New Mexico VA HealthCare System



PurposeTo establish guidelines for the appropriate processing and shipping of patient specimens from the Community Based Clinics to the NMVAHCS Laboratory. Proper collection, handling, and transporting of specimens are fundamental to the quality of specimens for analytical testing in the laboratory. Transportation of samples requires compliance with Federal transportation regulations.SafetyPractice Universal Precautions. Follow all facility Infection Control procedures to prevent exposure to bloodborne pathogens.Discard all blood collection sharps in biohazard waste containers approved for sharps disposal.Transferring a sample collected using a syringe to a tube is not recommended. Additional manipulation of sharps increases the potential for needlestick injury.Take precautions to protect against exposure to aerosols and splashes from open sample containers. Review and Print Lab Orders from CPRS Prior to CollectionRefer to the Lab Test Information in CPRS for sample requirements, completion times, and process accordingly.Print the lab orders to be collected from CPRS. The printed orders specify the sample and tube type for collection.Not all tests can be shipped due to sample stability limitations. Contact Pathology & Laboratory Medicine service 7 days/week, 24 hours/day at ext. 2383 for clarification on collection instructions.Patient IdentificationIdentify the patient using two identifiers prior to collection. Full name, birth date, and SSN are acceptable identifiers.Whenever possible, have the patient state his identifiers: “Please tell me your date of birth.” Do not ask a yes or no question like, “Is your birthday May 7th?” Collect sample according to the procedure described in POC.0053 “CBOC Venipuncture Procedure”.Fill Tubes AdequatelyAllow tubes to fill until the vacuum is exhausted to ensure the proper blood-to-additive ratio. Overfilling or under-filling of tubes will result in an incorrect blood-to-additive ratio and may lead to incorrect analytical results.Sample LabelingLabel all collection tubes in the presence of the patientLabel with the patient’s full name, full SSN, date and time of collection and collector’s initialsCentrifugationAllow Tubes for Serum to ClotPatients with abnormal clotting times due to disease or anticoagulant therapy require more time for complete clot formation. Separation of serum from cells should take place within 1 hours of collection.Allow blood Vacutainer tubes for Serum to clot thoroughly before centrifugation. BD recommends the following clotting times:60 minutes for Red Top tube (no gel separator)30 minutes for Gold Top (BD SST) tubeTubes for Plasma like the green top Lithium Heparin gel-separator tube do not need to sit for any period of time prior to centrifugation. These tubes are not intended to clot.Centrifuge to Separate Plasma/Serum from Red Blood CellsBalance tubes in the centrifuge. Match tubes of the same fill level and make sure that tubes are properly seated.Spin gel tubes at 1100 – 1300 RCF (g) for 15 minutes if using a fixed angle centrifuge or 10 minutes if using a swing rotor centrifuge. Spin all non-gel tubes at less than or equal to 1300 RCF (g) for 10 minutes.Allow centrifuge to come to a complete stop before attempting to remove tubes.Important Note: Do not re-centrifuge gel separator tubes. Aspirate serum or plasma from the tube and place in a clean test tube to re-centrifuge.Transfer Sample to Transport TubeAfter centrifuging, carefully remove tube stoppers to prevent aerosolization. Gauze or a stopper removal device may be used.Transfer serum or plasma to a plastic transport tube using a polyethylene transfer pipette.Securely fix lid on transport tube to prevent leakage.Label all tubes with the patient’s full name, full social security number, date and time of collection and initials of collector.Mark transport tubes to indicate sample type.Mark Plasma tubes with a green marker on the lid and label.If the sample is from a tube other than a Green or Gold top, write the tube type on the label. For example, “Plain Red”.Refrigerate separated samples until just prior to packing the shipping box.Lavender Top TubesDo not centrifuge tubes for CBC (Hemogram & Five-Part Diff)HGB & HCT onlyReticulocyte countHemoglobin A1CRBC Folate These tests are performed on whole blood onlyUrine SamplesRandom Urine Collections:Instruct the patient to collect the urine into a sample cup labeled with their ID information.Transfer the urine to the appropriate transport tube using a polyethylene transfer pipette or BD urine transfer device (straw).Preserving Urines for ShippingShip urine samples in the appropriate preservative transport tube.Label tubes with the patient’s full name, full social security number, and date and time of collection. Refrigerate all urines until just prior to packing the shipping boxTestPreservative/Transport TubeUrinalysisUA Transport tubeUrine Culture & Sensitivity (C&S)Urine C&S TubeMicroalbuminNo