Specimen Collection
Phlebotomy Order of Draw
As per the CLSI standard H3-A6 (Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard – Sixth Edition; October 2007), the following order of draw is recommended for both glass and plastic venous collection tubes when drawing multiple specimens for clinical laboratory testing during a single venipuncture. Its purpose is to avoid test result error due to additive carryover. All additive tubes should be filled to their stated volumes.
1. Blood culture tube
2. Coagulation tube (e.g. light blue top tubes)
3. Serum tube with or without clot activator, with or without gel (e.g. red, gold, or speckle-top tubes)
4. Heparin tube with or without gel plasma separator (e.g. green top tubes)
5. EDTA tube with or without gel separator (e.g. lavender top tubes)
6. Glycolytic inhibitor tube (e.g. gray top tubes)
Note: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube. The discard tube must be used to prime the tubing of the collection set, which will assure maintenance of the proper anticoagulant/blood ratio in the first tube filled. The discard tube should be a non-additive or a coagulation tube, and need not be completely filled.
It is extremely important to draw a waste tube when drawing blood for coagulation studies other than prothrombin time (PT), and activated partial thromboplastin time (aPTT) testing.
Microtainer Order of Draw
The order of collection for microcollection differs from that of venipuncture. As per the CLSI standard H4-A6 (Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard – Sixth Edition; September 2008), collect multiple specimens in the following order:
1. Arterial blood gases (ABG)
2. EDTA specimens (e.g. lavender)
3. Other additive specimens
4. Specimens requiring serum (e.g. gold, red)
Order Priorities
Laboratory test turnaround time is dependent on the priority assigned to the requested procedure. The test turnaround time priority definition is as follows:
STAT 60 minutes from the receipt of the specimen into the laboratory site performing the test.
Urgent 4 hours from the receipt of the specimen into the laboratory site that is performing the test.
Routine 24 hours from the receipt of the specimen into the laboratory site performing the test, except for tests only performed certain days of the week. See individual test in the Alphabetized Test Listing (Section III).
Note: Only certain tests will be performed STAT. Please refer to the STAT list located at the end of this section.
Specimen Labeling - Regulatory Standards
Laboratory Alliance is committed to following the highest ethical standards to provide quality laboratory services to our customers and to comply with all federal, state, and local laws and regulations.
Laboratory Alliance of Central New York is licensed to operate by the New York State Department of Health. In addition, Laboratory Alliance is fully accredited by The Joint Commission. The four laboratory locations, which comprise Laboratory Alliance, undergo biannual inspections by both the New York State Department of Health and The Joint Commission.
Part 58-1.10 (e) of the New York Code of Rules and Regulations for Clinical Laboratories states: A specimen received by a laboratory shall not be tested if:
(1) the apparent condition of the specimen indicates that it is unsatisfactory for testing or that it is inappropriate for the test requested;
(2) it has been collected, labeled, preserved or otherwise handled in such a manner that it has become unsatisfactory or unreliable as a test specimen;
(3) it is perishable and the time lapse between the collection of the specimen and its receipt by the laboratory is of such duration that the test finding may no longer be reliable; or
(4) the date and, in the case of tests specified by the department, the hour when the specimen was taken by the physician or other authorized person is not furnished with the specimen.
The purpose of The Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety. The goals highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. As with The Joint Commission standards, accredited laboratories are evaluated for continuous compliance with the specific requirements associated with the National Patient Safety Goals.
National Patient Safety Goal.01.01.01 – Use at least two patient identifiers when providing laboratory services.
Rationale for NPSG.01.01.01: Wrong-patient errors occur in virtually all stages of diagnosis and treatment. The intent for this goal is two-fold; first, to reliably identify the individual as the person for whom the service or treatment is intended; second to match the service or treatment to that individual.
Implementation Expectations for NPSG.01.01.01:
1. Prior to any specimen collection, medication administration, transfusion, or treatment, the laboratory actively involves the patient and, as needed, the family in the identification and matching process. When active patient involvement is not possible or the patient’s reliability is in question, the laboratory will designate the caregiver responsible for identify verification. Note: The involvement of a single caregiver is acceptable as long as the other components of patient identification are satisfied.
2. Two patient identifiers are used when administering medications, blood, or blood components.
3. Two patient identifiers are used when collecting blood samples and other specimens for clinical testing.
4. Two patient identifiers are used when providing other treatments or procedures.
5. The patient’s room number or physical location is not used as an identifier.
6. Containers used for blood and other specimens are labeled in the presence of the patient.
7. The laboratory establishes processes to maintain specimen identify throughout the pre-analytical, analytical, and post-analytical processes.
All specimens collected from hospital inpatients, outpatients, and physician office patients submitted for medical testing must be properly labeled so that there is no ambiguity as to the patient’s identity.
Properly labeled specimens must include:
· Patient’s full first and last name.
· Second identifier such as identification number or date of birth. A room or bed number is unacceptable.
· Collection date.
In order to comply with NYSDOH and Joint Commission regulations, a mechanism must exist to identify the individual who collected the specimen. Thus, identification of the person collecting the specimen must be recorded on the specimen label or the test requisition.
Thesource of the specimen must be noted either on the specimen label or the test requisition when the specimen is tissue, a culture, or a body fluid other than blood.
NOTE à Per Part 58-2.7 (a) of the New York Code of Rules and Regulations for Clinical Laboratories: Labeling of specimens intended for pre-transfusion testing shall include:
· Patient’s full first and last name.
· Second identifier such as identification number or date of birth. A room or bed number is unacceptable.
· Collection date.
· Collection time.
· Identification of the person collecting the specimen.
Computer-generated labels with the barcode will sometimes have the first name truncated because of space limitations. Specimens with truncated names will not be accepted by the Transfusion Services department.
One-Of-A-Kind Specimens
A one-of-a-kind specimen is any specimen not easily obtained (or re-obtained). This list includes, but is not limited to, bone marrow aspirate, bronchial lavage, cerebrospinal fluid and other body fluids, and surgical specimens.
If an improperly labeled one-of-a-kind specimen is received in the laboratory, the attending physician or his/her designee will be notified immediately. The specimen must be properly labeled by the attending physician or his/her designee prior to the laboratory taking any additional steps to process the specimen.
Specimens Received with Needles Attached
Hospital-Collected Specimens:
If a specimen is received in the laboratory with a needle attached, the patient’s nursing unit will be notified to recollect the specimen. If the specimen is a one-of-a-kind specimen, the nursing unit will be required to send someone to the laboratory to remove the needle. A hospital quality assurance tracking form will be submitted documenting the event.
