c6-SPECIMEN HANDLING.docx

SPECIMEN HANDLING ================= In many settings, the phlebotomy team accepts and accessions (checks in) all specimens that come into the laboratory for testing. Therefore, it is important to know how to handle and process these specimens correctly. Handling requirements also include pre-collec...

SPECIMEN HANDLING ================= In many settings, the phlebotomy team accepts and accessions (checks in) all specimens that come into the laboratory for testing. Therefore, it is important to know how to handle and process these specimens correctly. Handling requirements also include pre-collection specifics (time, temperature, light). When tests require specific timing, heat, cold, or protection from light, your role in transporting specimens to the laboratory after collection is as important as the venipuncture for securing a high-quality test result. For timed tests when patients are taking a specific medication or drinking a liquid preparation (such as for a glucose tolerance test) make sure they have satisfied the testing requirements. Examples include a 2-hour postprandial blood glucose level, which requires a fasting blood glucose level plus a blood glucose test at exactly 2 hours after patients started eating their meal or consumed the liquid preparation. Other timed tests include peak and trough values for antibiotics like gentamicin or vancomycin, for which the phlebotomist collects blood samples at a specific time after the administration of the antibiotics. Coordinate these procedures with the clinical staff-including nurses and medical assistants-to ensure accurate results. Label every type of collection container immediately after collection with the patient\'s name, the date and time of collection, and the specimen type. Position it correctly on the tube or container. If the facility requires it, sign or initial the specimen. Then compare the information on the label with the patient\'s wristband, or verbally verify it with the patient. If the container has a lid, make sure that the label is on the container, not on the lid. Wear gloves when handling patient-collected, nonblood specimens. Change gloves between each specimen. Correct handling is essential, because incorrect handling can affect the quality of the specimen. For example, components of urine change if the specimen stands at room temperature for an extended period of time. If the specimen will not be tested immediately, refrigerate urine specimens and process them within 1 hour of collection. Some urine tests are best performed at room temperature. Be aware of what the specimen is being tested for to ensure proper handling. Use evacuated transport tubes containing preservatives for transporting urine specimens to reference laboratories. To transfer urine from a collection container to the transport container, use a disposable pipette, or pour the urine into the tube after removing the stopper. Preservatives in these tubes prevent bacterial overgrowth and prevent changes in the urine that can affect test results. When handling preserved urine specimens, keep the tubes at room temperature no longer than 72 hours before performing a urinalysis with chemical reagent strip testing. Keep tubes for culture and sensitivity (C&S) tests at room temperature for up to 72 hours. Otherwise, if not preserved, refrigerate them if there is any delay in transferring the urine to the culture medium. Complete the laboratory requisition forms for all specimens for transportation to other sites for analysis. This form should include the patient\'s name, date, type of test, ordering provider\'s name, ICD-10-CM code for diagnosis (if the form requires it), and a line where the provider can sign after reviewing the results. When sending specimens to the laboratory, use plastic biohazard bags with zipper seals. These bags feature an outside pocket in which to place the laboratory request. They also protect those who transport the specimen from any pathogens in the specimen. Ideally, blood tubes should remain upright during transportation to prevent unnecessary agitation (which could cause hemolysis) and to promote effective clotting in specimens that do not have anticoagulant additives. Delivery of specimens from clinics or blood-collection stations to reference laboratories should be as prompt as possible. With delays between collection and processing, glucose in blood cells can break down and interfere with results of various tests (phosphorus, glucose, aldosterone, calcitonin, enzymes). It is also essential to transport microbiology specimens quickly so that the laboratory technicians can transfer the specimens to the culture media or incubator. These samples include blood, urine, sputum, wound exudate, stool, and other body substances. The sooner they get to the environment where micro-organisms can grow, the sooner the technicians can identify them and generate the results so that the patients can receive proper treatment. The delivery process must include adequate specimen handling, packaging, and communication with the courier or other delivery services. Coordinate the schedule of pickups, including the process for delivering stat specimens, where to place the specimens for pickup, and how to document the delivery process accurately and completely. Specimen delivery methods include the following: - **Hand delivery** directly to a reference laboratory, following timeliness of delivery guidelines, completing log-in processes, and using necessary carrying devices (trays, carts, tube racks, leakproof containers). - **Pneumatic tube systems,** usually in an inpatient setting. These systems have enhanced mechanical reliability, increased transport distance and speed, specific control mechanisms, and shock-absorbing features to help prevent hemolysis of blood samples. There is an inner padding that lines the canister and separates the blood tubes. Use caution when choosing this type of transport for tests for potassium, plasma hemoglobin, lactate dehydrogenase, and acid phosphatase, because of the increased chance of disrupting red blood cells, which can affect the test results. Coagulation specimens also need protection from shock and vibration to prevent platelet activation. For most other tests, this is an efficient means of transport that does not interfere with analysis. - **Automated carrier** using a transport vehicle, such as a motorized container car that travels on a network of tracks to various destinations within the facility. This includes some of the same features of pneumatic tube systems. ### Pneumatic tube systems Pneumatic tube systems are used in hospitals to send and receive laboratory