preservative is required, but it is advised to ship in the BD No Additive (Z) tubeUrine Tox ScreenNo preservative required, store refrigeratedShip in 50-mL screw top tube24-Hour Urine CollectionsNo preservative is required for most 24-hour collections24-Hour Urine – Processing for Transport1.Write on the printed test order:Total Volume collected (in milliliters)Start and End dates/times2.Gently mix the sample. Pour off a portion (30-50 mL) into a transport tube.3.Label the transport tube with:Patient’s full name and full SSNTotal Volume of urine collected (for example, 1550 mL)4.Discard the remainder of the sample in the toilet.Do not send the 24-hour collection container to the NMVAHCS Lab.Samples in Preservative CupsThinPrep Pap, Cytology and Histology samplesCarefully seal each labeled sample cup in a re-closeable biohazard bag along with an absorbent pad, such as a paper towel. Include a completed request form. Stool SamplesStool Culture and Sensitivity (C&S)Vial with orange lid - “Para-Pak C&S”Using the collection spoon in the pack, add sufficient stool to bring the liquid level up to the "fill to here" line (approximately 5 ml of sample).Mix well to ensure adequate mixing with the preservative. When mixing is completed the sample should appear homogeneous.Label container with full name, full SSN and collection date/timeOva and Parasite Exam (O&P)Each kit contains one vial with 15 mL LV-PVA-fixative (grey lid) and one vial with 15mL 10% formalin preservative (pink lid). Each vial has a built-in collection spoon. Using the collection spoon in the pack, add sufficient stool to bring the liquid level up to the "fill to here" line (approximately 5 ml of sample).Mix well to ensure adequate mixing with the preservative. When mixing is completed the sample should appear homogeneous.Label both vials with full name, full SSN and collection date/timePreserved stool is stable for 7 daysClostridium Difficile (C. Diff)Test name in CPRS/VistA: C DIFF TOX B GENE PCRUnpreserved sample stable for 5 days at 2-8CCollect in clean container. Ship in sterile urine cup.Formed stools are not accepted.Giardia Test name in CPRS/VistA: GIARDIA (ELISA)Performed on stool preserved in the 10% Formalin (pink lid) vial for O&P exam or in the Para-Pak C&S vial (orange lid).Fecal Occult Blood Test (FOBT)Use FIT collection kit (distributed by Lab to clinics)Samples are stable for 14 days at ambient temperature and up to 30 days if stored between 2-8CPacking Samples for ShipmentShip samples with ice packs unless otherwise indicated in VistA. Do not use ice packs to ship samples that require room temperature storage (also known as ambient temperature).Packing the Shipping Box1.Place the tubes in a biohazard-labeled plastic bag along with an absorbent pad. Carefully seal the bag.2.Place the samples in a pressure-tested leak proof canister.3.Line the bottom of a Styrofoam-lined shipping container with ice packs. Place the canisters in the box.plete a Shipping Manifest for the boxThe manifest should match the contents of the box exactly. Do not indicate samples on the manifest that will not be shipped.5.Place the accompanying printed orders and sample manifest in the box, separate from the samples. 6.Seal the box and apply appropriate labels. A label reading “UN3373 Biological Substance Category B” should be clearly visible indicating that the box contains samples for diagnostic testing.plete the courier’s waybill according to the courier’s instructions and affix to the box8.Email the tracking information to the NMVAHCS LaboratoryLaboratory ContactsContact Pathology & Laboratory Medicine Service 7 days/week, 24 hours/day at ext. 2383 for clarification on collection instructions.Be sure to mention that you are calling from a CBOC and need instructions for processing/preserving and shipping.Additionally, the Ancillary Testing Department is available to answer any questions on collection, processing or shipping of samples Monday through Friday 7:00 am to 3:30 pm at ext. 5087.References“BD Vacutainer Evacuated Blood Collection System”, Becton Dickinson Co, Franklin Lakes, NJ, 07417, 2010.IATA Dangerous Goods Regulations, Packing Instruction 650, January 2015.NMVAHCS P&LMS Policies & Procedures:POC.0053 CBOC Venipuncture ProcedurePOC.0077 CBOC Urinalysis TransportPOC.0044 CBOC Urine Culture TransportPOC.0048 CBOC/CCBOC Lab Specimen Acceptability Reference GuidePOC.0013 CBOC Urine Transport GuidePOC.0074 CBOC Specimen ManifestDATE: ______________ COURIER TRACKING NUMBER________________LOCATION: ___________________ PAGE _______OF _______Last Name - First Name - Full SSN LB #Specimen Types Place Patient Label Here FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: FORMCHECKBOX Green FORMCHECKBOX Gold FORMCHECKBOX Lavender FORMCHECKBOX Urinalysis (UA) FORMCHECKBOX Urine Microalbumin FORMCHECKBOX Urine Culture FORMCHECKBOX Urine (No preservative) FORMCHECKBOX Other: ................
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