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Sample Collection

Specimen Collection and Preparation

• Blood
• Urine
• Microbiology
• Pathology Services

The quality of laboratory tests depends greatly upon the specimen and how it is collected and submitted. To ensure the best possible results, please complete the following steps.

Collect specimen as follows:

1. Before collecting specimens, determine the specific requirements for each test by referring to the Test Directory.
2. If you are unable to determine the requirements, please contact IRL Client Services at 703-504-3475 for assistance.
3. Collect specimen(s).
4. Label specimens immediately.
5. Clearly label each tube or specimen with specific patient identification, date and time of collection, source of specimen (for Microbiology, Cytology and Histology requests) and an Inova Reference Laboratory accession number.
6. Complete the IRL requisition form.

Unlabeled or improperly identified specimens will cause delays in processing and may require re-collection of the specimen. A fully completed IRL requisition form must accompany each specimen or set of specimens. If required information is missing, IRL will contact the client before continuing with the testing process.

Specimen Identification Policy

IRL's specimen identification policy states that all specimens received for testing must be correctly and adequately labeled to assure positive identification. Specimens must have two person-specific identifiers on the specimen.

Person-specific identifiers may include:

• Patient's full name
• Patient's Social Security number
• IRL requisition number
• Medical record number
• Date of birth

Specimens are considered mislabeled when the person-specific identifiers on the specimen do not match information on the accompanying requisition or other paperwork. In this situation, IRL will recommend that a new specimen be obtained, if feasible.

Specimens Unsuitable for Analysis

Some specimens cannot be analyzed with accurate results. Reasons include missing patient information and degraded or incorrectly-identified specimens. IRL will make every attempt to notify clients of problems as soon as possible.

Specimen Volume

The Specimen Required section of each test in the Test Directory includes a preferred volume and a minimum volume.

The preferred volume optimizes testing and allows the laboratory to quickly process specimen containers, present the containers to the instruments, perform the test and repeat it if necessary.

Many of our testing processes are fully automated. The preferred volume allows hands-free testing and our quickest turnaround time. Preferred volumes also allow for repeat testing, dilution or other specimen manipulations if needed. If at all possible, please submit the preferred specimen volume.

When the venipuncture is technically difficult or the patient is at risk of complications from blood loss (e.g., pediatric patients), smaller volumes may be necessary. The specimen minimum is the amount required to perform an assay once, including instrument and container dead space.

IRL makes every possible effort to successfully test patients' specimens. If you have concerns about submitting a specimen for testing, please call IRL Client Services at 703-504-3475.

Blood

Many laboratory tests are performed on blood obtained from a peripheral (venous) source. Please see the Test Directory section for specific requirements, and follow the blood-draw, separation and transport instructions.

• Draw blood specimen using venipuncture technique, if possible
• Vacutainer®-type tubes should fill automatically to the proper amount.
• If using a syringe, refer to manufacturer's guide or call Client Services.

If possible, draw tubes in the following order for optimum results:

1. Blood culture bottle
2. Red (non-additive)
3. Serum gel tube
4. Light blue
5. Purple
6. Green
7. Grey (potassium oxalate/sodium fluoride)

• Gently invert all tubes 5-10 times immediately after filling.
• Immediately identify the tube with the patient-specific identifiers by affixing a label, writing the patient's name on the tube or affixing a requisition number.
• Allow the serum gel tube to clot for a minimum of 15 minutes but not longer than 60 minutes.
• Centrifuge serum gel tube for 10 minutes at 3,000 RPM.
• Place all specimens in biohazard bags with properly completed IRL requisition forms in the outer pocket.
• Specimens are now ready for transport to IRL.

Fasting Specimens

• The patient may not eat anything for at least 12-14 hours before the blood is drawn.
• The patient may drink only water. No coffee, tea, soda or chewing gum is permitted.
• The patient may take prescribed medications.

Specimen Collection Tubes

Click here for a list of tubes referred to in IRL's Test Directory.

Urine Collection

Routine Urinalysis: Urine Collection Cup

• To avoid contamination, do not touch the inside of the cup or the cap of the urine collection cup.
• Unscrew the cap of the urine collection cup. Place cap on the counter with the inside of the lid facing upwards.

Cleanse with Towelettes® as follows:

Male: Wipe head of penis in single motion with one towelette. Repeat with remaining towelette(s). If not circumcised, hold foreskin back before cleaning. Have patient urinate small amount into toilet or bedpan.

Female: Separate labia. Wipe inner labial folds front to back in single motion with one towelette. Wipe down through center of labial folds with remaining towelette(s). Keep labia separated and have patient urinate small amount into toilet or bedpan.

• Place cup under stream and have patient continue to urinate into cup. Collect specimen.
• Replace cap on cup. Tighten cap securely. Label and refrigerate until courier pickup.

