renal function and

protein metabolism; to monitor

effectiveness of kidney dialysis

Additional Information:

Elevated BUN levels occur in

chronic glomerulonephritis,

pyelonephritis, and other causes

of chronic renal disease; muscle

wasting may cause increase as

well. Low BUN levels occur in

normal pregnancy, decreased

protein intake, with IV fluids,

some antibiotics, and in some

instances of liver disease.

BNP see (NT-proBNP)

Body Cavity Fluid Cytopathology

Lab: Cytopathology

Availability: Mon.-Fri., 5:00 am – 5:00 pm

TAT: 24-48 hours

Specimen: Fresh body cavity fluid.

Container: Clean 50 ml container or collection

device uses for centesis.

Minimum volume: 50ml

Collection: Gently agitate the bag as fluid is

collected to mix the heparin with the fluid. Label

with patient’s name, hospital number, room number, and

date. Deliver immediately to cytopathology laboratory.

Special instructions: Fluids should be submitted

fresh, unfixed, and heparinized. To provide well

preserved, representative, diagnostic material. Add 3

units of heparin per anticipated 1ml of fluid (each

1ml of fluid contains 1000 units). Include pertinent

clinical information. After hours store in the

Pathology rack in the refrigerator in main lab.

Use: to establish the presence of

primary metastatic neoplasms or

microorganisms. Limitations:

Lack of diagnostic cellular

material or clotted material.

Additional info: Special stains

and immunohistochemistries

will be performed when

appropriate.

Body Fluid Cell Count see (Cell Count Body Fluid)

Body Fluid pH and Occult Blood

Lab: WMC Urinalysis



STAT, 1 hour

Specimen: Body fluid (synovial, ascetic, pleural, or

pericardial)

Tube: Plain red, or in clean specimen container - or

request Gastroccult card from lab for occult blood

portion.

Collection: usual aseptic collection. Tube must be

properly labeled.

Causes for rejection: mislabeled specimen

Bone Marrow (Aspirate/Biopsy)

Lab: WMC Hematology/surgical

pathology

Availability: Mon.-Fri. 8:00am-5:00pm;

after hours contact the pathologist

TAT: 24-48 hours

Additional info: Clinicians perform all

biopsies. Call the clinical laboratory for

materials and assistance.

Specimen: Bone marrow aspirate and/or biopsy

Minimum volume: 2ml of aspirate, 4cm core of

marrow

Collection: Slides of aspirated marrow and touch

preps of biopsy are made at the bedside by a

technologist. The biopsy core is placed in B Plus

solution and the clot in a separate container of B Plus

solution. Both containers must be properly

labeled with the patient’s information, date and time

specimen was put in the solution.

Causes for rejection: No marrow obtained

Use: To evaluate the bone

marrow morphology;

hematopoesis, myelopoiesis,

myeloid/erythoid ratio,

megakaryocyte, cellularity, and

marrow iron stores. Also to

evaluate platelet dependent

clotting dysfunction, and anemia.

Marrow culture can contribute to

a study of fever of undetermined

origin and possible systemic

infection, in particular

histoplasmosis and TB. Can also

establish presence of, classify,

and serve as a

follow up of neoplasia.

Bronchial Brushing Cytopathology

Lab: Cytopathology

Availability: Mon.-Fri., 5:00 am-5:00 pm

TAT: 24-48 hours

Specimen: Brush from area of lesion obtained by

physician.

Container: Cytolyt® solution vial.

Collection: Place specimen brush in Cytolyt® solution.

Make sure plastic sheath is removed. Label container

and submit all specimens to Cytopathology.

Causes for rejection: Improper fixation. Plastic

sheath left on brush.



neoplasms. To aid in the

diagnosis of respiratory infections

with herpes virus,

cytomegalovirus, measles virus,

aspergillus, coccidioides,

cryptococcus, histoplasma,

blastomyces, phycomycetes,

pneumecystis carinii,

strongyloides, echinoccus, and

paragonimus. Aid in diagnosis

of lipoid pneumonia,

sarcoidosis, hemosiderosis, and

asbestosis.

Limitations: Allowing brush to

dry before placing in Cytolyt®

will render specimen

unsatisfactory.

Bronchial Washing Cytopathology

Lab: Cytopathology

Availability: Mon.-Fri., 5:00am-

5:00 pm

TAT: 24-48 hours

Special Instructions: Include pertinent

clinical information, ie: previous

carcinomas, on requisition. Indicate need

to evaluate for Pneumocystis carinii or

fungal disease.

Specimen: Obtained by physician.

Container: Cell collection cup on bronchoscopy

tray.

Minimum volume: At least 2 ml of fresh unfixed

material.

Collection: Label bottle with patient name, hospital

number, room number and date. Submit the specimen to

Cytopathology. Be sure to indicate from which side and

lobe the specimen was obtained. After hours place

specimens in the Pathology rack in the refrigerator in

main lab.

Causes for rejection: improper labeling or fixation

Use: To establish the presence of

primary or metastatic neoplasms.

To aid in the diagnosis of

respiratory infections with Herpes

virus, cytomegalovirus, Measles

virus, Aspergillus, Coccidoides,

Cryptococcus, Histoplasma,

Blastomyces, Phycomycetes,

Pneumocystis carinii,

Strongyloides, Lipoid

pneumonitis, Sarcoidosis,

Hemosiderosis, Asbestosis, and

Alveolar proteninosis.

Buprenorphine



TAT: Routine, 4 hours Stat, 1 hour

Specimen: Freshly voided, untreated urine.

Container: Urine sample cup.

Volume: 10 ml

Storage: Refrigerate up to 24 hours.

Cause for rejection: Improperly labeled

Limitations: Adulterants added to urine specimen may

produce erroneous results. Substances and/or factors

may interfere with the test and cause false results. Drug

levels below the analyte cut off may not be detected

Use: Rapid immunoassay test

to detect a drug of abuse in

urine.

Note: The length of time

following drug use for which a

positive result may occur is

dependent on several factors

including the frequency and

amount of usage, metabolic rate,

excretion rate, drug half- life and

the user's age, weight, activity

and diet. For quantitation or

confirmation a GC/MS should be

ordered.

CA-125

Lab: WMC Chemistry



STAT, 1 hour





Causes For Rejection: Gross hemolysis, improper

labeling.

Use: To monitor patients with

various types of malignancies,

evaluate response to therapies,

and as a possible indicator of

recurrence and prognosis.

Calcium




STAT, 1 hour

Specimen: serum or heparinized plasma

Tube: SST, Plain red or green top (Li hep)

Minimum Volume: 2 mL


Causes For Rejection: Specimen improperly

labeled, improper tube, gross hemolysis,

contamination with IV fluids.

Use: Diagnosis of endocrine &

metabolic diseases Limitations:

Sodium citrate, EDTA, and

sodium fluoride interfere. Gross

hemolysis falsely elevates

results. Additional

Information:

Serum calcium levels will by

0.4-0.5 mg/dL within 30 minutes

of a patient changing from

upright to a supine position.

Carbamazepine (Tegretol)




STAT, 1 hour


Tube: SST, plain red, Green (Li hep)


Collection: Routine venipuncture; Peak level: 3

hours after a dose

Trough: immediately prior to next dose

Causes for Rejection: Gross hemolysis, improper

labeling

Use: Carbamazepine has

powerful antiepileptic properties

and is effective alone or with other

antiepileptic

drugs in partial seizures.


Leukopenia may be dose related,

and necessitates stopping the

drug if the absolute neutrophil

count falls to <1000/mm3.

Hyponatremia may occur,

especially in older patients.

Patients in the first month of

pregnancy are at an increased

risk of neural tube defects.

Carbamazepine may interfere

with the actions of oral

contraceptives, oral

anticoagulants and theophylline.

Carcinoembryonic Antigen (CEA)

Lab: WMC Chemistry



Stat, 1 hour

Specimen: Serum Tube:

SST or plain red Minimum

Volume: 5 mL


Causes for Rejection: gross hemolysis, improper

labeling

Use: To monitor patients with

various types of malignancies,

evaluate response to therapies,

and as a possible indicator of

recurrence and prognosis.

Limitation: CEA levels are

elevated in smokers; CEA is not a

screening test for occult cancer.

CBC / CBC With Auto Diff + Platelet (Plt)

Lab: WMC/CMH Hematology


TAT: Routine: 2 hours

Stat: 1 hour

CMH ED: 30 min

Specimen: Whole blood Tube:

EDTA (lavender) only Minimum

Volume: 2 mL Collection: Routine

venipuncture

Causes for Rejection: Wrong sample type, clotted

sample, gross hemolysis, improper labeling, tube not

filled to minimum volume.

Use: To diagnose and monitor

disease states

Limitations: Age and Sex

dependent

Cell Count Body Fluids

Lab: WMC Hematology



Stat, 1 hour

Specimen: Body fluid (synovial, ascitic, pleural, or

pericardial)

Tube: EDTA (lavender)


Collection: Usual aseptic collection, DO NOT STORE:

TRANSPORT IMMEDIATELY TO THE LABORATORY

Causes for Rejection: Clotted specimen, improper

labeling, specimens not received in proper tube.

Limitation: Traumatic (bloody)

tap may make interpretation

difficult. Clotted sample will

permit only a qualitative

examination.

Cell Count, CSF ( CSF - Cell Count )

Lab: WMC Hematology

Availability: 24 hours daily


Stat, 1 hour

*CSF specimens from patients with

suspected Creutzfeldt-Jakob Disease (CJD)

will be sent to the NC State Lab for testing.

The sample will not be opened prior to

shipping.

Specimen: Spinal Fluid

Container: Sterile plastic tube provided in lumbar kit

Minimum Volume: 1 mL CSF

Collection: Normal lumbar puncture using

established aseptic technique - performed only by

physicians

Storage: CSF must be refrigerated if testing is not

performed immediately.

Use: To aid in diagnosis of

infections of meninges,

subarachnoid hemorrhage,

malignancies of central nervous

system and demyelinating

disorders

Cerebrospinal Fluid (CSF) Cytopathology

Lab: Cytopathology

Availability: Mon.-Fri., 5:00am -

5:00 pm

TAT: 24-48 hours

*CSF specimens from patients with suspected Creutzfeldt-Jakob Disease (CJD) will be sent to the NC State Lab for testing. The sample will not be opened prior to shipping.

Specimen: Fresh fluid.

Container: Sterile tube from lumbar puncture tray.

Minimum Volume: At least 1 ml.

Collection: Label container with patient’s name,

hospital number, room number, date, and time of

collection. Submit specimen to Cytopathology, After

hours, place in Pathology rack in main lab refrigerator.

No anticoagulant or fixative is to be added.

Causes for Rejection: Improper fixation


primary or metastatic neoplasms.

Also to establish the presence of

microorganisms such as

Cryptococcus neoformans.

Comprehensive Metabolic Panel (CMP)




STAT, 1 hour

CMH ED - 44 min

Test Includes: glucose, BUN, calcium,

creatinine, total protein, total bilirubin,

alkaline phosphatase, AST, ALT, sodium,

potassium, chloride, CO2





Causes for Rejection: Gross hemolysis, improper

labeling, contamination with IV fluids, serum/plasma

not separated from cells within 2 hours of collection,

wrong anticoagulant.

Use: Typically used as a basic

screening panel for nutritional

and metabolic purposes.

Sometimes used to monitor

hyperalimentation therapy.

Chloride




Stat, 1 hour

Specimen: Serum or Heparinized plasma

Tube: SST, Plain red, or Green(Li hep)



Causes for Rejection: Improper labeling,

contamination with IV fluids.

