SPECIMEN COLLECTION-WAIVED TESTING POLICY 1. Application for waived testing will be submitted to CLIA (Clinical Laboratory Improvement Amendments) on a yearly basis. 2. All laboratory specimens: PURPOSE A. Will be collected using Universal Precautions. B. Will be collected using Quest s Directory of Services submission requirement. C. Will be transported in red puncture proof containers or puncture proof containers with the red Biohazard label affixed to the outside of the container. To assist the physician in assessing home care patient s status by collecting specimens for laboratory analysis. PROCEDURE For all specimen collection (see specific type of specimen needed for further instructions.) 1. Check physician s order for laboratory test to be performed. 2. Check Quest s Directory of Services for any specifics regarding type of specimen to be obtained (i.e. color of test tube, refrigeration needed, length of time specimen is stable.) 3. Explain the procedure to the patient. 4. Assemble equipment. 5. Wash hands before and after specimen collection. 6. Use Universal Precautions; use goggles if splashing is likely. 7. Clean tubes or specimen containers with Cavicide if contaminated with blood or body fluids. 8. Label specimen with patient s full name. Apply sticker with requisition number from laboratory requisition to specimen container.
9. Put specimen in plastic leak proof bag and then into puncture proof container. 10. Discard disposable items in a plastic bag and secure. 11. Fill out laboratory requisition and transport. 12. Document on visit report type of specimen obtained, patient toleration of test and laboratory to which the specimen was brought. VENOUS BLOOD SAMPLING To be obtained by registered nurse or licensed practical nurse (if IV certified.) Do not draw blood from the patient s arm that has a shunt or intravenous therapy line. Do not draw blood from lower extremities. Gray, blue, and purple-topped test tubes should be gently inverted a couple to times after they are filled with the blood sample to prevent clotting. Notify the nursing supervisor after three unsuccessful attempts to enter the vein. 1. Equipment A. Vacutainer specimen tubes B. Vacutainer holder and vacutainer needles or syringe large enough to hold the quantity of blood desired with a 19 to 21 gauge needle C. Tourniquet D. Bandage E. Cotton Ball F. Laboratory requisition G. Antiseptic wipes H. Disposable nonsterile gloves, sharps container 2. Procedure A. Assist the patient to either a sitting or supine position for venipuncture. B. Select the site for venipuncture. The antecubital fossae and veins in the arms and hands are suitable. C. Place the arm in a dependent position. Apply a tourniquet 6 to 8 inches above the site of venipuncture. D. Cleanse the area with antiseptic wipes, moving the wipes in a circular motion 3 to 4 cm outward from the needle insertion site. E. Fix the chosen vein with the thumb, and draw the skin taut immediately below the site before inserting the needle F. At approximately ½ inch below the venipuncture site, insert the needle with the bevel up at a 30-degree angle so that it enters the skin and then the vein. G. Observe for blood flow. H. Lower the syringe so that it is almost parallel to the skin.