Clean Catch (preferred collection method):

• Open Urine and Collection Transport Kit provided. Remove cup and towelette.
• To avoid contamination, do not touch the inside of the cup or the cap of the urine collection cup.
• Unscrew the cap of the urine collection cup. Place cap on the counter with the inside of the lid facing upwards.

Cleanse with Towelettes® as follows:

Male: Wipe head of penis in single motion with one towelette. Repeat with remaining towelette(s). If not circumcised, hold foreskin back before cleaning. Have patient urinate small amount into toilet or bedpan.

Female: Separate labia. Wipe inner labial folds front to back in single motion with one towelette. Wipe down through center of labial folds with remaining towelette(s). Keep labia separated and have patient urinate small amount into toilet or bedpan.

• Place cup under stream and have patient continue to urinate into cup. Collect specimen.
• Replace cap on cup. Caution: sharp needle located under cap label. Do not remove label from cap.
• Label and refrigerate until courier pickup.

The small grey-top tube included in the urine cup container kit is not suitable for routine urinalysis. It contains boric acid as a preservative and is to be used when a urine culture is requested.

Urine Culture: Grey-Top Transport Tube

• Collect urine specimen using Clean Catch Method as outlined above.
• Please use the grey-top urine-culture transport tube included in the collection kit. This grey-top tube contains boric acid as a preservative and will aid in the preservation of the specimen if delay is anticipated.
• Mix specimen.
• Peel back the yellow label and place grey-top urine collection tube rubber topside down over the needle port. Press down until approximately 3.0-4.0 cc of specimen has transferred to the transport tube. Mix or shake tube well.
• Replace the yellow label over the needle port.
• Label specimen. Refrigeration is preferred but not required.

Caution: This grey-top tube is not the same as the grey-top potassium oxalate/sodium fluoride tube used for blood draws. The two are not interchangeable.

Note: If urinalysis is not required in addition to a urine culture, discard the urine container cup and submit only the grey-top urine culture transport tube. This will help eliminate confusion.

24-Hour Urine Collection

IRL provides 24-hour urine collection containers. Use the following procedure for the correct specimen preparation and collection:

• Plan collection period so the specimen can be delivered to IRL within a day after completion.
• Provide the patient with a labeled, sterile 24-hour collection container. Refer to Test Directory for the proper preservative. Multiple 24-hour urine tests that share the same preservative may be collected using the same specimen. Notify patient of any potentially hazardous preservative.
• To begin the timed collection period, have patient urinate to empty his or her bladder. Discard this specimen.
• Write on the container the date and beginning time of the collection. The collection period begins at this time.
• Collect all urine during the timed collection period. (If even one specimen is lost, the results will not be valid.)
• At the end of the timed period, have the patient urinate to empty his or her bladder and add this specimen to the collection container.
• Write on the container the date and ending time of the collection.
• Keep the collection container in the refrigerator during the collection period and until courier pickup.

Note: Routine urinalysis and/or urine culture and sensitivity cannot be collected during the 24-hour collection period. Collect specimen either before or after the 24-hour urine collection.

Microbiology Specimens

Accurate testing of microbiological specimens depends on the quality of the specimen collection process and the amount of information that is submitted with the specimen.

Specimens submitted must be labeled with the name of the patient and date and time of the collection. IRL's requisition form must also include the source and/or site of the specimen (e.g., left arm wound vs. throat culture, clean catch vs. catheterized urine). Please be as specific as possible.

Different cultures require different setup media. Without all the required information, the specimen cannot be processed until the client is contacted and the missing information is obtained. This may result in significant delays and possible rejection of the specimen.

Routine cultures include isolation and identification of all bacteria that are reasonably expected to cause infections in the parts of the body from which the specimen is collected. Should there be unusual circumstances associated with the infection, please supply details which would assist us in testing for rare or fastidious organisms.

Routine Culture

When using a culture transport swab, follow the manufacturer's directions. After the swab has been reinserted into the collection tube, saturate the swab with the transport medium to maintain the viability of possible pathogens.

The culture transport swab may remain at ambient temperature until transport to IRL.

Antibiotic susceptibility tests are routinely performed when pathogens are isolated from significant sites. There are different antibiotics reported depending on organism and/or source. In most instances, the information provides both a minimum inhibitory concentration (MIC) of drug required for treatment and an interpretation of the numerical value (susceptible, indeterminate or resistant).

If the patient has unusual symptoms and requires an exception to the susceptibility policy for clinical management, please notify the laboratory and indicate which antibiotic and organisms are to be tested. We will notify you if the request cannot be accommodated.

Anaerobic Culture

True anaerobic cultures will be performed only when the proper collection and submission methods have been followed (specimen in syringe and/or two additional culture transport swabs).