Use: Evaluation of

fluid/electrolyte balance

Additional Information: Chloride

is increased in dehydration, renal

tubular acidosis, and excessive

infusion of normal saline. It is

decreased in over hydration,

CHF, vomiting, chronic

respiratory acidosis, and in some

cases of diuretic therapy.

Limitation: Bromide and

Iodide from therapeutic drugs

can interfere.

Cholesterol








Causes for Rejection: Improper labeling

Use: Evaluation of lipid status,

nutritional, and metabolic

disorders.

Additional Information: Serum

cholesterol concentration is the

consequence of the relative role of

cholesterol synthesis, clearance, and

dietary intake.

Cholesterol, HDL









Use: Helpful in determining the

risk of coronary heart disease.

Limitation: Ascorbic acid,

dipyrone, dopamine, and N-

acetyl cysteine can interfere.

Clostridium difficile (C. diff) Toxin Assay

Lab: CMH/WMC Microbiology


TAT: 24 hours (Outpatient) 3 hours (Inpatient) Testing performed at WMC/CMH

Specimen: Stool, fresh (< 1 hour old)

Container: Sterile container

Minimum Volume: 5 mL liquid or walnut size

unformed stool

Collection: Collect stool specimen in a clean, dry

container. Specimen must be refrigerated if testing

cannot be performed immediately.

Causes for Rejection: Improper storage, mislabeled

specimen, specimen contaminated with urine, specimen

contaminating outside of container, formed stool,

preserved specimen.

Use: To aid in the diagnosis of

antibiotic associated diarrhea.


Antibiotic associated diarrhea has

been shown to result from

the toxins produced by C. difficile. It

is recognized that this disease can

be caused by virtually any antibiotic.

The detection of the toxin, rather

than culture of the organism, is

important in the diagnosis of the

disease.

CK (Creatinine Kinase) (CPK)




STAT, 1 hour





Causes for Rejection: Hemolysis, wrong sample

type, improper labeling.

Use: To test for occurrence of

myocardial infarction, and for

skeletal muscle damage. CK levels

are elevated in muscular

dystrophy, muscle stress or

trauma, and myocarditis. The

CKMB test will be run if the CK is

found to be greater than 75 IU/L if

performed at WMC. Limitation: IM

injections increase serum CK

activity. CK is elevated following

exercise and normal at onset of

AMI unless patient has been

exercising.

CKMB




STAT, 1 hour


Tube: SST, Plain red, Green (Li hep)




type, improper labeling

Use: Diagnosis of AMI, and to

evaluate the extent of AMI

Additional Information: CKMB

increases have been reported with

entities which cause damage to

the myocardium (eg: myocarditis,

malignant hyperthermia, etc.)

however CKMB does not generally

abruptly rise and fall in such no-

acute MI settings as it does in AMI.

Limitation: The diagnosis of AMI

should not be based solely on MB

isoenzyme, but rather should be

supported by other clinical findings.

Cord Blood

Lab: WMC Transfusion Service Availability: 8:00am-4:30pm Daily TAT: 2-4 Hours

Specimen: Cord blood Tube: EDTA (lavender) Minimum Volume: 4 mL in each tube

Collection: The physician or designee collects cord

blood at the time of delivery. Label with the baby's

name, mother's name, date and time of collection, and

initials of the collector. Use the green cord blood

label for this purpose. Causes for Rejection: Improper labeling

Use: To determine the blood group and Rh of the newborn, and to evaluate the potential for HDN. Additional Information: An eluate is preformed on the cord blood if the DAT is positive, to determine if the mother’s antibodies are bound to the baby’s cells.

C - Reactive Protein, Quantitative

Lab: WMC/CMH

Chemistry

Availability: 24 hr


Stat, 1 hour


Tube: SST, Plain Red, Green (Li hep)

Minimum Volume: 1ml serum Collection:

Routine Venipuncture

Causes for rejection: Gross hemolysis or lipemia,

mislabeled specimen

Use: Can be used to test for

inflammatory diseases,

infections, and neoplastic

diseases.

Creatinine, Blood




STAT, 1 hour





Causes for Rejection: Wrong sample type, improper

labeling, gross hemolysis, contamination with IV fluids

Use: Evaluation of renal function.

Levels are elevated in renal

damage and/or disease that

cause a decrease in glomerular

filtration. Limitation: Avoid the

use of oxalate/fluoride, citrate,

and EDTA anticoagulants.

Lidocaine and dipyrone interfere.

Creatinine Clearance




Specimen: Serum/heparinized plasma and aliquot of

24 hour urine collection


Urine: 24 hour urine container without preservative

Minimum Volume: Serum/plasma - 2 mL

Urine - 10 mL aliquot of 24 hour collection

Collection: Serum/plasma- routine venipuncture; Urine-

refer to appropriate 24-hour urine collection form for

collection instructions. Container must be labeled with the

patient’s name, date of birth. date and time collection

started and completed.

Causes for Rejection: No blood creatinine collected,

improperly labeled specimen.

Use: To evaluate renal function,

estimate glomerular filtration rate,

evaluate renal function in small, or

wasted subjects, and

to follow progression of renal

disease.

Limitation: Exercise may cause

increased clearance. The

glomerular filtration rate is

substantially increased in

pregnancy. Ascorbic acid,

ketone bodies, hydration,

numerous cephalosporins, and

glucose might influence

creatinine determinations.

Creatinine, Urine




Specimen: Urine, 24 hour collection

Container: Clean plastic 24 hour urine container, no

preservative

Minimum Volume: 10 mL aliquot of 24 hour urine

specimen

Collection: Instruct patient to void and discard specimen

at 8:00a and then collect all urine for 24 hours including

the last specimen at 8:00a at the end of the collection

period. Urine should be kept on ice or refrigerated during

collection and until delivery to the lab. Transport urine to

the laboratory immediately after collection is complete.

Container must be labeled with the patient’s name, date

birth, date and time collection was started and

completed. Causes for Rejection: Times not indicated,

improperly labeled specimen

Use: Renal function test when

used as part of creatinine

clearance.

Additional Information: Urine

creatinine is not generally

ordered alone. Creatinine

clearance, which requires a serum

creatinine level, offers useful renal

function data. Serum creatinine

alone is not

an adequate index of

glomerular filtration rate.

Limitation: Completeness of

urine collection requires vigilance

on the part of nursing personnel.

Ingestion of meat may increase

urine as well as serum creatinine

levels. Drugs can interfere with

tubular creatinine secretion.

Creatinine reabsorption occurs

with very low urine flow rates.

Crossmatch

Lab: WMC/CMH Transfusion Service Availability: 24 Hours TAT: Routine, 2-4 Hours

Stat, 1 Hour

Specimen: Whole blood Tube: EDTA (lavender) Minimum Volume: 5 mL

Collection: Routine venipuncture. Specimen must be labeled with Blood Bank Band including patient's full name, Date of Birth, MR number or SS number, date and time of collection, and initials of person collecting the specimen. Blood Bank Band must be completed at time of sample collection.

Causes for Rejection: Improper labeling of sample,


Use: To ensure the compatibility of red blood cells for patients in need of transfusion. Additional Information:

Abnormal proteins and cold or warm auto agglutinins, or unexpected antibodies in the patient's blood may cause delays in the crossmatching process. For routine pre-operative use of type and screen is recommended. In the vast majority of cases this will allow adequate time to rule out any compatibility problems.

GC/Chlamydia (CTNG)

Lab: WMC Microbiology


TAT: 24 hours (Outpatient) 3 hours (Inpatient) Testing performed at WMC

Specimen: Swab or urine


Minimum Volume: 5 mL urine or single swab

Collection: Use Cepheid CTNG collection kits only.


specimen, sample not sufficient quantity


Neiserria gonorrhoeae or

Chlamydia trachomatis


Test uses PCR methodologies.

Culture, Anaerobic

Lab: WMC/CMH Microbiology


TAT: 24-72 hours

Test Includes: Anaerobic culture,

aerobic culture, and a Gram stain.

Testing performed at WMC.

Specimen: Pus, tissue, or other material properly

obtained from an abscess, biopsy, aspirate, drainage,

exudate, lesion or wound

Collection Device: Sterile container for tissue. Port-

A-Cul vial for pus and aspirate. BD Anaerobic Collection

Device for swabs. If using swabs, you must include an

aerobic swab.

Minimum Volume: Swab in anaerobic device, or 0.5

mL in appropriate anaerobic transport device.

Collection: Disinfect overlying and adjacent areas to

eliminate contamination with indigenous normal flora.

Collection of pus or other fluids through intact skin by

needle aspiration is ideal. Avoid exposure to air. Deliver

immediately to lab.

Causes for Rejection: Specimen not received in

anaerobic transport device, refrigerated specimens,

improper labeling

Use: Isolate and identify

anaerobic and aerobic

pathogens

Culture, Blood



TAT: 24-72 hours

Negative cultures are incubated for 5

days


Specimen: Whole blood

Tube: BacT/Alert blood culture bottles (aerobic and

anaerobic)

Minimum Volume: Optimum sample is 10 mL in each

of two BacT/Alert™ blood culture bottles (aerobic and

anaerobic). If less than 10 mL is collected inoculate

only the aerobic bottle. If more than 10 ml is collected,

inoculate both bottles with equal amounts.

Collection: Remove the plastic cap from blood

culture bottles and cleanse tops with ChloraPrep sponge

or sterile alcohol swab. Select vein of choice in an area

free of skin lesions. Using a ChloraPrep sponge (or

equivalent), scrub venipuncture site with repeated back

and forth strokes for 30 seconds. Allow to dry for 30

seconds. Perform venipuncture. Inoculate appropriate

bottles.

Draw with bottle at downward angle, using a butterfly or

in a syinge. Do not allow liquid in bottle to directly touch

the vacutainer needle due to possible induction of liquid

into bloodstream.


potentially pathogenic organisms

causing bacteremia; establish

the diagnosis of endocarditis and

other specific infectious

diseases.

Limitation: Two sets of

negative blood cultures in the

absence of antimicrobial therapy

are usually sufficient to exclude

the presence of

bacteria. One set is seldom

sufficient. Prior therapy may

cause negative cultures or

delayed growth. Improper site

preparation may lead to false

positive blood cultures.

1. For adult patients, two

separate samples (2

venipunctures) are required.

2. For pediatric patients,

smaller samples are

acceptable.

3. For newly admitted patients,

it is desirable to collect all

blood cultures before

antimicrobial therapy is

started. According to QA

protocol this should occur

within 4 hours of patient

arrival.

4. A-lines are in place in many

patients in the Critical Care

areas. It is permissible to

collect one blood culture from

the A-line. It is recommended

that the second culture be

collected by venipuncture.

Culture, Body Fluid



TAT: 24-72 hours Testing performed at WMC. *CSF specimens from patients with suspected Creutzfeldt-Jakob Disease (CJD) will be sent to the NC State Lab for testing. The sample will not be opened prior to shipping.

Specimen: CSF, synovial fluids, thoracentesis fluids,

etc., collected under aseptic conditions.

Tube: Sterile tube as appropriate, or syringe (with

needle removed)


Collection: Disinfect skin over puncture site with 2%

tincture of iodine in concentric circles. Iodine should

remain in contact with skin for at least one minute prior to

puncture to insure complete antisepsis. Immediately

transfer specimen to sterile container and close tightly to

avoid leakage.

Additional Information: If anaerobes are suspected,

order anaerobic culture (listed separately).