I. The following is the technique for use with a syringe; 1) Withdraw the desired amount of blood into the syringe. 2) Release the tourniquet before removing the needle from the vein to reduce the incidence of hematoma formation. 3) Elevate the arm. Apply pressure to the area with a cotton ball for approximately 2 to 4 minutes or longer if the patient is anticoagulated. 4) Inject blood from the syringe into the proper vacutainer specimen tubes. J. The following is the technique for using a vacutainer: CULTURE COLLECTION 1. Ova and Parasite 1) Insert the vacutainer specimen tube into the holder but not onto the 2-way vacutainer needle. 2) Perform venipuncture as described. 3) Gently push the vacutainer specimen tube against the end of the holder onto the 2-way needle; make sure that the 2-way needle completely pierces the rubber stopper of the specimen tube; the vacuum in the specimen tube will automatically draw up the blood sample. 4) If more than one sample is needed, gently withdraw the filled specimen tube from the holder; insert the next tube into the holder so that the needle completely pierces the rubber stopper. 5) Release the tourniquet before the last tube is completely filled; this reduces the incidence of hematoma formation; allow the last tube to fill. 6) Elevate the arm; apply pressure to the area for approximately 2 to 5 minutes or longer if the patient is receiving anticoagulant therapy. 7) Apply a bandage to the area as needed. Can be obtained by a registered nurse or licensed practical nurse. 1) Bedpan 2) Tongue blade 3) Specimen cup 4) Laboratory requisition 5) Disposable nonsterile gloves (See Infection Control)
2. Sputum 1) Assist the patient onto the bedpan or into the bathroom. 2) Collect a specimen by using a tongue blade to obtain a small amount of stool and placing it in the specimen cup. 3) Perform perineal care as needed. 4) DO NOT refrigerate for ova and parasite. Can be obtained by RN or LPN. Obtain a sputum specimen in the morning when the patient has more strength to expectorate. Sputum can be collected for culture by expectoration, as well as by naso-oropharyngeal, endotracheal, or tracheal suctioning. 3. Stool 1) Sterile specimen (if for culture and sensitivity) 2) Laboratory requisition 3) Antiseptic wipes 4) Disposable nonsterile gloves 1) Instruct the patient to expectorate. Clarify difference between sputum and saliva, as well as the time of day to collect the specimen. 2) Instruct the patient to rinse the mouth with water. The patient should breathe deeply and then forcefully cough to expectorate lower respiratory secretions directly into the container. 3) For tracheostomy the following is performed: a. Attach a sputum trap between the suction catheter and the suction tubing b. Suction the patient c. Remove the sputum trap, and close it according to the manufacturer s instructions 4) Offer oral hygiene as needed. Can be obtained by a registered nurse or licensed practical nurse. Culture the first morning stool.
4. Throat 1) Culturette or stool specimen cup 2) Tongue blade 3) Bedpan or container 4) Laboratory requisition 5) Disposable nonsterile gloves 1) Assist the patient onto the bedpan or into the bathroom 2) Collect a stool specimen using a tongue blade to obtain a small amount of stool, to be placed in a specimen cup or by swabbing stool with a swab culturette. 3) If you are using a specimen cup, replace the container cap. 4) If you are using a culturette, replace the swab in the container. Hold the cap down, and crush the ampule at the bottom to disperse culture medium fluid. 5) Perform perineal care as needed. 6) DO NOT refrigerate stool specimen. To be obtained by registered nurse or licensed practical nurse. 5. Wound 1) Assist the patient to a sitting or a lying-down position. 2) Remove the cap from the culture tube. Do not touch the cap or inside of the culture tube. Remove the swab from the culture tube. 3) Instruct the patient to open his/her mouth as wide as possible and to say ahh. Depress the tongue, with a tongue blade and culture area by moving the swab over the inflamed or purulent area. 4) Return the swab to the culture tube. Replace the cap. Holding the cap down, crush the ampule at the bottom of the culture tube to release the culture medium fluid. To be obtained by registered nurse or licensed practical nurse. Anaerobic cultures are not done with culturette specimens. Deep wounds should be aspirated by the physician using a syringe and sent to the lab in an anaerobic culture tube. 1) Culturette
FECAL OCCULT BLOOD 2) Wound dressings as prescribed by the physician 3) Laboratory requisition 4) Disposable nonsterile, sterile gloves 1) Position the patient to expose the wound. Drape the patient appropriately. 2) Apply nonsterile gloves and remove the dressing. 3) If order is to clean wound with normal saline; do this prior to obtaining wound culture. 4) Remove the cap and swab from the culturette; do not touch the cap end, the swab, or inside the culturette container. 5) Swab from the center of the wound outward and avoiding contaminating the skin. 6) Discard the nonsterile gloves, and apply sterile gloves. 7) Clean wound as prescribed (if using antimicrobial). 8) Return the swab to the culturette. Hold the cap end down, and crush ampule at the bottom to disperse the culture medium fluid. 9) Redress the patient s wound, as ordered. Can be obtained by RN or LPN. Ingestion of high doses of vitamin C (ascorbic acid) in excess of 250mg each day has been associated with false negative readings. Be aware that certain oral medications may cause gastrointestinal irritation and bleeding. Ingestion of iron preparations, turnips, fish, rare meat, and poultry are associated with false positive readings. 1) Hemoccult Sensa in a specimen cup 2) Tongue blade 3) Bedpan/container 4) Soap and warm water, basin, tissues, washcloth, and towels 5) Disposable nonsterile gloves 1) Assist the patient to the bedpan or to the bathroom. 2) Wash perineal area with soap and water as needed. Rinse and pat dry. 3) Obtain stool specimen in the bedpan or container. 4) Collect a small sample of the stool on the end of the tongue blade. 5) Smear stool sample on Homoccult Sensa where indicated or place sample in specimen cup.
