laboratory guide to services - yukon hospitals · 9.0 handling, packaging & transport of...
TRANSCRIPT
Implementation Date: April 2018
Laboratory
Guide to Services
LABORATORY GUIDE TO SERVICES TABLE OF CONTENTS
1.0 GENERAL LABORATORY INFORMATION 1 1.1 HOURS OF SERVICE ...................................................................................................................................................... 2 1.2 CONTACT INFORMATION ............................................................................................................................................... 2 1.3 SCOPE OF THIS MANUAL ................................................................................................................................................ 3 1.4 SPECIMEN DROP-OFF.................................................................................................................................................... 4 1.5 OBTAINING LAB RESULTS............................................................................................................................................... 4 1.6 CONSENT FOR RELEASE FORM ........................................................................................................................................ 5 1.7 POINT OF CARE TESTING ............................................................................................................................................... 6 1.8 REFERRED-OUT TESTS: OUR SUPPORT TEAM .................................................................................................................... 7 1.9 BOOKING PROCEDURES: TESTS REQUIRING APPOINTMENTS ................................................................................................. 8
A. Electrocardiogram (ECG/EKG) ................................................................................................................................. 9 B. Holter Monitor ........................................................................................................................................................ 9 C. Spirometry and Reversibility Testing at WGH Laboratory .................................................................................... 10 D. Oral Glucose Tolerance Testing (OGTT or GTT) and Gestational Diabetes Screen (GDS) ..................................... 12
2.0 WGH LABORATORY TEST INFORMATION 13 2.1 WGH LABORATORY TEST MENU: ON-SITE SERVICES ........................................................................................................ 14 2.2 WGH LABORATORY TEST REFERENCE ............................................................................................................................ 16
3.0 PATIENT IDENTIFICATION AND SAMPLE LABELLING 25 3.1 PATIENT IDENTIFICATION ............................................................................................................................................. 26 3.2 SAMPLE LABELLING .................................................................................................................................................... 26
Blood Collection tube labels ................................................................................................................................. 27 3.3 ACCEPTANCE CRITERIA FOR REQUISITIONS ...................................................................................................................... 28 3.4 SAMPLE REJECTION POLICY .......................................................................................................................................... 29 3.5 SAMPLE REJECTION CRITERIA ....................................................................................................................................... 29 3.6 SAMPLE REJECTION CRITERIA: MICROBIOLOGY ................................................................................................................ 31 3.7 SAMPLE REJECTION CRITERIA: TRANSFUSION MEDICINE .................................................................................................... 32 3.8 IRREPLACEABLE SAMPLE IDENTIFICATION POLICY .............................................................................................................. 32 3.9 IRREPLACEABLE SAMPLE IDENTIFICATION RECORD ............................................................................................................ 33
4.0 ORDERING TESTS AND REQUISITIONS 35 4.1 HYPERLINKED LIST OF REQUISITIONS .............................................................................................................................. 36 4.2 CREATING STANDING ORDERS ...................................................................................................................................... 39 4.3 ADD-ON TESTS ......................................................................................................................................................... 40
5.0 COLLECTION PROCEDURES: BLOOD 41 5.1 VENIPUNCTURE: BEST PRACTICES .................................................................................................................................. 42
Supplies for Venipuncture .......................................................................................................................................... 43 5.2 TUBE SELECTION, ORDER OF DRAW AND SAMPLE MIXING ................................................................................................. 44 5.3 PEDIATRIC BLOOD VOLUME DRAW GUIDANCE ................................................................................................................ 46 5.4 HOW TO PREPARE A BLOOD SMEAR................................................................................................................................ 47 5.5 HEMOLYSIS ............................................................................................................................................................... 51
6.0 TRANSFUSION MEDICINE INFORMATION 53 6.1 PATIENT IDENTIFICATION IN TRANSFUSION MEDICINE ....................................................................................................... 54 6.2 WGH BLOOD BANK IDENTIFICATION CARD ..................................................................................................................... 55 6.3 TEST: ABO BLOOD GROUP .......................................................................................................................................... 55 6.4 TEST: GROUP AND ANTIBODY SCREEN............................................................................................................................ 56 6.5 TEST: CROSSMATCH ................................................................................................................................................... 56 6.6 TEST: DIRECT ANTIGLOBULIN TEST (DAT) ...................................................................................................................... 56 6.7 TEST: CORD BLOOD INVESTIGATION .............................................................................................................................. 56 6.8 TEST: TRANSFUSION REACTION INVESTIGATION ............................................................................................................... 57 6.9 BLOOD COMPONENT USES .......................................................................................................................................... 57
LABORATORY GUIDE TO SERVICES TABLE OF CONTENTS
6.10 BLOOD COMPONENTS AVAILABLE (IN STOCK) AT WHITEHORSE GENERAL HOSPITAL ................................................................ 57 6.11 BLOOD PRODUCTS AVAILABLE (IN STOCK) AT WHITEHORSE GENERAL HOSPITAL ..................................................................... 58 6.12 ADDITIONAL TM PROCESS NOTES ................................................................................................................................. 59
7.0 COLLECTION PROCEDURES: MICROBIOLOGY 61 7.1 GENERAL SAMPLE REQUIREMENTS ................................................................................................................................ 62 7.2 SAMPLE REJECTION CRITERIA ....................................................................................................................................... 62 7.3 EAR SAMPLES ............................................................................................................................................................ 63 7.4 EYE SAMPLES ............................................................................................................................................................ 63 7.5 GENITAL SAMPLES ..................................................................................................................................................... 64 7.6 PREGNANCY SCREEN FOR GROUP B STREPTOCOCCUS ........................................................................................................ 66 7.7 INFECTION CONTROL SCREENING: MRSA OR VRE ........................................................................................................... 66 7.8 NASAL SWABS ........................................................................................................................................................... 67 7.9 SPUTUM SAMPLES ..................................................................................................................................................... 67 7.10 THROAT SAMPLES ...................................................................................................................................................... 68 7.11 URINE SAMPLES ........................................................................................................................................................ 68
A. Midstream Urine Collection .................................................................................................................................. 69 B. Straight line Catheters (In/ Out Catheters) ........................................................................................................... 69 C. Indwelling Catheter ............................................................................................................................................... 69 D. Peds bag (neonatal bagged urine) ........................................................................................................................ 69 Use of Bactube (Uricult Trio) .......................................................................................................................................... 71
7.12 WOUND SAMPLES ..................................................................................................................................................... 72 7.12.1 Superficial Wounds (<2 cm deep) (Includes drainage, surface wounds, ulcers, boils): ............................... 72 7.12.2 Deep Wounds (Includes deep abscess, aspirates, implanted devices, bites): ............................................... 73 7.12.3 Burns: ........................................................................................................................................................... 73
7.13 BLOOD CULTURES ..................................................................................................................................................... 74 7.13.2 How to Label Blood Culture Bottles .............................................................................................................. 79
8.0 COLLECTION PROCEDURES: FLUIDS, PATHOLOGY, CYTOLOGY 81 8.1 BODY FLUID COLLECTIONS ........................................................................................................................................... 82
8.1.1 Cerebral Spinal Fluid (CSF) ................................................................................................................................ 82 8.1.2 Dialysate Fluid .................................................................................................................................................. 83 8.1.3 Pericardial Fluid ................................................................................................................................................ 83 8.1.4 Peritoneal Fluid ................................................................................................................................................. 83 8.1.5 Pleural Fluid ...................................................................................................................................................... 84 8.1.6 Synovial Fluid .................................................................................................................................................... 84
8.2 PATHOLOGY SAMPLE COLLECTIONS ............................................................................................................................... 85 8.3 CYTOLOGY SAMPLE COLLECTIONS ................................................................................................................................. 86
9.0 HANDLING, PACKAGING & TRANSPORT OF SAMPLES 93 9.1 SAMPLE HANDLING & STORAGE OF BLOOD PRIOR TO TRANSPORTATION ............................................................................... 94 9.2 PACKAGING & TRANSPORT OF PATIENT SAMPLES ............................................................................................................. 95
9.2.1 Packaging ......................................................................................................................................................... 95 9.2.2 Inpatient and Outpatient Samples: Transport within WGH ............................................................................. 95
9.3 SENDING SAMPLES IN THE PNEUMATIC TUBE SYSTEM AT WGH ................................................................................................. 96 9.3.1 Items accepted in the PTS bullets ..................................................................................................................... 96 9.3.2 Filling the bullet ................................................................................................................................................ 97 9.3.3 Transporting samples on ice ............................................................................................................................. 98 9.3.4 Launching a PTS Bullet ...................................................................................................................................... 98 9.3.5 Trouble-shooting: ............................................................................................................................................. 98
LABORATORY GUIDE TO SERVICES TABLE OF CONTENTS
10.0 PATIENT INSTRUCTIONS 99 10.1 PATIENT INSTRUCTIONS: A REMINDER ABOUT PATIENT LITERACY ...................................................................................... 100
Clues Indicating Low Health Literacy ........................................................................................................................... 101 10.2 A LIST OF PATIENT INSTRUCTIONS FOR LABORATORY TESTS .............................................................................................. 102 YOUR ECG: STUDYING YOUR HEART ........................................................................................................................................ 103 THE HOLTER MONITOR: STUDYING YOUR HEART FOR 24 HOURS ................................................................................................... 104 SPIROMETRY: HOW IS YOUR BREATHING? .................................................................................................................................. 104 NON-GESTATIONAL ORAL GLUCOSE TOLERANCE TEST ................................................................................................................. 106 GESTATIONAL ORAL GLUCOSE TOLERANCE TEST ......................................................................................................................... 107 50 GM ORAL GLUCOSE LOAD TEST ........................................................................................................................................... 108 HELICOBACTER PYLORI UREA BREATH TEST (UBT) ....................................................................................................................... 109 24 HOUR URINE TESTING ....................................................................................................................................................... 110 12 HOUR URINE TESTING ....................................................................................................................................................... 111 MIDSTREAM URINE COLLECTION .............................................................................................................................................. 112 URINE COLLECTION (FOR CYTOLOGY TESTING) ............................................................................................................................ 113 INFANT URINE COLLECTION (USING A U-BAG) ............................................................................................................................ 115 FIT (FECAL IMMUNO TESTING): SCREENING FOR COLORECTAL CANCER ............................................................................................ 117 STOOL COLLECTION (FOR CULTURE & SENSITIVITY OR C. DIFFICILE TESTS) ......................................................................................... 118 STOOL COLLECTION (FOR OVA & PARASITE EXAM) ...................................................................................................................... 119 HOW TO COLLECT SPUTUM (FOR BACTERIOLOGY OR FUNGAL STUDY) ............................................................................................. 121 HOW TO COLLECT SPUTUM (FOR CYTOLOGY TESTING) ................................................................................................................. 123 HOW TO COLLECT SPUTUM (FOR TB TESTING) ........................................................................................................................... 126 SEMEN ANALYSIS .................................................................................................................................................................. 128
11.0 ORDERING SUPPLIES 129 11.1 VISUAL KEY TO COLLECTION KITS ................................................................................................................................ 129 SUPPLIES ORDER FORM .............................................................................................................................................. 131
APPENDIX I. GLOSSARY OF LIS SOFTWARE 136
APPENDIX II. COLLECTION INSTRUCTIONS FROM MANUFACTURERS 137 I. COLLECTION PROCEDURE FOR PERTUSSIS TESTING .............................................................................................................. 138 II. COLLECTION PROCEDURE FOR URINE TESTING: CHLAM GC, TV ............................................................................................ 139 III. COLLECTION PROCEDURE FOR NASOPHARYNGEAL SWABS ..................................................................................................... 140
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 1
1.0 GENERAL LABORATORY INFORMATION This section contains: 1.1 Hours of Service
1.2 Contact Information
1.3 Scope of this manual
1.4 Specimen Drop-off
1.5 Obtaining Lab Results
1.6 Consent for Release Form
1.7 Point of Care Testing
1.8 Referred-Out Tests: Our Support Team
1.9 Booking Procedures: Tests Requiring Appointments
A. Electrocardiogram (ECG/EKG)
B. Holter Monitor
C. Spirometry and Reversibility Testing at WGH Laboratory
D. Oral Glucose Tolerance Testing (OGTT or GTT) and
Gestational Diabetes Screen (GDS)
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 2
1.1 Hours of Service
Main Laboratory
The Lab is now open 24 hours per day, 365 days of the year.
Microbiology Laboratory
7 days per week 0800-1600 All testing & processing of Microbiology samples is performed during Regular
Hours
STAT requests after-hours: please contact Main Laboratory staff
Outpatient Collection Clinic
Monday-Friday 0700-1130
Regular Hours & 1230-1600
Weekends & Holidays Closed
Blood work needed on weekends & holidays must be pre-arranged with the Lab.
1.2 Contact Information
General Lab Inquiries: Phone Fax Appointment Bookings
867-393-8739
867-393-8772
Collection Instructions Test Results
Microbiology: 867-393-8794 Collection Instructions
Results Mailing Address:
WGH Laboratory 5 Hospital Road Whitehorse, Yukon Y1A 3H7
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 3
1.3 Scope of this manual The purpose of this manual is broad in order to inform a diverse group of providers and clientele. This manual does not include all procedural instructions for each group- we have selected those topics of highest priority and for which we encounter the greatest confusion. This Guide to Services is not intended to be a stand-alone document; it is to be used in conjunction with other references:
Resource (with hyperlinks) Content Description
Lab Guide to Services
Includes general lab information; sample labelling & sample acceptance criteria; collection procedures; requisitions; patient instructions; transport of samples; ordering supplies
WGH Lab Test Reference (new April 2018)
PRIMARY RESOURCE- This new reference document provides instructions for lab tests run at WGH Lab: Meditech codes; preferred sample container; minimum sample quantity; TAT; sample stability; special instructions.
St. Paul’s Hospital Accessioning Test Reference
PRIMARY RESOURCE- List of orderable Referred-Out tests with instructions regarding: preferred sample container; minimum sample quantity; special instructions.
St. Paul’s Hospital Test Catalog
New online guide for tests run strictly at SPH. Includes: preferred sample container; minimum sample quantity; special instructions.
BCCH & BCCDC e-Lab Handbook
Online guide for tests run by BC Children’s & Women’s Hospital and by BC Centre for Disease Control- includes: specimen requirements; TAT; shipping; special instructions.
Meditech Training Manual
Training manual provided during nurse orientation/ training- provides guidelines for using Meditech: register patients; order tests; patient care inquiries; print sample labels; etc.
Process improvements and technological changes are constant in Laboratory Science. The WGH Laboratory has been undergoing rapid growth and expansion in recent years to meet the needs of a changing Yukon demographic. For these reasons printed versions of this document may become rapidly out of date. We thank you for your understanding.
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 4
1.4 Specimen Drop-off Specimens may be delivered directly to the main Laboratory and dropped off in the specimen drop-off bucket (at the front of the Laboratory).
1.5 Obtaining Lab Results Tests are performed in many different labs and the method of reporting differs with each one. Depending on the tests in question, results are: 1) automatically available in Meditech; 2) faxed, 3) delivered to clinics; or 4) available in Plexia in physicians’ offices. Lab Technologists phone physicians with critical test values. If you require test results, phone the Laboratory at 867-393-8739. Please provide the following information when you phone:
• Your full name and authority to access results • Secure fax # to receive results • Patient’s name and date of birth • Patient’s health care number • Date the specimen was collected • Site or source of the sample
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 5
1.6 Consent for Release Form This form must be completed by the patient to release information from Whitehorse General Hospital Laboratory. I, _______________________________ D.O.B. ____________ Health Care #:________________
(Patient Name – Please Print) DD/MM/YY Yukon Health Insurance #
consent to the release of my test results from sample(s) collected ________________________
Date sample collected (DD/MM/YY)
(if release to person other than stated above provide contact phone number to confirm authorization: ____________________) to:
Name of Person/Organization to whom information will be released)
for the following purpose:
Access is restricted to the above named person/ organization. No other persons shall have access to my health information without my written consent. ___________________________________ ______________________________
Patient Signature Date
____________________________________
Witness Signature
Laboratory Use Only:
Confirming identification (picture ID): Meditech comment by: Release date/time: Tech ID:
[From: WGH Laboratory Quality Manual- Document # OP-09-01F]
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 6
1.7 Point of Care Testing Point-of-care testing (POCT) is defined as medical diagnostic testing at or near the point of care—i.e. at the time and place of patient care. POCT is typically performed by non-Laboratory personnel and the results are used for acute clinical decision making. This contrasts with a wider array of tests performed in the medical laboratory (e.g. WGH Lab) by Medical Laboratory Technologists. The WGH Laboratory’s Point of Care Coordinator provides support to Nurses and CLXT’s for use of Point of Care instruments within WGH and community hospitals. One example of POCT within YHC is the glucometer program. The Laboratory is not responsible for POC testing and results outside of Yukon Hospital Corporation. When performing Point of Care testing, record:
• Patient name, date of birth, health care number
• Time and date the sample was collected
• Tester name
• Test results
• Time that test results were obtained
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 7
1.8 Referred-Out Tests: Our Support Team This Table lists the referral laboratories outside the Yukon to which we send samples for testing.
Facility Website Dynacare (locations: ON, QU) https://www.dynacare.ca/
Dynalife (location: AB) https://dynalifedx.com/
In-Common Laboratories (ICL) (location: ON) http://www.hicl.on.ca/
Providence Health Care (PHC) http://www.providencehealthcare.org/
Within PHC we have contracts with:
St. Paul's Hospital (location: BC) http://www.providencehealthcare.org/hospitals-residences/st-paul%27s-hospital
Provincial Health Services Authority (PHSA) http://www.phsa.ca/
Within PHSA we have contracts with:
BC Communicable Diseases Control (BCCDC) http://www.bccdc.ca/
BC Children's Hospital http://www.bcchildrens.ca/
BC Women's Hospital & Health Centre www.bcwomens.ca
BC Cancer Agency http://www.bccancer.bc.ca/
Canadian Blood Services (CBS) BC-Yukon region http://www.blood.ca/
Lifelabs Medical Laboratory Services (BC) (formerly BC Biomedical) http://www.lifelabs.com/
TrueNorth Respiratory Therapy Services (Whitehorse) https://www.truenorthrespiratory.com/
Vancouver Coastal Health http://www.vch.ca/
Within VCH we have contracts with:
Vancouver General Hospital http://www.vch.ca/Locations-Services/result?res_id=644
Note: Other Canadian Laboratories are periodically used for rare tests. Out of country test requests require approval from the Medical Director- consult the Lab Manager for details.
Samples for the following tests are sent to referral Microbiology/ Virology Laboratories for testing: Microbiology/ Virology Referred-Out Testing:
Stool samples (all tests) Viral Cultures (all sample types/tests) TB testing (all sample types) Influenza (ILI) Pertussis GI Outbreaks Chlamydia/ GC
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 8
1.9 Booking Procedures: Tests Requiring Appointments
The following procedures and tests require appointments:
Procedure or Test Requisition Phone to book appointment?
A. Electrocardiogram (ECG/ EKG) WGH Lab On Site Testing Yes
B. Holter Monitor Holter Monitor Yes
C. Spirometry and Reversibility Testing WGH Lab Spirometry No
D. Oral Glucose Tolerance Test (OGTT) WGH Lab On Site Testing Yes
1. Fill out a Requisition for the patient
2. Phone the Laboratory at 393-8739 to book the appointments on behalf of the patient (Exception: Spirometry tests are booked by the clinic performing the test once the requisition is received)
3. Write the appointment date and time on the Requisition
4. Fax completed Requisitions to the Laboratory: 867-393-8772
See specific instructions for each test in the proceeding pages.
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 9
A. Electrocardiogram (ECG/EKG)
1. Refer patients with acute chest pain directly to the WGH ED, not to the Laboratory. A requisition is not required.
2. Appointments: ensure the ordering physician is available, in their clinic, at the proposed time of the patient’s ECG appointment. The physician must review abnormal ECG reports before patients can leave the hospital.
3. Pediatric patients may require longer appointment times, so please indicate the age of the child when booking the appointment.
4. Provide patient with a Patient Information Sheet (see Section D).
5. Verbally state to the patient:
• Arrive at least 10 minutes early for the appointment so there is time for check-in. If you are late, there may be delays or your appointment may need to be rebooked.
• Be prepared to wait, there can be delays if your doctor needs to review the ECG test results. While the actual test is fast, the entire appointment may last 30 minutes.
B. Holter Monitor
1. Provide patient with a Patient Information Sheet (see Section D).
2. Verbally state to the patient:
• You must come to the WGH Laboratory to have your Holter Monitor fitted- the fitting appointment will take approximately 20-30 minutes.
• You must wear the Holter Monitor for a 24 hour period.
• You must return to the lab the next day to have the monitor removed (10 minutes).
• Read the Patient Instructions thoroughly to prepare for the appointment.
• You will complete a diary of your activities for 24 hours.
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 10
C. Spirometry and Reversibility Testing at WGH Laboratory
These tests were formerly referred to as Pulmonary Function Tests (PFT’s). Both Spirometry testing (one session, no bronchodilator administered) and Reversibility testing (Pre & Post bronchodilator Spirometry) are performed. We have created a separate requisition (see Section B) to reflect requirements. Please note the following guidelines for determining patient suitability before submitting a requisition:
Patients must be ≥6 years old to be eligible. Indications for spirometry (as listed on requisition): Reason for testing:
□ For confirmation of diagnosis: patient must withhold respiratory medications
Physician must provide specific instructions to patient OR □ Monitoring therapy: continue respiratory medications
Contraindications for Spirometry Postpone if the patient: Absolute Contraindications: -is experiencing an acute respiratory illness
-history of an aneurysm
-has had a recent (within one month) heart attack
-uncontrolled hypertension -has had a recent stroke
-has had recent eye, abdominal, thoracic surgery -has had a recent pneumothorax
Withholding Medications It is recommended that some respiratory medications be withheld prior to spirometry testing. It is the physician’s responsibility to provide their patients with specific instructions about withholding medications. For a current list of recommended respiratory medications to withhold prior to spirometry testing, contact True North Respiratory at 667-7120.
Laboratory Guide to Services
General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 11
Appointments for Spirometry and Reversibility testing are now booked by True North Respiratory.
1. Obtain the patient’s current phone number(s) where they can be reached during business hours to book the appointment.
2. Fax the Requisition with contact phone numbers to the Laboratory: 867-393-8772
3. Patients will be contacted by True North Respiratory in the order in which Requisitions are received.
4. Provide patient with a Patient Information Sheet (see Section D).
5. Verbally state to the patient:
• You will be contacted by True North Respiratory to book your appointment. These tests are performed on select days.
• Avoid smoking for at least 1 hour prior to the test • Avoid eating a large meal 2 hours prior to the test • Avoid exercising heavily 30 minutes prior to the test • Avoid drinking alcohol 4 hours prior to the test • Avoid wearing tight clothing that might restrict full deep breaths • Do not wear fragranced products (perfume, cologne, shower gels, etc.) • Bring your medication (‘puffers’) with you to the appointment. You must follow your
doctor’s instructions about using these medicines before the test • Arrive 10 minutes early to check in • The appointment will last approximately 1 hour because the test will be done twice
(before and after you are given a medicine). • You cannot smoke during the test
The following ‘YouTube’ video (Title: “Spirometry Technique Review”, uploaded by ‘LungAssociationSK’) depicts the test we perform at the WGH Laboratory: http://www.youtube.com/watch?v=--7ORNHWVrY&list=UUo2i4iUca7JpewgD9xY5GVA&index=2&feature=plcp
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General Laboratory
Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 12
D. Oral Glucose Tolerance Testing (OGTT or GTT) and Gestational Diabetes Screen (GDS)
1. Includes Non-Gestational and Gestational GTT tests.
2. Provide patient with:
• Requisition
• Patient Information Sheet (see Section D)
3. Verbally inform patient of the following information:
• Fast for 8 hours before the test.
