Laboratory Specimen Labeling Guidelines. Rutland Regional Medical Center 8/1/2018

Transcription

1 2019 Laboratory Labeling Guidelines Rutland Regional Medical Center 8/1/2018

2 Table of Contents LABORATORY SPECIMEN LABELING GUIDELINES GENERAL LABORATORY... 1 BLOOD BANK... 1 CYTOLOGY AND PATHOLOGY... 1 ACCEPTABLE & UNACCEPTABLE LABELING FOR LABORATORY SPECIMENS... 2 HEMATOLOGY, COAGULATION, AND URINALYSIS BODY FLUID CELL COUNT (NON CSF)... 3 COMPLETE BLOOD COUNT... 3 COMPLETE BLOOD COUNT WITH AUTO-DIFFERENTIAL... 3 CORRECTION STUDIES (PT OR PTT)... 3 CSF CELL COUNT... 4 D DIMER... 4 FETAL MEMBRANE RUPTURE (ROM) 4 FIBRINOGEN... 4 MONONUCLEOSIS SCREEN... 4 PARTIAL THROMBOPLASTIN TIME... 4 PLATELET FUNCTION ASSAY... 5 PROTHROMBIN TIME... 5 SEDIMENION RATE... 5 SYNOVIAL FLUID CRYSTALS... 5 URINALYSIS REFLEX MICROSCOPIC AND CULTURE, IF INDICATED... 5 URINALYSIS REFLEX MICROSCOPIC, IF INDICATED... 6 XA... 6

3 TRANSFUSION TESTING ABO/RH AND ANTIBODY SCREEN... 7 ABO/RH CONFIRMATORY TYPE..7 ABO/RH TYPE... 7 ANTIBODY SCREEN... 7 CORD BLOOD TESTING... 7 CRYOPRECIPIE... 7 DIRECT ANTIGLOBULIN TESTING... 8 FETAL SCREEN... 8 FRESH FROZEN PLASMA... 8 HOLD CLOT... 8 MICRHOGAM... 8 PLATELET... 8 RED BLOOD CELLS... 9 RH TYPE....9 RHOGAM... 9 TRANSFUSION REACTION... 9 CHEMISTRY BODY FLUIDS CARDIAC MARKERS CREATININE CLEARANCE CRITICAL CARE MARKERS DRUG LEVELS (SERUM ONLY) DRUG LEVELS (SERUM/PLASMA) DRUG SCREEN (URINE) GENERAL CHEMISTRIES HORMONES INFECTIOUS DISEASE RANDOM URINE TESTING TUMOR MARKER HOUR URINE I

4 MICROBIOLOGY ABSCESS, WOUND, ROUTINE CULTURE AFB CULTURE ANAEROBIC CULTURE BLOOD CULTURE BODY FLUID CULTURE C-DIFF CSF CULTURE CRYPTOCOCCAL ANTIGEN - CSF FUNGUS CULTURE FUNGUS CULTURE SKIN, HAIR, NAILS GARDNERELLA, TRICHOMONAS AND YEAST PROBE GI PATHOGEN GROUP A STREP CULTURE GROUP B STREP CULTURE LACTOFERRIN. 18 MRSA/STAPH SCREENING RAPID FLU A/B RAPID RSV RAPID STREP SPUTUM CULTURE STOOL GIARDIA AND CRYPTO STOOL OCCULT BLOOD STOOL O&P TISSUE CULTURE URINE CULTURE VIRUS DETECTION II

5 ANATOMIC PATHOLOGY ANAL-RECTAL CYTOLOGY (ANAL PAP) BODY FLUID CYTOLOGY BONE MARROW SPECIMEN EVALUATION BREAST LUMPECTOMY OR RESECTION BRUSH/SCRAPING CYTOLOGY CHLAMYDIA GONORRHOEAE TESTING NON-UROGENITAL SITES.22 CHLAMYDIA GONORRHOEAE TESTING - UROGENITAL SITES.22 CORE NEEDLE BIOPSY CSF CYTOLOGY CYTOGENETICS ON BONE MARROW SPECIMEN.23 CYTOGENETICS ON NON BONE MARROW SPECIMEN.23 EOSINOPHIL EVALUATION FLOW CYTOMETRY ON BONE MARROW SPECIMEN FLOW CYTOMETRY ON NON BONE MARROW SPECIMEN FNA CYTOLOGY (FINE NEED ASPIRATION) FRESH SPECIMEN FROZEN SECTION GYN PAP TEST WITH REFLEX HPV-DETECTION HEMOSIDERIN EVALUATION HPV DETECTION WITH REFLEX TO GYN PAP TEST CYTOLOGY.25 NASAL CYTOGRAM. 26 PJP (PNEUMOCYSTIS JIROVECI EVALUATION) SPUTUM CYTOLOGY TISSUE SPECIMEN TZANCK PREP URINE CYTOLOGY WASH CYTOLOGY III