Storage: Maintain at room temperature.


pathogenic organisms from

normally sterile body fluids.

Culture, Bronchial Washing/ Bronchial Brush



TAT: 24-48 hours


Specimen: Bronchial Washing / Bronchial Brush

Container: Sterile Container


Collection: Performed by Physician

Causes for Rejection: Improperly labeled specimen.

Use: Screen for bacterial

growth.

Note: Samples are also

processed for AFB and Fungi.

Culture, Ear



TAT: 24-48 hours


Specimen: Swab or Fluid

Collection Device: BBL Culture Swab (mini-

tip/aluminum shaft) or sterile container

Minimum Volume: 1 Swab or 0.5ml

Collection: Sample usually collected by physician.

Causes for Rejection: Improperly collected or

labeled specimen.


growth.

Culture, Eye



TAT: 24-48 hours Testing performed at WMC.

Specimen: Swab or Plates

Collection Device: BBL Culture Swab (mini-

tip/aluminum shaft) or plates inoculated by MD.

Minimum Volume: 1 Swab or plates

Collection: Sample usually collected by physician.

Causes for Rejection: Improperly collected or

labeled specimen.


growth

Culture, Stool (GI Panel)



TAT: 24-48 hours

Tests for 14 bacterial pathogens, 4 parasites and 5 viral pathogens.

Specimen: Stool, fresh (<1 hour old); stool in

appropriate transport (available in lab)

Container: Clean, dry plastic container, Meridian Para-

Pak™ Enteric Plus vial or equivalent.. Diapers are not

acceptable.

Minimum Volume: 5 mL or walnut size sample

Collection: Specimen should be collected in a sterile

bedpan, not contaminated with urine, residual soap, or

disinfectants. Those portions of stool which

contain pus, blood, or mucus should be transferred to a

sterile specimen container.

Storage: Refrigerate

Causes for Rejection: Specimens sent on a diaper or

tissue, unlabeled specimen, frozen specimen, specimen

contaminating outside of container.

Use: Screen for pathogenic

bacterial, viral and parasitic

organisms using PCR

technology.

Limitation: GI Panel should not

be done for patients

hospitalized for more than 3

days. See C. difficile toxin.

Culture, Group B Strep




Specimen: Vaginal/rectal swab.

Collection Device: BBL CultureSwab.

Minimum Volume: One swab

Collection: Using dual swab system, collect vaginal

sample with one swab and rectal sample with the

second swab. Return both swabs to original container.

Storage: Maintain at room temperature.

Use: Isolate and identify group

B beta streptococci.

Culture, Sinus




Specimen: Swab, Fluid, or Aspirate

Collection Device: Sterile container or BBL Culture

Swab (mini-tip/aluminum shaft)

Minimum Volume: 1 swab or 0.5 ml

Collection: Specimen usually collected by physician.

Causes for Rejection: Specimen not labeled properly.

Use: To determine bacterial

infections of the sinus cavities.

Culture, Sputum



TAT: 24-48 hours

Test Includes: Culture and Gram stain


Specimen: Sputum

Container: Sterile screw cap container

Minimum Volume: 5-10 mL sputum

Collection: Most samples will be collected by the

Cardiopulmonary Department. Expectorated and

induced sputa are screened for quality in the lab.

Causes for Rejection: Contaminated sample,

mislabeled specimen


pathogens of the lower

respiratory tract.

Limitation: An adequate

sputum specimen should

contain many WBC’s and few to

no epithelial cells. The latter

are indicative of contamination

with saliva. Results obtained

without proper screening for

contamination may be

misleading.

Culture, Throat (Group A Strep)



TAT: 24-48 hours


Specimen: Material from posterior pharynx, tonsils, or

other inflamed area

Collection Device: Copan Culture Swab sterile culture

collection system or equivalent.

Minimum Volume: One swab

Collection: Swab both tonsillar pillars and the

oropharynx. Do not allow swab to touch the tongue.

Storage: Maintain swab at room temperature

Use: Establish the diagnosis of

strep throat.

Note: Culture will not be done

without a previous negative

Strep Screen.

Culture, Urine



TAT: 24-48 hours


Specimen: Urine

Container: Sterile urine collection container or urine

collection device, which contains boric acid as a

stabilizer.

Minimum Volume: 1 ml urine or properly filled

Boric Acid Tube

Collection: Urine for culture may be midstream clean

voided, from catheter, I/O or indwelling (line only, freshly

voided) or a suprapubic specimen collected via syringe

(by physician only.) Early morning specimens yield

highest bacterial counts from overnight incubation in the

bladder, and are the best specimens for culture.

Storage: Specimen must be refrigerated or placed in

transport device containing boric acid.

Causes for Rejection: Room temperature for more

than two hours or in boric acid tube over 48 hrs,

specimen contaminated with fecal material.

Use: To investigate possible

urinary tract infection (UTI);

monitor treatment for UTI.

Limitation: Hair from the

perineum will contaminate the

specimen. The stream from a

male patient may be

contaminated by bacteria from

beneath the prepuce. Bacteria

from vaginal secretions, vulva, or

distal urethra may contaminate

the specimen, as might bacteria

from the hands or clothing.

Culture, Wound



TAT: 24-48 hours

Test Includes: Culture and Gram stain


Specimen: Aspirates or swabs.

Collection Device: Copan Culture Swab, sterile transport

tube for aspirates. See Culture, Anaerobic if anaerobic

culture is ordered.

Minimum Volume: Swab or 0.5 mL

Collection: Disinfect contiguous areas of skin or

mucus membrane containing resident normal flora

prior to collection of culture material. Collect exudates

from the interior of productive lesions.

Storage: Maintain specimen at room temperature.

Transport to lab immediately.

Reference Range: No growth.

Use: Isolate & identify potentially

pathogenic organisms.

Limitation: Only rapid-growing,

nonfastidious aerobic organisms

can be recovered & identified by

routine methods. Often only

organisms which predominate will

be identified. Anaerobic, fungal, &

mycobacterial pathogens should be

considered, and appropriate

cultures requested if indicated.

Normal skin flora may be

coagulase- negative staphylococci

& Corynebacterium sp

D-Dimer

Lab: WMC/CMH Coagulation



Stat, 1 hour

Specimen: Citrated plasma

Tubes: Sodium citrate (blue top) tube

Minimum Volume: fill mark on tube

Collection: Routine venipuncture. Fill tubes until

vacuum is exhausted.

Storage: Citrated plasma may be stored at room

temperature for up to 8 hours, or frozen at -20

degrees Celsius for up to one month.

Causes for Rejection: hemolysis, specimen not

stored properly, specimen improperly labeled,

specimen contaminated with IV fluids.

Use: Elevated levels of D-dimer

are found in such clinical

conditions as deep vein

thrombosis (DVT), disseminated

intravascular coagulation (DIC),

and pulmonary embolism.

Additional Information: D-

dimer levels rise with age,

pregnancy, and in malignancy,

among other conditions.

Digoxin




Stat, 1 hour

Specimen: Serum

Tube: SST, Plain red



Causes for Rejection: hemolysis, specimen not

stored properly, specimen improperly labeled,

specimen contaminated with IV fluids.

Use: To monitor drug levels.

Direct Coombs (DAT)

Lab: WMC Transfusion Service

Availability: 24 Hours Daily TAT: Routine, 2-4 Hours

Stat, 30 Minutes (WMC)

Testing performed at WMC



collection.

Causes for Rejection: Improper labeling of sample,


Use: For the detection of IgG antibodies and/or complement components bound to patient's red blood cells.

Additional Information: Positive

tests with monospecific anti-IgG

reagents

are found in warm autoimmune

hemolytic anemia, hemolytic

disease of the newborn (HDN),

transfusion reactions, and with

the use of certain drugs, especially methyldopa (Aldomet), penicillin, and cephalosporins. Complement coating may also occur in these situations. Positive tests only with anti- complement reagents may be found in warm autoimmune hemolytic anemia, cold agglutinin disease, paroxysmal cold hemoglobuinuria, and with such drugs as quinidine, insulin, sulphonamides, and phacetin. An eluate will be performed on all positive DATs.

ECO2 (Carbon Dioxide)




Stat, 1 hour





Causes for Rejection: Gross hemolysis, wrong sample

type, insufficient volume for testing, contaminated with IV

fluid, improper labeling, Serum or Plasma in contact with

cells for more than 2 hours.

Use: Evaluate acid-base

disorders. CO2 is generally

increased in respiratory acidosis,

metabolic alkalosis, and

excessive alkali intake. CO2 is

generally decreased in

compensated respiratory

alkalosis, metabolic acidosis, and

in renal disorders.

Electrolytes




Stat, 1 hour

Test Includes: sodium, potassium,

chloride, CO2





Storage: Remove Serum or Plasma from cells if plain

red tube is used; store in plastic transfer tube in

refrigerator if testing is not to be performed immediately.

Causes for Rejection: Gross hemolysis, wrong

sample type, insufficient volume for testing, contaminated

with IV fluid, improper labeling, Serum or Plasma in

contact with cells for more than 2 hours.

Use: Monitor electrolyte status.

Esophageal & Gastric Brushing Cytopathology

Lab: Cytopathology

Availability: Mon-Fri, 5:00-5:00 pm

TAT: 24-48 hours

Specimen: Esophageal and gastric brushing

collected by physician.

Collection: Place brush in Cytolyt® vial. Make sure

plastic sheath is removed. Label with patient name,

hospital number, room, and date. Submit to

Cytopathology. After hours place in Pathology rack in

refrigeratory in main lab


primary or metastatic neoplasm,

reactive processes or infectious

disease.

Limitation: Non-diagnostic if

gastric epithelium is not

present or if the specimen is

contaminated with food or

barium sulfate.

Estradiol

Lab: WMC Chemistry



Stat, 1 hour





Storage: Separate serum from RBC’s; may be stored

up to 2 days at 2-8˚ C

Use: For the evaluation of

normal sexual development,

causes of infertility, and

menopause.

Ferritin

Lab: WMC Chemistry



Specimen: Serum, heparinized plasma




Storage: 4˚C. If testing is to be delayed and plain tube is

used, separate serum from cells and transfer to a plastic

tube.


Use: Diagnose hypochromic,

microcytic anemias.


Decreased in iron deficiency

anemia and increased in iron

overload. Ferritin levels

correlate with and are useful in

evaluation of total body iron

stores. In hemochromatosis, both

ferritin and iron saturation are

increased. Limitation: Ferritin

escapes from necrotic

hepatocytes. In the presence of

liver disease, inflammatory

diseases such as rheumatoid

arthritis, malignancy, or iron

therapy, iron deficiency may not

be reflected by low serum ferritin.

Fetal Fibronectin (FFN)

Lab: WMC Hematology



Stat, 1 hour

Specimen: Cervicovaginal Secretions

Tube: Adeza Biomedical Specimen Collection Kit

Minimum Volume: Swab

Collection: Collect during a speculum exam. Lightly

rotate the sterile swab across the posterior fornix of the

vagina for 10 seconds. Place swab in buffer and break

the shaft at the score.

Tips for proper collection:

1. Collect prior to collection of specimen for culture,

digital cervical exam, or vaginal probe ultrasound.

2. Do not contaminate with soaps, lubricants,

disinfectants or Monistat Cream.

3. Do not collect if patient has had sexual intercourse

within 24 hours.

4. Do not use with moderate or gross vaginal

bleeding.

5. Do not collect if membranes are ruptured, placenta

abruption or placenta previa.

Causes for Rejection: Sample not properly labeled.

Expired specimen collection device. Specimens not

properly stored.