• You can continue to take your medications. Drinking water is permitted.
• Arrive 10 minutes early to get signed in. You will be at the Hospital for just over 2 hours.
• Read the Patient Information Sheet before the test to prepare for the appointment.
Dose and Collection Procedures for OGTT
Restrictions Dose of Trutol 100 (1gm/3mL)
Blood Collections
2 hr. OGTT, Non-Gestational
8 hr. fast; water permitted; take medication(s)
Adult: 225 mL= Fasting 75 gm 2 hr.
2 hr. OGTT, Gestational
8 hr. fast; water permitted; take medication(s)
Adult: 225 mL= Fasting 75 gm 1 hr. 2 hr.
50 gm GDS, Gestational Diabetes Screen
None See below
Adult: 150 mL= 1 hr. 50 gm
No appointment required for 50 gm GDS- patient must arrive at the WGH Outpatients Lab no later than 2:45 p.m. to complete the test before lab closure.
Laboratory Guide to Services
WGH Lab Test Information
Implementation Date: April 2018 Printed versions of this document are not controlled. 13
2.0 WGH LABORATORY TEST INFORMATION This section contains our new WGH Laboratory Test Reference. This reference is also available online on the YHC website and on the Lab’s Sharepoint Home page. 2.1 WGH Laboratory Test Menu: On-site Services
2.2 WGH Laboratory Test Reference
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Hum
an C
horio
nic
Gon
adot
ropi
n Ph
enyt
oin
(Dila
ntin
) Li
pase
(Per
itone
al)
Lact
ate
Vanc
omyc
in
Uric
Aci
d (S
ynov
ial)
Lact
ate
Deh
ydro
gena
se
…C
ontin
ued
on n
ext p
age
Labo
rato
ry
Guid
e to
Ser
vice
s W
GH
Lab
Tes
t In
form
atio
n Im
plem
enta
tion
Dat
e: A
pril
2018
P
rinte
d ve
rsio
ns o
f thi
s do
cum
ent a
re n
ot c
ontro
lled.
15
…C
ontin
ued
from
pre
viou
s pa
ge
Hem
atol
ogy
Tran
sfus
ion
Med
icin
e U
rinal
ysis
/ Sto
ol T
estin
g C
ompl
ete
Blo
od C
ount
(CB
C) w
ith a
utom
ated
AB
O &
Rh
Typi
ng
Urin
alys
is- m
acro
scop
ic &
mic
rosc
opic
diff
eren
tial
Antib
ody
Scre
en
Urin
e dr
ugs
of a
buse
Ab
solu
te n
eutro
phil
coun
t & a
bsol
ute
gr
anul
ocyt
e co
unt
Com
patib
ility
test
(cro
ss m
atch
) U
rine
fent
anyl
scr
een
D
irect
Ant
iglo
bulin
Tes
t (D
AT)
Preg
nanc
y te
st
Bloo
d fil
m re
view
Tr
ansf
usio
n re
actio
n in
vest
igat
ion
Feca
l Im
mun
oche
mic
al te
stin
g
Prot
hrom
bin
Tim
e/ IN
R
Bloo
d Pr
oduc
ts (L
imite
d R
ed C
ell
Inve
ntor
y)
Parti
al T
hrom
bopl
astin
Tim
e Bl
ood
Com
pone
nts
on-s
ite:
D
-Dim
er te
st
Red
cel
ls
Fi
brin
ogen
C
Plas
ma
R
etic
uloc
ytes
Al
bum
in (5
& 2
5%)
M
alar
ia s
mea
rs
IVIG
Cel
l cou
nt (o
ther
flui
ds)
RhI
g
Sem
en A
naly
sis-
infe
rtilit
y &
post
-vas
ecto
my
Fact
or V
III
R
heum
atoi
d Fa
ctor
Scr
een
& Ti
tre
Fact
or IX
Mon
onuc
leos
is
Pro
thro
mbi
n C
ompl
ex c
once
ntra
te
Ac
tivat
ed F
acto
r VII
(rec
ombi
nant
)
Mic
robi
olog
y Po
int-o
f-Car
e te
stin
g O
utpa
tient
Clin
ic P
roce
dure
s Te
sts
on b
lood
, urin
e, s
teril
e flu
ids,
spu
ta &
sw
abs
f
rom
var
ious
bod
y si
tes
Glu
com
eter
out
reac
h El
ectro
card
iogr
ams
Cul
ture
and
Sen
sitiv
ities
H
uman
Imm
unod
efic
ienc
y Vi
rus
Hol
ter m
onito
ring
Gra
m s
tain
Spiro
met
ry &
Rev
ersi
bilit
y Te
stin
g In
fect
ion
cont
rol s
cree
ning
for A
ntib
iotic
Res
ista
nt
Ure
a Br
eath
test
Org
anis
ms
(e.g
. MR
SA, V
RE)
C. d
iffic
ile a
ntig
en a
nd to
xin
assa
y
Tric
hom
onas
ant
igen
Labo
rato
ry
Guid
e to
Ser
vice
s W
GH
Lab
Tes
t In
form
atio
n Im
plem
enta
tion
Dat
e: A
pril
2018
P
rinte
d ve
rsio
ns o
f thi
s do
cum
ent a
re n
ot c
ontro
lled.
16
2.2
WG
H L
abor
ator
y Te
st R
efer
ence
This
new
refe
renc
e do
cum
ent p
rovi
des
inst
ruct
ions
for e
ach
test
run
at W
GH
Lab
:
• M
edite
ch c
odes
(bot
h th
roug
h th
e LA
B m
odul
e an
d th
e O
E m
odul
e)
• Pr
efer
red
sam
ple
cont
aine
r
• M
inim
um s
ampl
e qu
antit
y
• TA
T (T
urn
Arou
nd T
ime
from
tim
e of
rece
ipt i
n th
e La
b)
• Sa
mpl
e st
abilit
y
• Sp
ecia
l ins
truct
ions
The
Lab’
s ne
w T
est R
efer
ence
can
als
o be
foun
d on
the
YHC
web
site
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
1 of
7
OE
Cat
egor
yTe
st C
ode
Acet
amin
ophe
nAC
TMLA
BAC
TMY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
2 da
ys a
t 2-8
°C
Alan
ine
Amin
otra
nsfe
rase
(ALT
)AL
TLA
BAL
TY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Albu
min
ALB
LAB
ALB
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y3
days
at 2
-8 °
C
Albu
min
-Cre
atin
ine
Rat
io (A
CR
)AC
RLA
BAL
BCR
YU
rine
cont
aine
r0.
5 m
L R
ando
m U
rine
sam
e da
y2
days
at 1
8-24
°C
; 14
days
at
2-8
°C
Alka
line
Phos
phat
ase
(ALP
)AL
PILA
BAL
KY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Amm
onia
AMM
LAB
AMM
NPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in) o
n ic
eST
AT30
min
utes
on
ice.
Spe
cial
in
stru
ctio
ns a
pply
.In
-hou
se a
vaila
bilit
y on
ly. C
all l
ab fo
r ins
truct
ions
on
peds
co
llect
ions
. *D
eliv
er to
Lab
on
ice*
Arte
rial B
lood
Gas
ABG
LAB
ABG
NPI
CO
syr
inge
0.7
mL
PIC
O h
epar
iniz
ed s
yrin
geST
AT30
min
utes
on
ice.
In
-hou
se a
vaila
bilit
y on
ly. C
all l
ab fo
r ins
truct
ions
on
peds
co
llect
ions
.
Aspa
rtate
Am
inot
rans
fera
se (A
ST)
AST
LAB
AST
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
C
Bica
rbon
ate
(HC
O3)
/ C
arbo
n D
ioxi
deC
O2
LAB
CO
2Y
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
) *T
ape
tube
cap
shu
t*sa
me
day
Uno
pene
d se
para
ted
sam
ples
: 2 d
ays
at 2
-8 °
C*D
o no
t ope
n tu
be c
ap*
Bilir
ubin
– T
otal
BILT
LAB
BILT
Y P
ST0.
2 m
L Pl
asm
a (li
thiu
m h
epar
in)
*Pro
tect
from
ligh
t*sa
me
day
7 da
ys a
t 2-8
°C
*Pro
tect
fro
m li
ght*
Wra
p sa
mpl
e in
tinf
oil t
o pr
even
t pho
tode
grad
atio
n.
Bilir
ubin
– D
irect
BILD
LAB
call
Lab
YPS
T0.
2 m
L Pl
asm
a (li
thiu
m h
epar
in)
*Pro
tect
from
ligh
t*sa
me
day
7 da
ys a
t 2-8
°C
*Pro
tect
fro
m li
ght*
Tes
t add
ed b
y La
b w
hen
TBIL
ele
vate
d. P
edia
trics
by
spec
ial
requ
est.
Sam
ple
subj
ect t
o ph
otod
egra
datio
n.
Bloo
d U
rea
Nitr
ogen
(Ure
a)BU
NLA
BBU
NY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
).sa
me
day
7 da
ys a
t 2-8
°C
Cal
cium
CA
LAB
CA
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in).
sam
e da
y7
days
at 2
-8 °
C
Ioni
zed
Cal
cium
(ser
um)
CAI
LAB
CAI
YG
OLD
SST
½ fu
ll SS
T tu
be (S
erum
). *D
o no
t op
en. T
ape
tube
cap
shu
t. D
o no
t fre
eze*
sam
e da
y7
days
at 2
-8 °
C in
uno
pene
d tu
beM
ust b
e at
leas
t ½ fu
ll dr
aw. *
*DO
NO
T O
PEN
** T
ape
tube
cap
sh
ut. C
entri
fuge
and
sen
d on
ice
pack
. **D
O N
OT
FREE
ZE**
Cap
illary
Blo
od G
asC
APG
ASLA
BC
APG
ASN
Cap
illary
Tub
e0.
1 m
L W
hole
blo
od
(Lith
ium
Hep
arin
)ST
AT30
min
utes
on
ice
Col
lect
ed b
y La
b st
aff o
nly.
In-h
ouse
ava
ilabi
lity
only
.
Car
diac
Tro
poni
n I
TRO
PLA
BTR
OP
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
STAT
2 da
ys a
t 2-8
°C
Free
ze s
ampl
es if
in tr
ansi
t >48
hou
rs.
Chl
orid
eC
LLA
BC
LY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Cho
lest
erol
C
HO
LLA
BC
HO
LY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
2 da
ys a
t 2-8
°C
HD
L C
hole
ster
olH
DL
LAB
HD
LY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
2 da
ys a
t 2-8
°C
LDL
Cho
lest
erol
not o
rder
able
LAB
not
orde
rabl
eY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
LDL
Cho
lest
erol
is a
cal
cula
tion.
To
perfo
rm,
both
Trig
lyce
rides
& H
DL
test
s m
ust b
e or
dere
d.C
ord
Bloo
d pH
(arte
rial &
ven
ous)
pa
nel
CPH
LAB
CPH
NPi
co s
yrin
ge0.
7 m
L PI
CO
hep
arin
ized
syr
inge
sam
e da
y12
hou
rs o
n ic
e*D
eliv
er to
the
Lab
on ic
e*. I
n-ho
use
avai
Labi
lity
only
.
C-R
eact
ive
Prot
ein
CR
PLA
BC
RP
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y3
days
at 2
-8 °
CC
reat
inin
e an
d eG
FR (e
stim
ated
gl
omer
ular
filtr
atio
n ra
te)
CR
ELA
BC
RE
Y P
ST0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y
The
eGFR
cal
cula
tion
is n
ot re
porte
d on
pat
ient
s <1
8 ye
ars.
Chemistry
For A
ll B
lood
Col
lect
ions
: Fo
r acc
urat
e te
st re
sults
, col
lect
ions
mus
t be
free
from
hem
olys
is.
Sam
ples
sho
uld
be g
ently
inve
rted
8-1
0 tim
es im
med
iate
ly a
fter c
olle
ctio
n to
ens
ure
antic
oagu
lant
is m
ixed
com
plet
ely
with
the
sam
ple.
For
SST
tube
s, re
st s
ampl
e fo
r 10
min
utes
to a
llow
clo
tting
to o
ccur
prio
r to
cent
rifug
atio
n.
Cen
trifu
ge w
ithin
30
min
utes
of c
olle
ctio
n. E
xcep
tion:
Do
not s
pin
who
le b
lood
in E
DTA
(Lav
enda
r) tu
bes.
If sa
mpl
es w
ill b
e de
laye
d in
tran
sit,
plas
ma/
ser
um s
ampl
es s
houl
d be
aliq
uote
d an
d fr
ozen
.**
Che
mis
try
sam
ples
are
reta
ined
for 4
day
s up
on re
ceip
t in
the
Lab.
**
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
2 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
Cre
atin
e Ki
nase
(CK)
CKI
LAB
CK
Y P
ST0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
C
Ethy
l alc
ohol
(ETO
H)
ALC
LAB
ETO
HN
PST
Plas
ma
(Lith
ium
Hep
arin
) tub
e.
*Tap
e tu
be c
ap s
hut*
sam
e da
y2
wee
ks a
t 2-8
°C
in a
nev
er-
open
ed c
onta
iner
Use
non
-alc
ohol
ski
n cl
eans
er. D
ue to
the
vola
tile
natu
re o
f al
coho
l, sp
ecim
en tu
bes
shou
ld b
e co
mpl
etel
y fil
led
and
capp
ed
to a
void
eva
pora
tive
loss
to th
e at
mos
pher
e. T
est o
nly
orde
rabl
e fo
r med
ical
-not
lega
l- re
ason
s.Fe
rriti
nFE
RR
LAB
FER
Y P
ST0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
CG
amm
a (Ƴ
)-G
luta
myl
Tra
nsfe
rase
(G
GT)
GG
TLA
BG
GT
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m h
epar
in)
sam
e da
y2
days
at 2
-8 °
C
Glu
cose
- Ran
dom
GLU
LAB
GLU
Y0.
5 m
L Pl
asm
a (L
ithiu
m h
epar
in)
Glu
cose
- Fas
ting
GLU
FLA
BG
LUF
Y*T
ime
of c
olle
ctio
n m
ust b
e w
ritte
n on
blo
od tu
bes
and
the
requ
isiti
on* P
atie
nt m
ust f
ast p
rior t
o co
llect
ion.
Ref
er to
the
WG
H L
ab G
uide
to S
ervi
ces
for d
etai
ls.
Glu
cose
- Ges
tatio
nal D
iabe
tes
Scre
enin
g- 5
0 g
Cha
lleng
e Te
stG
LU50
LAB
call
Lab
Y*T
ime
of c
olle
ctio
n m
ust b
e w
ritte
n on
blo
od tu
bes
and
the
requ
isiti
on*
Ref
er to
Gui
de to
Ser
vice
s fo
r mor
e in
form
atio
n.G
luco
se- O
ral G
luco
se T
oler
ance
Tes
t (G
esta
tiona
l)- 7
5 g
GTT
GLA
BG
TTG
EST
YIf
in W
hite
hors
e, b
ook
with
the
Lab.
Ref
er to
Gui
de to
Ser
vice
s fo
r mor
e in
form
atio
n.G
luco
se- O
ral G
luco
se T
oler
ance
Tes
t (n
on-G
esta
tiona
l)- 7
5 g
GTT
2LA
BG
TT2
YIf
in W
hite
hors
e, b
ook
with
the
Lab.
Ref
er to
Gui
de to
Ser
vice
s fo
r mor
e in
form
atio
n.H
emog
lobi
n A1
cA1
CLA
BH
GBA
1CY
EDTA
(Lav
ende
r)2
mL
ETD
A w
hole
blo
odsa
me
day
7 da
ys a
t 2-8
°C
*Do
not c
entri
fuge
*H
uman
Cho
rioni
c G
onad
otro
pin
HC
GLA
BH
CG
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y2
days
at 2
-8 °
C
Lact
ate
(Ven
ous)
LAC
TVLA
BLA
CTV
N*P
ST o
n ic
e*0.
5 m
L W
hole
Blo
od (L
ithiu
m
Hep
arin
)ST
AT30
min
utes
on
ice.
*Do
not u
se to
urni
quet
whe
n co
llect
ing
bloo
d*
Del
iver
to L
ab o
n ic
e. In
-hou
se O
nly.
Lact
ate
Deh
ydro
gena
se (L
D)
LDI
LAB
LDH
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in) *
Do
not r
efrig
erat
e or
free
ze*
sam
e da
y3
days
at 1
8-24
°C
. *D
o no
t re
frige
rate
or f
reez
e**R
oom
Tem
pera
ture
sto
rage
& tr
ansp
ort O
NLY
*
Lipa
se (L
IP)
LIP
LAB
LIP
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
CM
agne
sium
MG
LAB
MG
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
CN
-term
inal
Pro
-BN
TBN
PLA
BBN
PY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
3 da
ys a
t 2-8
°C
Osm
olal
ityO
SMO
LAB
OSM
OY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
up to
3 d
ays
at 4
°C
Osm
olal
ity- U
rine
OSM
OU
LAB
UO
SMO
YU
rine
cont
aine
r0.
5 m
L R
ando
m U
rine
sam
e da
yup
to 3
day
s at
4 °
C
Met
hano
l Inv
estig
atio
nM
ETIN
VLA
BM
ETIN
VY
PST
Also
Ord
er: A
BG o
r VBG
STAT
7 da
ys a
t 2-8
°C
in a
nev
er-
open
ed c
onta
iner
This
test
is c
ondu
cted
in c
onju
nctio
n w
ith O
smol
ality
test
ing.
Use
no
n-al
coho
l ski
n cl
eans
er. D
ue to
the
vola
tile
natu
re o
f alc
ohol
, sp
ecim
en tu
bes
shou
ld b
e co
mpl
etel
y fil
led
and
capp
ed to
avo
id
evap
orat
ive
loss
to th
e at
mos
pher
e.
Phos
phor
usPH
OS
LAB
PHO
SY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Po
tass
ium
KLA
BK
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y7
days
at 2
-8 °
CSa
licyl
ate
(ASA
)SA
LLA
BSA
LY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Sodi
umN
ALA
BN
AY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Thyr
oid
Stim
ulat
ing
Hor
mon
e (T
SH)
TSH
LLA
BTS
HY
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
)sa
me
day
7 da
ys a
t 2-8
°C
Tota
l Pro
tein
TPLA
BTP
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y3
days
at 2
-8 °
CTo
tal P
rote
in- C
reat
inin
e R
atio
PRC
RR
LAB
UR
INEP
rCr
YU
rine
cont
aine
r0.
5 m
L Fr
esh
Ran
dom
Urin
esa
me
day
3 da
ys a
t 2-8
°C
See
also
24
hour
urin
e - T
otal
Pro
tein
. Sam
ple
can
be fr
ozen
.
Trig
lyce
rides
TRIG
LAB
TRIG
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y3
days
at 2
-8 °
CPa
tient
mus
t fas
t for
12
hour
s pr
ior t
o bl
ood
colle
ctio
n (*
not
requ
ired
whe
n us
ed fo
r pan
crea
titis
risk
ass
essm
ent).
Uric
aci
dU
RC
ALA
BU
RIC
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m H
epar
in)
sam
e da
y3-
5 da
ys a
t 2-8
°C
Chemistry
PST
0.5
mL
Plas
ma
(Lith
ium
Hep
arin
). *T
ime
of c
olle
ctio
n m
ust b
e w
ritte
n on
tu
bes*
sa
me
day
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
3 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
Veno
us B
lood
Gas
VBG
LAB
VBG
N*P
ST o
n ic
e*3
mL
Who
le B
lood
(Lith
ium
Hep
arin
)ST
AT30
min
utes
on
ice
*Del
iver
imm
edia
tely
to th
e La
b- o
n ic
e*
Car
bam
ezap
ine
(Teg
reto
l)C
RBM
LAB
CR
BMY
PST
0.5
mL
Plas
ma
(Lith
ium
hep
arin
)sa
me
day
2 da
ys a
t 2-8
°C
Col
lect
just
prio
r to
next
dos
e un
less
toxi
city
is s
uspe
cted
. Pr
ovid
e D
ate
and
Tim
e of
last
dos
e.
Dig
oxin
DIG
LAB
DIG
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m h
epar
in)
sam
e da
y7
days
at 2
-8 °
CC
olle
ct ju
st p
rior t
o ne
xt d
ose
unle
ss to
xici
ty is
sus
pect
ed.
Prov
ide
Dat
e an
d Ti
me
of la
st d
ose.
Gen
tam
icin
GEN
(Loo
kup)
LAB
GEN
(L
ooku
p)Y
PST
0.5
mL
Plas
ma
(Lith
ium
hep
arin
)sa
me
day
2 da
ys a
t 2-8
°C
Mul
tiple
Med
itech
cod
es b
ased
on
dosi
ng a
nd ti
min
g of
co
llect
ion-
pea
k or
trou
gh. T
ype
in th
e fir
st 3
lette
rs G
EN th
en h
it F9
key
to L
ooku
p ne
eded
test
cod
e.
Lith
ium
LI
LAB
LITH
Y*S
ST (r
ed o
r ye
llow
top)
*0.
5 m
L se
rum
(SST
) *D
o no
t use
Li
thiu
m h
epar
in tu
be*
sam
e da
y7
days
at 2
-8 °
C*D
o no
t use
Lith
ium
hep
arin
tube
* -in
terfe
res
in a
ssay
. Col
lect
ju
st p
rior t
o ne
xt d
ose
unle
ss to
xici
ty is
sus
pect
ed. P
rovi
de D
ate
and
Tim
e of
last
dos
e.
Phen
ytoi
n (D
ilant
in)
PTN
LAB
PTN
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m h
epar
in)
sam
e da
y2
days
at 2
-8 °
CC
olle
ct ju
st p
rior t
o ne
xt d
ose
unle
ss to
xici
ty is
sus
pect
ed.
Prov
ide
Dat
e an
d Ti
me
of la
st d
ose.
Vanc
omyc
inVA
N (L
ooku
p)LA
BVA
N
(Loo
kup)
YPS
T0.
5 m
L Pl
asm
a (L
ithiu
m h
epar
in)
sam
e da
y2
days
at 2
-8 °
CM
ultip
le M
edite
ch c
odes
bas
ed o
n do
sing
and
tim
ing
of
colle
ctio
n- p
eak
or tr
ough
. Typ
e in
the
first
3 le
tters
VAN
then
hit
F9 k
ey to
Loo
kup
need
ed te
st c
ode.
Cal
cium
, 24
hour
urin
eC
A24
LAB
UC
AL24
Chl
orid
e, 2
4 ho
ur u
rine
CL2
4LA
BU
CL2
4C
reat
inin
e, 2
4 ho
ur u
rine
CR
E24
LAB
UC
REA
T24
Mag
nesi
um, 2
4 ho
ur u
rine
MG
24LA
BU
MG
24Ph
osph
orus
, 24
hour
urin
eU
PHO
S24
LAB
UPH
OS2
4Po
tass
ium
, 24
hour
urin
eK2
4LA
BU
K24
Prot
ein,
24
hour
urin
eTP
24LA
BU
PRO
24Pr
otei
n, C
reat
inin
e R
atio
, 24
hour
PRC
R24
LAB
call
Lab
Sodi
um, 2
4 ho
ur u
rine
NA2
4LA
BU
NA2
4U
rea,
24
hour
urin
eU
REA
24LA
Bca
ll La
bU
ric A
cid,
24
hour
urin
eU
RC
ALA
BU
UR
IC24
Cre
atin
ine
Cle
aran
ce. 2
4 ho
ur u
rine
CR
CL
LAB
UC
RC
L24
Com
plet
e Bl
ood
Cou
nt (C
BC) w
ith
auto
mat
ed d
iffer
entia
lC
BCLA
BC
BCY
EDTA
(Lav
ende
r)1.