6 Laboratory Labeling Guidelines: ALL SPECIMENS MUST BE LABELED WITH PATIENT NAME AND AT LEAST 1 OTHER SIGNIFICANT IDENTIFIER (DOB/MRN) General Laboratory (Chemistry, Hematology, Coagulation, Urinalysis, Microbiology, Reference) Labeled with a Cerner Accession Label or Patient Chart Sticker If labeled by hand, must have 2 patient identifiers (NAME and DOB/MRN) Labels placed so they are not covering any other patient identification Labels placed so the contents of the tubes/sterile containers are visible Cerner Accession labels must be as straight as possible for instrument reading Labels must be flat to tube, and not go over the bottom, or placed on the cap For microbiology, place the source and type of specimen on label Blood Bank DO NOT REMOVE A BLOOD BANK BRACELET WITHOUT VERIFYING WITH THE BLOOD BANK FIRST 1. Patient must be asked to verbally verify their full name (spell it) and date of birth, if possible, before collection or completion of the Blood Bank Bracelet. 2. Use a blue or black permanent ink pen (no gel pens) to legibly complete the Blood Bank Bracelet. 3. RRMC policy states that there must be at least 2 identifiers on the band. If possible, Blood Bank requests full completion of the information on the band, i.e. Name/DOB/MRN. 4. Place the label vertically on the patient s tube. 5. Place the bracelet on the patients arm before leaving the bedside. 6. Remove the tail of the bracelet and return it to the blood bank along with the tube. Criteria for rejection: write overs, incorrect spelling, smudged or illegible writing. Labeled with a Cerner Accession Label or Patient Chart Sticker Labels placed so they are not covering any other patient identification Labels placed so the contents of the tubes/sterile containers are visible type/source on label Cytology and Pathology 1

7 Acceptable Labeling for Laboratory s: Unacceptable Labeling for Laboratory s: 2

8 Hematology, Coagulation, and Urinalysis Body Fluid Cell Count (NON CSF) Cerner Order Name Useful for Body Fluid Cell Count Cell Count Body Fluid Synovial Fluid Cell Count Providing the WBC in all fluids tested. A differential will indicate which WBC cells are present and how many of each type of cells are in the fluid being tested Send to Lab S RT - 1 hour 1 of the following Lavender K2 EDTA: 4.0ml 2.0ml Complete Blood Count CBC Monitoring or detecting any of the following: Infection Anemia Bleeding disorder C 24 Room Temp **For best results, send all samples to lab ASAP** 1 of the following Lavender K2 EDTA: 4.0ml (min 1ml) 2.0ml (min 1ml) 500µl- *must filled to top line Complete Blood Count with auto-differential Correction Studies (PT or PTT) CSF Cell Count CBC Auto Diff reflex Manual Diff CBC-D Corr PT CorrPTT Body Fluid Cell Count CSF Cell Count Monitoring or detecting any of the following: Anemia Infection Inflammation Bleeding disorder Leukemia Determining whether a prolonged PT/PTT are due to an inhibitor or factor deficiency Provided the WBC and RBC count in CSF. If indicated, a differential will indicate what WBC cells are present, and how many of each type of wells are in the fluid tested C 24 Room Temp **For best results, send all samples to lab ASAP** 1 Room Temp **For best results, send all samples to lab ASAP** Send to Lab S ST - 2 hour TS - 2 hour RT - 1 hour 1 of the following Lavender K2 EDTA: 4.0ml (min 1ml) 2.0ml (min 1ml) 500µl- *must filled to top line SPECIAL REQUIREMENTS - CALL LAB Sterile CSF Collection containers * Containers must be number according to order of fill. 3

9 D Dimer Cerner Order Name Useful for D Dimer Investigating/ruling out the presence of inappropriate blood clots seen in deep vein thrombosis, pulmonary embolism, or DIC (Disseminated Intravascular Coagulation) 8 Room Temp **For best results, send all samples to lab ASAP** 1 of the following Blue Sodium Citrate: 2.7ml 1.8ml Number of Inversions: 3-4 Tubes must be filled to line on tube for proper dilution Fetal Membrane Rupture (ROM) ROM PLUS Detecting the Rupture of membrane in pregnant women Send to Lab S *Testing must be completed within 30 minutes of collection ST - 15 minutes ROM Plus collection kit Fibrinogen Fibrinogen Measuring the amount of fibrinogen and its ability to be converted into fibrin 8 Room Temp **For best results, send all samples to lab ASAP** 1 of the following Blue Sodium Citrate: 2.7ml 1.8ml Number of Inversions: 3-4 Tubes must be filled to line on tube for proper dilution Mononucleosis Screen Mononucleosis Screen Monospot Detecting, or ruling out, if patient has Mononucleosis C **For best results, send all samples to lab ASAP** 1 of the following Lavender K2 EDTA: 4.0ml (min 1ml) 2.0ml (min 1ml) 500µl- *must filled to top line Partial Thromboplastin Time Partial Thromboplastin Time PTT Diagnosing unexplained bleeding or clotting 4 Room Temp- Patient not on Heparin 2 Room Temp- Patient on Heparin **For best results, send all samples to lab ASAP** 1 of the following Blue Sodium Citrate: 2.7ml 1.8ml Number of Inversions: 3-4 Tubes must be filled to line on tube for proper dilution 4

