The laboratory runs a tour of the department for Practice Nurses on request, as part of their training, explaining the procedures and requirements for Gynae LBC. RECOMMENDED PROTOCOL FOR SMEAR TAKERS Only take the sample if the woman is due for a sample Only Cytyc thin prep kits must be used. All smear takers must be suitably trained to take Cytyc thin prep samples and have their own unique smear taker identity number. Only use LBC vials provided by the laboratory and ensure they are within the expiry date. Expired vials cannot be processed. Do not use any other containers. One sample per patient is adequate. The vial has an area provided for recording patient information. For hand written entries, use permanent markers or inks that will not rub off or blur (not ball point pens). Complete the label on the LBC vial immediately before taking the sample. Never label vials in advance. Include First name, Surname, DOB and NHS number. Check directly with the woman for accuracy. The following samples will be rejected and the laboratory will notify the sender. Specimen received unlabelled. Absence of 2 or more of key demographic information. (Patient s full name and NHS number or date of birth or Hospital number). Major mismatch of key demographic information. Out of programme samples: Samples from women under 24.5 years unless woman is on routine recall after previously tested at 20 years in Wales, Scotland or Northern Ireland, being followed up for previous abnormal cytology, being followed up after having and incidental biopsy showing CIN but have had no prior cytology, taken by a colposcopist/gynaecologist where they have clearly documented on the request form the rationale for taking the sample. Samples from women over 65 unless woman unscreened, missed last invitation at 60 or is in follow up for previous abnormal Samples taken more than 6 months ahead of schedule following a routine recall Samples taken at an inapropriate period after a previous HPV negative test and returned to routine recall Samples requested following an unreliable HPV test repeated in less than 3 months as part of a test of cure QPulse record: Pathology 2436 Revision: 7 Page 1 of 5
Unreliable HPV test repeated in less than 6 months as part of a triage Samples taken inappropriately at colposcopy contrary to the NHSCSP HPV testing implementation guidelines Samples taken less than 3 months ahead of schedule following a previous inadequate test Vault samples from women with total hysterectomy for non-cervical malignancy or benign conditions. 1. No fluid in vial received 2. Samples received without a form, sender contacted and no form received or found within 2 days. 3. Form received without a sample, sender contacted and no sample received or found within 2 days. 4. No form received with sample Unable to trace the sender 5. No sample received with form Unable to trace the sender 6. Sample received in the wrong type of container e.g formalin pot 7. Specimen received in an out of date vial For further information regarding labelling of specimens. refer to document Pathology: General guidance on completing request forms, request forms in use & labelling specimens If your clinic prepares patient information via adhesive label, place the label over the PreservCyt solution vial label. However, take care not to overlap multiple labels and do not obscure the frosted areas on the vial. Apply labels smoothly and evenly; all edges should be flat and contacting the surface of the vial. Where possible, limit the number of labels placed onto the vial. Do not place labels on top of the vial cap or on the bottom of the vial or over the expiry date of the vial. Do not use any adhesive tapes on vials. Do not place the brush head in the vial. QPulse record: Pathology 2436 Revision: 7 Page 2 of 5
Please ensure that vial lid is not cross-threaded, then is securely tightened, some vials will be provided with a black line on the lid and vial, please ensure the lid is tightened so that the black lines correspond. Remove any remaining cellophane from the vial. Place in a specimen transport bag with the vial in the sealed part and the corresponding form in the plastic sleeve of the bag. What to do if the vial contents are spilt It is important for the laboratory to know if the sample was added before or after the contents were spilt. If the vial is knocked over after the sample has already been added to the fluid in the vial: Look to see if any fluid still remains in the vial. If about 1/3 of the fluid still remains, continue to send the sample to the laboratory for processing and make a note on the request form to inform the laboratory that the sample was added before the spillage occurred. Do not top up the vial with fluid from a new vial as the laboratory will make the necessary adjustments. If less than 1/3 of the fluid remains, continue to send the sample to the laboratory for processing and make a note on the