0 m
L ED
TAsa
me
day
Smea
rs m
ust b
e m
ade
with
in
3 ho
urs
of c
olle
ctio
nIn
form
atio
n ab
out m
akin
g bl
ood
film
s (s
mea
rs) c
an b
e fo
und
in
the
WG
H L
ab G
uide
to S
ervi
ces
man
ual.
Abso
lute
neu
troph
il co
unt &
abs
olut
e gr
anul
ocyt
e co
unt
ANC
/AG
CLA
BAN
C/A
CG
YED
TA (L
aven
der)
1.0
mL
EDTA
sam
e da
ySm
ears
mus
t be
mad
e w
ithin
3
hour
s of
col
lect
ion
CBC
mus
t be
orde
red
with
this
test
. Spe
cial
cas
es o
nly
(e.g
. ch
emo
patie
nts)
.
Prot
hrom
bin
Tim
e (P
T)/ I
NR
INR
LAB
INR
YSo
dium
citr
ate
(blu
e)*M
ust f
ill th
e tu
be c
ompl
etel
y*sa
me
day
24 h
ours
at 1
8-24
°C
*do
not
refri
gera
te o
r cen
trifu
ge*
*Do
not r
efrig
erat
e or
cen
trifu
ge* I
f not
test
ed w
ithin
24
hour
s,
rem
ove
plas
ma
from
cel
ls a
nd
freez
e at
-20°
C.
Parti
al T
hrom
bobl
astin
Tim
ePT
TLA
BPT
TY
Sodi
um c
itrat
e (b
lue)
*Mus
t fill
the
tube
com
plet
ely*
sam
e da
y4
hour
s at
18-
24 °
C in
un
open
ed tu
beIf
not t
este
d w
ithin
4 h
ours
, rem
ove
plas
ma
from
cel
ls a
nd fr
eeze
at
-20°
C.
Dim
er te
stD
IMER
LAB
DIM
YSo
dium
citr
ate
(blu
e)*M
ust f
ill th
e tu
be c
ompl
etel
y*sa
me
day
4 ho
urs
at 1
8-24
°C
If no
t tes
ted
with
in 4
hou
rs, r
emov
e pl
asm
a fro
m c
ells
and
free
ze
at -2
0°C
.
Chemistry
24 h
our u
rine
cont
aine
r with
10-
20 m
L 6
M H
Cl
Ther
apeu
tic D
rug
Mon
itorin
g:
24 H
our U
rine
Test
ing
(Not
e th
at s
ome
24 H
our U
rine
test
s ar
e se
nt to
Ref
fera
l Lab
s fo
r tes
ting)
Y
Hem
atol
ogy
Hematology
24 h
our u
rine
cont
aine
r with
10-
20 m
L 6
M H
Cl
24 h
our u
rine
cont
aint
er, n
o pr
eser
vativ
e24
hou
r urin
e co
ntai
nter
, no
pres
erva
tive
24 h
our u
rine
cont
aine
r with
10-
20 m
L 6
M H
Cl
24 h
our u
rine
cont
aint
er, n
o pr
eser
vativ
e
24 h
our u
rine
cont
aine
rs m
ust b
e re
frige
rate
d du
ring
and
afte
r the
24
hour
col
lect
ion
perio
d.U
pon
rece
ipt,
mix
con
tain
er w
ell a
nd th
en m
easu
re &
reco
rd to
tal v
olum
e on
Req
uisi
tion.
Su
bmit
5mL
aliq
uot t
o La
b fo
r pro
cess
ing.
Do
not s
end
entir
e co
ntai
ner t
o th
e La
b.R
ecor
d ty
pe a
nd v
olum
e of
pre
serv
ativ
e us
ed if
app
licab
le.
We
are
in th
e pr
oces
s of
upd
atin
g ou
r writ
ten
prot
ocol
s fo
r pro
cess
ing
24 H
our U
rine
sam
ples
. Pl
ease
pho
ne th
e La
b fo
r fur
ther
inst
ruct
ions
on
proc
essi
ng c
olle
ctio
ns: 3
93-8
739.
N
ote
that
som
e 24
urin
e te
sts
are
refe
rred
out
to S
PH fo
r tes
ting.
Con
sult
SPH
man
ual f
or a
dditi
onal
test
s.
Prov
ide
patie
nt h
eigh
t & w
eigh
t for
cal
cula
tion
of c
reat
inin
e cl
eara
nce.
Yo
u m
ust a
lso
subm
it a
plas
ma
sam
ple
for c
reat
inin
e te
stin
g.
24 h
our u
rine
cont
aint
er, n
o pr
eser
vativ
e24
hou
r urin
e co
ntai
nter
, no
pres
erva
tive
24 h
our u
rine
cont
aint
er, n
o pr
eser
vativ
e24
hou
r urin
e co
ntai
nter
, no
pres
erva
tive
24 h
our u
rine
cont
aine
r with
10
mL
5% N
aOH
24 h
our u
rine
cont
aint
er, n
o pr
eser
vativ
e
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
4 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
Fibr
inog
en C
FIB-
CLA
BFI
B-C
YSo
dium
citr
ate
(blu
e)*M
ust f
ill th
e tu
be c
ompl
etel
y*ST
AT4
hour
s at
18-
24 °
C
If no
t tes
ted
with
in 4
hou
rs, r
emov
e pl
asm
a fro
m c
ells
and
free
ze
at -2
0°C
.R
etic
uloc
ytes
RET
ICLA
BR
ETIC
YED
TA (L
aven
der)
1.0
mL
EDTA
sam
e da
y3
days
at 2
-8 °
CC
BC m
ust b
e or
dere
d w
ith th
is te
st.
Mal
aria
scr
een
MAL
LAB
MAL
YED
TA (L
aven
der)
1.0
mL
EDTA
STAT
*Sm
ears
mus
t be
mad
e w
ithin
1 h
our o
f col
lect
ion*
Mus
t pro
vide
trav
el h
isto
ry: c
ount
ries
visi
ted,
dat
es. C
BC m
ust
be o
rder
ed. C
all L
ab fo
r mor
e in
form
atio
n.Se
men
Ana
lysi
s- In
ferti
lity
SAIN
FLA
BSF
NTr
ansp
ort t
o La
b im
med
iate
ly (w
arm
).sa
me
day
30 m
inut
es k
ept w
arm
Mon
day
to T
hurs
day
befo
re n
oon.
Sem
en A
naly
sis-
Pos
t-Vas
ecto
my
SAPV
LAB
SPP
NTr
ansp
ort t
o La
b im
med
iate
ly.
sam
e da
y4
hour
sR
heum
atoi
d Fa
ctor
Scr
een
RA
LAB
RA
YSS
T0.
5 m
L Se
rum
7 da
ys a
t 2-8
°C
Mon
onuc
leos
is s
cree
nM
ON
OLA
BM
ON
OY
SST
0.5
mL
Seru
m7
days
at
2-8
°CB
ody
Flui
ds
Ster
ile c
onta
iner
2 bu
sine
ss
days
Hematology
Batc
hed
Test
s ru
n at
leas
t 2 ti
mes
per
wee
k.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Bod
y Fl
uids
**B
efor
e be
ginn
ing
any
Flui
d co
llect
ion,
ple
ase
phon
e th
e la
b fo
r dire
ctio
n on
sam
ple
hand
ling
& tr
ansp
ort.
Sam
ples
nee
d to
be
tran
sfer
red
imm
edia
tely
into
the
corr
ect s
peci
men
con
tain
ers.
Al
iquo
t spe
cim
ens
into
con
tain
ers
as li
sted
bel
ow.
See
WG
H L
ab G
uide
to S
ervi
ces
for m
ore
deta
ils.
All
fluid
cyt
olog
y sp
ecim
ens
are
sent
to R
efer
red
out l
abs.
Con
sult
the
WG
H G
uide
to S
ervi
ces
and
St. P
aul's
Hos
pita
l Tes
t Ref
eren
ce D
irect
ory
for h
andl
ing
inst
ruct
ions
.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
**B
efor
e be
ginn
ing
any
Flui
d co
llect
ion,
ple
ase
phon
e th
e la
b fo
r dire
ctio
n on
sam
ple
hand
ling
& tr
ansp
ort.
Sam
ples
nee
d to
be
tran
sfer
red
imm
edia
tely
into
the
corr
ect s
peci
men
con
tain
ers.
Al
iquo
t spe
cim
ens
into
con
tain
ers
as li
sted
bel
ow.
See
WG
H L
ab G
uide
to S
ervi
ces
for m
ore
deta
ils.
All
fluid
cyt
olog
y sp
ecim
ens
are
sent
to R
efer
red
out l
abs.
Con
sult
the
WG
H G
uide
to S
ervi
ces
and
St. P
aul's
Hos
pita
l Tes
t Ref
eren
ce D
irect
ory
for h
andl
ing
inst
ruct
ions
.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Ster
ile F
luid
- Cul
ture
(any
flui
d ex
cept
C
SF)
CSF
LUM
ICFL
UN
Ster
ile c
onta
iner
5 da
ysD
eliv
er to
the
Lab
as s
oon
as
poss
ible
.Te
st p
erfo
rmed
in M
icro
biol
ogy
depa
rtmen
t.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Cer
ebra
l Spi
nal F
luid
- Cul
ture
CSC
SFM
ICC
SFN
CSF
tube
s, n
o ad
ditiv
eST
ATD
eliv
er to
the
Lab
as s
oon
as
poss
ible
.Te
st p
erfo
rmed
in M
icro
biol
ogy
depa
rtmen
t. In
dica
te ty
pe o
f flu
id
in c
omm
ents
.
N
See
note
s ab
ove.
STAT
WG
H In
-Hou
se o
nly
CSF
tube
s, n
o ad
ditiv
e
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Cer
ebra
l Spi
nal F
luid
- Cel
l Cou
ntC
SFC
CLA
BC
SFC
C
N
See
note
s ab
ove.
STAT
WG
H In
-Hou
se o
nly
CSF
tube
s, n
o ad
ditiv
e
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Cer
ebra
l Spi
nal F
luid
- Glu
cose
CSF
GLU
LAB
CSF
GLU
N
See
note
s ab
ove.
STAT
WG
H In
-Hou
se o
nly
CSF
tube
s, n
o ad
ditiv
e
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Cer
ebra
l Spi
nal F
luid
- Tot
al P
rote
inC
SFTP
LAB
CSF
TP
STAT
N
See
note
s ab
ove.
STAT
WG
H In
-Hou
se o
nly
CSF
tube
s, n
o ad
ditiv
e
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Dia
lysa
te F
luid
- Cel
l Cou
ntD
IAC
CLA
BD
IAC
CED
TA (L
aven
der)
1 ho
ur o
n ic
e.
Dia
lysa
te fl
uids
are
han
dled
diff
eren
tly th
an P
erito
neal
flui
ds
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Peric
ardi
al F
luid
- Cel
l Cou
ntPC
CC
LAB
PCC
CED
TA (L
aven
der)
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Peric
ardi
al F
luid
- Tot
al P
rote
inPC
TPLA
BPC
TPR
ED T
OP
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Peric
ardi
al F
luid
- LD
HPC
LDH
LAB
PCLD
HR
ED T
OP
*Roo
m te
mpe
ratu
re o
nly*
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Peric
ardi
al F
luid
- Glu
cose
PCG
LULA
BPC
GLU
RED
TO
P
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Perit
onea
l Flu
id- C
ell C
ount
PTC
CLA
BPT
CC
EDTA
(Lav
ende
r)
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Perit
onea
l Flu
id- T
otal
Pro
tein
PTTP
LAB
PTTP
RED
TO
PST
AT1
hour
on
ice.
*If L
DH
test
is
requ
ired,
sep
arat
e tu
be a
nd
stor
e at
18-
24 °
C.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Perit
onea
l Flu
id- L
DH
PTLD
HLA
BPT
LDH
RED
TO
P*R
oom
tem
pera
ture
onl
y*ST
AT1
hour
on
ice.
*If L
DH
test
is
requ
ired,
sep
arat
e tu
be a
nd
stor
e at
18-
24 °
C.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Perit
onea
l Flu
id- G
luco
sePT
GLU
LAB
PTG
LUR
ED T
OP
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Perit
onea
l Flu
id- L
ipas
ePT
LIP
LAB
PTLI
PR
ED T
OP
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Pleu
ral F
luid
- Cel
l Cou
ntPL
CC
LAB
PLC
CED
TA (L
aven
der)
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Pleu
ral F
luid
- Tot
al P
rote
inPL
TPLA
BPL
TPR
ED T
OP
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Pleu
ral F
luid
- LD
HPL
LDH
LAB
PLLD
HR
ED T
OP
*Roo
m te
mpe
ratu
re o
nly*
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Pleu
ral F
luid
- Glu
cose
PLG
LULA
BPL
GLU
RED
TO
P
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- C
ell C
ount
SYC
CLA
BSY
CC
EDTA
(Lav
ende
r)
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- T
otal
Pro
tein
SYTP
LAB
SYTP
RED
TO
PST
AT1
hour
on
ice.
*If L
DH
test
is
requ
ired,
sep
arat
e tu
be a
nd
stor
e at
18-
24 °
C.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- L
DH
SYLD
HLA
BSY
LDH
RED
TO
P*R
oom
tem
pera
ture
onl
y*ST
AT1
hour
on
ice.
*If L
DH
test
is
requ
ired,
sep
arat
e tu
be a
nd
stor
e at
18-
24 °
C.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- G
luco
seSY
GLU
LAB
SYG
LUR
ED T
OP
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*
N
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- U
ric A
cid
SYU
ALA
BSY
UA
RED
TO
P
STAT
1 ho
ur o
n ic
e. *I
f LD
H te
st is
re
quire
d, s
epar
ate
tube
and
st
ore
at 1
8-24
°C
.*
N
This
is a
refe
rred
out
test
- con
sult
St. P
aul's
Tes
t Ref
eren
ce M
anua
l for
inst
ruct
ions
.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
Syno
vial
Flu
id- C
ryst
als
SYC
RY
LAB
SYC
RY
RED
TO
P
N
This
is a
refe
rred
out
test
- con
sult
St. P
aul's
Tes
t Ref
eren
ce M
anua
l for
inst
ruct
ions
.
Body Fluids (includes testing in Chemistry, Hematology & Microbiology)
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
5 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
ABO
& R
h Ty
ping
ABO
BBK
ABO
Y2
mL
EDTA
sam
e da
yAB
O &
Rh
Baby
<6
mon
ths
ABO
BABY
BBK
ABO
BABY
Y0.
5 m
L ED
TAsa
me
day
Antib
ody
Scre
enAB
SCBB
KAB
SCY
2 m
L ED
TAsa
me
day
Gro
up &
Scr
een
(Pre
-Tra
nsfu
sion
) G
PSC
BBK
GS
N2-
6 m
L ED
TA<1
hr o
r sa
me
day
96 h
ours
- 30
day
sBl
ood
Bank
ID (w
ristb
and)
sys
tem
mus
t be
used
.
Dire
ct A
ntig
lobu
lin T
est (
DAT
)D
ATBB
KC
OO
DY
0.5
mL
EDTA
sam
e da
y7
days
Also
kno
wn
as D
irect
Coo
mbs
test
.C
ord
Bloo
d In
vest
igat
ion
(Ord
er o
n B
aby)
CO
RD
BBK
BABY
C
OR
DN
EDTA
or R
ed T
op1.
0 m
L ED
TAsa
me
day
7 da
ysO
rder
on
new
born
of R
h N
egat
ive
mot
her.
Ord
er R
hIg
Req
uire
men
t for
Mot
her a
t the
sam
e tim
e.R
hIg
Req
uire
men
t for
Mot
her
(Ord
er o
n M
othe
r)N
EED
RH
IGBB
KC
OR
D
MO
MR
HN
N/A
N/A
sam
e da
yN
/AO
rder
this
test
for R
h N
egat
ive
mot
hers
onl
y. O
rder
Cor
d Bl
ood
Inve
stig
atio
n on
new
born
at t
he s
ame
time.
Pren
atal
Inve
stig
atio
nPR
ENAT
BBK
PREN
ATY
EDTA
6 m
L ED
TA10
day
s*T
est p
erfo
rmed
at C
BS,
not W
GH
.O
rder
ear
ly in
Pre
gnan
cy. T
est R
h N
egat
ive
mot
hers
aga
in a
t 24-
28 w
eeks
. Blo
od m
ust b
e co
llect
ed b
efor
e R
hIg
is g
iven
.
Tran
sfus
ion
reac
tion
inve
stig
atio
nTX
RX
INV
BBK
TXR
XIN
VN
EDTA
& U
rine
12 m
L bl
ood
& 50
mL
Urin
eST
AT
Red
Blo
od C
ells
RBC
BBK
TRPC
NVa
ries
Clin
ical
lySe
e G
roup
& S
cree
nG
roup
and
Scr
een
Req
uire
d; in
dica
te n
umbe
r of u
nits
.
Froz
en P
lasm
aFF
PBB
KTR
FPN
30 m
inBl
ood
Gro
up R
equi
red
Cry
opre
cipi
tate
CR
YOBB
KTR
CR
YON
45 m
inBl
ood
Gro
up R
equi
red,
Issu
ed P
oole
d
Plat
elet
sPL
TBB
KTR
PLT
N24
hrs
Not
sto
cked
in W
GH
Lab
. Blo
od G
roup
Req
uire
d.
Issu
ed b
y "A
dult
Dos
e".
Albu
min
5%
A5BB
KTR
A5N
10 m
inAl
bum
in 2
5%A2
5BB
KTR
A25
N10
min
Fact
or V
IIIF8
BBK
TRF8
N10
min
Hem
ophi
lia A
pat
ient
s on
lyPr
othr
ombi
n C
ompl
ex C
once
ntra
tePR
OC
OM
BBK
TRP
RO
CO
MN
15m
inFo
r urg
ent W
arfa
rin (C
oum
adin
) Rev
ersa
lR
ecom
bina
nt a
ctiv
ated
Fac
tor V
IIF7
ABB
KTR
F7N
10 m
inPa
thol
ogis
t App
rova
l Req
uire
d
Rh
Imm
une
Glo
bulin
RH
IGBB
KR
HIG
N/A
10 m
inBl
ood
Gro
up R
equi
red;
issu
ed to
Rh
nega
tive
fem
ales
onl
y.
Intra
veno
us Im
mun
e G
lobu
linIV
IGBB
KTR
IVIG
NN
/AN
/A10
min
Prio
r App
rova
l Req
uire
d - C
all L
abH
epat
itis
B Im
mun
e G
lobu
linH
BIG
BBK
HBI
G10
min
At-R
isk
Neo
nate
s an
d as
per
bod
y flu
id e
xpos
ure
prot
ocol
Varic
ella
zos
ter I
mm
une
Glo
bulin
VZIG
BBK
TRM
VZIG
10 m
inC
MO
H A
ppro
val R
equi
red
Imm
une
Seru
m G
lobu
lin (2
mL)
ISG
BBK
N/A
10 m
inC
MO
H A
ppro
val i
s re
quire
d.
Transfusion Medicine
Tran
sfus
ion
Med
icin
e
EDTA
7 da
ys
Com
mun
ities
: req
uest
R
HIG
via
Fax
.
Blood Components and Products
N/A
http
s://
prof
essio
nale
duca
tion.
bloo
d.ca
/en/
tran
sfus
ion/
clin
ical
-gui
de-t
rans
fusio
n
Com
mun
ities
: app
rova
l vi
a YC
DC
Not
to b
e us
ed fo
r Pre
-Tra
nsfu
sion
Tes
ting.
*Sto
p tr
ansf
usio
n. S
uppo
rt c
linic
ally
, not
ify p
hysi
cian
& p
hone
Lab
imm
edia
tely
.*B
lood
Com
pone
nts
and
Prod
ucts
[Fo
r cur
rent
info
rmat
ion
abou
t the
se b
lood
com
pone
nts
and
prod
ucts
, vis
it:]
N/A
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
6 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
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(Tur
n Ar
ound
Tim
e up
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ceip
t at
Lab
)
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itech
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M
odul
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st C
ode
Orderable in Communities?
Test
Nam
e
Urin
alys
isU
ALA
BU
AY
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L ur
ine
2 ho
urs;
12
hour
s at
2-8
°C
R
efrig
erat
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mpl
e if
dela
yed
in tr
ansp
ort.
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ugs
of a
buse
scr
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OA
LAB
UD
OA
Y2
mL
urin
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OA
now
incl
udes
Fen
tany
l scr
een.
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e fe
ntan
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cree
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DO
ALA
BU
DO
AY
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L ur
ine
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test
is n
ow in
clud
ed w
ithin
the
UD
OA
scre
en.
Preg
nanc
y te
stPR
EGLA
BU
HC
GY
2 m
L ur
ine
2 da
ys a
t 2-8
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Fe
cal I
mm
unoc
hem
ical
test
ing
(FIT
)(C
olor
ecta
l Can
cer S
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ning
)FI
TLA
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FIT
colle
ctio
n ki
tSe
e FI
T ki
t Ins
truct
ions
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kday
s (b
atch
ed)
7 da
ys a
t 2-8
°C
Del
iver
to th
e La
b w
ithin
48
hour
s of
col
lect
ion.
Elec
troca
rdio
gram
sEC
GLA
BEC
GY
3 da
ysN
/ATe
stin
g av
aila
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at a
ll 3
Yuko
n ho
spita
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ooke
d pr
oced
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ter m
onito
ring
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LLA
BH
OL
Y6
wee
ksTe
stin
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aila
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ll 3
Yuko
n ho
spita
ls; b
ooke
d pr
oced
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met
ry (N
o Br
onch
odila
tor)
SPIR
OLA
BY
14 d
ays
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met
ry: R
ever
sibi
lity
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ing
(Pre
&
Post
Bro
ncho
dila
tor)
RE
VE
RS
IBIL
ITY
LAB
Y14
day
s
Ure
a Br
eath
test
UBT
LAB
YU
BT tu
bes
4 bu
sine
ss
days
No
appo
intm
ent n
eces
sary
- lim
ited
to a
ftern
oons
. Tes
ting
avai
labl
e at
all
3 Yu
kon
hosp
itals
; see
spe
cial
inst
ruct
ions
in
Gui
de to
Ser
vice
s.
Gra
m s
tain
(sm
ear)
MIC
GS
YSm
ear s
lide
Prep
are
a sm
ear f
rom
sam
ple
at ti
me
of c
olle
ctio
n2-
3 da
ysIn
defin
itely
if p
repa
red
at
time
of c
olle
ctio
n.C
ompl
etel
y fil
l out
requ
isiti
on.
Thro
at (r
/o G
roup
A s
trep)
MIC
TSY
Mod
ified
Am
ies
Cle
ar s
wab
2-
3 da
ys2
days
Mus
t pro
vide
pat
ient
his
tory
, inc
ludi
ng a
llerg
ies
to p
enic
illin
& pr
evio
us a
ntib
iotic
trea
tmen
t (co
mpl
etel
y fil
l out
Req
uisi
tion)
.
Sput
umM
ICC
SSPU
YSt
erile
con
tain
er
*Ref
riger
ate*
2 m
L (0
.5 te
aspo
on)
2-3
days
Ref
riger
ate
2-8
°CD
eliv
er to
the
Lab
with
in 4
8 ho
urs.
Eye(
s)M
ICC
SEYE
2-3
days
Ear(
s)M
ICC
SEAR
2-3
days
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th/G
ingi
va/T
ongu
eM
ICC
SWH
N2-
3 da
ysN
ose
Cul
ture
MIC
CSN
2-3
days
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cho
alve
olar
Lav
age
YSt
erile
con
tain
er
*Ref
riger
ate*
2-3
days
Ref
riger
ate
2-8
°CD
eliv
er to
the
Lab
with
in 4
8 ho
urs.