10 Platelet Function Assay Prothrombin Time Cerner Order Name Useful for PFA Platelet Aggregate Platelet Function Prothrombin Time Protime, PT/INR Detecting platelet dysfunction induced by intrinsic platelet defects, von Willebrand disease, or exposure to platelet inhibiting agents. Monitoring or diagnosing bleeding or clotting disorders 4 Room Temp **For best results, send all samples to lab ASAP** 24 Room Temp **For best results, send all samples to lab ASAP** RT - 1 hour PHLEB DRAW ONLY - CALL LAB 1 of the following Blue Sodium Citrate: 2.7ml 1.8ml Number of Inversions: 3-4 Tubes must be filled to line on tube for proper dilution Sedimentation Rate Sedimentation Rate Sed Rate Used to monitoring inflammation C **For best results, send all samples to lab ASAP** RT -4 hours 1 of the following Lavender K2 EDTA: 4.0ml (min 2ml) 2.0ml- must be to the line * Cannot be collected in a Microtainer Synovial Fluid Crystals Syn Crystal examination Crystal Examination Synovial Looks for the presence of uric acid or CPPD crystals in synovial fluid Send to Lab S RT - 1 hour 1 of the following Lavender K2 EDTA: 4.0ml 2.0ml Urinalysis Reflex Microscopic and Culture, if indicated UA Rflx Mic/Clt Detecting urinary tract infections or kidney disease. If certain criteria are met, a culture can be indicated based on microscopic findings. A culture will help identify the type of bacteria that may be the cause of the UTI. UA: C Culture: C **For best results, send all samples to lab ASAP** Sterile Container *For best results, collect at least 5ml of urine 5

11 Urinalysis Reflex Microscopic, if indicated Cerner Order Name Useful for UA Microscopic Detecting urinary tract infections or kidney disease C 1 Room Temp **For best results, send all samples to lab ASAP** Sterile Container *For best results, collect at least 5ml of urine Xa Anti-XA (LMWH) Anti-Xa (UFH) Anti-Xa (UFH)-Heparin Monitoring heparin therapy. It can be used to monitor unfractionated heparin (UFH) or low molecular weight heparin (LMWH). 1 Room Temp **For best results, send all samples to lab ASAP** RT - 1 hour SPECIAL REQUIREMENTS - CALL LAB 6

12 Transfusion Testing ABO/Rh and Antibody Screen Cerner Order Name Type and Screen Gel T&S Gel Orders Needed to Process depends on workflow, e.g. traumas, massive bleeds, and OR patients. Type and Screen 72 hours RT - 2 hours 1 Pink EDTA Patient must be banded with Blood Bank bracelet. ABO/Rh Confirmatory Type ABO/Rh Confirmatory ABO/Rh Confirmatory 72 hours ST - 20 minutes TS - 20 minutes RT - 1 hour SPECIAL REQUIREMENTS - CALL LAB ABO/Rh Type ABO/Rh ABO/Rh 72 hours ST - 20 minutes TS - 20 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. Antibody Screen Cord Blood Testing Antibody Screen Gel ABSCR Gel DAT Cord Infant DAT ABO/Rh Cord Infant ABO/Rh Cord Blood Workup Antibody Screen 72 hours RT - 2 hours DAT ABO/Rh * Tests may be ordered individually or as a full workup that includes both. *if clinically significant antibodies are identified, workup will be longer. 72 hours RT - 2 hours 1 Pink EDTA Patient must be banded with Blood Bank bracelet. 1 Red Top tube Number of Inversions: 5 and 1 Lavender K2 EDTA: Tube must be labeled with infant information Cryoprecipitate Blood Bank Cryoprecipitate ABO/Rh * Full workup recommended but not required 72 hours ST - 40 minutes TS - 40 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. 7

13 Direct Antiglobulin Testing Fetal Screen Cerner Order Name DAT Poly Direct Antiglobulin Testing- Polyspecific Fetal Screen ABO/Rh Orders Needed to Process depends on workflow, e.g. traumas, massive bleeds, and OR patients. DAT Poly 72 hours ST - 30 minutes TS - 30 minutes RT - 1 hour Fetal Screen and ABO/Rh * Commonly ordered on Rh negative females within 72 hours after birth. Also used for Fetal/Maternal Bleeds. 72 hours RT - 2 hours SPECIAL REQUIREMENTS - CALL LAB 1 Pink EDTA Must be labeled with patient identification and 1 red sticker off Blood Bank Bracelet and placed on tube. Do NOT cut off current Blood Bank Bracelet Fresh Frozen Plasma Blood Bank Plasma ABO/Rh * Full workup recommended but not required 72 hours ST - 40 minutes TS - 40 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. Hold Clot Hold Clot 72 hours Not Applicable 1 Pink EDTA Hold Clot Patient must be banded with Blood Bank bracelet. micrhogam Blood Bank MicRhoGAM ABO/Rh 72 hours ST - 30 minutes TS - 30 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. Platelet Blood Bank Platelet ABO/Rh- if no previous history * Full workup recommended but not required 72 hours ST - 15 minutes TS - 15 minutes RT - 30 minutes 1 Pink EDTA Patient must be banded with Blood Bank bracelet. 8