Use: It is used as an aid in

assessing the risk of preterm

delivery in less than or equal to

7 to 14 days in pregnant women

with signs of early pre term

labor, intact amniotic

membranes and minimal

cervical dilatation (<3cm),

sampled between 24 weeks, 0

days and 34 weeks, 6 days

gestation.

Limitation: It should not be

interpreted as absolute evidence

for the presence or absence of a

process that will result in delivery

in less than or equal to 7 to 14

days.

Fetal Hemoglobin Stain

Lab: WMC Transfusion Service Availability: 24 Hours TAT: 2-4 Hours


Collection: Routine venipuncture. Causes for Rejection: mislabeled specimen

Use: To detect the presence of fetal red blood cells in an adult female’s circulation and to determine the post partum dose of RHIG for Rh Negative females with a positive fetal screen.

Fibrinogen

Lab: WMC Hematology



Stat, 1hour

Specimen: Plasma, citrated

Tube: Blue (sodium citrate)

Minimum Volume: 4.5 mL or 2.7 mL whole blood,

depending on tube being used for collection. Tube

must be filled to fill line.

Storage: 8 hours at Room Temp. One month in

freezer at -20˚C.

Patient Preparation: The patient should not receive

heparin within 1 hour of collection.

Collection: Routine venipuncture. Collect blue top tube

after Ir tube to prevent the contamination of the specimen

with tissue thromboplastin. Allow tube to fill until vacuum

is exhausted.

Causes for Rejection: Gross hemolysis or clotted

sample, mislabeled specimen

Use: Identify congenital

afibrinogenemia, disseminated

intravascular coagulation (DIC),

and fibrinolytic activity.

Limitation: Increased in patients

on oral contraceptives.

Interpretations of results may be

limited if patient is receiving

anticoagulant therapy, depending

on method of analysis.


Increased levels may be seen

with inflammation and

pregnancy. Congenital

hypofibrinogenemia may be

responsible for mild

hemorrhagic symptoms;

fibrinogen levels are usually

<100 mg/dL, and screening tests

(PT, PTT) may be normal or only

slightly prolonged.

Folate, Serum (Folic Acid)

Lab: WMC Chemistry






Collection: Routine venipuncture. Avoid hemolysis

and exposure to light.

Storage: Separate serum from cells and refrigerate at

40C, protected from light.

Causes for Rejection: Hemolysis, prolonged

exposure to light, improperly labeled specimen.

Use: Detect folate deficiency;

monitor folate therapy,

evaluate megaloblastic and

macrocytic anemia.

Limitation: Folate will

deteriorate on exposure to

light.

Additional Information: Serum

folate levels are affected by

dietary intake. Drugs such as

methotrexate and pentamidine,

may induce deficiency. Some

drugs (oral contraceptives,

phenytoin, and ethanol) impair

absorption.

Free T3

Lab: WMC Chemistry



Stat, 1 hour




Collection: Routine venipuncture.

Storage: If plain tube is used, allow to clot and centrifuge

within 45 minutes of collection. Remove serum and store

in a plastic transfer tube at 4° C until testing is performed.

Causes for Rejection: Improper labeling.

Use: A physiologic index of

metabolic activity that

correlates with Free T4 and

TSH.

Free T4

Lab: WMC Chemistry



Stat, 1 hour

Specimen: Serum (CMH can also accept heparinized

plasma)

Tube: SST or plain red (CMH- green (Li. hep)



Storage: If plain tube is used, allow to clot and centrifuge

within 45 minutes of collection. Remove serum and store

in a plastic transfer tube at 4° C until testing is performed.

Causes for Rejection: Plasma specimen (except

CMH), improper labeling.


metabolic activity that

correlates with TSH.

Frozen Tissue Section

Lab: Surgical Pathology

Availability: Mon-Fri, 8:00am-5:00pm;

after hours call pathologist. Frozen

sections must be scheduled with the

Pathology Department.

TAT: ~20 minutes

Specimen: Fresh tissue with no added fixative.

Container: Plastic specimen container

Collection: Label with patient’s information,

operating room, date and requesting surgeon.

Causes for Rejection: Specimen submitted in

fixative

Limitation: Bone and heavily

calcified tissue cannot be frozen.


Pathologist calls physician with

diagnosis.

Genital Cytopathology , Routine

Lab: Cytopathology

Availability: Mon-Fri, 5:00am -

5:00 pm

TAT: 24-48 hours

Special Instructions: Submit pertinent

clinical history: age, LMP, history, PMP,

surgery, HRT, abnormal vaginal bleeding,

previous abnormal paps, oral

contraceptives and IUD usage etc.

Notes: Ancillary testing may be ordered

from same ThinPrep PreservCyt® vial i.e.

HPV testing. Call Cytopathology with any

questions about ancillary testing from the

ThinPrep PreservCyt® vial .

Specimen: Endocervical brush, cervical scrap or brush.

Vaginal cuff scrap. For lesions of the vagina or vulva,

scrapings made directly from lesions are desirable.

Container: ThinPrep PreservCyt® vial may be

obtained from the cytopathology department.

Patient Preparation: Patient to avoid douches 48-

72 hours prior to examination. Patient needs to

reschedule if there is excessive menstrual bleeding.

Collection: Label ThinPrep PreservCyt® vial with two

patient identifiers. Submit to cytopathology. Sampling:

1) Endocervix Brush is obtained by inserting brush

into cervical os and rotating, then rinse material into

the ThinPrep PreservCyt® vial. Make sure material

is off the brush.

2) Ectocervical scrape with spatula or broom

thoroughly the entire ectocervix with emphasis on the

squamo-columnar junction. Rinse material into the

ThinPrep PreservCyt® vial . Make sure material is off

the brush.

3) Vaginal specimen obtain specimen by lightly

scraping the vaginal cuff spatula Rinse material

into the ThinPrep PreservCyt® vial. Make sure

material is off the brush.

Causes for Rejection: Fixation in FORMALIN.

Specimen not labeled properly.

Use:

1) To establish the presence


neoplasms.

2) To aid in the diagnosis of

genital infections with HPV,

Herpes virus, Candida,

Trichomonas vaginalis, and

Actiniomyces.

Limitation: Failure to obtain

adequate ectocervical,

enodcervical or vaginal cell

population Ih is suboptimal for

evaluation. Use of lubricating jelly

on the vaginal speculum will

interfere with cytologic

examination.

Gentamicin

Lab: WMC Chemistry



Stat, 1 hour





collection. Specimens should be collected prior to the

fourth dose for trough levels and 30 minutes to 1 hour

after fourth dose for peak levels, depending on mode of

administration. See nursing Gentamicin Protocol.

Storage: Refrigerate specimens if testing is not to be

performed immediately.

Causes for Rejection: Improper labeling. Samples

MUST be labeled as peak or trough.

Use: To monitor gentamicin

therapy to maintain effective

levels but avoid toxic side

effects.

Gestational Diabetes Screening (O'Sullivan)


Availability: Mon. - Fri. (7a-5p)

TAT: 2-4 hours




Collection: Routine venipuncture 1 hour after

glucola.

Patient Preparation: 50 grams of oral glucose given

without regard to time of day or last meal.

Storage: Separate serum / plasma from RBC’s and

maintain specimens at room temperature.

Causes for Rejection: Patient in a stressed condition

(surgery, infection, corticosteroids) or improper labeling.

Use: Investigate the possibility of

Gestational diabetes.

Limitations: A normal result

does not assure that diabetes will

not develop.

GGT (Gamma Glutamyl Transferase)

Lab: WMC Chemistry

Availability: 24 hours TAT:

Routine, 4 hours

Stat, 1 hour





Storage: Separate serum from cells if plain red tube is

used. Refrigerate if testing is not to be performed

immediately.

Causes for Rejection: Improper labeling.

Use: GGT is a biliary enzyme useful

in the diagnosis of obstructive

jaundice, intrahepatic cholestasis,

pancreatitis, and metastatic

carcinoma of the liver. GGT parallels

ALP in liver disease but is not

elevated in bone disease.

Limitation: GGT is elevated in

patients on anticonvulsives and

barbiturates. Acetaminophen can

cause an in-vivo increase. GGT is

sensitive to ethanol intake.

Additional Information: GGT is

more specific for hepatic disease

than ALP. GGT has no origin in

bone or placenta, unlike ALP. GGT

is highest in obstructive liver disease.

Commonly elevated in patients with

cirrhosis, carcinoma of liver and

pancreas, hepatitis, stone,

pancreatitis, and CHF.

GI Panel (see Culture, Stool)

Glucose (Blood Sugar)




Stat, 1 hour





Storage: If tube other than SST is used, remove

serum/plasma from cells ASAP and refrigerate if

testing is delayed.

Causes for Rejection: Gross hemolysis, in contact

with cells for prolonged periods of time, collected

above IVs

Use: Diagnosis diabetes mellitus;

evaluate disorders of carbohydrate

metabolism; evaluate acidosis and

ketoacidosis.

Limitation: Mild glucose

impairment can exist with fasting

glucose within normal range.

Specimen not handled properly

can lead to falsely depressed

levels (serum/plasma left in

contact with cells for extended

time.) Additional Information: A

fasting glucose of >140 mg/dL on

more than one occasion is virtually

diagnostic of diabetes mellitus;

likewise a 2-hour postprandial

glucose level >200 mg/dL is also

virtually diagnostic, obviating the

need for a GTT.

Glucose, CSF

Lab: WMC Chemistry


TAT: 1 hour

*CSF specimens from patients with

suspected Creutzfeldt-Jakob Disease

(CJD) will be sent to the NC State Lab

for testing. The sample will not be

opened prior to shipping.

Specimen: CSF

Tube: Sterile plastic tubes provided in the Lumbar

puncture tray.


Collection: CSF specimens are collected only by

physicians or designee using established aseptic

technique.

Storage: CSF specimens are not stored. Testing is

performed immediately to avoid utilization of

glucose in the specimen by bacteria or cellular

components.

Glucose Tolerance (GTT)


Availability: Mon-Fri, times set at

scheduling

TAT: Fasting level will be performed

before glucose beverage is given to the

patient (approximately 30 minutes.)

Testing will be completed within 1 hour of

the collection of the final specimen.

Note: Glucose tolerance testing will not be

started after 0900, nor will it be performed

on weekends. Outpatient testing must be

scheduled in advance.

Specimen: Serum or heparinized plasma, whole

blood

Tube: SST or Green (Li hep)


Collection: Routine venipuncture, capillary puncture

Patient Preparation: Patient must be fasting. Collect

fasting specimen wait for results. If results of the fasting

specimen are less than 140 mg/dL continue with the

testing. If the fasting results are greater than

140 mg/dL contact the physician for further

instructions. If testing is to continue, have the patient

drink the glucose tolerance beverage according to

the following instructions: non-pregnant adult-75

grams; pregnant female-100 grams; child-1.75g/kg

body weight, not to exceed 75 grams.

Storage: Separate serum/plasma from RBCs and

maintain specimens at room temperature.

Causes for Rejection: Patient not fasting; patient in a

stressed condition (surgery, infection, corticosteroids)

should not have a GTT; improper labeling; fasting results

greater than 140 mg/dL unless physician instructs

otherwise, obvious diabetes mellitus.

Use: Investigate the possibility of

diabetes mellitus.

Limitation: Slight hyperglycemia

is seen in patients on oral

contraceptives. Failure to have

patient on a 3- day high

carbohydrate diet may result in a

false positive GTT. Impaired

glucose tolerance is NOT

equivalent to diabetes mellitus,

neither does a normal result

assure that diabetes will not

develop.