URINE COLLECTION Can be obtained by RN or LPN. 1. Midstream Urine Collection 2. Routine Urine Collection 1) Urine collection kit 2) Bedpan or urinal 3) Laboratory requisition 4) Soap and warm water, basin, washcloth or disposable towelettes and towels 5) Disposable nonsterile gloves 1) Assist the patient onto the bedpan or to the bathroom. 2) Wash the perineal area with soap and water. Rinse and dry. 3) Remove the contents from the midstream collection set. 4) Cleanse urinary meatus with presaturated towelettes, using each towelette only once. (Retract the foreskin if applicable.) 5) Remove the lid from the specimen container by using only the tab or outside of lid. DO NOT touch the rim or underside of the lid. 6) Instruct the patient to release a small amount of urine into the bedpan or urinal and then to finish emptying bladder into the specimen container. 7) Replace the lid, handling only the tab or outside of lid. Secure the lid tightly. 8) Perform perineal care as needed. Can be obtained by RN or LPN. 1) Bedpan or urinal 2) Urine specimen container with lid 3) Laboratory requisition 4) Soap and warm water, basin, washcloth or disposable towelettes and towels 5) Disposable nonsterile gloves
1) Assist the patient onto the bedpan or to the bathroom. 2) Wash the perineal area with soap and water as needed. Rinse and dry. 3) Instruct the patient to urinate into the specimen container, bedpan or urinal. 4) After the bedpan or urinal has been used, pour approximately 50ml of urine into the urine specimen container and seal with a lid. 3. Sterile Urine Specimen Collection from a Foley Catheter To be obtained by RN or LPN. 1) 10-12cc syringe 2) 23-gauge needle 3) Clamp or rubber band 4) Sterile specimen container 5) Laboratory requisition 6) Antiseptic wipes 7) Soap and warm water, basin, washcloth or disposable towelettes and towels 8) Disposable nonsterile gloves 1) Assist the patient to a supine position with the knees flexed and legs separated. Uncover the Foley catheter. 2) Wash the perineal area with soap and water as needed. Rinse and dry. Drape the patient for privacy. 3) Clamp or kink off the Foley catheter with a rubber band below the aspiration port. Wait 20 to 30 minutes so that the urine can accumulate in the catheter. 4) Clean the port with an antiseptic wipe. 5) Insert a 23-gauge needle at a 909-degree angle into the port. 6) Aspirate urine into the syringe. 7) Inject the urine into a sterile specimen container. 8) Seal the sterile specimen container. 9) Unclamp or unkink the catheter to allow the urine to flow to the collection bag. 4. Sterile Urine Specimen from a Urostomy To be obtained by RN or LPN.
1) Sterile straight catheter (size specified by physician) 2) Sterile catheter tray 3) Sterile urine specimen container 4) Laboratory requisition 5) Soap and warm water, basin, washcloth and towels 1) Position the patient in a supine position to expose the urostomy. Drape the patient for privacy. 2) Open the catheter tray, and set up a sterile field. Pour the antiseptic solution over cotton balls. 3) Don nonsterile gloves to remove urostomy pouch and wash around stoma with soap and water (leave the water on.) Use a spiral pattern working outward from the stoma. Pat dry. 4) Discard nonsterile gloves and don sterile gloves to clean stoma with cotton balls, Use one ball for each wipe. 5) Apply lubricant to the tip of the catheter. Place the other end of the catheter into the sterile urine specimen container for urine collection. 6) Insert the tip of the catheter approximately 2 to 3 inches into the stoma, and collect urine in the sterile urine specimen container. DO NOT force the catheter into the stoma. 7) Seal the sterile urine specimen container. 8) Reapply urostomy pouch.