SPECIMEN SUBMISSION POLICY AND PROCEDURE

Policy
Label all specimens submitted for testing with the patient’s name and identifying number as written on the test requisition form. Positive identification and integrity of patient specimens from the time of collection until testing has been completed and results reported. Biotech will reject inappropriately labeled specimens and the specimens will be returned to the client. Tests will not be performed on unlabeled or incompletely labeled specimens.

ROUTINE BLOOD COLLECTION

Purpose

The Vacutainer System is used to collect blood specimens for diagnostic analysis in the laboratory. This system is comprised of three basic elements:

1. An evacuated glass or plastic tube containing a premeasured vacuum to provide a controlled prespecified draw.
2. A holder, which is used to secure the needle during insertion into the tube and venipuncture site.
3. A sterile single-use needle.

Procedure

PREVENTION OF BACKFLOW

To guard against backflow, the following precautions should be taken when drawing blood with evacuated tubes:

1. Ask patient to identify himself/herself and give you their DOB. This information must match the request form.
2. Place patient’s arm in a downward position during the procedure.
3. Hold the tube in a vertical position.
4. Release the tourniquet as soon as a strong flow of blood is obtained.

NOTE: In the event that the patient is feeling faint while the procedure is in progress, you should stop the procedure immediately. Make sure the patient does not fall from the draw chair and never move the patient while they are unconscious. Use an ammonia inhalant to awaken the patient. Once the patient has regained consciousness, follow these steps:

• Place the patients head back, resting against the wall if possible.
• Place the patients legs on a stool or chair elevated above their waist.
• Place a cool cloth on the back of their neck and forehead.
• Offer the patient some juice or cold water. Juice is preferred if the patient has been fasting.
• Have the patient remain in the chair until they are feeling back to normal.

If the patient passes out and you are having a difficult time awakening them, call for help, but never leave the patient unattended.

ORDER OF DRAW

When more than one tube is drawn, special attention should be given to the order in which tubes are filled.

• First Draw – Blood culture tubes
• Second Draw – Citrate Tube (Light blue)
• Third Draw – SST and/or Plain Red top tubes
• Fourth Draw – Heparin Tube (Green top)
• Fifth Draw – EDTA Tube (Lavender top)
• Last Draw – Fluoride (glucose) Tube (Gray top)

PREPARATION FOR SPECIMEN COLLECTION

The following materials should be readily accessible before beginning venipuncture.

1. All necessary tubes
2. Appropriate needle and holder.
3. Alcohol swab (plus iodine swab for a sterile specimens)
4. Dry sterile swab
5. Bandage

VENIPUNCTURE TECHNIQUE

1. Open needle package but do not remove needle shield. Thread needle into holder until secure.
2. Select tubes for draw. Tubes that contain additives should be gently tapped to dislodge any additive which may be trapped around the stopper.
3. Insert tube into holder, but do not puncture the stopper.
4. Select site for venipuncture by palpation.
5. Apply tourniquet. Prepare venipuncture site with an appropriate antiseptic. Place the patient’s arm in a downward position.
6. Remove needle shield. Perform venipuncture with the arm in a downward position and tube in vertical position, stopper uppermost.
7. Push tube to end of holder, puncturing diaphragm of stopper.
8. As soon as adequate blood flow is obtained, remove tourniquet.
9. Note: If at this point there is no blood flow into the tube or if blood flow ceases before adequate sample is obtained, the following steps are suggested to complete satisfactory blood collection. Each successive step should be taken until flow into the tube occurs.
   A. Confirm correct positioning of needle cannula in vein.
   B. Remove tube and fully insert a new tube into holder.
   C. Remove tourniquet and needle, and repeat venipuncture.

Single Sample Collection

1. 1. When vacuum is exhausted and blood stops flowing into tube, immediately remove needle from vein, and apply pressure to puncture with a dry sterile swab. Keeping swab in place, elevate arm to prevent oozing of blood.
   2. Remove the tube of blood from holder. If the tube contains additives, gently invert 8-10 times to mix. Do not shake.
   3. Apply bandage if required.

Multiple Sample Collection

1. 1. When vacuum is exhausted and blood flow ceases, immediately remove tube from holder.
   2. Place second tube in holder. While blood is flowing into succeeding tubes, gently invert previously filled tubes containing additives 8-10 times to mix.
   3. As soon as blood stops flowing into the last tube to be drawn, remove needle from vein and apply pressure to puncture site with a dry sterile swab. Keeping swab firmly in place, elevate arm to prevent oozing of blood.
   4. Apply adhesive bandage to site if required.

SPECIMEN LABELING PROCEDURE

1. Patient’s last name, first name, and DOB shall be written on all specimens that you have drawn or collected. You should be verifying the spelling of the patient’s name and their DOB by having them spell it to you as you are writing it on the tube/container. All specimens shall be labeled in front of the patient after the specimen is collected. The only specimen that shall be labeled prior to collection is a urine container.
2. When labeling with the 4medica label, the label should be under the patient’s name on the tube. Line the 4medical label up with the label on the tube (far left). On the 5ml tubes there will be an over lap at the bottom, this is okay.
3. All tubes of blood, urine specimens, stool specimens (in urine container) should be labeled with a 4medica label if a 4medica test requisition was generated.

NOTE: Do not put 4medica labels on Thin Preps, Sure Paths, Culture swabs, stool O&P bottles and biopsy bottles. These specimen types are too small for a label to fit on properly.