Bloo
d C
ultu
reM
IC B
YBa
cT/A
lert
Bottl
esFo
llow
det
aile
d in
stru
ctio
ns in
the
WG
H L
ab G
uide
to S
ervi
ces
man
ual
5 da
ys 2
4 ho
urs
at 1
8-24
°C
*Del
iver
as
soon
as
poss
ible
* Se
e W
GH
Lab
Gui
de to
Ser
vice
s fo
r det
ails
abo
ut c
olle
ctio
n an
d tra
nspo
rt.
Urin
e C
ultu
reM
ICU
YU
ricul
t bot
tle
Dip
Uric
ult d
ipst
ick
in u
rine
sam
ple
imm
edia
tely
- les
s th
an 2
hou
rs a
t ro
om te
mpe
ratu
re o
r 24
hour
s if
sam
ple
refri
gera
ted
2-3
days
Del
iver
as
soon
as
poss
ible
Com
plet
ely
fill o
ut re
quis
ition
.
Com
plet
ely
fill o
ut W
GH
M
icro
Lab
R
equi
sitio
n
Microbiology
Test
ord
ers
mad
e ou
tsid
e W
GH
: C
ompl
etel
y fil
l out
WG
H
Mic
ro L
ab
Req
uisi
tion
See
WG
H L
ab G
uide
to S
ervi
ces
man
ual f
or P
atie
nt In
stru
ctio
ns. S
ee C
hem
istry
sec
tion
for b
ooke
d G
luco
se te
stin
g (G
TTG
, GTT
2)
N/A
Urine & Misc.
Urin
e co
ntai
ner
2 da
ys a
t 2-8
°C
Booked Outpatient Procedures
WG
H L
ab p
erfo
rms
urge
nt s
piro
met
ry te
stin
g on
ly; m
ost t
estin
g do
ne b
y Tr
ue N
orth
Res
pira
tory
(Whi
teho
rse)
. Te
stin
g si
te s
ubje
ct to
cha
nge.
sam
e da
y
Mic
robi
olog
y
Book
with
La
b
**Th
e W
GH
Mic
robi
olog
y La
bora
tory
Req
uisi
tion
mus
t be
com
plet
ed in
full
to e
nsur
e ap
prop
riate
cul
ture
and
sen
sitiv
ity te
stin
g is
per
form
ed.**
Rou
tine
Cul
ture
:
YM
odifi
ed A
mie
s C
lear
sw
abSw
ab s
ampl
e as
qua
ntity
allo
ws
Del
iver
to L
ab w
ithin
48
hour
sC
ompl
etel
y fil
l out
requ
isiti
on.
Urin
e te
sts
[See
Che
mis
try
(AC
R, O
smol
ality
) and
Mic
robi
olog
y (C
ultu
re) s
ectio
ns fo
r mor
e de
tails
.]
Boo
ked
Out
patie
nt P
roce
dure
s
WG
H La
bora
tory
Tes
t Ref
eren
ceLa
b Ph
one
Num
ber:
(867
) 393
-873
9
Impl
emen
tatio
n Da
te: A
pril
2018
Appr
oved
by:
Lab
orat
ory
Med
ical
Dire
ctor
Prin
ted
vers
ions
of t
his d
ocum
ents
are
not
con
trol
led
7 of
7
OE
Cat
egor
yTe
st C
ode
Pref
erre
d Sa
mpl
e C
onta
iner
Min
imum
sam
ple
quan
tity
and
spec
ial i
nstr
uctio
ns
Med
itech
(O
E M
odul
e)
( WG
H In
tern
al
non-
Lab
only
! )Sa
mpl
e St
abili
tyAd
ditio
nal C
omm
ents
TAT
(Tur
n Ar
ound
Tim
e up
on re
ceip
t at
Lab
)
Med
itech
(Lab
M
odul
e)Te
st C
ode
Orderable in Communities?
Test
Nam
e
Vagi
nal
MIC
GEN
YM
odifi
ed A
mie
s C
lear
sw
abSw
ab s
ampl
e as
qua
ntity
allo
ws
2-3
days
Del
iver
as
soon
as
poss
ible
Cer
vix
MIC
GEN
YM
odifi
ed A
mie
s C
harc
oal s
wab
Swab
sam
ple
as q
uant
ity a
llow
s2-
3 da
ysD
eliv
er a
s so
on a
s po
ssib
le
Ure
thra
MIC
GEN
YTh
in w
ire D
acro
n sw
ab (w
ith
char
coal
med
ium
)Sw
ab s
ampl
e as
qua
ntity
allo
ws
2-3
days
Del
iver
as
soon
as
poss
ible
IUD
MIC
call
Lab
YIU
D in
ste
rile
cont
aine
r2-
3 da
ysD
eliv
er a
s so
on a
s po
ssib
le
Intra
vasc
ular
Cat
hete
r Tip
MIC
call
Lab
YSt
erile
con
tain
er2-
3 da
ysD
eliv
er a
s so
on a
s po
ssib
le
Cul
ture
- Hea
d an
d N
eck
MIC
WH
N2-
3 da
ysC
ultu
re- L
imbs
MIC
WL
2-3
days
Cul
ture
- Low
er B
ody
MIC
WLB
2-3
days
Cul
ture
- Upp
er B
ody
MIC
WU
B2-
3 da
ys
Gra
m S
tain
- Gen
ital
MIC
call
Lab
Gla
ss s
lide
Prep
are
a sm
ear f
rom
sam
ple
at ti
me
of c
olle
ctio
n2-
3 da
ysIn
defin
itely
if p
repa
red
at
time
of c
olle
ctio
n.
Tric
hom
onas
vag
inal
is a
ntig
enM
ICTV
AM
odifi
ed A
mie
s C
lear
sw
ab2
days
Less
than
36
hour
s
Gro
up B
Stre
p Sc
reen
(pre
gnan
cy o
nly)
MIC
GBS
Mod
ified
Am
ies
Cle
ar s
wab
2-3
days
Mus
t ind
icat
e if
patie
nt h
as a
Pen
icilli
n al
lerg
y.
Gon
orrh
oeae
(GC
) Rec
tal C
ultu
reM
ICG
CR
EC2-
3 da
ysG
onor
rhoe
ae (G
C) T
hroa
t Cul
ture
MIC
GC
T2-
3 da
ys
MR
SA S
cree
nM
ICM
RSA
(L
ooku
p)1-
3 da
ys
VRE
Scre
en- R
ecta
l Sw
abM
ICVR
ER2-
4 da
ysVR
E Sc
reen
- Wou
nd S
wab
MIC
VREW
2-4
days
C. d
iffic
ile a
ntig
en a
nd to
xin
assa
yC
DIF
FLA
BC
DIF
FY
Star
plex
Ste
rile
cont
aine
r with
sp
oon
Loos
e or
wat
ery
stoo
l onl
yST
AT<2
hou
rs a
t 18-
24 °
C;
< 72
hou
rs a
t 2-8
°C
*Ref
riger
ate
spec
imen
* Spe
cim
ens
>72
hour
s ol
d ar
e re
ject
ed.
This
test
is n
ot o
rder
able
for
child
ren
< 12
mon
ths.
Del
iver
as
soon
as
poss
ible
Test
ord
ers
mad
e ou
tsid
e W
GH
: C
ompl
etel
y fil
l out
WG
H
Mic
ro L
ab
Req
uisi
tion
Microbiology
Swab
sam
ple
as q
uant
ity a
llow
sD
eliv
er a
s so
on a
s po
ssib
leC
ompl
etel
y fil
l out
requ
isiti
on.
Y
Mod
ified
Am
ies
Cha
rcoa
l sw
ab
Stoo
l spe
cim
ens:
Swab
sam
ple
as q
uant
ity a
llow
s
Test
ord
ers
mad
e ou
tsid
e W
GH
: C
ompl
etel
y fil
l out
WG
H
Mic
ro L
ab
Req
uisi
tion
Gen
ital T
ract
Spe
cim
ens:
Ant
ibio
tic-R
esis
tant
Org
anis
ms:
Skin
/ Wou
nd/ U
lcer
/ Abs
cess
Cul
ture
:
[M
ust s
peci
fy s
ourc
e/ b
ody
site
]
YM
odifi
ed A
mie
s C
lear
sw
abSw
ab s
ampl
e as
qua
ntity
allo
ws
Del
iver
as
soon
as
poss
ible
Che
ck y
our d
epar
tmen
t-spe
cific
gui
delin
es b
efor
e co
llect
ing.
YM
odifi
ed A
mie
s C
lear
sw
ab
Labo
rato
ry
Guid
e to
Ser
vice
s W
GH
Lab
Tes
t In
form
atio
n Im
plem
enta
tion
Dat
e: A
pril
2018
P
rinte
d ve
rsio
ns o
f thi
s do
cum
ent a
re n
ot c
ontro
lled.
24
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 25
3.0 PATIENT IDENTIFICATION AND SAMPLE LABELLING This section contains: 3.1 Patient Identification
3.2 Sample Labelling
3.3 Acceptance Criteria for Requisitions
3.4 Sample Rejection Policy
3.5 Sample Rejection Criteria
3.6 Sample Rejection Criteria: Microbiology
3.7 Sample Rejection Criteria: Transfusion Medicine
3.8 Irreplaceable Sample Identification Policy
3.9 Irreplaceable Sample Identification Record
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 26
**Additional Patient identification steps are required for Transfusion Medicine samples**
See 6.1 Patient Identification in Transfusion Medicine for more details.
3.1 Patient Identification
1. Verbally confirm the patient’s identity using a minimum of Two Patient Identifiers: (see YHC Policy PC-100 for more information)
• Patient’s last and first name
• Date of birth
• Healthcare number
2. Label samples immediately after collection and in the presence of the patient. Label samples with at least two patient identifiers and information about the collection process.
3. Record other pertinent collection information: • Date and time of collection. It is acceptable to use the date format on a computer generated
label provided it is accurate. Collection time is recorded using the 24hr clock format
• Collector (identity of individual collecting the sample), where required
• Sample source (e.g. swab from urethra) where applicable.
[Reference: WGH Laboratory Quality Manual, QP-07-01 p.1]
3.2 Sample Labelling
Some of our testing is automated- computer scanners can be very particular about how labels and barcodes appear on the sample. Valuable time is lost in sample processing when lab staff must re-position labels. Please follow the guidelines below.
Important rule of thumb: the actual specimen should be visible at all times in
its container. Ensure a ‘window’ of visibility remains. Cover the
manufacturer’s label if needed.
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 27
Remember: * Never affix labels to collection tubes prior to collection * Always affix labels in the presence of the patient
These golden rules reduce the chances of improper labeling
In the lab: coloured caps are removed for analysis & tubes recapped with non-specific
caps. If add-on tests are ordered, label colour helps find the proper tube in storage racks.
Blood Collection tube labels
Affix labels to blood collection tubes as follows:
Position labels such that the Patient’s name begins near the coloured cap of the collection tube
Cover the original tube label such that a portion of the blood sample is visible (to verify quantity and quality)
Mint-green (PST) and Gold (SST) -capped collection tubes: ensure a small portion of the original tube label colour is visible (once coloured caps are removed for analysis, they are recapped with non-specific generic caps- tube label colour is necessary info for technologists)
Ensure the label isn’t crooked & doesn’t surpass the tube’s length- our analyzers may reject the sample or labels may be ripped off when placed in racks
Reference Clinical and Laboratory Standards Institute (CLSI). 2007. Procedures for the Collection of Diagnostic Blood
Specimens by Venipuncture; Approved Standard- Sixth Edition. CLSI document H3-A6 (ISBN 1-56238-650-6). Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA.
Detailed instructions for the unique labeling of blood culture bottles is found in7.13.2 How to Label Blood Culture Bottles
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 28
3.3 Acceptance Criteria for Requisitions It is the submitting client’s responsibility to ensure that requisitions are filled out completely, accurately and legibly. Failure to do so could mean delays in processing and testing of Patient samples.
Complete Name (Surname & Given Name)
Health Care Number
Date of Birth (DD/MM/YYYY)
Gender
Complete Name
Physician's Billing Number (MSC)
Fax Number if Outside Yukon
Doctor or Facility Name
Billing Number or Facility Number
Fax Number if Outside Yukon
Date and Time: (If Patient collects sample, remind them to fill out)
Sample Type
Test Requested
Relevant Clinical/ Travel History
Sample Type: Blood: if decanted from original tube, specify serum, heparanized plasma, citrated plasma, whole blood, etc. Indicate if frozen.
Acceptance Criteria for Requisition Forms
Ensure the following information is provided:
Tests Ordered:
Ordering Physician:
Copies to:
Patient Information:
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 29
3.4 Sample Rejection Policy
The WGH Laboratory reserves the right to delay or cancel testing on samples that have been improperly collected, labelled, processed, stored or transported.
The laboratory shall take measures to maintain sample integrity while following up on the receipt of an inadequate sample. Please note that the large number of samples received by the laboratory makes it impossible to positively identify samples that are not clearly labelled in accordance with the sample identification criteria.
3.5 Sample Rejection Criteria Samples may be rejected for the following reasons:
Unlabelled Samples
• Common sample types (blood, urine, swabs, sputum, stool, etc.) will require recollection.
• Less common samples that are more difficult to recollect (CSF, fluids, tissues, etc.) require the Physician who collected them to come to the Laboratory to identify the sample and complete the 3.9 Irreplaceable Sample Identification Record Form (ACC010F). They assume responsibility for the identification of the sample.
• If the person responsible for collecting the sample is unable, with certainty, to identify the sample, the appropriate Clinical Care Manager, designate and Ordering Physician will be notified.
Unlabelled Samples
Incorrectly Labelled (Mislabelled) Samples
Incorrect Container or Preservative
Insufficient Sample for Procedure(s)
Unsuitable Sample for Procedure(s)
Blood Sample Hemolyzed
Blood Sample not Centrifuged within 2 hours
Improper Transport Conditions
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 30
Incorrectly Labelled (Mislabelled) Samples
• If the patient’s name, date of birth or health care number conflict with those recorded on the Requisition, the Unlabelled Samples criteria apply.
• If only one patient identifier appears on the sample or Requisition, the Unlabelled Samples criteria apply.
• Samples with patient names misspelled, but with correct health care number and D.O.B. will have a notation accompany the patient report. Procedures ordered may be performed after every effort is made to confirm spelling. These errors cause delays in sample processing.
Incorrect Container or Preservative
• Recollection is required for samples received in an incorrect container, or with/ without the appropriate preservative (e.g. a blood collection in the wrong collection tube). These errors can lead to invalid results.
Insufficient Sample for Procedure(s)
• Repeat collections will be requested when there is insufficient sample to provide results for all tests ordered. Procedure(s) for which there is sufficient sample will be performed.
Unsuitable Sample for Procedure(s)
• Samples will be rejected if samples collected are unsuitable for the test requested (saliva for sputum tests, urine for blood tests).
Blood Sample Hemolyzed
• Hemolyzed blood samples will be rejected. Free hemoglobin in hemolyzed blood samples interferes with the accuracy of most test results. See 5.5 Hemolysis for more details
Blood Sample not Centrifuged within 2 hours
• Samples requiring centrifugation should be separated within 30 minutes and may be rejected if not spun within 2 hours.
Improper Transport Conditions
• Samples will be rejected if the samples were subjected to improper transport conditions. Examples include blood samples that were not centrifuged in a timely manner and blood samples for LDH that were not transported at room temperature.
• Note- frozen samples that arrive thawed may not provide accurate results and are treated with caution, based on the specific circumstances.
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 31
Sample Too Old to Process
• Samples will be rejected when the sample has been in transit too long for obtaining valid results. Time sensitivity varies for each test. Contact the lab if you are uncertain about the viability of a sample. Every effort should be made to transport samples to the Lab as soon as they are collected.
3.6 Sample Rejection Criteria: Microbiology Microbiology samples may be rejected for the following reasons:
Please refer to 7.0 COLLECTION PROCEDURES: MICROBIOLOGY for further details.
Note that samples collected using the wrong swab (e.g. “Amies Charcoal medium” instead of “Amies Clear medium”) are kept and detailed comments are added to the record. The wrong swab may impact results.
Unlabelled Samples
Incorrectly Labelled (Mislabelled) Samples
Incomplete information on the Requisition or Sample
Sub-optimal sample: leaking urine/ stool containers; insufficient quantity
Duplicate microbiology samples received on the same day (e.g. multiple ova & parasite stool samples, sputa samples).
Sample delayed in transit.
Did you know? Gram smears are treated with alcohol which can dissolve writing on the sample if pen or Sharpie pen is used! Please use pencil to label smears. Thank you!
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 32
3.7 Sample Rejection Criteria: Transfusion Medicine
Refer to “Transfusion Service Manual (TT010) Patient Identification and Sample Labelling” for correct labelling procedures. All other samples will be rejected.
In all cases where samples have been rejected, the appropriate patient care unit will be notified of the rejection and a request for recollection will be made.
3.8 Irreplaceable Sample Identification Policy
The WGH Laboratory recognizes that if the sample: is less common; involves an invasive procedure; or could not otherwise be easily recollected, it may be acceptable to apply an exception to sample rejection. Upon receipt of samples that do not provide the information listed above, an Irreplaceable Sample Identification Record Form (see next page) will be filled out and returned to the physician or your clinic.
Laboratory Guide to Services
Patient ID & Sample Labelling
Implementation Date: April 2018 Printed versions of this document are not controlled. 33
3.9 Irreplaceable Sample Identification Record
Samples received on ________________________________ showed the following deficiencies:
Patient Full Name: Ordering
Physician:
Date of Birth: YT Health
Care #:
(Please check the appropriate box):
Collection Tube or Container Requisition
Unlabelled No patient information provided Illegible No requisition received Incorrect No test(s) ordered No secondary identifier Illegible No date & time of collection Other, specify:
Other, specify:
This record must be signed by the Ordering Physician and the sample and Requisition as indicated above must be corrected before testing will be performed.
I verify that the sample from the above named patient cannot be recollected. The information has been corrected and I take full responsibility for the results and repercussions of testing on this sample.
Print name clearly: ____________________________________________
Signature (declaring corrected patient identity) ____________________________________________
Date: ____________________________________________
Medical Lab Technologist Witness: ____________________________________________
Date and time of receipt in the Laboratory
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Patient ID & Sample Labelling
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Laboratory Guide to Services
Ordering Tests & Requisitions
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4.0 ORDERING TESTS AND REQUISITIONS This section contains: 4.1 Hyperlinked List of Requisitions
4.2 Creating Standing Orders
4.3 Add-On Tests
Please review the Acceptance Criteria for Requisitions in 3.3 Acceptance Criteria for Requisitions
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4.1 Hyperlinked List of Requisitions The following table provides a list of the most frequently used requisitions. Each is hyperlinked to a copy of the requisition online. This table of links is also available on the YHC website. Hyperlinks to home pages of Referral Laboratories are also provided under the ‘Site of Testing’ column in the table. Be aware that Referral Laboratories may update their websites and links to requisitions may inadvertently be lost. If you notice any broken web links, please inform the Laboratory Information Systems (LIS) Lead at WGH Lab as soon as possible so we can update our webpage links.
Infrequently ordered tests (e.g. specialized molecular genetic testing) may require a requisition not listed in the table- please phone the Lab to discuss requirements.
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Hyperlinked List of Requisitions Requisition Title
(Header) Site of Testing Types of Tests Run
1 WGH Laboratory- On Site Testing
Whitehorse General Hospital
Blood, Urine, Fluid Tests; Booked Procedures
2 WGH Laboratory- Referred Out Testing
St. Paul's Hospital Blood & Urine tests Vancouver General Hospital Blood tests
BC Children's Hospital Blood tests Other
3 WGH Microbiology Laboratory
Whitehorse General Hospital Culture & Sensitivity, Gram stain, from various sources
4 Holter Monitor
Interpretation: Cardiology Unit at St. Paul's Hospital Holter Monitor
5 FIT Testing Requisition
Yukon Health & Social Services, YHC
Colorectal Cancer Screening
6 Spirometry True North Respiratory/ WGH Spirometry testing
7 Lifelabs (H. pylori Urea Breath Test)
LifeLabs, BC H. pylori Breath Test
8 BCCA Gynecological Cytology Requisition Form
Cervical Cancer Screening Laboratory, Vancouver BC
Cancer Screening (Pap smear samples)
9 PHSA Laboratories Tumour Marker Lab Requisition
BC Cancer Agency (BCCA) Cancer Markers
10 BCCDC Serology Screening Requisition
BC Centre for Disease Control
Prenatal Screening; HIV, Syphilis, Hepatitis
11 St. Paul's Hospital Virology and Reference Laboratory
St. Paul's Hospital Chlamydia + GC NAAT
12
Canadian Blood Services- Diagnostic Services- Perinatal Screen Request
Canadian Blood Services, Vancouver
Perinatal Screening
13 Prenatal Genetic Screening Laboratory Requisition
Prenatal Biochemistry Laboratory, BC Children's & BC Women's Hospital
Serum Integrated Prenatal Screen (SIPS)
14 Harmony Prenatal Test Dynacare
Prenatal cell free DNA (restrictions apply)
15 LifeLabs Specific Allergen IgE Request
LifeLabs, BC Allergen IgE
16 BCCDC Virology Requisition
BC Centre for Disease Control
Viruses- as detected from various tissue samples
17 BCCDC Bacteriology & Mycology Requisition
BC Centre for Disease Control
Respiratory Infections (e.g. pertussis), Gastrointestinal Infections, Mycology
…continued on next page
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…continued from previous page
Requisition Title (Header) Site of Testing Types of Tests Run
18 BCCDC Parasitology Requisition
BC Centre for Disease Control
Parasites- as detected from various tissue samples
19 BCCDC Mycobateriology/ TB Requisition
BC Centre for Disease Control
Mycobacteria- as detected from various tissue samples
20 BCCDC Zoonotics Diseases & Emerging Pathogens Requisition
BC Centre for Disease Control Zoonotics & Emerging Pathogens
21
St. Paul's Hospital Department of Pathology Surgical Requisition
St. Paul's Hospital Pathology samples
22 BCCA Diagnostic Cytology Requisition
PHSA & BCCA Cytology samples, various (* not for WGH In-patient samples)
23 Molecular Genetics Laboratory Requisition
BC Children's & BC Women's Hospital (test directory), Molecular Genetics Lab
Molecular Genetics
24
Cancer Genetics Laboratory Myeloid Testing Requisition
BCCA Department of Pathology and Laboratory Medicine
Cytogenectis (FISH) and Molecular testing, Myeloid & other
25 Cytogenetics Laboratory Requisition Constitutional Studies
Vancouver Coastal Health/ (Gordon and Leslie Diamond Health Care Centre - Vancouver General Hospital)
Cytogenetics Constitutional Studies
If you suspect a Gastrointestinal (GI) Outbreak or Influenza-Like-Illness (ILI) Outbreak, please contact the Yukon Communicable Diseases Control office at 867-667-8323
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4.2 Creating Standing Orders
Procedure: Fill out the appropriate requisition as per usual. Write standing order instructions on the top of the page:
** The ordering physician must sign the Requisition in order for the request to be processed. (Requisitions submitted electronically via Plexia will be accepted as signed documents. Standing Order instructions can be added in the Comments section) The Patient is responsible for bringing their Requisition to the Lab each time they are tested. We will make a photocopy of the Requisition each time. The patient retains the original up to the expiry date. Notes:
• Standing Orders are only valid for a maximum of 1 year.
• Once expired, a new request form will need to be completed.
• Results will only be sent to the Ordering Physician(s) on the standing order.
• Only tests listed on the Standing Order will be completed.
• If additional tests are needed at a given time, you must fill out a separate Requisition.
• Refer to Standing Order tests on the Requisition if both are to be done.