If anaerobes are suspected, please use proper collection techniques and specifically request an anaerobic culture.

Specimens such as urine, vaginal swabs, stool and decubiti are not acceptable for anaerobic culture.

Blood Culture

Collect the specimen using sterile techniques to reduce the chance of contamination with bacteria on the skin. The ideal collection is from two separate sites.

Use the following procedure for the correct antiseptic preparation and specimen collection:

1. Examine the blood culture bottles for any evidence of contamination such as cloudiness or cracks in the glass. Check the expiration date.
2. Locate and identify the draw site by usual method and release the tourniquet.
3. Cleanse the site using a ChloraPrep One-Step Frepp Applicator®.
4. Open the sterile prep kit. Remove the Frepp® chlorohexidine scrub.
5. Gently squeeze the wings to release antiseptic into the sponge.
6. Thoroughly scrub the site for 30 seconds. Scrub with pressure and in multiple directions. Allow to air dry. Do not fan, blow on site, or wipe with alcohol.
7. While site is drying, remove the snap-off cap of the blood culture vial. Wipe the top rubber septum with a alcohol wipe.
8. Re-apply the tourniquet and draw specimen, using the blood culture bottle butterfly adaptor, into the blood culture vial. The ideal volume to draw is 8.0-10.0 ml of blood per vial. Lesser volumes may reduce bacterial recovery. A minimum volume of 1 ml blood is required for each blood culture bottle collected.
9. If both aerobic and anaerobic blood cultures are specifically collected, draw the anaerobic vial first.

Note: If re-palpitation of the vein is required, either re-clean the draw site with a new Frepp® scrub or clean the gloved finger tip with a new Frepp® scrub, using identical aseptic technique as used on the draw site.

• Label the blood culture vials with patient's full name, date and time of draw, the source of the collection (right arm vs. left arm) and the phlebotomist's initials. Transport the specimen at ambient temperature only.

Urine Culture

Please use the grey-top urine culture transport tube included in the collection kit. This grey-top tube contains boric acid as a preservative and will aid in the preservation of the specimen if delay is anticipated.

Caution: This grey-top tube is not the same as the grey-top potassium oxalate/sodium fluoride tube used for blood draws. The two are not interchangeable.

Urine susceptibilities will be performed when counts from:

• Catheterized specimens are > 1,000 colonies/cc
• Clean-catch specimens are > 10,000 colonies/cc

Note: No more than two organisms with significant colony counts will be reported.

Sputum Culture

Instruct patient to provide a deep-cough specimen. Expel the material into a sterile container with as little saliva as possible. Refrigerate immediately until courier pickup.

Stool Culture

Routine stool culture will include determination of the pathogens salmonella, shigella, Campylobacter and Shiga-like toxin assay. If specimens are to be tested for other types of microorganisms such as yersinia, vibrio, rotavirus, Clostridium difficile toxin or occult blood, a separate request for these tests is required.

Stool specimens should be submitted in a sterile stool or urine collection cup. We will not accept specimens submitted in diapers and/or bathroom tissue. Do not refrigerate specimen. Call for immediate transport. Enteric pathogens are very time-sensitive and delay in processing may result in a false-negative.

Stool for Ova and Parasite

• This requires a special three-part collection kit to collect three specimens over a 10-day period.
• Specimen may be kept at ambient temperature.
• A history must accompany the request.
• Unless special circumstances are communicated to the Microbiology Laboratory, the Giardia Antigen, Feces (test number 690175/MC8023) test will be substituted. Refer to the Test Directory for specific instructions.

Special Microbiology Testing

Specimens to be tested for other types of microorganisms such as fungi, mycobacteria, viral cultures and chlamydia require a separate test requisition.

Note: Special transport media may be required. Please refer to the Test Directory section or contact IRL Client Services at 703-504-3475.

Pathology Services

Bone Marrow Biopsies

Bone marrow biopsies should be sent fixed with B-5 supplied by IRL. For best results, processing should begin within two hours of collection. Note the time and the date of collection on the requisition or container. We encourage clients to submit aspiration smears, peripheral smears and clinical background, as these are helpful. Special requests (such as iron staining) should be clearly noted on the IRL requisition form.

Tissue Biopsies

Tissue biopsies should be submitted either in Histochoice™, a non-formalin based fixative or 10% formalin.

All Pathology Specimens

Remember to include the specific site of the specimen (i.e., left pleural fluid vs. right pleural fluid). Include any pertinent patient history. If slides are submitted, spray with aerosol fixative immediately upon collection and allow to air dry. Place in slide container for transport. For Pap smears, include:

• The date of last menstrual period
• Previous history and hormone information
• Previous date of testing
• Whether the patient is pregnant, postpartum or postmenopausal