Contraindications: FBS >140

mg/dL on two occasions or

postprandial blood glucose

>200 mg/dL on two occasions in

a non-stressed patient are

indicative of diabetes mellitus and

obviate the need for a GTT. GTT

is also contraindicated in the

presence of obvious diabetes

mellitus.

HCG, Beta Quantitative - Pregnancy Test




Stat, 1 hour

Specimen: Serum or plasma

Tube: Plain red, SST or Green (Li Hep.)

Minimum Volume: 1.0 mL


Cause for Rejection: gross hemolysis, improperly

labeled specimen

Use: To determine the presence

of hCG in patients with gestational

trophoblastic disease, evaluate

and monitor males with testicular

tumors; follow pregnancy. The

quantitative hCG assay should

also be used for non-routine

detection of hCG (eg. ectopic

pregnancy, threatened

miscarriage, or very early

pregnancy).

HCG, Qualitative Serum - Pregnancy Test




STAT, 1 hour


Plain red or SST Minimum

Volume: 0.5 mL


Cause for Rejection: gross hemolysis, improperly

labeled specimen, plasma specimen

Use: Early detection of

pregnancy

Limitations: A number of

conditions other than pregnancy

may cause elevated levels of

hCG. These diagnoses should

be considered if appropriate to

the clinical evidence.

HCG, Qualitative Urine - Pregnancy Test



TAT: Routine: 4 hours

STAT: 1 hour

Specimen: Urine

Container: any clean, dry plastic or glass container


Storage: 2-8°C; if testing is to be delayed for more than

48 hours, the specimen should be frozen. Cause for

Rejection: improperly labeled specimen, improper

storage

Use: Early detection of

pregnancy

Limitations: A number of

conditions other than pregnancy

may cause elevated levels of

hCG. These diagnoses should

be considered if appropriate to

the clinical evidence.

Hemoglobin (Hgb)/Hematocrit (Hct)



TAT: Routine: 2-4 hours

Stat: 1 hour


Tube: EDTA-lavender top

Minimum Volume: 2.7 to 4.5 mL, depending upon

size of tube being used.

Collection: Routine venipuncture. Mix thoroughly

but gently.

Storage: Maintain specimen at room temperature for up

to 24 hours

Causes for Rejection: Clotted specimen, insufficient

quantity, hemolysis, improperly labeled specimen.

Use: Evaluate anemia, blood

loss, hemolysis, polycythemia,

and response to treatment

Limitation: Hyperlipemic plasma

may falsely elevate hemoglobin

result, with corresponding

increase in MCH. Cold agglutinins

may also interfere with

hemoglobin measurement.

Hemoglobin A1C (Hgb A1c)

Lab: WMC Chemistry


Routine: 4 hours

Stat: 1 hour



Minimum Volume: 2.7 to 4.5 mL, depending on size of

tube being used.

Collection: Routine venipuncture. Mix thoroughly but

gently.

Storage: Room temp for up to 24 hours

Causes for Rejection: Clotted specimen, insufficient

quantity, hemolysis, improperly labeled specimen.

Use: The level of hemoglobin

A1C is proportional to the level of

glucose in the blood over a

period of approximately 2

months. Thus, hemoglobin A1C

is accepted as an indicator of the

mean daily blood glucose over

the preceding 2 months. Regular

measurement of hemoglobin A1C

leads to changes in diabetes

treatment and improvement of

metabolic control as indicated by

lowering of hemoglobin A1C

values.

Hepatic Function Panel (LFT / HFP)




Stat, 1 hour

Test Includes: albumin, total bilirubin,

direct bilirubin, alkaline phosphatase,

AST, ALT


Tube: SST, Plain red or Green(Li hep)



Storage: Remove serum from cells if tube other than

SST is used, store at 4°C in refrigerator, protect from

light.

Causes for Rejection: Prolonged exposure to light,

improper labeling

Use: To evaluate liver function,

investigate abdominal pain.

Hepatitis B Surface Antibody (HBsAb)

Lab: WMC Chemistry


TAT: 24 hours



Volume: 5 mL


Storage: 4˚C. If tube other than SST is used, separate

serum from cells and transfer to a plastic transfer tube

prior to shipping or storing.

Causes for Rejection: Recently administered

isotopes.

Use: Indicator of clinical recovery

and subsequent immunity to

hepatitis B virus. Limitation:

Presence of HBsAb is not an

absolute indicator of resolved

hepatitis infection, nor of

protection from future infection.

Since there are different serologic

subtypes of hepatitis B virus, it is

possible for a patient to have

antibody

to one surface antigen type and

to be acutely infected with a virus

of a different subtype. Thus,

patients may have co- existing

HBsAg and HBsAb. Transfused

patients or hemophiliacs

receiving plasma components

may give false positive results for

HBsAb.

Hepatitis B Surface Antigen (HBsAg)

Lab: WMC Chemistry


TAT: 24 hours

Note: All indeterminate samples will be

sent to Ref Lab for confirmatory testing.

Specimen: Serum, Plasma




Storage: 4˚C. Remove Serum or Plasma from cells if

tube other than SST is used. Test within 48 hrs. Causes

for Rejection: Improperly labeled specimen.

Use: Hepatitis B surface antigen

is the earliest indicator of the

presence of acute infection.

Also indicative of chronic

infection. Useful in the

differential diagnosis of

hepatitis.

Limitation: Patients who are

negative for HBsAg may still

have acute type B viral hepatitis.

There is sometimes a “window”

stage when HBsAg has become

negative and the patient has not

yet Id the antibody.

Hepatitis C Antibody

Lab: WMC Chemistry


TAT: 24 hours

Note: All indeterminate samples will be

sent to Ref Lab for confirmatory testing.


Plain red, SST Minimum

Volume: 5 mL


Storage: If tube other than SST is used, separate

serum from cells and store in a plastic transfer tube.

Causes for Rejection: Insufficient volume, improperly

labeled specimen.

Use: Evaluation panel for

patients with symptoms or

clinical history that suggest

Hepatitis C infection.

Histopathology

Lab: Surgical Pathology

Availability: Mon-Fri, 5:00am-5:00 pm

after hours call pathologist

TAT: 48 hours; tissue requiring

decalcification and/or special stains-48-

72 hours.

Specimen: Fresh tissue or tissue fixed in formalin.

Container: Plastic formalin filled specimen container.

Collection: Container must be properly labeled with

the patient’s information, date and time of collection, and

physician’s name, time placed in formalin. The complete

requisition form should accompany the specimen to

pathology.

Causes for Rejection: Unlabeled or mislabeled

specimen.

Limitation: Fixed tissue cannot

be used for culture and certain

types of histochemistry.

Additional Info: Lymph nodes

suspected of lymphoma should be

submitted on saline moistened

gauze. Muscle biopsies are sent

to lab fresh, without any fixative.

Human Immunodeficiency Virus Screen (Rapid HIV-1/2, p-24 Ag)




Test Included: HIV antibody screen and

confirmation by Western Blot if indicated by

positive screening result

Specimen: Serum

Tube: SST that has not been opened

Minimum Volume: Full tube


Storage: 4˚C

Use: Investigate possible

exposure to human

immunodeficiency virus.

Additional Information: HIV,

the etiologic agent of the

acquired immunodeficiency

syndrome (AIDS) is a cytopathic

retrovirus. Sera which are

repeatedly reactive

in two of three tests are subject

to confirmatory testing by the

Western blot method. Some

individuals may be initially reactive

by the screening and negative or

indeterminate by Western blot.

This may be caused by other viral

antibodies or autoantibodies ,

although this is extremely rare.

Influenza A And B (Flu A / B)



TAT: 1 hour

Rapid Antigen Test: Initial test

is performed using rapid antigen

detection

Specimen: Nasal/Nasopharyngeal swab

Minimum Volume: 1 foam tipped or flocked swab

Storage: Room Temperature

Collection: Nasal swab for patients over 3 years old.

Rotate swab against the nasal wall and return to

container. Nasopharyngeal Swab for under age 3. Insert

swab in the posterior nasopharynx and rotate. Remove

and return to container. For nasal wash, flush one nostril

with 1.0 to 2.5mL normal saline. Allow fluid to run out of

nostril into sterile container.

Causes for Rejection: mislabeled specimen

Use: Confirm the diagnosis of

influenza A & B


Presentation of influenza infection

ranges from mild respiratory

illness to fatal pneumonia. In

addition, secondary infection can

be a serious complication. People

at high risk from infection include

the elderly and patients with

underlying health problems.

Intact PTH (Parathyroid Hormone)

Lab: WMC Chemistry


Intra-operative Intact PTH scheduled

TAT: OR, 30 minutes

Routine, 4 hours

Specimen: Plasma

Tube: EDTA (full) spin and separate

Storage: 2-8°C if tested within 24 hrs;

Freeze if testing is delayed > 24 hours.

Causes for rejection: Improperly filled, improperly

labeled or collected in wrong tube.

Use: Important marker to

diagnose the disease of the

parathyroid gland and the

kidney. iPTH is used to judge

success or failure of surgery in

the removal of malignant

parathyroid gland, and to

monitor postoperative recovery.

Iron Panel

Lab: WMC Chemistry


Routine, 4 hours

Stat, 1 hour

Test Includes:

Total Iron, Total Iron Binding Capacity,

% Saturation [(Fe/TIBC) x 100]



Volume: 5 mL

Patient Preparation: Specimen should be drawn

fasting in the morning. Specimen should be drawn

before transfusion or before patient is given

therapeutic iron.


Storage: 4˚C. If plain red tube is used, allow to clot and

centrifuge within 45 minutes of collection. Remove serum

and store in a plastic transfer tube until testing is done.

Causes for Rejection: Gross hemolysis, plasma

specimen, improperly labeled specimen.

Use: Differential diagnosis of

anemia, especially with

hypochromia and/or low MCV;

work up hemochromatosis in

which iron is increased and

saturation is high; evaluation of

iron poisoning and overload in

renal dialysis patients or patients

with transfusion dependent

anemia.

Ketones (Serum/Plasma)

Lab: WMC/CMH Urinalysis


Routine, 4 hours

Stat, 1 hour

Specimen: Serum or Plasma

Tube: SST, green (Li. Hep), or plain red



Storage: 4˚C

Causes for Rejection: Improper tube or labeling

Use: To detect ketoacidosis

Lactic Acid




Stat, 1 hour

Specimen: Heparinized plasma

Tube: Green


Collection: Routine venipuncture, drawn on ice.

Plasma must be separated from cells within 15

minutes of collection. Sample may be used up to 3

hours after collection if collected on ice, centrifuged

immediately and kept on ice or refrigerated.

Causes for Rejection: Not collected and or labeled

properly.

Use: Elevated lactate levels can

occur as a result of tissue

hypoxia, diabetes mellitus,

phenformin therapy,

malignancies, glycogen storage

disease, ethanol, methanol or

salicylate ingestion and metabolic

acidosis.

LDH (LD/Lactate Dehydrogenase), Blood

Lab: WMC Chemistry



Stat, 1 hour




Collection: Routine venipuncture. Avoid hemolysis.

Storage: Specimen should be stored at room

temperature.


type, dilution of sample with IV fluids, improper

storage

Use: Differential diagnosis of

cardiac and liver disorders,

evaluation of hemolytic

disorders.

Limitation: Hemolysis falsely

elevates LDH results. Ascorbic

acid can decrease LDH values.

Elevated total protein >12 g/dL

(associated with Multiple

Myeloma) can interfere with LDH

analysis.