14 Red Blood Cells Cerner Order Name Blood Bank RBC Orders Needed to Process ABO/Rh + Antibody Screen Gel or Type and Screen Gel depends on workflow, e.g. traumas, massive bleeds, and OR patients. 72 hours RT - 1 hours 1 Pink EDTA Patient must be banded with Blood Bank bracelet. Rh Type Rh Type Rh Only Rh Type 72 hours ST - 20 minutes TS - 20 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. RhoGAM Blood Bank RhoGAM ABO/Rh 72 hours ST - 30 minutes TS - 30 minutes RT - 1 hour 1 Pink EDTA Patient must be banded with Blood Bank bracelet. Transfusion Reaction Transfusion Reaction Workup Trxn Workup Transfusion Reaction Workup 72 hours All transfusion reactions will be worked up as soon as they are ordered. The length of the workup depends on the type of reaction. 1 Pink EDTA Must be labeled with patient identification and 1 red sticker off Blood Bank Bracelet and placed on tube. Do NOT cut off current Blood Bank Bracelet 9

15 Chemistry CSF Glucose CSF Protein Testing Send to Lab S RT - 1 hour What To Collect CSF Collection Tubes Body Fluids BF LDH BF Glucose BF Protein BF Albumin BF Amylase BF BUN BF Creatinine BF Triglycerides BF Uric Acid Send to Lab S RT - 1 hour At least 1 full: Light Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 Or Sterile Container BF ph Send to Lab S RT - 1 hour 1 Dark Green Lithium Heparin Cardiac Markers CK CKMB hscrp Troponin s must be spun within 2 hours of Draw. For best results send to lab ASAP. At least 1 full: Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 Creatinine Clearance Creatinine Clearance: Must record duration of collection (usually 24 hours) Must have creatinine Blood test collected within 24 hours of Creatinine Clearance. All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample. Call Lab for Instructions * Green Lithium Heparin Tube Preferred 10

16 Testing Critical Care Panel Ionized Calcium Lactate ph Carboxyhemoglobin VBG Cord Blood Gas s must be drawn, placed on ice, and sent to the lab IMMEDIATLEY ST- 30 minutes TS- 30 minutes RT- 30 minutes What To Collect 1 Dark Green Lithium Heparin Tube Or Heparinized Syringe Needle must be removed, and end capped before sending the sample to the lab *Lab does not provide arterial draw kits. Contact Respiratory Therapy for arterial kits Critical Care Markers ABG s must be drawn, placed on ice, and sent to the lab IMMEDIATLEY ST- 30 minutes TS- 30 minutes RT- 30 minutes 1 Heparinized Syringe-needle must be removed, and end capped before sending the sample to the lab *Respiratory usually collects these specimens Lab cannot collect these specimens *Lab does not provide arterial draw kits. Contact Respiratory Therapy for arterial kits. Capillary Blood Gas s must be drawn, placed on ice, and sent to the lab IMMEDIATLEY ST- 30 minutes TS- 30 minutes RT- 30 minutes 1 full capillary tube with flea inside. All items for collection of this test are located within the lab. Call the lab when this test is ordered. Drug Levels (Serum Only) Lithium s must be spun within 2 hours of Draw. For best results send to lab ASAP. At least 1 full Gold SST Tube Number of Inversions: 5 Drug Levels (Serum/Plasma) Drug Screen (Urine) Acetaminophen Digoxin Phenobarbital Salicylate Gentamicin (Random, Trough, Peak) Vancomycin (Random, Trough, Peak) Carbamazepine Ethanol Phenytoin Valproic Acid Urine Drug Screen (ordered as a panel) s must be spun within 2 hours of Draw. For best results send to lab ASAP. All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample. At least 1 full: Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 Sterile Container * Green Lithium Heparin Tube Preferred 11

17 General Chemistries Acetone Albumin Alk Phos Amylase ALT AST Bun CO2 CRP GGT Magnesium Uric Acid Sodium Testing Protein Potassium Calcium Chloride Cholesterol Creatinine Ferritin Phosphorous Triglycerides LDL HDL Bilirubin (Direct, Total, Total & Direct) Glucose (Fasting, Diabetic Screen, 2hr PP, 2hr GTT, 3GTT) Panels: o CMP o BMP o Liver Function o Renal Function, o Lipid Profile C3 C4 Folate Iron Rheumatoid Factor Vitamin D IgA IgG IgM TIBC Vitamin B12 s must be spun within 2 hours of Draw. For best results send to lab ASAP. s must be spun within 2 hours of Draw. For best results send to lab ASAP. What To Collect At least 1 full: Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 At least 1 full Gold SST Tube Number of Inversions: 5 * Green Lithium Heparin Tube Preferred 12

18 TSH, T4, Free T4, Total T3 Free Testing s must be spun within 2 hours of Draw. For best results send to lab ASAP. What To Collect At least 1 full: Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 Hormones TSH Cascade Cortisol, Random Cortisol, Baseline, 30 min., 60min (ACTH) FSH Prolactin T3 Total PTH s must be spun within 2 hours of Draw. For best results send to lab ASAP. At least 1 full Gold SST Tube Number of Inversions: 5 * Green Lithium Heparin Tube Preferred Infectious Diseases Hepatitis A/B/C Panel HIV Antibody Syphilis Lyme Measles Mumps Rubella Procalcitonin Varicella Zoster s must be spun within 2 hours of Draw. For best results send to lab ASAP. Hepatitis, HIV, and Syphilis samples are only run M-F between 8am-1pm. At least 1 full Gold SST Tube for Syphilis 2 full Gold SST Tubes for Hepatitis Testing Number of Inversions: 5 Random Urine Testing Phosphorous Protein Urea Nitrogen Microalbumin Calcium Creatinine Glucose Potassium Sodium Uric Acid All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample. Sterile Container 13