request form to inform the laboratory that the sample was added before the spillage occurred. Do not top up the vial with fluid from a new vial. The laboratory will issue an inadequate report and the sample should be repeated after an interval of 3 months. Overfull vials will be queried with the sender before any processing can be done If the vial is knocked over before the sample has been added to the fluid in the vial: Use a new vial for the sample. Remember to re-label the new vial correctly. Discard the unused vial. Request form Please ensure the information on the accompanying request form matches that on the LBC vial, including the correct collection date. This will avoid delays in processing the specimen. Always include the patient s current home address. Where the result is not to be sent to the home address state No letter to home address clearly on the form, then give an alternative address wherever possible stating clearly on the form where the result is to be sent. QPulse record: Pathology 2436 Revision: 7 Page 3 of 5
The sample will not be processed if the sample test date is missing. Clarification of missing or unclear information will be required from the sender in writing before sample processing is undertaken. Document clearly when the cervix is not fully visualised. Smear takers should write their unique identification code on all the request forms. The request form must be signed and dated (where applicable) by the sample taker. The laboratory will only accept samples from suitably trained samples takers trained in the Thinprep method who have been issued with a PIN. The sample taker PIN must be written on the request form (close to the sample taker signature). Please note that samples taken by untrained senders and/or by sample takers not on the laboratory PIN log will be destroyed. PIN are managed and issued by the laboratory and all enquiries/requests for PIN should be addressed through the Cytology Administrator on the above contact telephone number If the samples are taken at the colposcopy clinic, always write the colposcopic opinion of the cervix. If the woman has any previous history of treatment to her cervix record the histology results, date and type of treatment on the request form.( i.e LLETZ, cone biopsy, cold coagulation or cervical biopsy). This information is particularly important if treatment has been carried out elsewhere. Patients HIV status (if HIV positive) must be provided on the request form to aid accurate management. A Patient-specific form is available to download from the Open Exeter website. This can include some previous Cervical Cytology history from elsewhere and is preferred form of use. GP practices with multiple doctors - please ensure that you write the GP s name on the form, and on all copies of a multipart form not just the stamp of the surgery. For further information regarding labelling of specimens, refer to document Pathology: General guidance on completing request forms, request forms in use & labelling specimens QPulse record: Pathology 2436 Revision: 7 Page 4 of 5
Endocervical Brush Samples. Brush samples should be taken at the same time as a LBC sample. Brush samples should not be used alone for screening purposes. Endocervical Brush samples are requested if: An endocervical lesion is suspected. In post cone follow-up. Tight Cx OS. Factors that can affect the result: The use of lubricant during LBC sample taking is not recommended as this can lead to inadequate processing. A mid - cycle sample is the sample of choice as menstrual samples may lead to inadequate processing. The recent use of talcum powder, Canestan (or similar) pessaries may lead to contamination of the sample. The presence of a brush head in the sample (if no dyskaryosis is seen) will lead to an inadequate report being issued. The sample taker will be informed. When the cervix is not fully visualised and if no dyskaryosis is reported, an inadequate report will be issued. The presence of TZ (Transformation Zone) sampling is required in follow up samples from patients with a history of CGIN. When samples are reported as inadequate or if the laboratory reports an unprocessed sample, repeat cytology should not be performed less than three months after a previous test. Consumable stock ordering and storage All LBC consumables necessary for taking cervical cytology specimens are supplied by the Cytology laboratory at Queens hospital NHS trust. To request stock either telephone the laboratory on ext. 3684 (01708 435000 ext. 3684) or alternatively complete an order form supplied by the cytology laboratory and return by fax or with samples. LBC vials should be stored at 15 C 30 C and cervix brushes should be stored at room temperature or on open shelves. We do not recommend sample takers hold vast quantities of stock and it should be rotated to ensure it does not exceed the use by date. QPulse record: Pathology 2436 Revision: 7 Page 5 of 5