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4.3 Add-On Tests
Purpose: When another test needs to be added to an existing order. The original sample, if stored, may be used for additional tests. Due to sample stability and storage requirements (temperature, light, etc.) not all Add-On tests can be performed (e.g. bilirubin, troponin tests on blood plasma).
Length of time that samples are stored at WGH Lab varies, but in general: Sample Type Test type Length of time stored Blood Chemistry tests 4 days Urine Drugs of abuse Frozen for 1 month Fluids Various 4 days
Refer to the WGH Laboratory Test Reference Manual for test-specific information on sample stability.
Procedure:
1. Phone the lab to verbally indicate the need for additional tests.
2. Fax the Add-On Test Requisition to the Laboratory at 867-393-8772. The Requisition should be clearly marked: “Add on to sample drawn on [date]”
Laboratory Guide to Services
Collection Procedures:
Blood
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5.0 COLLECTION PROCEDURES: BLOOD
This section contains:
5.1 Venipuncture: Best Practices
5.2 Tube Selection, Order of Draw and Sample Mixing
5.3 Pediatric Blood Volume Draw Guidance
5.4 How to prepare a blood smear
5.5 Hemolysis
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5.1 Venipuncture: Best Practices The WGH Laboratory follows guidelines and procedures for venipuncture outlined by the Clinical and Laboratory Standards Institute (CLSI 2007). The following table provides an overview of the phlebotomy and specimen labelling procedure. Detailed descriptions of each step are provided after the table.
A. Pre- Phlebotomy
1 Prepare Labels and review 2.2 WGH Laboratory Test Reference for each test
2 Wash Hands & Put on Gloves
3 Assemble Other Supplies
B. Phlebotomy Procedure
1 Identify the Patient
2 Verify Diet Restrictions & Medication Schedule
3 Create Safe Work Environment: Ergonomics
4 Reposition the Patient's Arm
5 Select the Best Venipuncture Site
6 Apply the Disposable Tourniquet
7 Cleanse the Venipuncture Site
8 Perform Venipuncture with Correct Tube Selection, Order of Draw and Sample Mixing: 5.2 Tube Selection, Order of Draw and Sample Mixing
9 Release Tourniquet after last tube is 2/3 full
10 Place Gauze Pad Over Venipuncture Site, Remove Needle
11 Dispose of Needle in Sharps Bucket; Dispose of Tourniquet
C. Post- Phlebotomy
1 Invert Filled Tubes to mix blood with tube contents
2 Ensure Bleeding has Stopped & Bandage Patient’s Arm
3 Label Blood Tubes( Blood Collection tube labels); Record Date and Time of Collection
4 Thank the Patient for their Cooperation
5 Remove gloves & Wash hands
6 Prepare samples for transport: centrifuge/ separate/ refrigerate, etc.
7 Send Collection Tubes & Requisition to the Laboratory ASAP
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Supplies for Venipuncture
needles of various gauges ‘sharps’ container for waste Band-Aids butterfly needles isopropyl alcohol wipes disposable tourniquets needle adapter gauze pads or cotton balls non-latex gloves Vacutainer collection tubes adhesive tape (syringe-difficult draws)
For more detailed information on phlebotomy, consult the references provided below. References Clinical and Laboratory Standards Institute (CLSI). 2007. Procedures for the Collection of Diagnostic
Blood Specimens by Venipuncture; Approved Standard- Sixth Edition. CLSI document H3-A6 (ISBN 1-56238-650-6). Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA.
Vancouver Coastal Health. 2010. Phlebotomy & Specimen Labelling Procedure. VCH Regional Laboratory Medicine. Version 2.3. March 16, 2010.
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5.2 Tube Selection, Order of Draw and Sample Mixing Order of Draw for Frequently Used Tubes:
Tube Top Colour
(Additive)Label Code
1 See detailed Blood Culture collection instructions.
Light Blue(Sodium citrate)
BLUE
Red(silica)
RED
5 mL Gold or 10 mL Tiger Top
(silica,polymer gel)
SST
Light Green(Lithium heparin)
PST
5 mL Lavendar or 7 mL
pink/magenta(EDTA)
LAV or PINK
Notes
4
5
Most routine chemistry
Hematology, Transfusion Medicine
3
Plasma
Whole Blood
Blood Culture bottles- always collect first- keep warm
Order of Draw:
2
Product (Indicate on
transfer-tube labels)
Common Lab Tests
Citrate plasma
Coagulation (PT, INR, PTT, Dimer)
Tube must be completely filled. If using a butterfly needle, draw at least a bit of blood into a discard
tube to clear the air from the butterfly.
Serum Therapeutic drug monitoring
Serum
Most Referred-out chemistry tests;
Infectious Disease testing; Tumour markers
Allow sample to rest for at least 10 minutes prior to centrifugation
to ensure clotting.
Centrifuge immediately. Sample rejected if not centrifuged within 2 hours of collection.
Do not centrifuge.
Note: Two blood smears must be made from
blood collected for hematology testing at the time of collection. For more information on BD vacutainer tubes, visit: http://www.bd.com/ca/
Gently Invert (mix) tubes 8-10 times immediately
after collection to ensure the anticoagulant/ clot
activator is mixed completely with the
sample.
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Order of Draw for Infrequently Used Blood Tubes
Tube Top Colour (Additive)
Label Code
Pale yellow (rubber) 8.5 mL
(Anticoagulant Acid Citrate Dextrose)"ACD Solution A"
ACD-APale yellow (rubber)
6 mL(Anticoagulant Acid
Citrate Dextrose- ACD)"ACD Solution B"
ACD-B
10 mL Dark Green (rubber) or
2 mL Translucent green
(Sodium heparin)
NA HEP
Dark Green(Lithium heparin)
LI HEP/ ICE
Navy Blue(EDTA- Trace
Elements)
NAVY
Navy Blue(No additive)
NAVY
Notes
Whole Blood
Whole Blood
Order of Draw:
Venous Blood Gases
Order as in PST tubes. WGH On-site testing.
4 Chromosome Studies
*Do not confuse 2 mL translucent tube with PST tube!*
Draw these tubes after SST.
4
2.5 Whole BloodHemophilia genotyping
Draw after Sodium citrate tube and before SST tubes.
Product (indicate on
transfer-tube labels)
Examples of Lab Tests
2.5 Whole BloodCD4 & CD8 viral loads
Draw after Sodium citrate tube and before SST tubes.
N/A SerumTrace
Elements
*Must be drawn separately from all other blood tests*
Consult SPH Test Reference manual for specific tests.
N/A
Consult SPH Test
Reference manual for
specific tests.
Trace Elements
*Must be drawn separately from all other blood tests*
Consult SPH Test Reference manual for specific tests.
Minimum Blood Tube Fill Standards
The amount of blood required to perform a single test and the number of tests to be performed on a single blood tube sample will vary.
Completely filled tubes preferred.
(Review Pediatric collection requirements on next page)
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5.3 Pediatric Blood Volume Draw Guidance The University of British Columbia- Children’s & Women’s Health Centre of BC Research Ethics Board (UBC C&W REB) has provided the following guidelines for safe limits of total blood volumes collected from pediatric patients. (CWREB 2013) Blood volumes falling within the limits outlined below may be considered of minimal risk to otherwise healthy patients. Blood volumes above these limits or blood collected more frequently should be referred to a Pediatrician for review. Note: Blood drawn from infants with risk factors must always undergo full review by a Pediatrician.
PEDIATRICS: MAXIMUM ALLOWABLE TOTAL BLOOD DRAW VOLUMES (CLINICAL + RESEARCH) CONSIDERED OF MINIMAL RISK (adapted from (1))
Body Weight
(Kg)
Body Weight (lbs.)
Total blood
volume (mL)
Maximum allowable volume (mL) in one blood
draw ( = 2.5% of TBV)
Maximum allowable volume (mL) drawn over a 30 day
period ( = 5% of TBV) for outpatients only *note: must occur no more than
3 6.6 240 6 12
4 8.8 320 8 16
5 11 400 10 20
6 13.2 480 12 24
7 15.4 560 14 28
8 17.6 640 16 32
9 19.8 720 18 36
10 22 800 20 40
11-15 24-33 880-1200 22-30 44-60
16-20 35-44 1280-1600 32-40 64-80
21-25 46-55 1680-2000 42-50 64-100
Based on charts from the Children's Memorial Research Centre (Chicago, IL) (1) adapted by Rhona Jack, Ph.D. Children's Hospital and Regional Medical Center Laboratory Seattle WA and used by the Committee on Clinical Investigations, Children’s Hospital in Los Angeles, CA; Baylor College of Medicine, Dallas, TX; Cincinnati Children’s Hospital Institutional Review Board, OH; North Shore Long Island Jewish Health System, NY; University of California Davis. For Safe Limits for Pediatric Patients with Risk Factors consult a Pediatrician for expert advice. Reference: CWREB (Version 3.2- February 19, 2013). Pediatric Blood Draw Guidance Document. University of British
Columbia – Children’s & Women’s Health Centre of BC Research Ethics Board (UBC C&W REB). http://bcchr.ca/docs/reb-policies/pediatric-blood-draw-guidance.pdf (Retrieved 2017-Nov-06).
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5.4 How to prepare a blood smear A properly prepared blood smear is essential for accurate assessment of cellular morphology. If you are equipped with a Hemaprep® Automated Blood Smearing Instrument. Ensure that you have read the Operator Manual and that the instrument is properly calibrated. Here is a summary of instructions for Hemaprep:
1. Place slides into slots with the frosted ends at the front. If a single smear is desired, place an empty slide in the second tray.
2. Using a capillary tube or a Dif Safe blood dispenser, place a drop of blood at the target location indicated by black marks on the trays. Repeat for second slide.
3. Depress the front lever with a firm, smooth stroke. Release when fully depressed.
4. Remove slide and label from collection tube with full name and barcode number.
5. Refer to Operator manual for further instructions (including a troubleshooting section).
In the event that your Hemaprep is not operating properly, a wedge smear slide can be prepared by hand. See next pages for instructions.
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The wedge smear technique is as follows (see next page for illustration):
1. Use two high-quality beveled-edge microscope slides- one serves as the blood smear slide and the other as the spreader slide
2. Place a drop of EDTA anticoagulated blood, about 3 mm in diameter, at one end of the smear slide. The size of the drop is important- too large a drop creates very long or thick smears; too small a drop often makes short or thin smears.
3. Place the spreader slide in front of the drop at a 30-45-degree angle to the smear slide
4. Pull the spreader slide back into the drop of blood and hold it in that position while the blood spreads across the width of the slide
5. Quickly and smoothly push forward to the end of the slide to create a wedge smear. Moving the spreader slide too slowly accentuates poor leukocyte distribution by pushing larger cells (monocytes/ granulocytes) to the very end of the sides of the smear. For higher-than-normal hematocrit, the angle between the slides must be lowered so that the smear is not too short and thick. For extremely low hematocrit, the angle must be raised.
A well-made peripheral blood smear has the following characteristics:
1. About two-thirds to three-fourths of the length of the slide is covered by the smear
2. The feather edge (thin portion) is very slightly rounded, not bullet-shaped
3. Lateral edges of the smear should be visible.
4. The smear is smooth without irregularities, holes or streaks
5. When the slide is held up to light, the feather edge of the smear should have a “rainbow” appearance
6. The whole drop is picked up and spread
See illustrations (Figures 1-1 to 1-3) on the following pages. Reference: Carr, J.H. and B.F. Rodak. 1999. Clinical Hematology Atlas. W.B. Saunders Company. Toronto. 217 pp.
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From: Carr, J.H. and B.F. Rodak. 1999. Clinical Hematology Atlas. W.B. Saunders Company. Toronto. 217 pp.
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From: Carr, J.H. and B.F. Rodak. 1999. Clinical Hematology Atlas. W.B. Saunders Company. Toronto. 217 pp.
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5.5 Hemolysis Hemolysis, or the rupture of red blood cells, usually occurs during sample collection and can result in rejection of a sample. Possible causes of hemolysis include:
• unsecure line connections • contamination • prolonged tourniquet application • incorrect needle size (excessive suction can cause red blood cells to be smashed on their way
through a hypodermic needle) • excessive suction from use of vacuum syringe (veins may collapse) • Vigorous shaking of filled tubes • difficult collections (e.g. veins that are difficult to find; small, fragile veins in elderly patients)
Experience and proper technique will prevent hemolysis.
From: Dugan et al. (2005)
Reference: Dugan, L., L. Leech, K.G. Speroni, J. Corriher. 2005. Factors Affecting Hemolysis Rates in Blood Samples Drawn From Newly Placed IV Sites in the Emergency Department. Journal of Emergency Nursing. 31(4):338-345.
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Laboratory Guide to Services
Transfusion Medicine Information
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6.0 TRANSFUSION MEDICINE INFORMATION Note: This information is provided for staff in Whitehorse General Hospital only This Section includes: 6.1 Patient Identification in Transfusion Medicine
6.2 WGH Blood Bank Identification Card
6.3 Test: ABO Blood Group
6.4 Test: Group and Antibody Screen
6.5 Test: Crossmatch
6.6 Test: Direct Antiglobulin Test (DAT)
6.7 Test: Cord Blood Investigation
6.8 Test: Transfusion Reaction Investigation
6.9 Blood Component Uses
6.10 Blood Components Available (in stock) at Whitehorse General Hospital
6.11 Blood Products Available (in stock) at Whitehorse General Hospital
6.12 Additional Process Notes
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6.1 Patient Identification in Transfusion Medicine Positive patient identification is of utmost importance for transfusion medicine- errors can result in death. Only specimens collected using the WGH Blood Bank Identification Card system will be used for crossmatching and transfusion purposes. This card is normally only available within Whitehorse General Hospital. You must follow this specialized patient identification procedure if you anticipate the patient may require blood components: 1. Order a Group and Screen test. 2. Identify the patient using at least two unique identifiers. Ask the patient their full name and date of
birth; check this information against the hospital admission wristband. Compare other identifiers (i.e. Healthcare Number, Chart Number, etc.) if available.
3. Collect two 6 mL EDTA collection tubes (tall pink or lavender topped tubes) of blood. 4. Label each collection tube with at least two patient identifiers (use of an ID sticker is acceptable),
the date & time of collection and your initials. Affix a Blood Bank Identification Number sticker from the card on each tube collected.
5. Write the date, time and your initials on the wristband strip from the bottom of the Blood Bank Identification Card. Insert it into a pink wristband and affix to the patient at the time of specimen collection. Label the Identification Card with the patient’s identifiers, your initials and the date & time of collection to verify you have confirmed identification of the patient with the samples.
Note: The pink, numbered identification band must be securely fastened to the patient (wrist, ankle, etc.) before a Transfusion can be performed
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6.2 WGH Blood Bank Identification Card
6.3 Test: ABO Blood Group This test is used to identify a patient’s blood group for medical indications (example: to determine if patient needs RhIg after miscarriage) and non-medical (example: travel visas) indications. Non-medical requests will require payment by the client.
Label with Patient info, date time &
initials of collector
Attach ID # stickers to
blood collection
tubes
Record date, time & your
initials. Detach and insert into pink wristband. Affix to patient.
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6.4 Test: Group and Antibody Screen This test is used to identify the patient’s blood group and to establish if they have any unexpected red blood cell antibodies in preparation for a possible transfusion. Red Blood Cell units will be crossmatched when a transfusion is ordered. Do not order “GROUP & HOLD”, as this restricts inventory and causes unnecessary workload. Should the need for blood arise after a Group and negative Antibody Screen is complete, the crossmatching can be completed within 15 minutes. Positive Antibody Screens are sent to Canadian Blood Services in Vancouver for identification of the detected antibody. This will delay the availability of red cells units for transfusion. Contact the Laboratory for more information if this occurs. Order Prenatal Screens (blood group and antibody screen) on the Canadian Blood Services Prenatal Screen requisition.
6.5 Test: Crossmatch This test is used to prove compatibility between the patient and the donor red cells and will be completed only when the blood is required for prompt transfusion. Please see the General Nursing Manual, Blood and Blood Product Transfusion Guidelines for information on ordering, retrieving and transfusing blood components and products.
6.6 Test: Direct Antiglobulin Test (DAT) This test is used to determine if the patient’s red blood cells are abnormally coated with immune proteins (Antibodies and/or Complement). It is ordered by a physician to rule-out certain autoimmune problems, transfusion reactions or incompatibility between mother and newborn.
6.7 Test: Cord Blood Investigation
• Must be done on all infants born to Rh Negative mothers or mothers of unknown blood group. • It includes a determination of ABO/Rh and a DAT. • Collection requirements:
One 6 mL EDTA tube (lavender or pink stopper)
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6.8 Test: Transfusion Reaction Investigation
• Used to determine the cause of a suspected transfusion related adverse event. It must be initiated as soon as a reaction is suspected to determine the possible severity and therefore, morbidity/mortality for the patient. It will also determine if the transfusion can continue and identify future transfusion requirements.
• Please see the General Nursing Manual, Blood and Blood Product Transfusion Guidelines for more information on recognizing and managing a Transfusion Reaction.
• Always order as STAT, notify a Lab Technologist at WGH Lab by phone.
6.9 Blood Component Uses
• The “Circular of Information for the Use of Human Blood and Blood Components” from Canadian Blood Services describes various blood components and their intended use. Each patient area within the hospital should have a copy and it is also available on-line at: http://www.transfusionmedicine.ca
• Refer to the following websites for more information: http://www.transfusionmedicine.ca http://belite.transfusionontario.org/ http://www.traqprogram.ca/ http://www.blood.ca/
6.10 Blood Components Available (in stock) at Whitehorse General Hospital
1. Red Blood Cell Units (Packed Cells) [N.B. Phenotyped blood for patients with antibodies and special red cell requirements (i.e. Irradiated)
will need to be ordered from Vancouver and will require additional time].
2. Frozen Plasma – requires 15 minutes to prepare
3. Cryoprecipitate
Platelets must be ordered from Vancouver as the need arises. Please allow a minimum of 24 hours for delivery. Platelets are to be ordered in “Adult Doses”; each dose should bring the platelet count up by approximately 20x109/L in the absence of ongoing lose/consumption.
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6.11 Blood Products Available (in stock) at Whitehorse General Hospital
1. Rh Immune Globulin (WinRho)- see special notes below this list
2. 25% Albumin
3. 5% Albumin
4. Intravenous Immune Globulin (IVIG) – for specific diseases (IVIG Utilization Management Policy
defines approval process) 5. Hepatitis B Immune Globulin - for high risk neonates and Needlestick patients
6. Varicella zoster Immune Globulin – for high risk exposures
7. Serum Immune Globulin – for high risk exposures to Measles
8. Recombinant Factor VIII – for specific hemophilia patients
9. Recombinant activated Factor VII (NiaStase)
10. Prothrombin Complex Concentrate (Octaplex) – for the immediate reversal of oral Vitamin K
antagonist anticoagulants in specific circumstances
All other products must be ordered from Vancouver as the need arises. Please allow a minimum of 24 hours for delivery.
Special notes on Rh Immune Globulin
• Standard 300mcg (1500 IU) dose is to be administered.
• Used for Rh Negative mothers to prevent immune Anti-D sensitization. It is given: - At 28 weeks - Postpartum (as indicated by Cord Investigation) - After a Therapeutic Abortion - Post-amniocentesis - Threatened Abortion/ miscarriage - Other- trauma, etc.
See product insert or Fact Sheet in the General Nursing Manual for administration procedures.
Follow the Prenatal Checklist provided by Yukon Health and Social Services for testing schedule.
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6.12 Additional TM Process Notes
• Issue/Transfuse cards are issued with each unit by the lab and must by fully completed
and returned to the Lab.
• Please sign-out the crossmatched unit according to established protocol and ensure you
leave the “ticket” from the bottom of the Issue/Transfuse card on the bench.
• Blood Products will only be picked up from the Lab by healthcare workers who have been
oriented to the process.
• Empty blood product containers are to be retained on the ward for a minimum of four hours
after the transfusion is complete, in case a Transfusion Reaction develops. They are not
to be returned to the lab unless a Transfusion Reaction is suspected.
• If units are not issued within 72 hrs. or the patient is discharged, any remaining units will be
cancelled and returned to the blood bank inventory.
• If the units are unmatched or full testing is not yet complete, the doctor ordering the
transfusion must acknowledge the assumption of increased risk. This can be done by a
signed notation in the patient chart.
DISCLAIMER: This document summary is intended to provide general information only. Please see the General Nursing Manual Blood and Blood Product Transfusion Guidelines and the Clinical Transfusion Resource Guide for specific information about Transfusion Medicine procedures.
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Laboratory Guide to Services
Collection Procedures:
Microbiology
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7.0 COLLECTION PROCEDURES: MICROBIOLOGY This section contains: 7.1 General Sample Requirements
7.2 Sample Rejection Criteria
7.3 Ear Samples
7.4 Eye Samples
7.5 Genital Samples
7.6 Pregnancy screen for Group B Streptococcus
7.7 Infection Control Screening: MRSA or VRE
7.8 Nasal Swabs
7.9 Sputum Samples
7.10 Throat Samples
7.11 Urine Samples
A. Midstream Urine Collection
B. Straight line Catheters (In/ Out Catheters)
C. Indwelling Catheter
D. Peds bag (neonatal bagged urine)
Use of BacTube (Uricult Trio)
7.12 Wound Samples
7.12.1 Superficial Wounds (<2 cm deep) (Includes drainage, surface wounds, ulcers, boils):
7.12.2 Deep Wounds (Includes deep abscess, aspirates, implanted devices, bites):
7.12.3 Burns:
7.13 How to Collect Blood Cultures
7.13.1 Number of sets of blood culture bottles & Timing of collections
7.13.2 How to Label Blood Culture Bottles
For information on culturing sterile fluids, review 8.1 Body Fluid Collections
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7.1 General Sample Requirements 1. The quality of a Microbiology test result is dependent on the quality of the sample and the
information provided on the sample label and the requisition. There are no normal values in Microbiology. An improperly collected sample means inaccurate results.
2. Ensure that samples are labelled with:
• Patient’s legal name (last, first), • Patient’s health care number • Date of Birth (important for interpretation of Microbiology test results) • Date and Time of collection • The site (or type) of collection.
3. Complete the WGH Microbiology Requisition, including the same information as above. 4. List any antibiotics presently in use or intended to be used on the Requisition, as well as a
tentative diagnosis (e.g. R/O UTI). This will enable the lab to set up special plates, techniques, etc. as needed.
5. Transport to the Laboratory within 24 hours of collection (see specific sample requirements).
7.2 Sample Rejection Criteria Rejection criteria are designed to prevent inaccurate data and to ensure the safety of laboratory personnel. Microbiology samples may be rejected for the following reasons:
Unlabelled Samples
Incorrectly Labelled (Mislabelled) Samples
Incomplete information on the Requisition
Sub-optimal sample: leaking urine/ stool containers; insufficient quantity
Duplicate microbiology samples received on the same day (e.g. multiple ova & parasite stool samples, sputa samples).
Sample delayed in transit.
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7.3 Ear Samples Otitis Externa (External Ear) -
Collect using clear swab (Amies transport medium) and make smear 1. Clean the ear canal with a disinfectant (i.e. 70% alcohol or SOLU-I.V) and rinse it with saline. 2. Sample the canal several minutes after cleansing by swabbing briskly over any lesion present. 3. Use a separate sterile swab to make a direct smear on a glass slide. Label the frosted end of
the slide (Patient’s full name and date of birth AND health care number; site of collection; date of collection).
4. Label the swab with the same information as above 5. If delay in transport is unavoidable, refrigerate the sample at 4°C.
7.4 Eye Samples
Collect using clear swab (Amies transport medium) and make smear
1. These instructions are not meant for skin areas around the eye – see “superficial wound” samples for these types of swabs.
2. Specify left or right eye and the site of the sample: • Conjunctival • Lid margin • Corneal • Aqueous; or • Vitreous sample
Do not use the non-specific term “eye” for identifying a sample.