19 Ca125 CEA Testing s must be spun within 2 hours of Draw. For best results send to lab ASAP. What To Collect At least 1 full Gold SST Tube Number of Inversions: 5 Tumor Marker PSA, Diagnostic PSA, Screening s must be spun within 2 hours of Draw. For best results send to lab ASAP. At least 1 full: *Green Lithium Heparin Tube Or Gold SST Tube Number of Inversions: 5 24 Hour Urine Phosphorous Protein Urea Nitrogen Uric Acid Microalbumin Calcium Creatinine Glucose Potassium Sodium All urine testing should be sent to the lab ASAP. If unable to transport right away, refrigerate sample Call Lab for Instructions * All 24-hour urines MUST be refrigerated on kept on ice during the whole collection process * Green Lithium Heparin Tube Preferred 14

20 Microbiology Abscess, Wound, Routine Culture Cerner Order Name C Abscess C Wound C Routine *Orders require a source. Useful For Identifying bacteria responsible for infections Sterile Container: 2 hours Room Temperature 24 hours Refrigerated Swab: 48 hours Room Temp **For best results, send all samples to lab ASAP** 3 days *Gram stain completed within 1 shift Sterile Container ESwab-White Cap (Most Common) ESwab-Green Cap( small sources) Collect material from actual infection site with minimal contamination from adjacent areas. AFB Culture C AFB AFB Culture *Orders require body fluid type or source Detect the presence of Acid Fast Bacilli in a specimen Sterile Container: 2 hours Room Temperature 24 hours Refrigerated Negative: 6 weeks Positive: Reported when become positive Sterile Container Anaerobic Culture Anaerobic with Aerobic Scr. Culture C Anaerobe *Orders require a source. *Note difference in collection containers for tissues and body fluids. Detection of bacteria only capable of surviving in oxygen lacking environments Send to lab Immediately 3 days *Gram stain completed within 1 shift Tissues All anaerobic tissues MUST be collected in the small anaerobic jar and CANNOT be placed in the tall, skinny anaerobic vial for fluids. Body Fluids All body fluids for anaerobic testing MUST be collected in the tall, skinny anaerobic vial, and should not be placed in the small anaerobic jar meant for tissues. *Note: Tissue samples should be in contact with the media in the vial *Do NOT pierce gel. * Do not remove cap. Open sterile pack, then pierce rubber stopper on cap with syringe to add fluid. ***Swabs are not acceptable collection devices for anaerobic cultures ***Swabs are not acceptable collection devices for anaerobic cultures 15

21 Blood Culture Cerner Order Name Blood Culture Useful For Testing for septicemia and bacteremia Bring to Lab ASAP Negative: 5 days Positive: Called to floor when bottle becomes positive Green BacT Alert Aerobic Bottle Orange BacT Alert Aerobic Bottle Yellow BacT Alert Pedi Bottle (12 yrs. and under ONLY) Adult: Aerobic: 8-10ml Anaerobic: 8-10 ml Pediatric: ml Body Fluid Culture C Body Fluid Body Fluid Culture *Orders require body fluid type Detect the presence of bacteria in normally sterile body fluids Send to lab immediately 3 days *Gram stain completed within 1 shift Sterile Container Red Top Tube Syringe with no needle *Swabs are unacceptable* C- Diff C Diff Toxin Clostridium Difficile Toxin Detection of toxogenic C- Diff DNA in liquid fecal specimens 3 days Refrigerated **For best results, send all samples to lab ASAP** 1 day Sterile Container White Para-Pak Vial *Formed stools not accepted CSF Culture CSF Culture C CSF Detect bacterial infection or presence in CSF. Often seen in cases of meningitis Send to lab immediately. 3 days *Gram stain completed within 1 hour Sterile Container Cryptococcal Antigen - CSF CSF Crypt Ag Cryptococcal Antigen Scr Detection of the capsular polysaccharide antigens of Cryptococcus species in CSF Send to lab immediately 1 hour Sterile Container 16