Lipase




Stat, 1 hour






Use: Evaluate

diseases/disorders of the

pancreas.

Lithium




Stat, 1 hour

Specimen: Serum

Tube: Plain red or SST

Minimum Volume: 2 mL blood


Storage: Refrigerate. Separate serum from cells if

plain red tube is used; store in plastic transfer tube.

Causes for Rejection: Collection in green lithium

heparin tube, improperly labeled specimen.

Use: Monitor therapeutic drug

level

Lipid Profile




Test Includes:

Total cholesterol, HDL cholesterol,

triglycerides, LDL cholesterol, VLDL

cholesterol (calculated),

cholesterol/HDL ratio





Storage: 4˚C

Causes for Rejection: Insufficient volume, wrong

sample type, improper labeling.

Use: Evaluation of hyperlipidemia

as an index to coronary heart

disease. Limitation: Triglyceride

levels greater than 400 mg/dL

invalidate the calculations of LDL

and VLDL and a comment must

be made that these parameters

are invalid.

Magnesium (Mg)




Stat, 1 hour





Storage: Remove serum from cells if plain tube is

used. Refrigerate at 4oC.

Causes for Rejection: Gross hemolysis,

Use: Magnesium deficiency

produces neuromuscular

disorders. Increased

magnesium levels relate mostly to

patients in renal failure.

Magnesium is used as an

anticonvulsant in pre-eclamptic

patients.

Meningitis Panel




Stat, 4 hours

Testing performed at WMC

Specimen: CSF

Tube: Clear CSF container


Collection: Normal lumbar puncture using established

aseptic technique. Lumbar punctures are performed only

by physicians.

Storage: CSF should be refrigerated if testing is not

performed immediately. Be sure to freeze all extra CSF

in reference transfer tube in case more testing is ordered

Use: Screen for pathogenic

bacterial, viral and parasitic

organisms using PCR

technology.

Mono Test (Infectious Mononucleosis)

Lab: WMC/CMH Serology



Stat, 1 hour

Specimen: Serum or Plasma (WMC)

Whole Blood (CMH)

Tube: Plain red, SST, or EDTA

(WMC), EDTA only (CMH)



Storage: Remove plasma/serum from cells and

refrigerate at 4˚C if testing is to be delayed.

Causes for Rejection: Hemolysis, contamination

with IV fluids, bacteria, etc.

Use: A serological test to

support the diagnosis of

infectious mononucleosis.

MRSA Screening

Lab: CMH/WMC Microbiology


TAT: 24 hours (Outpatient) 3 hours (Inpatient) Testing performed at WMC/CMH

Specimen: Swab


Minimum Volume: single swab

Collection: Collect by swabbing inside of the nares


specimen, sample not sufficient quantity


or colonization with MRSA


Test uses PCR methodologies.

Mycoplasma pneumoniae IgM Antibody

Lab: WMC Microbiology


TAT: 4 hours

Specimen: Serum

Tube: Plain red or SST



Storage: 4˚C

Causes for Rejection: Hemolysis, lipemia, gross

bacterial contamination, improperly labeled

specimen.

Use: Aid in the serodiagnosis of

M. pneumoniae infection.

Additional Info: Mycoplasma

pneumoniae is the cause of the

relatively common “primary

atypical pneumonia.”

Mycoplasma is more difficult to

culture than ordinary bacteria and

the serologic confirmation of the

diagnosis is often desirable.

Nipple Discharge Cytopathology

Lab: Cytopathology

Availability: Mon-Fri 05:00am-

5:00 pm

TAT: 24-48 hours

Special Instructions: Specify nipple

discharge and from which breast.

Include pertinent clinical date, history of

carcinoma on requisition.

Specimen: Nipple discharge

Container: Cytolyt ® Vial

Collection: Gently grip subareolar area and nipple with

thumb and fore finger. When secretion occurs, allow

discharge to drip into the Cytolyt® vial. Label vial and

submit to Cytopathology.

Causes for Rejection: Improper fixation or

mislabeled vial.



neoplasm.

NT-proBNP

(BNP)




Stat, 1 hour



Collection: Routine venipuncture. Spin and

separate, Samples may be used up to 3 days.

Causes for rejection: Hemolysis, turbidity,

mislabeled specimen.

Use: The concentration indicates

the prognosis for left ventricular

dysfunction and is useful in

assigning symptoms to cardiac or

non-cardiac causes.

Obstetric Panel

(OB Panel)

Lab: WMC Chemistry, Hematology,

Blood Bank



Panel consists of:

CBC, RPR, Type (ABO/Rh) & Antibody

Screen, Hepatitis B Surface Antigen

Specimen: Serum, EDTA whole blood

Tube: SST, 2 EDTA

Collection: Routine venipuncture. Spin and

separate SST.

Causes for rejection: Hemolysis, incorrectly labeled

specimen, or clotted EDTA specimen.

Use: Prenatal screening

Note: Please refer to individual

tests for additional information.

Occult Blood (Hemoccult)




Specimen: Feces (stool)

Container: Hemoccult slide or a clean dry plastic

container.

Minimum Volume: Pea size amount or thin smear of

stool on both boxes of hemoccult slide

Collection: Fresh stool specimen free of gross blood.

When inoculating hemoccult slides use applicator to

apply a thin smear of stool to box A. Reuse applicator to

apply a thin smear of stool from a different part of the

specimen to box B.

Causes for Rejection: Contamination of specimen

with urine or toilet bowel cleaner; mislabeled

specimen.

Storage: Hemoccult slides once inoculated can be

stored at room temp for up to 14 days

Use: It is a qualitative screening

test for the detection of fecal

occult blood which may be

indicative of gastrointestinal

disease.

Limitation: Patient should

avoid red meat and vitamin C in

excess of 250mg for 3 days

before collecting samples. Non-

steroidal anti-inflammatory drugs

should be discontinued for 7 days

prior to collecting samples.

Osmolality, Serum

Lab: WMC Chemistry



Stat, 1 hour

Specimen: Serum, Tube:

SST or Plain red Minimum

Volume: 2 mL


Storage: Separate serum from cells as soon as clot

forms. Refrigerated samples may be used for up to

three days.

Causes for Rejection: Hemolysis, plasma specimen,

insufficient volume, improper labeling.

Use: Evaluate electrolyte and

water balance, hyperosmolar

status, hydration status; evaluate

seizures; clue to alcoholism,

methanol toxicity, ethylene glycol

ingestion. Additional Info: High

osmolality can result from

hypernatremia, dehydration,

hyperglycemia, mannitol therapy,

azotemia, ingestion of ethanol,

methanol, and ethylene glycol.

Low osmolality may result from

over hydration, hyponatremia.

Osmolality, Urine

Lab: WMC Chemistry



Stat, 1 hour

Specimen: Urine, random or 24-hour

Container: Plastic urine container, no preservative


Collection: Centrifuge urine sample after collection for

5 minutes to remove gross particulate matter. Storage:

Refrigerate up to 3 days.


Use: Evaluation of

concentrating ability of the

kidneys, evaluate electrolyte

and water balance.

Oxycodone Urine Drug Screen

Lab: WMC Chemistry



Stat, 1 hour

Specimen: Freshly voided, untreated urine.

Container: Urine sample cup.

Volume: 10 ml

Storage: Refrigerate up to 24 hours. Cause for

rejection: Improperly labeled, Limitations: Adulterants

added to urine specimen may produce erroneous

results. Substances and/or factors may interfere with the

test and cause false results. Drug levels below the

analyte cut off may not be detected

Use: Rapid immunoassay test

to detect a drug of abuse in

urine.

Note: The length of time

following drug use for which a

positive result may occur is

dependent on several factors

including the frequency and

amount of usage, metabolic rate,

excretion rate, drug half- life and

the user's age, weight, activity

and diet. For quantitation or

confirmation a GC/MS should be

ordered.

Phenytoin (Dilantin)




Stat, 1 hour


Tube: SST, Plain red or Green(Li hep)



Causes For Rejection: Incorrect tube or improperly

labeled specimen.

Use: To monitor therapeutic

drug level.

Phosphorus




Stat, 1 hour


Tube: SST, Plain red or green (Li hep)



Causes For Rejection: Wrong sample type,

improper labeling

Use: Evaluation of phosphorus

metabolism, calcium/

phosphorus balance.

Platelet Count (Plt Count)




Stat, 1 hour


Tube: Purple (EDTA)

Minimum Volume: 2 ml in EDTA tube, 0.5 in a

Microtainer


collection

Storage: Count cannot be performed if sample is

held at room temperature for more than 8 hours or

more than 24 hours refrigerated.

Causes For Rejection: Incorrect specimen

container, clotted specimen, hemolysis, specimen

collected above IV, insufficient volume.

Use: Quantitation of platelets,

evaluation of bleeding disorders,

aid of evaluation of

chemotherapeutic agents in the

management of malignant

disease states, evaluation of

platelet transfusions. Additional

Information: Some patient’s

exhibit clumping of platelets when

the specimen is

collected in EDTA containers. In

these cases, specimens should be

collected in citrate (blue top)

tubes. If a capillary puncture is

performed, large free flowing

drops of blood must be

obtained in order to avoid a

clotted specimen or clumping.

Specimen must be well mixed

during and immediately after

collection.

Platelet Function Screen

Lab: WMC Coagulation



Stat, 1 hour


Tube: 2 Blue - Citrate DO NOT SPIN

Minimum Volume: 2 tubes


Causes For Rejection: Specimen is over 2 hours old.

Specimen has been spun down. Improperly labeled

specimen or a clotted sample.

Use: Screening test to evaluate

platelet function. Can distinguish

patients on aspirin therapy from

those with a true platelet

dysfunction. Limitations: Low

hemoglobin can interfere with

testing.

Potassium, Blood




Stat, 1 hour





Storage: Separate serum or plasma from cells.

Refrigerate if testing is not to be performed

immediately.

Causes For Rejection: Wrong anticoagulant, gross

hemolysis, sample in contact with cells for more

than 4 hours, diluted with IV fluids, improper

labeling, insufficient volume.

Use: Monitor electrolyte status

Additional Information: Samples

in contact with RBC for prolonged

periods of time will produce

erroneously high

levels of potassium. Some

anticoagulants contain

potassium, e.g., EDTA, which

will lead to falsely elevated

levels.

Potassium, Urine




Stat, 1 hour

Specimen: Urine, Random or 24 hr

Minimum Volume: 10 ml Collection:

No preservatives, on ice.

Causes For Rejection: Improperly labeled

specimen.

Use: May be elevated with

dietary increase,

hyperaldosteronism, renal

tubular acidosis and at the

onset of alkalosis.

Pregnancy Test - See HCG

Prolactin

Lab: WMC Chemistry



Stat, 1 hour





Causes For Rejection: Improperly labeled specimen or

grossly hemolyzed.

Use: To help with the diagnosis

of disease states such as

infertility, gonadial disorders, and

others.

Procalcitonin

Lab: WMC/CMH

Chemistry



Stat, 1 hour





Causes For Rejection: Improperly labeled specimen or

grossly hemolyzed.

Testing must be performed within 4 hours

after collection.

Use: To help with the diagnosis of

sepsis, septic shock and antibiotic

efficacy.

Note: Same specimen

type must be use for all

serial testing.

Protein, CSF

Lab: WMC Chemistry


TAT: Stat, 1 hour

*CSF specimens from patients with suspected Creutzfeldt-Jakob Disease (CJD) will be sent to the NC State Lab for testing. The sample will not be opened prior to shipping.