3. The method of sample collection depends on the site of the eye infection. In bilateral conjunctivitis, culture of one eye only is necessary.
4. Please make a smear at time of collection: Use a separate sterile swab to make a direct smear
on a glass slide. Label the frosted end of the slide (patient’s legal name, site of collection, date of collection).
5. Label swab, smear and Requisition with patient information.
6. If delay in transport is unavoidable, hold the sample at 4°C.
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7.5 Genital Samples Collect smears for patients of all ages. Collect swabs using a Modified Amies Clear Medium swab as warranted (see table below). This protocol includes routine genital testing for: urethritis, cervicitis, bacterial vaginosis, vulvovaginitis (Trichomoniasis and Candidiasis), pregnancy and patients at risk of STIs
1. Include any relevant information on the Requisition, such as: routine screen, possible STI contact, pregnancy, etc.
2. Complete separate Requisition for Chlamydia & GC PCR testing as these are referred-out tests. (‘Virology and Reference Laboratory’ requisition- see Section B)
3. Transport immediately to Laboratory. If delay in transport is unavoidable, keep sample at 4° C.
4. For Chlamydia testing, freezing no longer required.
5. When two slides are prepared (e.g. one for Micro and one for a Pap smear) please use two separate blue slide holders. We do not want to receive two slides in one slide holder. Using pencil, label each slide with site (one ‘PAP’, the other ‘VAG’, as well as other common descriptors.) Vag gram stains are processed on site – do not “spray” with fixative. PAP smears are sent out and do require the spray fixative.
6. For Trichomonas Antigen Testing, collect a second vaginal sample (Modified Amies Clear swab). Send within 24 hours; if delayed, refrigerate specimen at 4°C. The Lab will not process swabs > 36 hours old. This test is performed only when patients are exhibiting clinical symptoms. Contact the Microbiology Lab for more details.
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Genital Samples (continued) Site of sample collection for genital pathogens is dependent upon Clinical conditions:
Clinical Condition Site Common Pathogens
Sought Test Performed
Cervicitis Cervix Neisseria gonorrhoeae (GC) Combined Chlamydia/GC PCR Swab
Urethritis Urethra/Urine Neisseria gonorrhoeae (GC)
Combined Chlamydia/GC PCR (males- collect a urine specimen)
STI Risk Genital
Cervix
Neisseria gonorrhoeae (GC) Combined Chlamydia/GC PCR Swab
Chlamydia trachomatis Combined Chlamydia/GC PCR Swab
Urethra/Urine
Neisseria gonorrhoeae (GC)
Combined Chlamydia/GC PCR (males- collect a urine specimen)
Chlamydia trachomatis Combined Chlamydia/GC PCR (males- collect a urine specimen)
STI Risk Other
Rectal
Neisseria gonorrhoeae (GC) Modified Amies Charcoal Swab Throat
Eye
Vulvovaginitis Initial presentation Vagina
Candida Smear for Gram stain
Bacterial vaginosis Smear for Gram stain
Trichomonas vaginalis See below
Bacterial vaginosis Smear for Gram stain
Vulvovaginitis Recurrent/ Chronic Vagina
Candida Candida Culture (Modified Amies Clear swab)
Trichomonas vaginalis See below
Other pathogens Vaginal Culture (Modified Amies Clear swab and a smear)
Female Patients < 14 Vagina GC, other pathogens Vaginal Culture (Modified Amies
Clear swab and a smear)
Trichomoniasis Vagina Trichomonas vaginalis Trichomonas examination (Modified Amies Clear swab)
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7.6 Pregnancy screen for Group B Streptococcus (Refer to Health & Social Services’ Prenatal Checklist for further details on schedule of testing)
Clinical Condition / Site Common Pathogens Sought Test Performed
Vagino-Anorectal (remember to request Group B screen!) Group B Streptococcus Vagino-anorectal culture at 35- 37
weeks gestation (clear swab)
7.7 Infection Control Screening: MRSA or VRE Samples submitted solely for the detection of MRSA (Methicillin Resistant Staphylococcus aureus) OR VRE (Vancomycin Resistant Enterococcus)
For MRSA screening collect one of the following:
Perianal (preferred site) or groin Nares (left and right on ONE swab) Previously positive sites All open wounds (swab each one separately) Ostomy site (if applicable) Invasive device site (if applicable) Open wounds (if applicable)
For VRE screening collect: Rectal swab Swabbing sites for MRSA or VRE:
1. Collect using clear swab (Amies transport medium) 2. Pre-moisten a swab with Sterile Saline
3. One swab per site, except for Nares (1 swab for both right and left nares)
4. Roll the swab at the site for 2-3 seconds
5. Label appropriately with: • patient’s legal name • date of birth • health care number • “MRSA screening” • site of swab • date/time of collection
6. Send sample and completed Microbiology Requisition to the Laboratory ASAP
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7.8 Nasal Swabs
1. Submit for detecting Staphylococcus aureus carriers 2. Collect using clear swab (Amies transport medium) 3. Insert swab into the nose until resistance is met at the level of the turbinates (approx. 1
inch into the nose) 4. Rotate the swab against the nasal mucosa 5. Repeat the process on the other side (both nares on one swab) 6. Label swab with:
• patient’s legal name • date of birth • health care number • site of swab (nasal) • “S.aureus screen” • date/time of collection
7. Send sample and completed Microbiology Requisition to the Laboratory ASAP
7.9 Sputum Samples 1. Collect using a sterile container (clear, disposable, & leak-proof)
2. Early morning, deep cough sample or samples after chest physiotherapy are best. Morning samples are the most concentrated sample of disease causing organisms. Food or saliva contamination ruins samples.
3. Give the patient a sample container and the Patient Instruction Sheet for sputum collection (see Section D)
• Gargle/ rinse with water and discard prior to sample collection (no mouthwash). • Remove lid from sample container and hold container to open mouth with lips inside the container opening. • Take as deep a breath as is comfortable, and cough, do not spit, into the container. • Screw container lid tightly in place. • Clean the outside of the container with a paper towel soaked in disinfectant if it is soiled
4. Samples that appear like saliva, spit or postnasal samples are not appropriate collections 5. Create a slide at the time of sample collection. For proper slide preparation:
• Use a sterile swab and aggressively stir the sputum focusing on the ‘purulent chunks’- bacteria are harboured in these chunks. • Distribute sample from swab onto glass slide and air dry.
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6. Label the frosted end of the slide using a pencil: patient’s legal name, date of birth, health care number, date of collection, “sputum”.
7. Submit labelled sample, smear and Microbiology Requisition to the Laboratory for testing in a timely manner (preferably within 2 hours of collection).
• Samples should be sent to the laboratory within 24 hours of collection. • If immediate transport is not possible, please refrigerate sample (4° C). • Refrigeration prevents oropharyngeal bacteria from multiplying and overwhelming pathogenic bacteria. Too long at room temperature can kill pathogenic bacteria.
8. Only one satisfactory sample is required for “C&S”.
7.10 Throat Samples
1. Submit for the detection of Group A Streptococcal infections
2. Collect using clear swab (Amies transport medium). Exception: if N. gonorrhoeae is suspected, use a charcoal swab. Clearly state methodology on the Requisition.
3. Depress tongue gently with a tongue depressor.
4. Extend sterile swab between the tonsillar pillars and behind the uvula. Avoid touching the cheeks, tongue, uvula or lips.
5. Sweep the swab back and forth across the posterior pharynx, tonsillar areas and any inflamed or ulcerated areas to obtain sample.
6. Label swab with patient’s name, date of birth (or health care number), collection site (throat) and date of collection
7. Submit swab and Microbiology Requisition to the Laboratory for testing.
7.11 Urine Samples Urine samples are submitted to the microbiology lab to rule out urinary tract infections (UTI’s). Samples may be collected in a number of ways:
A. Midstream Urine B. Peds bag (neonatal bagged urine) C. Straight line catheters (in/out catheters) D. Indwelling catheter
Once collected, prepare a BacTube (Uricult Trio) with the urine sample (see Use of BacTube (Uricult Trio)
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A. Midstream Urine Collection 1. Provide patients with Patient Instructions for Midstream Urine collection (see Section D). For
patients unable to collect samples themselves, see instructions below.
2. An attempt should be made to collect the first voided sample in the morning. Otherwise, advise patient to hold urine as long as possible before collection for culture and sensitivity testing.
3. Avoid forcing the patient to increase fluid intake to void urine.
4. Collect urine directly into a sterile container (pink lid); do not use a urinal or bedpan or paper cup for collection.
5. Immediately after collection, dip BacTube (Uricult) slide in the container. Do not send urine to the Laboratory for dipping.
B. Straight line Catheters (In/ Out Catheters) 1. Clean the patient’s urethral opening (and in females, the vaginal vestibule) with soap, and
carefully rinse the area with water. 2. Using sterile technique, pass a catheter into the bladder. 3. Collect the initial 15 to 30 mL of urine and discard it from the mouth of the catheter. 4. Collect a sample from the mid or later flow of urine into a sterile container.
C. Indwelling Catheter 1. Clean the catheter collection port with 70% alcohol wipe. 2. Using sterile technique, puncture the collection port with a needle attached to a syringe.
(Note: do not collect urine from collection bag) 3. Aspirate the urine, and place it in a sterile container.
D. Peds bag (neonatal bagged urine) Note: This method is used to collect urine from newborns and those without bladder control (neonates and young toddlers). Because of the potential for contamination, this method is not a very effective method for ruling out UTI (due to contamination). 1. Wash the external genitalia
2. Place a collection bag over the external genitalia
3. Transfer urine from the bag immediately to a clean, sterile container
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Use of BacTube (Uricult Trio) 1. Dip the Bactube before contaminating the urine with urinalysis dipstick 2. If urine cannot be dipped within 2 hours of collection, refrigerate (up to a
maximum of 24 hours) 3. Inspect agar surfaces of the unopened Bactube: they should not be
dried out or falling off 4. Check expiry date 5. Unscrew the cap, remove the slide from the plastic tube; do not touch
the agar surfaces 6. Dip the slide three times into the freshly voided urine so that the agar
surfaces are completely immersed 7. If there is insufficient urine, carefully pour the urine over the agar
surfaces 8. Let excess urine drip off by holding the tip of the slide against the inside
rim of the sample container 9. Eliminate the last drops by holding the tip of the slide to a piece of
paper towel or tissue 10. Carefully return the slide to the plastic tube and close tightly 11. Do not leave excess urine in the Bactube container 12. Label the Bactube container with: patient’s name, date of birth (or health care number), date &
time of collection as well as type of collection (i.e. MSU, catheter) 13. Keep the Bactube at room temperature 14. Submit labelled Bactube and completed Microbiology Requisition to the Laboratory for testing
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7.12 Wound Samples “Wound” is a broad term used by Microbiology Technologists to describe: abscesses, bites, burns, carbuncles, cuts, incision lines, lacerations, lesions, rashes, ulcers, etc. This protocol includes routine culture & sensitivity testing for many miscellaneous body sites. Samples can generally be divided into 3 main groups: Superficial, Deep & Burns. See specific instructions below for each wound type. All wounds 1. Clinical suspicion of infection must be present before a sample is collected to avoid misleading
results. 2. Swabs of serous fluids are not recommended, as this is part of normal healing. 3. For dry, encrusted lesions, culture is not recommended unless an exudate is present. 4. Collect using syringe, clear swab or anaerobic collection kit as required– then make a smear
5. Prepare a smear slide at the same time the sample is collected.
6. Label smear with patient’s name, site of collection and date of collection on frosted end of slide using a pencil. Submit this smear for Gram stain so that Microbiology is able to assess the amount of infection present at time of collection and can perform appropriate testing.
7. Submit labelled sample, smear and completed Requisition to the Laboratory for testing in a timely manner. If a delay in transport is unavoidable, refrigerate the sample at 4°C
8. Please include useful information on the Requisition:
1. Wound Type e.g. left knee rash; right arm abscess; diabetic ulcer left leg 2. Location
3. Condition 4. Signs of Infection e.g. presence of pain; inflammation; exudate; pyrexia
5. Sampling Method 6. Testing Requested i.e. C&S; anaerobic culture 7. Indicate if Wound Deep or Superficial Deep (>2 cm deep)
7.12.1 Superficial Wounds (<2 cm deep) (Includes drainage, surface wounds, ulcers, boils):
1. Syringe aspiration is preferable to swab collection.
• Disinfect the surface of the wound with SOLU-I.V and allow to dry.
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• Using a 3- to 5-ml syringe with a 22- to 23-gauge needle, a Physician will aspirate the deepest portion at the advancing margin of the lesion (not just the pus).
• From a closed wound collect exudates and a sample of the abscess wall.
• Place aspirate into a sterile container.
• Using a sterile swab make a smear of the aspirate, ensuring that you roll the swab as you streak, on a clear glass slide. Label the smear at the frosted end of slide, with the patient’s legal last name, date of collection, and collection site.
2. If syringe aspiration is not possible a swab may be collected.
• For open wounds, cleanse wound with sterile, non-bacteriostatic saline using gauze. Do not irrigate wound.
• Place swab deep at the leading edge of the wound.
• Label sample patient’s name, date of birth (or health care number), site/type of collection, and date/time of collection
3. Use separate sterile swab to make a smear; label the frosted end of the slide.
7.12.2 Deep Wounds (Includes deep abscess, aspirates, implanted devices, bites):
Repeat instructions as for superficial wound. If an anaerobic infection is suspected obtain an anaerobic swab from the Microbiology Laboratory.
7.12.3 Burns:
1. Debride the area and disinfect the surface of the burn with SOLU-I.V. Allow to dry. 2. As exudate appears, sample it firmly with a swab. 3. Submit the swab sample for aerobic culture (C&S).
4. Try to collect biopsies from deeper tissues.
The surfaces of burn wounds will become colonized by the patient’s normal flora or by environmental organisms; cultures of the surface alone are therefore misleading.
5. Sample different areas of the burn. Organisms may not be distributed evenly in burn wounds.
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7.13 Blood Cultures Use the WGH Microbiology Laboratory Requisition to order Blood Cultures if ordered outside WGH. The rapid, accurate isolation and identification/susceptibility testing of organisms found in the blood is vitally important. Left undetected and untreated, septicemia can be fatal within 24 hours. Blood cultures are obtained whenever there is reason to suspect bacteremia. This includes patients with:
1. Pneumonia, meningitis and pyelonephritis 2. Suspected intravascular infection, i.e. endocarditis, infection of the graft 3. Prolonged fever 4. Fever accompanied by rigor 5. Afebrile but known or suspected of having endocarditis, treated or untreated 6. Certain multisystem infections, i.e. enteric fever (typhoid or paratyphoid), leptospirosis,
brucellosis, etc. 7. Immunosuppression with significantly decreased amount of neutrophils
7.13.1 Number of sets of blood culture bottles & Timing of collections The optimal number and frequency of blood cultures will depend on the disease suspected, and can only be determined by the Physician. Most cases of bacteremia, for example, are detected by using 3 sets of separately collected blood cultures. More than 3 sets of cultures yield little additional information. Conversely, a single blood culture may miss intermittently occurring bacteremia and make it difficult to interpret the clinical significance of certain isolated organisms. The following guidelines apply for both adult and pediatric patients. • Fever of unknown origin: obtain 2 separate culture sets, from 2 separately prepared sites initially.
After 24-36 hours, obtain 2 more before patient’s temperature rises.
• Acute sepsis, meningitis, osteomyelitis, arthritis, acute untreated bacterial pneumonia or pyelonephritis: obtain 2 separate culture sets, from 2 separately prepared sites prior to starting therapy.
• Endocarditis, Acute: obtain 3 culture sets with 3 separate venipunctures over 1-2 hours and begin therapy.
• Endocarditis, Subacute: obtain 3 culture sets on day 1 (at least 15 min apart). If all are negative at 24 hours, obtain 3 more sets (at least 15 min apart).
• Endocarditis, on antimicrobial therapy: obtain 2 separate culture sets for 3 successive days.
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Remember: To avoid contamination, Blood Culture samples must be drawn first, before any other blood samples. You must collect two sets of aerobic & anaerobic bottles from two different vein sites. Plan the order of the blood collection sites accordingly.
1. Assemble needed supplies:
• Computer-generated labels (preferred) • blood culture bottles • butterfly needle attached to blood culture collection adapter cap • alcohol swabs & antiseptic swabs • tourniquet • gauze pads/ adhesive tape/ Band-Aids • protective gloves • Sharps container
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2. Blood Volumes needed in Blood Culture bottles are based on the age of the patient:
3. Confirm the identity of the patient. Ensure the tube labels are accurate.
4. Locate the vein and cleanse the site first with an antiseptic swab and then with a 70% alcohol swab. Use a radiating circular motion, from vein site outwards. Allow to air dry. Do not re-palpate the vein before venipuncture.
AGE GROUP
FIRST SET SECOND SET (from different vein site) TOTAL
VOLUME Aerobic:
Volume (bottle type) Anaerobic:
Volume (bottle type) Aerobic:
Volume (bottle type) Anaerobic:
Volume (bottle type)
Newborn
N/A N/A N/A 0.5 mL 0.5 mL Pediatric (PF Plus) Yellow
< 1 year
N/A N/A N/A 1 mL 1.0 mL Pediatric (PF Plus) Yellow
1-6
N/A N/A N/A 3-4 mL 3– 4mL Pediatric (PF Plus) Yellow
7-12
N/A N/A 16-20 mL 8 – 10mL Aerobic (FA Plus) Mint Green
8– 10mL Anaerobic (FN Plus) Orange
> 13
40 mL 10 mL Aerobic (FA Plus) Mint Green
10 mL Anaerobic (FN Plus) Orange
10mL Aerobic (FA Plus) Mint Green
10 mL Anaerobic (FN Plus) Orange
FUNGAL
(skinny neck bottle) N/A N/A N/A 10 mL 10 mL ‘Myco’ bottle
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5. Prepare the blood culture bottles:
• Adults: you must collect 1 green-capped aerobic bottle and 1 orange-capped anaerobic bottle; Pediatrics: collect 1 yellow-capped bottle • Ensure integrity of each bottle- (sensor on the bottom should be grayish-green; yellow-coloured sensor indicates the broth is contaminated & bottle must be discarded). Check
the expiry date & discard if necessary. • Remove protective plastic cap on bottles; sterilize rubber septum with 70% alcohol • Mark the desired fill volume level on each bottle- see Blood Volumes table on page x. 10 mL of blood per bottle is optimal for adults (bottles are pre-marked with 5mL increments)
6. Perform venipuncture.
7. Attach the aerobic (green) bottle to the collection adapter cap and hold the cap down on the bottle.
8. Using the fill indicator line you marked, obtain the needed volume of blood. Then remove the adapter cap from the bottle and attach it to the anaerobic (orange) bottle. Obtain the needed volume of blood.
9. If additional blood is required for other tests, draw them after the blood culture bottles are filled.
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10. Terminate the venipuncture and dispose of butterfly needle in the Sharps container. Dispose of the disposable adapter cap.
11. Label the specimen bottles- in the presence of the patient- with prepared labels. Please follow guidelines in the next section: How to Properly Label Blood Culture Bottles as there is a special protocol for the automated analyzer.
12. Repeat this collection process from another vein site. You must collect two sets of aerobic & anaerobic bottles from two different vein sites (4 bottles in total). Note that some tests require 3 sets (e.g. endocarditis). Refer to the Test Reference Manuals for specific instructions for each test. Once finished, collect other blood samples as needed.
13. Place labelled specimens in plastic biohazard bags, place the requisition in the outer sleeve of the bag and prepare for transport using TDG protocols.
14. Keep blood cultures at room temperature prior to and during transport. Deliver to the Lab asap.
Reference: BioMérieux Inc. 2008. Worksafe BacT/ALERT Blood Culture Collection Procedure. Instruction sheet
available from: www.biomérieux-usa.com
AFTER collection: wipe off any external blood with an alcohol pad
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7.13.2 How to Label Blood Culture Bottles The new automated blood culture instrument in our lab automatically reads labels. If they are not affixed to the bottle as specified, the instrument rejects the sample. Please label blood culture bottles accordingly: Apply Patient Label Barcode Vertically Avoid covering “volume window” Avoid covering 2D Barcode Avoid covering Lot # & Expiry Date Affix only ONE label on each bottle
DO NOT LABEL IN THIS AREA LABEL HERE
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8.0 COLLECTION PROCEDURES: FLUIDS, PATHOLOGY, CYTOLOGY This Section includes: 8.1 Body Fluid Collections
8.1.1 Cerebral Spinal Fluid (CSF)
8.1.2 Dialysate Fluid
8.1.3 Pericardial Fluid
8.1.4 Peritoneal Fluid
8.1.5 Pleural Fluid
8.1.6 Synovial Fluid
8.2 Pathology Sample Collections
8.3 Cytology Sample Collections
8.4 St. Paul’s Hospital Division of Anatomic Pathology: “Sample Collection Criteria for Surgical and Cytology Specimens(Whitehorse)”
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8.1 Body Fluid Collections
Chemistry, Hematology and Microbiology tests may be ordered on the following fluids at the WGH Lab:
1. Cerebral Spinal Fluid 2. Dialysate Fluid 3. Pericardial Fluid 4. Peritoneal Fluid 5. Pleural Fluid 6. Synovial Fluid
All fluids are considered STAT and must be brought to the Laboratory within one hour of collection. Before beginning any fluid collection, please phone the Lab for direction on sample handling and transport. Samples need to be transferred immediately into the correct specimen containers. All fluid cytology specimens are sent to Referral Laboratories; consult the St. Paul’s Hospital Test Reference Directory for handling instructions.
8.1.1 Cerebral Spinal Fluid (CSF) The physician collects up to 20 mL of CSF on adults for testing. The CSF is divided into 3 to 4 sterile plastic screw-cap tubes (avoid glass).
CSF Sample distribution in tubes, based on quantity of fluid collected:
4 tubes (~20 mL) 3 tubes (~15 mL) 2 tubes (~10 mL) 1 tube (<10 mL)
① Chemistry ① Chemistry ① Chemistry and Hematology
① only
Ask physician (processed according to priority test(s)).
② Microbiology ② Microbiology ② Microbiology
③ Virology and Extra tests ③ Hematology
and Virology
④ Hematology
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8.1.2 Dialysate Fluid All testing is initiated when, upon inspection, the collected bag of dialysate appears cloudy.