22 Fungus Culture Cerner Order Name C Fungus Fungus Culture *Orders require body fluid type or source Useful For Detect the presence of fungi in a specimen Sterile Container: 2 hours Room Temperature 24 hours Refrigerated Negative: 6-8 weeks Positive: Reported when become positive Sterile Container Fungus Culture Skin, Hair, Nails Fungus Culture Skin, Hair, Nails Detect the presence of fungi in a specimen Sterile Container: 2 hours Room Temperature 24 hours Refrigerated Negative: 6-8 weeks Positive: Reported when become positive Sterile Container Gardnerella, Trichomonas and Yeast Probe GTY Probe Useful for the detection of Candida, Gardnerella, and Trichomonas in vaginal fluid specimens 72 hours 1 day S: 1 hour Affirm GTY Kit GI Pathogen (Previously Stool Culture) GI Pathogen PCR Stool Pathogen PCR Detection of: Campylobacter Salmonella Shigella Yersinia Enterocolitica Vibrio Norovirus Rotavirus Shiga Toxins Sterile Container: 1-hour Room Temperature Orange Para-Pak: 48 hours refrigerated **For best results, send all samples to lab ASAP** 24 hours Sterile Container Orange Para-Pak Vial (preferred) Group A Strep Culture C Strep A Group A Strep Detect the presence of Group A Step 48 hours Room Temperature **For best results, send all samples to lab ASAP** 3 days White Cap (Flocked) ESwab Collect from inflamed throat and/or tonsil area 17

23 Group B Strep Culture Cerner Order Name C Strep B Group B Strep Useful For Prenatal Screening for Group B Strep colonization 48 hours Room Temperature **For best results, send all samples to lab ASAP** 3 days Green Star Swab II Collection from vaginal introitus and anorectum Lactoferrin Lactoferrin Screen for fecal leukocytes Sterile Container or White Para- Pak: Refrigerated within 1 hour of collection. Acceptable 14 days refrigerated 1 day Sterile Container White Para-Pak Vial MRSA/Staph Screening Rapid Flu A/B C MRSA C Pre-op Staph Screen Rapid Influenza A/B PCR Vir Rapid Flu PCR Detection of MRSA from anterior nares, groin, and or axilla. Detection of MRSA or MSSA from preop anterior nares specimen only. Not intended to monitor treatments Rapid detection of Influenza A & B in respiratory specimens Swab: 48 hours Room Temperature **For best results, send all samples to lab ASAP** 72 hours Refrigerated **For best results, send all samples to lab ASAP** 3 days White Cap (Flocked) ESwab Only 1 hour NP swab only Rapid Flu/ RSV PCR Rapid Influenza A/B and RSV PCR Rapid detection of RSV in respiratory specimens 72 hours Refrigerated 1 hour NP swab only Rapid RSV **For best results, send all samples to lab ASAP** 18

24 Rapid Strep Cerner Order Name Rapid Strep Strep A Ag Useful For Rapid detection of the Group A Antigen 48 hours Room Temperature **For best results, send all samples to lab ASAP** 1 hour Green Star Swab II Sputum Culture C Sputum Sputum Culture *Required source: Endotrach, Sputum Induced, Sputum, Sputum Aspirate, Trach Aspirate Identifying bacteria responsible for respiratory tract infections 2 hours Room Temperature 24 hours Refrigerated **For best results, send all samples to lab ASAP** 3 days *Gram stain completed within 1 shift Sterile Container Expectorated or induced sputum: Collect a deep, vigorous cough, directly into sterile container Stool Giardia and Crypto Giardia/ Cryptosporidium Ag Detecting Giardia or Cryptosporidium antigen in feces Sterile Container: 1-hour Room Temperature Black Para-Pak: 96 hours 2-3 days Sterile Container Black Para-Pak Vial *Collection kit available upon request from lab Stool Occult Blood Fecal Occult Blood Diagnostic or Screening Occ Bld Fec, Dgn, or Scr Detection of Hemoglobin in stool samples. Often seen in GI Bleeds. **For best results, send all samples to lab ASAP** Sterile Container: 1-hour Room Temperature Occult Card: 14 Days Room Temperature 1 day Sterile Container Occult Card Stool O&P O&P Exam Ova and Parasite Exam Identifying parasites and/or ova in feces **For best results, send all samples to lab ASAP** Sterile Container: Fresh stool in white top must be transferred to black top within 1 hour of collection 2-3 days Sterile Container Black Para-Pak Vial *Collection kit available upon request from lab Black Para-Pak: 96 hours **For best results, send all samples to lab ASAP** 19

25 Tissue Culture Cerner Order Name Tissue Culture C Tissue *Orders require a source. Useful For Detection of bacteria on or in body tissues Send to lab Immediately Refrigerate only if there is a delay 3 days *Gram stain completed within 1 shift Sterile Container * DO NOT SEND SWAB OF TISSUE. C Urine Urine Culture Detection of UTI **For best results, send all samples to lab ASAP** 24 hours Refrigerated 3 days Sterile urine container Urine Culture *Orders require collection type: Clean Catch, Mid- Stream, Cystoscopy, Kidney, Pedi Bag, Suprapubic Asp, Ureteral, NOS **For best results, send all samples to lab ASAP** Virus Detection Virus Adenovirus Detection Virus Cytomegalovirus Detection Virus Influenza & RSV Detection Virus Herpes Simplex Detection Virus Metapneumovirus Detection Virus Parainfluenza Detection Virus Varicella Zoster Virus VTDH Flu Detection Rapid (qualitative) detection of viruses through PCR Return to lab within 24 hours refrigerated **For best results, send all samples to lab ASAP** 3-5 Days NON-Nasopharyngeal/ Body Fluid sites: Adult Virology FloqSwab Collection Kit Nasopharyngeal: Wire shaft, polyester tipped swab in Copan sleeve Body Fluids: Sterile Container *Requires Type 20