Specimen: Spinal fluid

Container: Sterile plastic transfer tubes provided in

lumbar tray.

Minimum Volume: 1 ml CSF

Collection: Normal lumbar puncture using established

aseptic technique. Lumbar punctures are performed only

by physicians.

Storage: CSF should be refrigerated if testing is not

performed immediately. Be sure to freeze all extra CSF

in reference transfer tube in case more testing is ordered

later.

Causes For Rejection: Improper labeling. See also

Limitations

Use: A reliable, but non-specific

indicator of CNS pathology,

including meningitis, brain

abscess, CVA, MS, and other

degenerative processes causing

neurologic disease.

Limitations: Fresh blood in

specimen will invalidate the

protein result. Turbid samples

may exhibit a positive

interference. Hemolyzed or

xanthochromic samples may

falsely depress results.

Protein, Total Serum/Plasma




Stat, 1 hour

Calculate Globulin:

TP – Albumin = Globulin

A/G Ratio: Albumin divided by globulin





Storage: Separate serum from cells within 45

minutes. Refrigerate at 4˚ C

Causes For Rejection: Hemolysis, improperly

labeled sample.

Use: Evaluation of nutritional

status, to investigate edema

Additional Information: Causes

of high total protein: dehydration,

some cases of chronic liver

disease, including chronic active

hepatitis and cirrhosis;

neoplasms, especially myeloma.

Causes of low total protein:

pregnancy, IV fluids, cirrhosis or

other liver disease, including

chronic alcoholism;

prolonged immobilization, heart

failure, nephritic syndromes,

glomerulonephritis; neoplasia,

Crohn’s disease and chronic

ulcerative colitis, starvation,

malabsorption or malnutrition,

hyperthyroidism; burns, severe

skin disease; and other chronic

diseases. Very low total protein,

(<4 g/dl) and low albumin cause

edema.

Prothrombin Time (PT)



TAT: Routine, 2-4 hours

STAT, 1 hour

CMH ED, 44 min

Synonyms: INR Protocols for anticoagulants are posted on the ARHS Intranet and are available to all clinicians. Any clinician contacting the laboratory for anticoagulant information will be told the in-house testing available and then referred to the intranet/pharmacy for protocols or to the pathologist for further questions.


Tube: Sodium citrate (blue top)

Minimum Volume: Full tube , volume depends on

tube

Collection: Routine venipuncture. Fill tube until

vacuum is exhausted.

Storage: Test within 8 hours.

Causes For Rejection: Clotted specimen, hemolysis,

under filled tubes, lipemia, improperly labeled sample.

Use: Evaluation of extrinsic

coagulation; screen for

congenital deficiencies of

factors II, V, VII, X; prothrombin

deficiency, dysfibrinogenemia,

heparin, effect, coumarin effect,

liver failure, DIC, vitamin K

deficiency.

Limitations: Prothrombin

times collected less than 2 hours

after heparin administration will

be prolonged. Many drugs

modify the effect of coumarin,

including salicylates,

barbiturates, quinidine,

antacids, many antidepressants,

and antibiotics.

PTT (APTT)



TAT: Routine, 2-4 hours

STAT, 1 hour

Synonyms: APTT, Activated Partial

Thromboplastin Time

Protocols for anticoagulants are posted on the ARHS Intranet and are available to all clinicians. Any clinician contacting the laboratory for anticoagulant information will be told the in-house testing available and then referred to the intranet/pharmacy for protocols or to the pathologist for further questions.


Tube: Sodium citrate (blue top)

Minimum Volume: full tube, volume depends on

tube

Collection: Routine venipuncture. Collect blue tube after

another tube. This procedure avoids contamination of

the specimen with tissue thromboplastin. Fill tube until

vacuum is exhausted. Storage: Test within 4 hours at

room temperature. Causes For Rejection: Specimen

older than 4 hours, clotted specimen, hemolysis, under

filled tubes, lipemia, improperly labeled sample

Use: Evaluation of extrinsic

coagulation; screen for

congenital and acquired

deficiencies of factors VIII, IX,

XI, and XII. Also the test used to

monitor heparin therapy.

Limitations: PTT samples

collected less than 2 hours after

heparin administration will be

prolonged.

PSA (Prostate Specific Antigen)

Lab: WMC Chemistry



Stat, 1 hour





Storage: Separate serum from cells immediately.

Causes For Rejection: Improper labeling, wrong

sample type.

Use: Used to monitor disease

status in prostate cancer

patients.


Elevated levels are found in

men with benign prostatic

hypertrophy.

Renal Function Panel (RFP)

Lab: WMC/CMH Chemistry Lab


TAT: Routine, 4 Hours

Stat, 1 hour

Test Includes: Albumin, BUN, Calcium,

Chloride, CO2, Creatinine, Glucose,

Phosphorous, Potassium, Sodium


Tube: SST, Plain red, Green (Li hep)



Causes For Rejection: Gross hemolysis, improperly

labeled specimen

Note: Please refer to individual

tests for additional information.

Respiratory Panel

Lab: WMC/CMH Microbiology Availability:

24 Hours

TAT: Routine, 24 Hours

Stat, 4 hour

Specimen: Nasopharengeal Swab in UTM

Tube: UTM

Collection: Nasopharengeal collection

Storage: Maintain specimen at room

temperature for up to 24 hours

Causes For Rejection:, improperly labeled

specimen, specimen not placed in transport

within 1 hour after collection

Reticulocyte Count

Lab: WMC/CMH

Hematology Availability: 24

Hours TAT: Routine, 4

Hours Stat, 1 hour

Specimen: Whole Blood

Tube: EDTA (lavender

top tube) Minimum

Volume: 2 ml

Collection: Routine

venipuncture

Storage: Maintain specimen at room

temperature for up to 24 hours

Causes For Rejection: Clotted specimen,

hemolysis,

specimens more than 24 hours old,

Use: Evaluate erythropoietic activity.

Increased in acute and chronic hemorrhage

and hemolytic anemias. Evaluate response to

antianemic therapy Limitations:

Reticulocytes may decrease on a dilutional

basis in transfused patients.

RPR - VDRL

Lab: WMC Hematology


2 days

Specimen: Serum or Plasma

Tube: SST, plain red, lavender, or green

Minimum Volume: 2

mL Collection:

Routine venipuncture

Storage: 4oC

Causes For Rejection: Hemolysis,

lipemia, gross bacterial contamination,

mislabeled specimen

Use: Screening test for syphilis Note: If

positive reflexes to quantitative RPR and a

confirmatory MHA-TP.

RSV



Routine, 4 hours Stat, 1 hour

Specimen: Nasopharyngeal swab

Minimum Volume: swab

Collection: Nasal swab - insert swab into

nostril (1 inch), rotate swab against the

nasal wall then remove.. Nasopharyngeal

Swab - insert swab in the posterior

nasopharynx and rotate then remove. For

nasal wash, flush one nostril with 1.0 to

2.5mL normal saline. Allow fluid to run out

of nostril into sterile container.

Storage: Room temp

Causes For Rejection: mislabeled specimen.

Use: For the diagnosis of RSV

infections.

Rubella

Lab: WMC Chemistry


TAT: 24 hours





Storage: 4˚C up to 7 days

Causes For Rejection: Hemolysis, lipemia, gross

bacterial contamination

Use: Recommended for immune

status determination. Additional

Information: Rubella virus is the

cause of German measles,

usually a mild exanthema, often

subclinical, however, when

acquired in utero, rubella virus

can cause the congenital rubella

syndrome, deafness, and

mental retardation. For this

reason, it is very important to

immunize women before they

have children. If a woman has

antibodies against rubella, even of

low titer, demonstrated by any of

multiple methods, she need not

worry about infection during

subsequent pregnancy.

If she is not immune, and is not

pregnant, she can receive the

rubella vaccine.

Salicylates, Serum




Stat, 1 hour

Specimen: Serum (CMH/WMC), heparinized

plasma (WMC only)

Tube: SST, Plain red (CMH/WMC); Green (Li hep. /

WMC only)

Minimum Volume: 2ml


Causes For Rejection: improper labeling.

Use: In the diagnosis of

salicylate overdose and in

monitoring salicylate therapy.

Sedimentation Rate (ESR)




Stat, 1 hour

Synonoms: Sed rate, Westergren Sed

Rate, Erythrocyte Sedimentation Rate Note: Best results are from blood less

than 4 hours old.





Storage: Room temperature for up to four hours;

refrigerate at 4 °C up to 12 hours if testing is to be

delayed

Causes For Rejection: Obvious hemolysis, clotted

specimen, under-filled tube, specimen older than 12

hours, improperly labeled specimen

Use: Evaluate the non-specific

activity of infections, inflammatory

states, autoimmune disorders,

and plasma cell dyscrasias and

autoimmune disorders.


Elevations in fibrinogen, alpha-

and beta-globulins, and

immunoglobulins increase the

sedimentation of RBCs through

plasma. The test is important

in the diagnosis of temporal

arthritis, as well as its

management.

Semen Analysis

Lab: WMC Urinalysis

Availability: Mon-Fri 8am-4pm Specimen: Semen must be collected after

abstinence of at least 48 hours, but no more than 7

days

Container: Clean wide mouth plastic or glass

Container. Condoms are unacceptable as

spermicides and lubricants interfere with test

results

Minimum Volume: Entire ejaculate

Storage: Specimen must be kept warm (body

temperature) and delivered to the lab within 30 minutes

(4 hours for post vasectomy specimens). Causes For

Rejection: Collected in unacceptable Container,

improperly labeled, and not delivered to lab within

required time frame.

Use: Used as part of a fertility

investigation, to aid diagnosis

of prostatic disease, and for the

presence of sperm after

vasectomy.

Sodium, Urine




Specimen: Urine, random or timed

Container: Plastic urine Container, no preservative.

Collection: For timed specimen, have patient void at

0800 and discard the first specimen, then collect all

urine, including last specimen for the specified

collection period. Label Container with patient’s name,

date of birth, date and time started, date and time

finished.

Storage: Measure and record total volume on

requisition, transfer aliquot (at least 5 mL) to a

transfer tube, and label. Store at 4˚C.

Causes For Rejection: Improperly labeled or

collected specimen

Use: Work up depletion, acute

renal failure, and acute oliguria.

Synovial Fluid Crystal Exam

Lab: Cytopathology

Request Form: Cytopathology

Availability: 7am-5:00pm

TAT: Same day, usually within an hour of

receiving the specimen.

Test Includes: Microscopic

examination of specimen for crystals

and inflammatory cells.

Specimen: Synovial fluid.

Container: Specimen may be left in syringe (needle

must be removed).

Minimum Volume: 0.5 ml

Collection: Aspirate must be label with two patient

identifiers.

Storage: Sample should be examined as soon as

possible. After hours refrigerate in Pathology rack in

main lab refrigerator.

Use: Intracellular monosodium

urate (MSU) crystals are observed

in acute gouty arthritis.

Methodology: Polarized light

microscopy.

Theophylline

Lab: WMC Chemistry



Stat, 1 hour





Storage: 2-8˚C

Causes For Rejection: Hemolysis, gross lipemia,

improper labeling.

Use: monitor therapeutic drug

level.

Limitations: Troleandomycin &

erythromycin may slow theophylline

elimination. Heart failure, liver

disease, prolonged fever, and

obesity may have similar effects.

Prolonged half-life occurs in

premature infants. By contrast, half

life is shortened in smokers,

variable with Phenobarbital use.