Orderable tests: • Cell Count and differential (use WGH On-Site requisition) • Culture and Sensitivity (use WH Microbiology requisition) • Amylase (use WGH On-Site requisition)
Collection notes:
• Mix dialysate bag well to ensure the contents are evenly distributed
• Clean access port prior to collection of fluid using 70% isopropyl alcohol
• Collect a 50 mL aliquot of fluid and place it into a sterile collection container
• Collect one lavender top (EDTA) and one gold top (SST) vacutainer
• Samples MUST be sent to the Laboratory immediately for processing- cells disintegrate rapidly- results will be inaccurate if processing is delayed
• DO NOT send the entire bag
8.1.3 Pericardial Fluid Orderable tests:
• Cell count and differential • Total Protein • LDH (Lactate Dehydrogenase) • Glucose
8.1.4 Peritoneal Fluid
Orderable tests: • Cell count and differential • Total Protein • LDH (Lactate Dehydrogenase) • Glucose • Lipase • Amylase (referred-out test only)
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8.1.5 Pleural Fluid
Orderable tests: • Cell count and differential • Total Protein • LDH (Lactate Dehydrogenase) • Glucose
8.1.6 Synovial Fluid
Test ordered Vacutainer Tube/ Collection container type
Cell count EDTA or Fresh sample
Chemistry Red Top or sterile urine container
Crystals Red Top or sterile container
Bacteriology Red Top or sterile urine container (green tube is clotted for gram’s stain)
Mucin Clot Test Supernatant of chemistry tube
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8.2 Pathology Sample Collections Pathology Samples are sent to St. Paul’s Hospital Division of Anatomical Pathology in Vancouver for analysis. Their most recent guide to sample collection criteria is provided at the end of this chapter. Pathology samples are considered irreplaceable. An Irreplaceable Sample Form will need to be completed if:
Doctor’s signature missing on Requisition
Samples or Requisition not labelled with patient demographics and/or history
Pathology description on container does not exactly match description on the Requisition
Time of collection and time sample added to formalin are not listed on Requisition
Pathologists at SPH need clarification about the sample(s)
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8.3 Cytology Sample Collections WGH In-Patient Cytology Samples are sent to St. Paul’s Hospital Division of Anatomical Pathology in Vancouver for analysis. Their most recent guide to sample collection criteria is provided on the next page. All samples should be sent in CytoLyt Solution®. Cytology Samples collected outside of the WGH are sent to the BC Cancer Agency- Vancouver Centre’s Diagnostic Cytology Laboratory (phone: 1-604-877-6000, fax: 604-873-5384). Along with a current Requisition for Diagnostic cytology, the BC Cancer Diagnostic Cytology Laboratory has updated their website to provide detailed information on collection procedures, supplies and indications for the following sample types:
1. Anal specimens 2. Bile drainage 3. Body cavity fluids 4. Breast nipple secretions 5. Bronchial brushing 6. Bronchial washing 7. Bronchoalveolar lavage 8. CSF, Cerebral spinal fluid 9. Fine needle aspirate (FNA) 10. Gastric brushing 11. Gastric washing 12. Oral scraping or brushing 13. Pelvic washing 14. Sputum 15. Urine (voided or catheterized) 16. Urological specimens (other)
Please consult their website for current information before collecting samples. http://www.bccancer.bc.ca/health-professionals/clinical-resources/laboratory-services/diagnostic-cytology
Division of Anatomic Pathology, St. Paul’s Hospital, Vancouver B.C., Canada
Page 1 of 5
Approved by :Sue Finley
Quality Manual Procedure Manual for Whitehorse General Hospital Laboratory
Revision date: March, 2018 :
Electronic Document in Lab QMS is the Current Approved Version
Sample Collection Criteria for Surgical and Cytology Specimens (Whitehorse) Purpose: This procedure provides instructions to be utilized as procedure manual for an outside facility, such as Whitehorse General Hospital. Providence Health Care Group Histology Laboratory Working Hours Hours of Operations ………………………………………………Mon.-Fri.6:00-19:00 Contact Numbers: Histology Phone Numbers…………………….(604) 683-2344 (Local 62383 ,62303,or 62540) Cytology Phone Number ……………………………………………….(604) 806-8181 Technical Leader…………………………………………………………(604) 806-8254
Division of Anatomic Pathology, St. Paul’s Hospital, Vancouver B.C., Canada
Page 2 of 5
Approved by :Sue Finley
Quality Manual Procedure Manual for Whitehorse General Hospital Laboratory
Revision date: March, 2018 :
Electronic Document in Lab QMS is the Current Approved Version
Patient Sample Integrity Requirements and Corresponding Requisitions (for WH) Surgical specimen Send In Requisition Surgical and biopsies specimens
10% Buffered Neutral Formalin 10X the volume of tissue
Surgical Requisition form No. LA124
Skin for Immunofluorescence Zeus Medium
Surgical Requisition form No. LA124
Stone No fixative Surgical Requisition form No. LA124
Lymph node biopsies
10% Buffered Neutral Formalin Surgical Requisition form No. LA124
All cytology specimens Cyto Lyt PHC-LA176
Note: All samples must be sent to PHC pathology laboratory in fixative as outlined above. Information Requirements for Sample Containers and Requisitions All specimens received in the laboratory at PHC must be properly labeled with two unique patient’s demographics on both specimen container and accompanying surgical requisition. Note: The requisition must also include patient history and the requesters name and billing number.
Division of Anatomic Pathology, St. Paul’s Hospital, Vancouver B.C., Canada
Page 3 of 5
Approved by :Sue Finley
Quality Manual Procedure Manual for Whitehorse General Hospital Laboratory
Revision date: March, 2018 :
Electronic Document in Lab QMS is the Current Approved Version
Labeling criteria for sample container and requisition are as follows: Container Labeling Criteria
Surgical • Patient's full name • Source of specimen (include a brief description , e.g.
upper/lower, left/right) Cytology
• As above • Source description can be written on either the cytology label or
container.
Requisition Labeling Criteria
• Patient's full name and birth date • Patient's MRN and encounter number (Inpatient and outpatient
clinic location) • Patient's PHN number (outpatient location) • Ward or location • Date and time of collection • Clinical history • Clinical diagnosis if possible • Ordering doctor's full name and billing number • Request for copies of results sent to other doctors.
o Please submit copies to physician names in full plus billing number. This will hopefully eliminate any confusion during report distribution.
Additional Information
If a rush diagnosis is required Then state on the accompanying patient surgical or cytology requisition in bold letters.
Quality Control
A specimen tracking system is in place to ensure the delivery of patient specimens have arrived in the pathology at PHC in a timely and orderly fashion. • The sender of patient material will provide on separate information
sheet patient information and sample type and will initial each item. • When samples arrive in PHC lab, staff will verify contents of
package, initial information sheet and once verification is complete PHC staff will reply to sender by faxing receipt of specimens back to the agency/facility
If there are any discrepancies or sample loss
Then sender will be notified immediately after the verification is completed and can begin to trouble shoot concern
Division of Anatomic Pathology, St. Paul’s Hospital, Vancouver B.C., Canada
Page 4 of 5
Approved by :Sue Finley
Quality Manual Procedure Manual for Whitehorse General Hospital Laboratory
Revision date: March, 2018 :
Electronic Document in Lab QMS is the Current Approved Version
Reasons for Sample Rejection
When an unlabeled or mislabeled specimen is received in PHC pathology the laboratory will not label the specimen. PHC pathology laboratory will contact referral facility, operating room, clinic, or doctor’s office for proper labeling prior to processing patient sample.
If two unique identifiers are not included on either the container or requisition
or If there is a lack of ordering Dr. info
or If the hand writing is illegible
or If either the specimens requisition or container are unlabeled
Then PHC lab staff will photo copy information on container and requisition and fax the photocopies and declaration of patient unlabeled or mislabeled anatomic pathology form to WH lab for correction. WH lab staff will arrange with the OR, clinic or Dr office to correct sample info. When the information is corrected WH lab will fax back corrected photocopies and signed declaration of patient unlabeled form to PHC lab. Once PHC pathology lab has received the correct information sample processing will begin.
Note: • If you require any additional information please contact the laboratory and request to
speak with the frozen section pathologist (806-8810 or 806-3614/68373). • Fax correction declaration form to 604-806-8592
Division of Anatomic Pathology, St. Paul’s Hospital, Vancouver B.C., Canada
Page 5 of 5
Approved by :Sue Finley
Quality Manual Procedure Manual for Whitehorse General Hospital Laboratory
Revision date: March, 2018 :
Electronic Document in Lab QMS is the Current Approved Version
Interpretation/Results: Reference: Revision/Review History: Date Revision Type By Summary of Changes July 23, 2009 New File Agnes Tchao Format change for LabQMS upload Dec 27,2013 Minor Change Susan Li Yan Format change for LabQMS Upload March 2018 Minor Change Sue Finley To support WH labeling criteria request Hard Copy Distribution Log: Location(s) Archived Obsolete version, replaced
with Current version by: Date
Laboratory Guide to Services
Collection Procedures: Fluids, Pathology,
Cytology
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Laboratory Guide to Services
Handling, Packaging & Transporting
Samples
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9.0 HANDLING, PACKAGING & TRANSPORT OF SAMPLES This section contains:
9.1 Sample Handling & Storage of blood prior to Transportation
9.2 Packaging & Transport of Patient Samples
9.2.1 Packaging
9.2.2 Inpatient and Outpatient Samples: Transport within WGH
9.3 Sending Samples in the Pneumatic Tube System at WGH
9.3.1 Items accepted in the PTS bullets
9.3.2 Filling the bullet
9.3.3 Transporting samples on ice
9.3.4 Launching a PTS Bullet
9.3.5 Trouble-shooting
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Handling, Packaging & Transporting
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9.1 Sample Handling & Storage of blood prior to Transportation Analytes in blood samples can be affected by delayed or improper handling prior to transport. Centrifugation, time, temperature, light exposure and storage conditions can affect some test results-- sometimes with severe consequences to patient health and safety. ** Centrifuge samples within 30 minutes of collection. Samples that have not been centrifuged will be rejected if they arrive more than 2 hours post-collection. Glycolysis, the metabolism of glucose, can occur when serum or plasma remains in contact with red blood cells during storage and transport. Glycolysis can result in falsely lower glucose results. The process is accelerated in higher temperatures or with white blood cell counts.
Ion Exchange can also occur when samples are not centrifuged in a timely fashion. Potassium moves through red cell membranes when samples are cooled, increasing potassium levels substantially in the plasma. False readings of potassium are a potential threat to patient safety.
These are just two consequences of improper handling. The table below lists some tests that undergo changes in analytes during serum-cell exposure.
Examples of Analytes That Change During Serum- Cell Exposure
Increased: Decreased: Lactate Dehydrogenase (LD) Glucose Phosphorus Ionized Calcium Ammonia Bicarbonate Potassium
Creatinine B12 ALT AST
! Sample Handling Affects Patient Care!
Disregarding time, temperature and light specifications for blood samples can
lead to analytical errors. Results could be dramatically altered and this may result in medical errors.
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Handling, Packaging & Transporting
Samples
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9.2 Packaging & Transport of Patient Samples The transport of Patient samples is regulated by the Canadian Transportation of Dangerous Goods Regulations (TDGR). All staff responsible for packaging samples for transport to the WGH Laboratory should have completed TDG training. All specimens must be handled in a manner in which the safety of the handler and the environment are protected while preserving the integrity of the specimens.
9.2.1 Packaging 1. Place labelled sample(s) into a biohazard bag with absorbent and seal bag 2. Place corresponding requisition (paperwork) into the front sleeve of the biohazard bag –
paperwork cannot be placed in same pouch as sample since it may become contaminated by leakage
3. Place sample bags into a container/ bag/ box for transportation to WGH Lab.
4. Indicate required sample transportation conditions on the outside of the package- i.e. room temperature, frozen, keep refrigerated.
9.2.2 Inpatient and Outpatient Samples: Transport within WGH Transport specimens from inpatient units to the main Laboratory in biohazard bags. Transport larger numbers of samples in a secondary container. Keep laboratory specimen paperwork separate from the primary specimens and free of contamination. Contact the Laboratory immediately in the event of accidents or spills. Where appropriate, Laboratory personnel will take necessary action to contain the spill or notify the appropriate officials.
Note: The information summarized here is meant as a guide to certain parts of the Transportation of Dangerous Goods Regulations and is not meant to be a substitute for them.
It is the responsibility of those handling, shipping or transporting dangerous goods to consult the Regulations for exact requirements.
A copy of the TDGR can be found on Transport Canada’s website: http://www.tc.gc.ca/eng/tdg/clear-menu-497.htm
Information on packing material is found on the Saf-T-Pak website: http://www.saftpak.com/StpPack/stpackaging.aspx
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Handling, Packaging & Transporting
Samples
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9.3 Sending Samples in the Pneumatic Tube System at WGH With expansion of the new WGH Emergency Department the hospital now has a vacuum Pneumatic Tube System (PTS) for rapidly transporting samples. Follow these important guidelines to ensure samples arrive in the Lab safely.
9.3.1 Items accepted in the PTS bullets
All blood vacutainers *Venous Blood Gas on IceVenous Lactate on IceUrine samples < 100 mLUrine culture vial (Uricult BacTube) Stool samplesStool samples for C&S and O&P
Swabs All swabsRequisitionsECG reportsCompleted WGH Blood Bank Identification cards
Arterial blood gasesCerebral Spinal FluidBody FluidsTissue biopsiesPathology specimensBiopsies in fixativeUrine in cytology fixative
*Heavy metal blood collections
(Dark Green Heparin tubes must be transported upright)
Fluid volumes > 1000mL or specimens >2.2 kg
24 hour urines
Used or transfused blood product bags/ tubingUsed or transfused Derived Blood Product containers
Food/ drinkMoney/ chequesValuables
Sensitive and irretrievable samples
All required lab supplies
Blood Culture Bottles
Accepted Items for transport via the PTS bullets:
Blood Collection Tubes
Sterile Sample Containers (with properly secured lids)
Paper Documents
DO NOT SEND in PTS bullets:
Specimens in formalin or cytoLyte
Blood Products
Other
Sharps/ non-leak tight containersSeminal fluids
Bone Marrow
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9.3.2 Filling the bullet
• Ensure all lids are tightly sealed on sample containers. • All specimens must be placed inside a biohazard bag. • Place requisition in outside sleeve of the biohazard bag • Remove air and seal all biohazard bags • Place all biohazard bags in the reusable biohazard bag (heavier plastic)
• Expel air from the reusable biohazard bag, roll top down and seal shut with the attached velcro
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• All contents must fit inside the bullet when it is properly locked with its locking mechanism
9.3.3 Transporting samples on ice
• Samples that require transport on ice include Venous Blood Gas, Venous Lactate, etc. • Place icepack in a reusable biohazard bag, expel air and seal • Place blood sample and bag of ice in a 2nd biohazard bag, together • Place sealed biohazard bag in reusable biohazard bag and place in bullet
**Send samples on ice in a separate bullet**
9.3.4 Launching a PTS Bullet
1. Place “bullet” in pneumatic tube system slot (bottom first).
2. Select appropriate destination: • 1 = Pharmacy • 2 = Laboratory • 3 = New ED
3. Select “E” to send 4. **Phone the Lab (8739) to notify staff that a bullet is in transit**
9.3.5 Trouble-shooting:
• Wrong location selected – hold * for 2 seconds to clear and re-enter correct location (must be done before selecting E)
• Power Failure – do not use system, hand deliver • Destination Full – phone location to advise their collection basket is full. • System Failure – notify facility management and locations
Phone numbers:
Pharmacy – 8737 Laboratory – 8739 ER- 8926 All instructions for use of the PTS can be found by each Launching Station.
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Patient Instructions
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10.0 PATIENT INSTRUCTIONS This section contains: 10.1 Patient Instructions: A Reminder about Patient Literacy
Clues Indicating Low Health Literacy
10.2 A List of Patient Instructions for Laboratory tests
The Holter Monitor: Studying Your Heart for 24 Hours
Spirometry: How is your breathing?
Non-Gestational Oral Glucose Tolerance Test
Gestational Oral Glucose Tolerance Test
50 gm Oral Glucose Load Test
Helicobacter pylori Urea Breath Test (UBT)
24 Hour Urine Testing
12 Hour Urine Testing
Midstream Urine Collection
Urine Collection (for Cytology Testing)
Infant Urine Collection (Using a U-Bag)
FIT (Fecal Immuno Testing): screening for colorectal cancer
Stool Collection (for Culture & Sensitivity or C. difficile tests)
Stool Collection (for Ova & Parasite Exam)
How to Collect Sputum (for Bacteriology or Fungal Study)
How to Collect Sputum (for Cytology Testing)
How to Collect Sputum (for TB Testing)
Semen Analysis
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10.1 Patient Instructions: A Reminder about Patient Literacy
Patient health literacy skills impact the collection, testing and interpretation of laboratory results. Samples improperly collected can yield inaccurate results.
Definitions: Level 3 Literacy (an International Standard): the minimum level of proficiency required to meet the demands of modern life, independently and reliably in an industrialized nation Prose literacy: the knowledge & skills needed to understand and use text information Document literacy: relates to locating and using information contained in materials Numeracy: is the knowledge and skills required to apply arithmetic operations embedded in printed materials. The Stats: Among Canadians aged 16 and over:
• 48% (about 12 million) score below Level 3 on the prose and document scales • 55% score below Level 3 on the numeracy scale (Statistics Canada, 2005)
(There is considerable variation in literacy proficiency across the provinces and territories).
Removing barriers in health care:
• Build your own skill set. Develop culturally-appropriate communications. • Encourage patients to ask questions and to express their feelings, preferences and
values about health-related concerns. • Listen carefully to patients and take the time to clearly explain what will be done. • Talk slowly to patients, use simple words, and most importantly, show respect. • Ask the patient to describe the instructions in their own words to ensure they have understood
fully. (Teach back technique). References: Rootman, I. and D. Gordon-El-Bihbety. 2008. Vision for a Health Literate Canada: Report of the Expert Panel on
Health Literacy.Canadian Public Health Association. Agency for Healthcare Research and Quality. Nd. Health Literacy Universal Precautions Toolkit, 2nd Edition.
Retrieved March 2018. https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool5.html
This publication is available from www.cpha.ca.
https://www.cpha.ca/sites/default/files/uploads/resources/healthlit/report_e.pdf
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Clues Indicating Low Health Literacy Many people with low literacy skills are masters at concealing their deficit and are often quite articulate when speaking. It can be difficult to recognize a communication disconnect. Observing closely and asking the right questions, however, will provide ‘red flags’ with respect to reading and comprehension of information. Characteristics and behaviors of patients with low health literacy The Patient:
• May appear nervous, confused, frustrated, angry or indifferent
• Makes excuses when asked to read or fill out forms (“I don’t have my glasses,” “I’m too tired to read” and “I’ll read this when I get home”)
• Lifts text closer to their eyes or points to the text with a finger while reading. Eyes wander over the page without finding a central focus.
• Provides incomplete medical history or checks items as “no” to avoid follow-up questions
• Misses appointments and/or make errors regarding their medication.
• Takes your oral instructions literally
• Identifies their medication using visual cues- pill’s color, size, and shape
• Gives incorrect answers when questioned about what they have read
Being mindful of these clues improves healthcare for patients. Reference: Cornett, S., (Sept. 30, 2009) "Assessing and Addressing Health Literacy" OJIN: The Online Journal of Issues in Nursing. Vol. 14, No. 3, Manuscript 2. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Assessing-Health-Literacy-.html If you suspect your patient has low health literacy, read the patient instructions with them to ensure they understand and can ask questions immediately.
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10.2 A List of Patient Instructions for Laboratory tests
Patient Instructions for:
ECG Electrocardiogram (ECG/EKG) 1 Holter Holter Monitors 2
Spirometry Spirometry & Reversibility testing (formerly PFTs) 3
Glucose Tolerance
Testing
Non Gestational 2 Hr Glucose Tolerance testing 4 Gestational 2 Hr Glucose Tolerance testing 5 50gm Oral Glucose Load 6
H. pylori Urea Breath Test for Heliobacter pylori 7
Urine Samples
24 Hour Urine Test 8 12 Hour Urine Test 9 Midstream Urine Collections 10 Urine Collection for Cytology testing 11 Infant Urine Collection using a Ubag 12
Stool Samples
Fecal Immuno Testing (FIT) 13 Stool for Culture & Sensitivity (C&S) testing 14 Stool for Ova & Parasites (O&P) testing 15
Sputum Samples
Sputum for Bacteriology & Fungal testing 16 Sputum for Cytology testing 17 Sputum for TB testing 18
Semen Samples
Post Vas Testing 19 Infertility Testing 20
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Your ECG: Studying Your Heart This test does not hurt. The machine listens to your heart beating. Your doctor’s office will give you an appointment time. Before you come:
• Shower and wash your body
• Please- no creams, powders or perfumes on your body (deodorant is ok)
• Wear a shirt that is easy to remove
• Women: you will need to remove your bra for the test; gowns are available
• Women: do not wear panty hose
• Men: we may need to shave off some chest hair
• Please come 10 minutes early to sign in
• You will be asked to remove your shirt and lie down for the test
The test is very short but your Doctor may need to look at your results before you can leave. So the visit may last 30 minutes.
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
Stickers with sensors attached to them
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The Holter Monitor: Studying Your Heart for 24 Hours
Your doctor’s office will give you an appointment time. This test does not hurt. The machine listens to your heart beating. You wear it overnight and bring it back the next day. Before you come:
• Shower and wash your body
• Please- no creams, powders or perfumes on your body (deodorant is ok)
• Best choice: Wear a shirt that opens in the front & pants with a belt
• Women: you will be given a gown; you need to remove your bra to put the sensors on, but can put it back on once it is set up
• If you want to hide the wires during the day, wear a shirt with a high neckline
• Men: we may need to shave off some chest hair
• Please come 10 minutes early to sign in
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
Stickers with sensors attached to them
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Spirometry: How is your breathing? This is a breathing test to study how your lungs work. You will be contacted about the date and time of your appointment. Please follow these instructions before your appointment: 1. Postpone your appointment if you’ve had:
• A heart attack in the last month
• A stroke in the last month
• Eye surgery in the last month
• Surgery in your chest or stomach in the last month
• Pneumothorax in the last month
2. You cannot take this test if you’ve ever had an aneurysm or if you have uncontrolled hypertension (high blood pressure).
3. Do you take medicines for breathing? If yes, bring them with you to the appointment. You may need to stop taking these medicines for a short time before the test- ask your doctor.
4. If you are sick (have a cold or flu) on the day of the test, please rebook your appointment. If you have been severely sick or have had ear infections, postpone the appointment for 3 weeks.
5. Avoid:
• Smoking for at least 1 hour before the test
• Drinking alcohol within 4 hours of the test
• Exercising heavily within 30 minutes of the test
• Wearing tight clothing that might restrict full deep breaths
• Eating a large meal within 2 hours of the test
6. Do not wear perfume, cologne, shower gels, etc. to the test.
7. Please arrive 10 minutes early to sign in.
If you want to see how the test is done, watch this YouTube video (Title: “Spirometry Technique Review” produced/ uploaded by ‘LungAssociationSK’): http://www.youtube.com/watch?v=--7ORNHWVrY&list=UUo2i4iUca7JpewgD9xY5GVA&index=2&feature=plcp
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
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Non-Gestational Oral Glucose Tolerance Test
This test studies the sugars in your blood. Your doctor’s office will give you an appointment time. Before the test:
• If you have had surgery, you must wait at least 2 weeks before doing this test.
• If you are sick on the day of the test, do not come. You must rebook the test.
• No food or drink for 8 hours before the test. You can drink water and take your prescription medicines.
On the day of your test, come to the hospital lab. Come a bit early to sign in.
• Your blood will be drawn.
• You will drink a sweet drink, then to sit and rest for 2 hours.
• You cannot leave the building and you cannot smoke, eat or drink during the 2 hours.
• After 1 hour your blood will be drawn, then again after 2 hours. Then the test is finished.
• You may wish to bring a warm sweater.
• Bring a snack to eat once the test is done.
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
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Gestational Oral Glucose Tolerance Test This test studies the sugars in the blood of pregnant women. Your doctor’s office will give you an appointment time. Before the test:
• If you have had surgery, you must wait at least 2 weeks before doing this test.
• If you are sick on the day of the test, do not come. You must rebook the test.
• No food or drink for 8 hours before the test. You can drink water and take your prescription medicines.
On the day of your test, come to the hospital lab. Come a bit early to sign in.
• Your blood will be drawn.
• You will drink a sweet drink, then to sit and rest for 2 hours.
• You cannot leave the building and you cannot smoke, eat or drink during the 2 hours.
• After 1 hour your blood will be drawn, then a third time after 2 hours. Then the test is done.
• You may wish to bring a warm sweater.
• Bring a snack to eat- you may eat it once the test is done.
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
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50 gm Oral Glucose Load Test This test studies the sugar in your blood. No appointment is needed.
• If you have had surgery, you must wait at least 2 weeks before doing this test.
• If you are sick on the day of the test do not come- you must rebook the test.