26 Anatomic Pathology Anal-Rectal Cytology (Anal Pap) Cerner Order Name Pathology NON-GYN Useful For Evaluation of HPV related lesions in upper anal-rectal mucosa. Send to lab in timely manner. is stable at room temperature. 1 Day Swab/brush above the anal transformation zone, and swish or clip the brush into NONGYN PreservCyt vial. Single-use Anal-Rectal kits available through the lab. Body Fluid Cytology Pathology NON-GYN Evaluating the presence or absence of malignant cell populations in effusions. Send to lab immediately 1 Day NO FIXATIVE. Tap effusion. Submit ALL fluid regardless of volume. Bone Marrow Evaluation Pathology Bone Marrow Must contact Cytology Dept for assistance x1786 Evaluating disorders involving blood and bone marrow hours refrigerated 1-2 Days (2)-1 ml Sodium Heparin Green (1)- 1 ml K2 EDTA (1)- Formalin container with clot specimen (1)- Formalin container with filter specimen 6 to 9 prepared slides Breast Lumpectomy or Resection Pathology TISSUE Refer to lab with any questions. Extension Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "fresh specimen Hours Fresh specimen. NO FIXATIVE. 21

27 Brush/ Scrapping Cytology Chlamydia Gonorrhoeae Testing - Non- Urogenital sites Chlamydia Gonorrhoeae Testing - Urogenital sites Cerner Order Name Pathology NON-GYN Misc Mayo GOKEY MCTGC CT PCR NG PCR Chlamydia Gonorrhea PCR Panel Useful For Evaluating possible malignant cell populations in brush/scraping of bronchial tree, gastric mucosa, oral mucosa, tongue scraping, or other surface lesions. Diagnosing Chlamydia trachomatis & Neisseria gonorrhoeae infections in Throat, Oral, Rectal or Eye specimens Diagnosing urogenital Chlamydia trachomatis & Neisseria gonorrhoeae infections in male and female. Transport as soon as possible or refrigerate with Cytolyt. Swab: 30 days at 2-30 C 1. Urine: 24 hours refrigerated (male or female) 2.Vaginal swab: 60 days at 2-30 C (female only) 3. PreservCyt Pap Test Co-collection: 60 days at 2-30 o C (female only) 1 Day Submit as 2 fixed slides made by rolling the brush across the slide, and rapidly submersing slides in Coplin Jar with 95% ethanol or fix with spray fix. Vigorously swish then clip the brush tip into the Cytolyt tube. Submit slides and Cytolyt tube containing brush tip. 1-3 Days Blue Swab Only: Discard White Swab. Use Blue Swab Only. Swab site and place in transport tube. Snap off swab at score line to fit inside tube. Securely fasten cap. 1-2 Days 1. Urine: (male or female) Collect first 30 ml of NON- Clean Catch (Dirty) urine, at least 2 hours post previous urination. 2. Vaginal swab: (female only) Use Uni-swab PCR Collection Kit, swab vaginal canal without prior cleaning. Submit swab in the collection tube, snapping it off at the demarcation line. Aptima Swab Collection Kit Vaginal Swab Collection Kit PreservCyt ThinPrep Urine Collection Vial Cup 3. PreservtCyt Pap Test: (female only) Collect as for Pap test with an endocervical broom/spatula, vigorously swish into ThinPrep vial, discard collection device. 22

28 Core Needle Biopsy Cerner Order Name Pathology TISSUE Useful For Routine Pathology. Transport specimen as soon as possible to the lab Hours Tissue Sample added to container with formalin. Record time specimen enters container on patient label. CSF Cytology Pathology NON-GYN Evaluating the presence or absence of malignant cell populations in Cerebrospinal Fluid. Send to lab immediately 1 Day Tapped CS Fluid. Submit as fresh. Cytogenetics on Bone Marrow Bone Marrow Must contact Cytology Dept for assistance x1786 Evaluating genetic abnormalities associated with various diseases hours refrigerated > 5 Days Testing Performed at Mayo Medical Labs (2)-1 ml Sodium Heparin Green OR (2)- 2 ml bone marrow OR Tissue in RPMI (RPMI located in Histology refrigerator). Cytogenetics on NON Bone Marrow Cytogenetics Evaluating genetic abnormalities associated with various diseases hours refrigerated > 5 Days Testing Performed at Mayo Medical Labs (1)-1 ml Sodium Heparin Green Peripheral Blood only Eosinophil Evaluation Pathology NON-GYN *Please specify in Order Comments tab whether testing request is for "eosinophils only" or "eosinophils and cytology" Detection of eosinophils in fluid specimens. Transport as soon as possible or refrigerate with Cytolyt. 1 Day Submit as fresh or with Cytolyt fixative. 23