Thyroid Profile

Lab: WMC Chemistry


Routine, 4 hours

Stat, 1 hour

Test Includes: Free T4, TSH

Specimen: Serum

Tube: SST or Plain red



Storage: If plain tube is used, allow to clot and

centrifuge within 45 minutes of collection. Remove

serum and store in a plastic transfer tube at 2-8˚C until

testing is performed.

Causes For Rejection: Plasma specimen , improper labeling


metabolic activity that correlates

with free thyroxine (T4).

Tobramycin

Lab: WMC Chemistry



Stat, 1 hour






specimen.

Use: To monitor drug levels

during therapy.

Triglycerides



TAT: 4 hours


Tube: SST. Plain red or Green (Li hep).


Patient Preparation: Patient should be fasting for

12-14 hours prior to specimen collection.


Storage: 4˚C. Separate serum from cells within 45

minutes of collection.

Causes For Rejection: Non-fasting specimen,

glycerinated tube used for collection, improper

labeling.

Use: Evaluation of

hyperlipidemia

Limitations: The most

common cause of triglyceride

increase is inadequate patient

fasting.

Additional Information: High

concentrations may occur with

hypothyroidism, nephrotic

syndrome, glycogen storage

diseases, and diabetes mellitus.

Extremely high triglycerides

are common in acute

pancreatitis.

Troponin I




Stat, 1 hour

CMH ED, 50 min





Causes For Rejection: Incorrect specimen type or


Use: As part of the clinical

picture in the diagnosis of AMI.

Limitations: Heterophilic

antibodies are known to cause

interference with immunoassays.

Type And Screen (ABO/Rh and Antibody Screen)

Lab: WMC/CMH Transfusion Service Availability: 24 Hours TAT: Routine, 4 Hours

Stat, 1 Hour

Test Includes: Blood group (ABO), Rh, and Antibody screen.

Specimen: Whole blood Tube: EDTA (lavender) Minimum Volume: 5 mL Collection: Routine venipuncture. Specimen must

be labeled with patient's full name, Date of Birth, MR

number or SS number, date and time of collection, and

initials of person collecting the specimen. Blood Bank

Band must be completed at time of sample collection if sample will be used for crossmatch.



Use: To determine patient's blood group and Rh and to detect the presence of unexpected clinically significant antibodies, so that blood can be available quickly if a crossmatch is required.

Limitations: Abnormal proteins and cold or warm auto agglutinins, or unexpected antibodies in the patient’s

blood may cause delays in interpretation. May not detect antibodies to low incidence antigens.

Additional Information: If

transfusion is expected the

appropriate number of units

must be ordered to be

crossmatched.

Tzanck Prep for Cytopathology

Lab: Cytopathology


Availability: 5:00 am-5:00 pm

Specimen: Scraping of viral lesion.

Container: Cytolyt® Vial or PreservCyt® ThinPrep vial.


Collection: Scrap lesion with plastic applicator and

rinse in Cytolyt® Vial or PreservCyt® ThinPrep vial.

Specimen must be label with two patient identifiers.

Storage: After hours put in Pathology rack in main lab

refrigerator.

Use: In diagnosis of herpes

simplex virus.

Uric Acid

Lab: WMC Chemistry



Stat, 1 hour





Patient Preparation: At least a 4-hour fast is

preferred for routine testing.

Storage: 2-8˚C. Separate cells from serum prior to

storing.


specimen

Use: Uric acid is the end product

of purine metabolism. Elevations

in uric acid occur in renal failure,

prerenal azotemia, gout, lead

poisoning, excessive cell

destruction (e.g.,

chemo), hemolytic anemia, CHF

and after myocardial infarction.

Urinalysis




Stat, 1 hour

Test Includes: Biochemical screening

only. Microscopic examination is

performed if any screening tests are

positive or if otherwise indicated.

Specimen: Urine, random

Container: A clean plastic urine container is

preferred

Collection: A mid-stream, clean-voided specimen is

preferred; catheterization

Storage: Refrigerate if testing is to be delayed more

than 1 hour

Causes For Rejection: Insufficient volume,

bacterial overgrowth, improperly labeled specimen.

Use: Screen for abnormalities

of urine, diagnose and manage

renal disease, urinary tract

infections, and systemic

diseases

Limitations: Insufficient

volume may limit extent of tests

performed. Metabolites of

pyridium may cause color

interference with the dipstick

reactions. High vitamin C

intake may cause an

underestimate of glucosuria, or a

false negative nitrate test.

Low osmolality, alkalinity, and

lack of refrigeration decrease

survival of WBC.

Urinalysis-Complete




Stat, 1 hour

Test Includes: Biochemical screening

and a microscopic evaluation of formed

elements

Specimen: Urine, random

Container: Sterile, plastic urine collection

container.

Minimum Volume: 12 mL is the standard amount used

for testing to insure consistency, and all normal values

are based upon a volume of 12 mL.

Collection: A mid-stream, clean voided specimen is

preferred; catheterization

Storage: Refrigerate if testing is to be delayed more

than 1 hour.

Causes For Rejection: Decomposition or

overgrowth of bacteria, insufficient quantity,


Use: Screen for abnormalities of

urine, diagnose and manage renal

disease, urinary tract infection,

systemic diseases Limitations:

Insufficient volume may limit

extent of tests performed.

Metabolites of pyridium may

cause color interference with the

dipstick reactions. High vitamin C

intake may cause an

underestimate of glucosuria, or a

false negative nitrate test. Low

osmolality, alkalinity, and lack of

refrigeration decrease survival of

WBC.

Urine Cytopathology

Lab: Cytopathology


Availability: Mon-Fri 5am-5:00 pm

TAT: 24-48 hours

Special Instructions: Be sure to

indicate on requisition whether

specimen is voided or catheterized,

from bladder, ureter, renal pelvic,

urethra, or bladder washing.

Specimen: Fresh urine or urine in Cytolyt ®

container.

Container: Specimen Container available in

cytopathology or central supply.

Minimum Volume: Not less than 10 ml. Clean

catch voided or cath specimen.

Storage: If collected after hours, place in the

Pathology rack in main lab refrigerator.

Causes For Rejection: Improper fixation, 24 hour

collection.



neoplasms. To aid in the

diagnosis of infections.

Urine Drug Screen

(Oxycodone ordered separately- see Oxycodone UDS)




Stat, 1 hour

Drugs Tested:

WMC : AMP, COC , MTD, OPI, MAMP, PCP, BAR, THC, BZO, OXY, BUP, PPX and TCA

CMH: AMP, BARB, BENZ, COC, OPI, PCP, Methadone and THC

Specimen: Urine

Container: Clean plastic urine cup.

Minimum Volume: 10 ml Collection:

Freshly voided sample

Storage: If not tested immediately refrigerate for up to

48 hours.


specimen.

Limitations: Adulterants added to urine specimen may

produce erroneous results. Substances and/or factors

may interfere with the test and cause false results. Drug

levels below the analyte cut off may not be detected.

Use: The detection of drugs of

abuse in urine

The length of time following

drug use for which a positive

result may occur is dependent on

several factors including the

frequency and amount of usage,

metabolic rate, excretion rate,

drug half-life and the user's age,

weight, activity and diet.

For quantitation or confirmation

a GC/MS should be ordered.

Valproic Acid (Depakote)




Stat, 1 hour

Synonyms:

Depakene, Depakote, Valproate



Minimum Volume:2 mL

Collection: Routine venipuncture. Peak: 1-4 hours

after dose (influenced by meals); Trough:

immediately prior to next dose (possibly more

useful than peak levels).

Storage: Separate serum from cells and refrigerate

at 2-8˚C.

Causes For Rejection: Hemolysis, lipemia

Use: Valproate controls absence,

myoclonic, and tonic-clonic

seizures in generalized, idiopathic,

and symptomatic epilepsy.


Hepatotoxicity may be fatal, but is

idiosyncratic and not preventable

by routinely monitoring liver

enzymes. Hepatotoxicity occurs in

very young children, usually those

on multiple anticonvulsants.

Valproate cytopenias may be

dose-related and warrant

monitoring of CBCs during

therapy.

Vancomycin




Stat, 1 hour






specimen.

Use: To monitor drug therapy

Vitamin B12 Lab: WMC Chemistry


TAT: 4 hours





Storage: Separate serum from cells; store at 4˚C.


specimen, wrong specimen type or sample not

properly stoppered.

Use: Detect B12 deficiency as in

pernicious anemia, diagnose folic

acid deficiency, evaluate

hypersegmentation of

granulocyte nuclei, diagnose

macrocytic anemia, diagnose

megaloblastic anemia, evaluate

alcoholism, prenatal care,

evaluate malabsorption,

neurological disorders, or the

elevation of B12 as seen in liver

cell damage or myeloid leukemia.

Limitations: Drugs capable of

interference with B12 and/or folic

acid absorption include

chemotherapeutic agents,

diuretics, antibiotics,

anticonvulsants, sedatives, oral

contraceptives, and many others.

Vitamin D Total (25-OH)

Lab: WMC Chemistry


TAT: 4 hours

Specimen: Serum

Tube: SST, Plain red


Patient Preparation: Fasting specimen preferred;

must collect prior to Schilling’s test, transfusions, or

initiation of B12 therapy


Storage: Separate serum from cells; store at

4˚C; specimen stable for 24 hours only


specimen, wrong specimen type

Clinical Significance:

Vitamin D is synthesized from cholelsterol upon skin exposure to UVB sunlight or through dietary intake. Vitamin D is hydroxylated in the liver to form 25-OH Vitamin D which is further hydroxylated in the kidney to form the biologically active form, 1,25-(OH)2 Vitamin D. The active form is tightly regulated by plasma parathyroid hormone levels and calcium and phosphorous levels. The active form, 1,25-(OH)2 Vitamin D, increases the intestinal absorption of calcium and phosphorous, both are required for regulating bone metabolism. Vitamin D metabolites are bound to vitamin D binding protein and are circulated throughout the body. The concentration of 1,25(OH)2Vitamin D is 1000 times lower than 25-OH Vitamin D and has a half life of 4 hours. Due to its half life of 2-3 weeks, 25-OH Vitamin D is the metabolite that is the most reliable clinical indicator of vitamin D status. Also, 25-OH Vitamin D levels are indicative of the body’s storage levels of vitamin D and correlate with the clinical symptoms of vitamin D deficiency.

Wet Prep / KOH

Lab: CMH Urinalysis/

WMC Micro


TAT: 4 hours

Specimen: Vaginal swab, nail clippings, hair, skin

scrapings

Collection:

Vaginal Swab - swab the vaginal region and immerse

the swab into a vial containing 2mLs of 0.9% NaCl Nails

- clean with 70% alcohol, scrap away outer portion and

obtain scrapings from the deeper infected areas. Place

in sterile container or on slide. Hair - remove at least 10

intact hairs from infected area. Place in between two

glass slides.

Skin - clean with 70% alcohol. Scrap away the outer

portion and obtain scraping from the deeper infected

areas. Place on a slide.


specimen, vaginal swab not received in saline.

Use: Potassium hydroxide

digests or lyses epithelial cells, WBCs, RBCs, mucus, and various other proteinaceous debris, bleaches many pigments and dissolves the “cement” that holds keratinized cells together. This permits detection of fungal elements (yeast and pseudohyphae) that are present in vaginal secretions and keratinized tissue. Most fungi can be demonstrated in the KOH preparation. Wet preps allow for microscopic observation of unfixed “wet mounts” of clinical specimens for the rapid detection of the presence of bacterial, fungal, and parasitic organisms. The presence of white blood cells and “clue cells” may also be identified.

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Laboratory and Pathology Test Menu and Specimen