On the day of the test:
• Eat normally before you come (no fasting needed)
• Come to the hospital lab about 10 minutes early to sign in- you must arrive before 2:45 pm.
• Your blood will be drawn
• You will drink a sweet drink, then you must sit and rest for 1 hour
• You cannot leave the building and you cannot smoke, eat or drink during the 1 hour
• After 1 hour your blood will be drawn again
• You may wish to bring a warm sweater
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
Clinic hours for this test:
Monday to Friday 7 a.m. to 11:30 a.m. or 12:30 p.m. to 2:45 p.m.
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Helicobacter pylori Urea Breath Test (UBT) This test takes ~45-60 minutes. You must stay at the hospital for the entire test. Please read carefully:
1. Laboratory Hours for this test: Tuesday-Friday between 12:30 p.m. and 2 p.m. [You do not need an appointment].
2. Before the test, avoid these medicines:
Medicine Examples Time to Avoid before Test
Antibiotics Amoxicillin, Clarithromycin, Metronidazole, Tetracycline 4 weeks
Proton pump inhibitors Losec, Prevacid, Pantaloc, Nexium, Prilosec 3 days
H2 receptor antagonists Tagamet, Zantac, Pepcid 1 day
Bismuth salts Pepcid, Pepto-Bismol 2 weeks
Antacids Maalox, Diovol 1 day
Talk to your doctor before the test if you are taking any of these medicines
3. For 4 hours before the test:
• Do not smoke
• Do not eat anything
• Do not drink anything (except small sips of water)
Note: You may chew gum and brush teeth
4. Come to the hospital lab. Bring your paper Requisition from your doctor.
5. Here are the steps for the Test: 1. You blow air through a straw into a tube for 4-8 seconds
2. Drink a lemon- flavoured drink
3. Wait 30 minutes (do not smoke, eat, chew gum, or drink).
4. Blow air again into a tube
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
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24 Hour Urine Testing
Please read carefully:
Before: Follow your doctor's orders about food and medicine
Start:
Empty your bladder (pee) in the toilet- Do not collect it
Mark down the date & time on the pink label: "start date" & "start time"
Collect ALL your urine (pee) for the next 24 hours
During Collection:
Put the orange collection container in the refrigerator when not in use
Urinate (pee) into the "white hat"
Transfer urine from white hat into orange container- Be careful not to splash!
If the test is for trace metals, do not rinse the white hat
Finish:
After 24 hours, empty your bladder completely and put urine into the container
Mark down the date & time on the pink label: "finish date" & "finish time"
Bring your filled orange container and Requisition to the Lab as soon as you can
Write dates & times on the container label:
Do not allow feces (poo) to get into your container Women: do not collect during your period (no blood) Phone the Lab if you have questions. Thank you!
WGH Laboratory at 393-8739
Caution! May have acid in it!
“white hat” on toilet
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12 Hour Urine Testing
Please read carefully:
Before: Follow your doctor's orders about food and medicine
Start:
Empty your bladder (pee) in the toilet- Do not collect it
Mark down the date & time on the pink label: "start date" & "start time"
Collect ALL your urine (pee) for the next 12 hours
During Collection:
Put the orange collection container in the fridge when not in use
Urinate (pee) into the "white hat"
Transfer urine from white hat into orange container- Be careful not to splash!
Finish:
After 12 hours, empty your bladder completely and put urine into the container
Mark down the date & time on the pink label: "finish date" & "finish time"
Bring your filled orange container and Requisition to the Lab as soon as you can
Write dates & times on the container label:
Do not allow feces (poo) to get into your container Women: do not collect during your menstrual cycle (period)
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Caution! May have acid in it!
“white hat” on toilet
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Midstream Urine Collection
Men:
1. Wash your hands with soap and water.
2. Pull back your foreskin, if present.
3. Completely wash your glans penis (“head” of penis) using the towelette provided. Wipe away from the urethra (opening of the penis).
4. Remove lid from container.
5. Urinate (pee) into the toilet a small amount, then stop.
6. Place the container a few inches from your penis then begin urinating in the container. [Do not touch the container to your penis].
7. Fill the container about half-full. If needed, continue urinating in the toilet.
8. Close the lid tightly to the container.
9. Wash your hands again.
Do not touch the inside of the container with your fingers
Women:
1. Wash your hands with soap & water.
2. Sit as far back on the toilet as possible and spread your legs.
3. Remove lid from container.
4. Hold your labia (folds of skin) apart with your fingers and keep apart for the rest of the collection.
5. Completely wash your entire inner genital area using the towelette provided. Wipe from front to back.
6. While continuing to hold your labia apart, urinate (pee) into the toilet a small amount and then stop.
7. Position the container then begin urinating in the container. [Do not touch the container to your body].
8. Fill the container about half-full. If needed, continue urinating in the toilet.
9. Close the lid tightly to the container.
10. Wash your hands again.
Do not touch the inside of the container with your fingers
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Implementation Date: April 2018 113
Urine Collection (for Cytology Testing)
Please read carefully before you begin: 1. Label your collection container #1 with:
• Your full first and last name
• Your health care number OR your date of birth
• The date and time of your collection
2. Do not collect your 1st morning urine (pee). If possible, collect your 2nd pee of the day.
3. Collect a midstream sample of urine:
• Men: completely wash the head of your penis
• Women: wash your entire genital area with soapy water and rinse well.
• As you start to pee, allow a small amount to fall into the toilet (this cleans the opening of your urethra, where the pee is coming out) then stop.
• Position the empty container (#1) near your body and then pee into it. Fill it about half full (50 mL).
• Remove the container. Finish peeing into the toilet if needed.
4. Very carefully add an equal amount of methanol from container #2 to your urine in container #1. [Read the warnings about methanol! Do not inhale! Do not spill onto your skin!]
5. Tightly seal the lid & place containers in a plastic bag. Seal the bag with a twist tie. Wash hands.
6. Collect 1 sample. Only one sample can be tested in a 24 hour period.
7. Bring the sample to the Lab within 2 hours of collection. If you can’t, put it in the fridge and then bring it to the Lab within 24 hours. Return BOTH containers to the Lab.
Call us if you have questions. Thank you! WGH Laboratory: 393-8739
Methanol Warning! See other side of this sheet
Return all containers to the Laboratory.
1 2
Keep out of reach of children!
(Empty)
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Patient Instructions
Implementation Date: April 2018 114
CAUTION!
METHANOL is FLAMMABLE. Keep away from sparks and flame.
METHANOL IS TOXIC.
Keep out of reach of children!
First Aid for Methanol Contact:
Lungs: Do not breathe fumes. Go outside for fresh air. Call 911 if difficulty breathing.
Skin:
1. Flush skin with lukewarm running water for at least 15 minutes
2. Remove clothing with Methanol spill on it; take care not to spread the spill
3. Discard or decontaminate clothing under running water
4. Unless contact has been very minor, go to the Hospital Emergency Department. Outside Whitehorse- contact your Doctor or Nurse right away.
Eyes:
1. Flush the eyes for at least 15 minutes with lukewarm running water. Hold the eyelids open. Take care not to rinse contaminated water into the other eye.
2. Go to the Hospital Emergency Department. Outside Whitehorse- call your Doctor or Nurse right away.
If Swallowed:
1. Rinse mouth thoroughly with water. Induce vomiting. Drink 1-2 cups of water. Call 911. Outside Whitehorse- call your Doctor or Nurse right away.
2. If another person swallowed Methanol and:
• collapses or is unconscious or convulsing, do not give anything by mouth- Call 911
• stops breathing, begin CPR if you have been trained- Call 911
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 115
Infant Urine Collection (Using a U-Bag)
Your collection kit contains:
- Towelettes (wipes) to clean your baby’s skin - U-bags (urine sample collection bags) - A sterile sample container (pink top)
Please read carefully before you begin: 1. Wash your hands with soap and water.
Carefully wash your baby’s genital area with the wipes provided and allow to air dry. See page 2 for detailed instructions for cleaning and attaching the U-bag.
2. Attach a U-bag to your baby’s genital area.
3. Check your baby often.
4. Label the pink top container with the following information:
- Baby’s full first and last name
- Baby’s health care number OR your date of birth
- The date and time baby urinated (peed)
5. As soon as your baby has peed into the bag, gently peel off the bag’s sticky tape from the skin and remove the bag. Tilt the bag so the pee is away from the blue tab.
6. Remove the blue tab from the bag and pour all the pee into the sterile container. Do not touch the inside of the container.
7. Discard the U-bag and wash your hands.
8. You must bring the sample and Requisition to the Laboratory immediately. Remote collections: you must refrigerate and transport the sample to the Laboratory within 24 hours.
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 116
…Infant Urine Collection (Using a U-Bag)- continued
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 117
FIT (Fecal Immuno Testing): screening for colorectal cancer
>>Care Providers! This is a sample- Use Patient Instructions prepared by Colon Check Yukon- Do not copy this page!<<
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Patient Instructions
Implementation Date: April 2018 118
Stool Collection (for Culture & Sensitivity or C. difficile tests) Please read carefully before you begin:
• Collect your stool (poo) between Monday & Thursday- Lab does not accept them on Fridays. • Bring your sample and your Requisition to the Lab on the same day you collect. • If you do not collect or label your stool (poo) sample properly, it will not be tested.
Day of collection
o Label the white –topped container with:
- Your full name
- Your date of birth or health care number
- Date and time of collection
- Your Doctor’s name
o Write date and time of collection on your Requisition form
o Empty your bladder (pee) completely. Do not let urine touch the stool sample.
o Collect stool onto a clean, disposable container (example: a paper plate).
o Add stool to the container (using spoon inside the jar)
o Take from parts of the stool that look bloody, slimy or watery. Please do not overfill!!
o Make sure nothing else is in the collection container (no toilet paper, etc.)
o Tightly close the container with the lid.
o For small children: Fasten plastic wrap inside a diaper with childproof safety pins; then remove the stool from the plastic and put it into the collection container. Do not bring used diapers to the Laboratory.
o Put the container in the plastic bag and seal the bag with a twist tie. (Container lids tightly closed!)
o Wash your hands with soap and water.
Remember: You must bring your sample & Requisition to the Lab on the same day you collect.
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 119
Stool Collection (for Ova & Parasite Exam)
Please read carefully before you begin:
• Collect your stool (poo) between Monday & Thursday- Lab does not accept them on Fridays.
• Bring your samples and your Requisition form to the Lab on the same day you collect.
Day of collection
1. Label the red and white –topped containers with:
- Your full name
- Your date of birth or health care number
- Date and time of collection
- Your Doctor’s name
3. Record Date and time of collection on your Requisition forms
4. Empty your bladder (pee) completely. Please do not let urine touch the stool sample.
5. Collect stool onto a clean, disposable container (example: a paper plate).
6. Add stool to red-topped container (using spoon inside the container) until liquid is at the fill line. …continued on next page
POISON The fluid in the red-topped collection container is poisonous. If swallowed, drink lots of milk or water. Phone 911. Outside Whitehorse: contact your Doctor or Nurse immediately
Empty container
1
2
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 120
7. Take from parts of the stool that look bloody, slimy or watery. Please do not overfill.
8. Be careful not to spill the fluid! It is poisonous!
9. Make sure nothing else gets inside the container (no toilet paper, etc.)
10. Tightly close the container’s lid and shake until the stool specimen and liquid are well mixed. Be careful not to spill the liquid.
11. From the same stool sample, add stool to the second collection container (white lid) using the spoon inside the container. Take from parts of the stool that look bloody, slimy or watery. Please do not overfill.
12. For small children: Fasten plastic wrap inside the diaper with childproof safety pins; then remove the stool from the plastic and put it into the collection containers. Do not bring used diapers to the Laboratory.
13. Put the 2 containers in the plastic bag and seal the bag with a twist tie.
14. Wash your hands with soap and water.
Remember:
• Bring the 2 labelled containers to the Laboratory on the same day you collect
• Bring your Requisition with your samples
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 121
How to Collect Sputum (for Bacteriology or Fungal Study)
Please read carefully before you begin:
1. Label your collection container with:
• Your full first and last name
• Your date of birth OR health care number
• The date and time of your collection
• Write “Sputum”
2. Collect in the early morning before eating.
3. Cough deeply to bring up sputum (spit…‘from deep down’) and spit it into the container (see pictures on next page)
4. Do not spit clear saliva into the container - sputum should look thick and green or yellow-green.
5. Collect more than ½ teaspoon if possible.
6. Tightly seal the lid on the container and place it in a plastic bag; seal the bag with a twist tie.
7. Collect 1 good sample. Only 1 sample can be tested in a 24 hour period.
8. If you are unable to get a good sample after 3 attempts, talk to your doctor.
9. Bring the sample to the Lab within 2 hours of collection. If you can’t, put it in the fridge and then bring it to the Lab within 24 hours.
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 122
½ teaspoon.
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 123
How to Collect Sputum (for Cytology Testing)
Please read carefully before you begin:
1. Read the warning about Methanol on the back of this page!
2. Label your collection container (#1) with the following information:
• Your full first and last name
• Your date of birth OR your health care number
• The date and time of your collection
• Write “Sputum”
2. Collect early in the morning before eating.
3. Rinse your mouth with water.
4. Hold the container (#1) to your mouth with your lips inside it. (See pictures on page 3).
5. Take a deep breath and cough deeply. Spit the sputum (‘from deep down’) into the container.
6. Do not spit clear saliva into the container - sputum should look thick and green/ yellow-green.
7. Collect more than ½ teaspoon if possible.
8. Pour an equal amount of Methanol (= the clear liquid from container #2) into your sample in container #1. Be very careful! Read the warning about Methanol on the back of this page!!
9. Tightly seal the lid on the container and place it in a plastic bag; seal the bag with a twist tie.
10. Collect just 1 sample. Only one sample can be tested in a 24 hour period.
11. Bring the sample to the Lab within 2 hours of collection. If you can’t, put it in the fridge and then bring it to the Lab within 24 hours.
12. Return BOTH containers to the Laboratory.
Call us if you have questions. Thank you! WGH Laboratory at 393-8739
Methanol Warning! See other side of this sheet.
1 2
Keep out of reach of children!
(Empty)
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 124
CAUTION!
METHANOL is FLAMMABLE. Keep away from sparks and flame.
METHANOL IS TOXIC.
Keep out of reach of children!
First Aid for contact with Methanol:
Lungs: Do not breathe fumes. Go outside for fresh air. Call 911 if difficulty breathing.
Skin:
1. Flush skin with lukewarm running water for at least 15 minutes 2. Remove clothing with Methanol spill on it; take care not to spread the spill 3. Discard or decontaminate clothing under running water 4. Unless contact has been very minor, go to the Hospital Emergency Department. Outside
Whitehorse- contact your Doctor or Nurse right away. Eyes:
1. Flush the eyes for at least 15 minutes with lukewarm running water. Hold the eyelids open. Take care not to rinse contaminated water into the other eye.
2. Go to the Hospital Emergency Department. Outside Whitehorse- call your Doctor or Nurse right away.
If Swallowed:
1. Rinse mouth thoroughly with water. Induce vomiting. Drink 1-2 cups of water. Call 911. Outside Whitehorse- call your Doctor or Nurse right away.
2. If another person swallowed Methanol and: • collapses or is unconscious or convulsing, do not give anything by mouth- Call 911 • stops breathing, begin CPR if you have been trained- Call 911
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 125
½ teaspoon.
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 126
How to Collect Sputum (for TB Testing)
Please read carefully before you begin:
1. Label your collection container with the following information:
• Your full first and last name
• Your date of birth OR health care number
• The date and time of your collection
• Write “Sputum”
2. Collect in the early morning before eating
3. Cough deeply to bring up sputum (‘from deep down’) and spit it into the container (see pictures on next page)
4. Do not spit clear saliva into the container - sputum should look thick and green or yellow-green
5. Collect more than ½ teaspoon if possible
6. Tightly seal the lid on the container and place it in a plastic bag; seal the bag with a twist tie
7. Collect 3 samples. You must wait at least one hour between collecting each sample.
8. Ensure your Requisition form is filled out, including the “Patient History” section.
9. Bring each sample to the Lab within 2 hours of collection. If you can’t, put it in the fridge and then bring it to the Lab within 24 hours. Bring the Requisition as well.
Call us if you have questions. Thank you!
WGH Laboratory at 393-8739
Collect 3 samples in 3 different containers
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 127
How to collect Sputum
½ teaspoon.
Laboratory Guide to Services
Patient Instructions
Implementation Date: April 2018 128
Semen Analysis
Drop-off hours at the Lab: Monday to Thursday 8:00 am to 12:00 noon do not bring your sample in the afternoon
Post-Vasectomy
• Collect the specimen twelve weeks (3 months) after your vasectomy- A second test may be required if tested too early.
• Obtain a Requisition and collection container from your doctor.
• You may collect the sample by masturbation or coitus interruptus.
• DO NOT collect the sample in a condom.
• Bring your sample AND your Requisition form to the WGH Laboratory within 3 hours of collection.
Infertility Investigation • Do not ejaculate for at least 24 hours (3 days is best) before making your collection.
• Obtain a Requisition and collection container from your doctor.
• Warm the collection container in your hand before collecting your sample.
• You may collect the sample by masturbation or coitus interruptus.
• DO NOT collect the sample in a condom.
• You MUST keep the sample warm while you are bringing it to the Lab. Keep the container inside your jeans pocket, for example.
• Bring your sample AND your Requisition form to the WGH Laboratory as soon as possible, within 30 minutes of collection.
Call us if you have questions. Thank you!
WGH Laboratory: 393-8739
Laboratory Guide to Services
Ordering Supplies
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11.0 ORDERING SUPPLIES This section contains:
11.1 Visual Key to Collection Kits
Supplies Order Form
Laboratory Guide to Services
Ordering Supplies
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Product Name & Applications Image of Supplies Item
Viral Collection Kit (Red top)Universal Transport Medium (UTM)
Kit (Copan®)
For Respiratory Viruses ONLY (H1N1, Influenza, severe respiratory illness; ILI)
Viral Collection Kit (Blue top)Multitrans System (Starplex®)
For non-respiratory Viruses - all sample types except stool samples
Modified Amies Clear Swab(Starswab II®)
For detecting a variety of bacteria- multiple collection sites
Chlamydia/Gonorrhoeae- SwabHologic Aptima Unisex Colletion
Swab for Endocervical & Male Urethral Specimens
Kits for detecting Chlamydia trachomatis & GC nucleic acid testing (NAT)
Chlamydia/Gonorrhoeae- UrineHologic Aptima Urine container
Kits for detecting Chlamydia trachomatis & GC nucleic acid testing (NAT)
11.1 Visual Key to Collection Kits
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Ordering Supplies
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Product Name & Applications Image of Supplies Item
Modified Amies- Charcoal swab(Starswab II®)
For Chlamydia/GCAntibiotic susceptibility testing
Modified Amies- Charcoal swab(Copan®)
Bordetella pertussis (Whooping cough)
Uricult Trio container(BacTube)
For Urine Culture & Sensitivity testing- detection of bacteriuria
Red top vialwith SAF Fixative
Stool: Ova & Parasite
Sterile container with spoonStarplex
Stool: Culture & Sensitivity; C. difficile ; virology
Laboratory Guide to Services
Ordering Supplies
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Product Name & Applications Image of Supplies Item
Sterile containerStarplex
Urine samplesSemen analysisSputum for AFB, bacteriology & fungal analysis, cytology (with methanol added)
FIT kits
For colorectal cancer screening
24 Hour Urine containers (B350 Urisafe®- Simport Scientific)
For 24 Hour urine collection (3L containers)
CytoLyt Solution(ThinPrep CytoLyt® Solution)
For some cytology specimens
Kit for Fungal specimens
Scrapings for fungal testing
back (with expiry date)
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Ordering Supplies
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WGH LABORATORY – SUPPLIES ORDER FORM Instructions: 1. Fax (867-393-8772) or drop off completed form to the WGH Laboratory. 2. Orders will be filled within 1 week and delivered to the WGH doctors' lounge for pick up. Ordering Clinic Information: Clinic Name: Ordered by:
Order Date:
Requisitions: Quantity Supplies: Quantity
WGH Lab On-Site Testing Amies Swabs- with Charcoal
Referred Out Testing Amies Swabs- Clear
WGH Microbiology Uricult Trio (BacTube) (for C&S urine)
Viral Collection kits- Respiratory (red top)
Viral Collection kits- Non-Respiratory (blue top)
Chlamydia/Gonorrhoeae: Swab Collection kits
Chlamydia/Gonorrhoeae: Urine Collection kits
Stool O & P (SAF fixative red top containers)
Stool C & S (white lid container with spoon)
Pertussis Collection kits (Swabs- Amies with Charcoal)
Semen Analysis kits
24 hr. Urine collection containers
FIT kits (Colorectal Cancer screening)
Referral Lab Requisitions: see website links on YHC website Harmony (prenatal testing) kits
Laboratory Use Only: Issued by: Date:
Comments:
Notes: Pap smear Requisitions and supplies must be ordered directly from BC Cancer Agency
Laboratory Guide to Services
Ordering Supplies
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Laboratory Guide to Services
Appendix I. Glossary of LIS
Software
Implementation Date: April 2018 Printed versions of this document are not controlled. 135
APPENDIX I. GLOSSARY OF LIS SOFTWARE
This section contains a summary of the LIS Software used by WGH Laboratory.
Laboratory Guide to Services
Appendix I. Glossary of LIS
Software
Implementation Date: April 2018 Printed versions of this document are not controlled. 136
APPENDIX I. GLOSSARY OF LIS SOFTWARE
Description of Uses by WGH Lab Maintained by
Meditech
(Modules used by Lab: LAB, ADM, EDM, MM, NUR, PCI)
Database- stores confidential information:
YHC IS
ADM: Admitting outpatients- Admissions EDM: Managing ER patients (ED Tracker) LAB: Ordering lab tests
Tracking status of samples & tests (receiving samples) Verifying results Looking up test results Printing labels for specimens; making batch labels Printing reports Reviewing pending tests Reviewing outstanding tests Retrieving Patient contact information Ordering Supplies in Stores
PCI: Retrieving Patient contact information (Patient Care Inquiry)
NUR: Recording Timecard/ hours worked
Excelleris Reporting storage system for distributing reports from Referral Labs
BC government
Sharepoint YHC & Lab Document Library storage & communication tool YHC
Muse Provides secure exchange of ECG reports between YHC and SPH for analysis by physicians
Vancouver Coastal Health
MARS Provides secure exchange of Holter monitor reports between YHC and SPH (feeds into MUSE)
Vancouver Coastal Health
Plexia Information System used by Physicians in private clinics; not used by Lab staff (LIS currently adding Requisition links between Meditech & Plexia)
Yukon Private Physician
Clinics
Mirth Connect
An interface engine that allows movement of reports and test orders between Meditech and Plexia YHC
Central Data Station (CDS) Used for iSTATs (Point of Care) WGH Lab
NovaNet Nova Stat Strip- Used for Glucometers (Point of Care) WGH Lab
Laboratory Guide to Services
Appendix II
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APPENDIX II. COLLECTION INSTRUCTIONS FROM MANUFACTURERS This section contains:
i. Collection Procedure for Pertussis Testing
ii. Collection Procedure for Urine Testing: Chlam GC, TV
iii. Collection Procedure for Nasopharyngeal swabs
Laboratory Guide to Services
Appendix II
Implementation Date: April 2018 Printed versions of this document are not controlled. 138
i. Collection Procedure for Pertussis Testing
Laboratory Guide to Services
Appendix II
Implementation Date: April 2018 Printed versions of this document are not controlled. 139
ii. Collection Procedure for Urine Testing: Chlam GC, TV
Laboratory Guide to Services
Appendix II
Implementation Date: April 2018 Printed versions of this document are not controlled. 140
iii. Collection Procedure for Nasopharyngeal swabs