29 Flow Cytometry on Bone Marrow Cerner Order Name Bone Marrow Must contact Cytology Dept for assistance x1786 Useful For Evaluating disorders involving blood and bone marrow hours refrigerated 1-2 Days Testing done at UVMMC. (2)-1 ml Sodium Heparin Green AND (2)-2 ml EDTA Lavender OR Tissue in RPMI (RPMI located in Histology refrigerator) Flow Cytometry on NON Bone Marrow Flow Cytometry Evaluating disorders involving blood and bone marrow hours refrigerated 1-2 Days Testing done at UVMMC. 6 ml Sodium Heparin Green for Peripheral Blood OR 1.5 ml CSF OR 5 mm 3 or larger tissue biopsy in RPMI (RPMI located in Histology refrigerator Must call to obtain) FNA Cytology (Fine Needle Aspiration) Fresh Pathology FNA Pathology TISSUE Evaluating the presence or absence of malignant cell populations in palpable or imaged lesions. Anything other than Routine Pathology. Example: lymph nodes, looking for lymphoma. Send to lab in timely manner. is stable at room temperature. Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "fresh specimen. 1 Day Generally, 1-3 needle passes, submitted as fixed material. Cell Blocks can be made from generous sampling for confirmation/typing stains (specimen material should be visible in the Cytolyt tube). Each pass should contain Preferred: 1. One Labeled, direct-smear slide dropped, while wet, into a Coplin Jar filled with 95% alcohol. 2. One labeled, direct smear, spreader slide allowed to air dry. 3. Needle rinse material in CytoLyt collection tube. Acceptable: 1. One Cytolyt tube with contents of each pass expressed directly into media Hours Fresh specimen. NO FIXATIVE. 24

30 Frozen Section GYN Pap Test Cytology with HPV Detection Cerner Order Name Pathology TISSUE *Place order in Cerner stating frozen section needed BEFORE the specimen is sent to pathology. Pathology GYN HPV reflex testing options include: HPV if ASC/LSIL HPV Co-testing Reflex Genotype Useful For Immediate diagnosis. Screening detection for squamous cancer or precursors and molecular detection of HPV in cervical, endocervical, and vaginal brushings. Transport specimen as soon as possible to the lab. Make sure to directly hand the specimen to a laboratory employee and communicate that it is a "frozen specimen. 60 Days from collection at Room Temperature 20 Minutes Fresh specimen. NO FIXATIVE. 3 to 5 Days Endocervical brush/spatula, vigorously swished into ThinPrep PAP Test vial, discard brush/spatula. Single-use collection kits available through the lab. Hemosiderin Evaluation Pathology NON-GYN *Please specify in Order Comments tab whether testing request is for "hemosiderin-macrophages only" or "hemosiderinmacrophages and cytology". Detection of hemosiderin-laden macrophages in fluid specimens. Transport as soon as possible or refrigerate with Cytolyt. 1 Day Submit as fresh or with Cytolyt fixative. HPV Detection with Reflex to Pap Test Cytology HPV Primary Screen Alternative screening algorithm for detection of squamous cancer or precursors and molecular detection of HPV. For women >25 yr. Cytology is performed only if HPV result is HPV HR Other Positive. 60 days from collection at 2-30 o C 1-3 days Endocervical brush/spatula in a ThinPep Vial, discard brush/spatula. 25

31 Nasal Cytogram Cerner Order Name Pathology NON-GYN Useful For Differentiation of allergic, nonallergic, infectious, inflammatory, and non-inflammatory forms of rhinitis Send to lab in timely manner. is stable at room temperature. 1 Day 1 air-dried slide in a slide holder and 1 CytoLyt tube containing the Rhino-probe. PJP (Pneumocystis Jiroveci Evaluation) Pathology NON-GYN *Please specify in Order Comments tab whether testing request is for "PCP only" or "PCP and cytology". Detection of PJP (formerly PCP) in respiratory specimens. Transport as soon as possible or refrigerate with Cytolyt. 1 Day Submit as fresh or with Cytolyt fixative Sputum Cytology Pathology NON-GYN Evaluating the presence or absence of malignant cell populations in sputum. Transport as soon as possible or refrigerate with Cytolyt. 1 Day Deep cough expectorate. Do not have patient spit. Submitted as fresh or with Cytolyt fixative. Tissue Pathology TISSUE Routine Pathology. Transport specimen as soon as possible to the lab Hours Tissue Sample added to container with formalin. Record time specimen enters container on patient label. 26

32 Cerner Order Name Useful For Pathology NON-GYN Detection of cellular change associated with varicella virus in surface lesions/blisters. Send to lab in timely manner. is stable at room temperature. 1 Day Directly scrape the blister/lesion base, spread onto 1 air dried slide, vigorously swish the collection device in the PreservCyt vial, discard collection device. Tzanck Prep or Varicella Zoster Submitted slides AND PreservCyt vial. Single-use Tzanck Prep kits available through the lab. Urine Cytology Pathology NON-GYN *Must Specify voided urine, catheterized urine or bladder wash Evaluating the presence or absence of malignant cell populations in voided urine, catheterized urine, and bladder washes. Transport as soon as possible or refrigerate with Cytolyt. 1 Day Clean-catch midstream urine, or catheterized-urine, or wash collection. Make sure to specify the collection type on the label. Can be submitted as fresh or with up to 30mL of Cytolyt fixative. Wash Cytology Pathology NON-GYN Evaluating the presence or absence of malignant cell populations in washes (bronchial, abdominal, etc.). Transport as soon as possible or refrigerate with Cytolyt. 1 Day Submit as fresh wash collection or mixed with Cytolyt fixative. 27