specimens, patients\' records, medications, and bills to and from stations in the patient care area and the in-house laboratory and pharmacy. Each sending station throughout the hospital has a large metal box built into the building. Most have lockable doors or pass-code entries for gaining access to the containers the system uses, and for maintaining security and confidentiality. The tube network runs throughout the hospital and connects to other large metal boxes that are the receiving stations. When a container arrives in the receiving station, the pneumatic tube system will signal an alarm or light to indicate that the specimen or document is available to access. After completing specimen collection, labeling specimen tubes, and completing laboratory requisitions, load and secure the specimen in the container, place it in the tube at the sending station, and close the door. Enter data into the computer to send the specimen to the proper department, double checking that all information is correct. Sending to the incorrect department can cause a delay in processing of the specimen. Hit enter or the send button to send the specimen. Chain of custody ---------------- The process that maintains control of and accountability for each specimen from the time of collection to the time of disposal is the chain of custody. All individuals who have handled a specimen must document their identity on the chain-of-custody form each time the specimen transfers. The form also requires the following components. - Name and identifying information of the patient, body, subject, or object the specimen came from - Name of the person who obtained and processed the specimen - Date, location, and signature of the person attesting that the specimen is the correct one and matches its documentation - Signature and date from every person who had possession of the specimen for any amount of time, even if only for transporting When transferring specimens during chain-of-custody processes, label the specimen correctly and place it in a biohazard bag with a permanent seal that verifies that no one has opened it until it is ready for analysis. These specimens are legal evidence; there must be no tampering with them until they reach their final destination. An intact seal provides evidence that there has been no tampering during the specimen\'s transfer to the laboratory. Several situations require initiating and following a chain-of-custody process, including forensic analysis, workplace drug testing, drug testing of professional athletes, neonatal drug testing, and blood alcohol content (BAC) testing. Occasionally DNA analysis, rape test kits, and parentage testing require following chain-of-custody guidelines for legal purposes. Forensic specimens ------------------ Forensic laboratory analysis involves various types of specimens, for example, from vaginal swabs after rape, blood and body fluids from crime scenes, and postmortem specimens from autopsies. Special handling of specimens is crucial, because the specimens might be decomposing, available in only trace amounts, or require analysis by a forensic scientist in extreme environments. Forensic specimens also involve toxicology testing of substances after poisoning or substance abuse. Collecting these specimens can require special training or experience and supervision. Unlike specimens collected in a clinical setting, forensic specimens can be in any condition, clotted, or in containers that would otherwise be unacceptable. Drug testing ------------ The Department of Health and Human Services initiated federal drug testing, which is mandatory for some government employees and many private-sector employees. Workplace drug testing often follows the U.S. Department of Transportation\'s mandated testing regulations, which have become an industry standard. Many employers require urine drug testing and use the Federal Drug Testing Custody and Control Form (CCF) for the process. This form must document the handling and storage information for specimens from the time they are obtained to their final disposal. Phlebotomists must undergo training and evaluation in the correct use of the CCF per federal guidelines. The process for collection has extremely specific guidelines to ensure that employees providing the specimen cannot tamper with it, such as adding water to dilute it or replacing it with urine they previously collected from someone else and concealed in clothing or a handbag. Urine drug tests can usually detect marijuana use within the past week and the use of cocaine, heroin, and other illegal drugs within the past 2 days. However, they do not measure the degree of impairment or the frequency of use. ### ### Workplace drug testing - Ensures compliance with federal regulations, customer contracts, and insurance carrier requirements - Reinforces a company's no-drug-use policy - Minimizes the risk of hiring an employee who uses drugs illicitly - Identifies employees who use drugs illicitly so that employers can enforce disciplinary action - Improves the safety and health of employees ### ### Sports-related drug testing - Detects use of stimulants (amphetamines, anabolic steroids, alcohol, diuretics, street drugs, peptide hormones, anti-estrogens, beta2 agonists) to enhance athletic performance - Encourages regulation of nutritional and dietary supplements - Analyzes blood and urine to detect blood doping or the use of erythropoietin ### Neonatal drug testing - Detects the use of cocaine, opiates, amphetamines, methamphetamines, and phencyclidine, which cause prenatal drug exposure and neonatal abstinence syndrome (withdrawal) - Requires obtaining specimens for analysis within 24 hours after childbirth to detect recent drug use - Confirms maternal drug use 24 to 72 hours prior to childbirth if the newborn\'s urine is positive for these substances Law enforcement officers who detain individuals they suspect of driving under the influence might conduct various sobriety tests. Then, depending on state laws, they might request or require a urine, blood, or breath test. The most accurate of these methods for identifying alcohol levels is blood specimen analysis from a routine venipuncture or capillary stick procedure. In the U.S., the legal limit for BAC is 0.08%, or 80 mg/100 mL. Drivers younger than age 21 must have no detectable alcohol in their blood. When collecting specimens for BAC testing, follow the chain-of-custody guidelines and special collection techniques. Clean the venipuncture site with an antiseptic that does not contain alcohol, such as chlorhexidine gluconate. Using alcohol for this purpose could lead to a false positive result. Do not use iodine swabs, because they contain alcohol.