D.15 Lab Instructions.docx

LABORATORY INSTRUCTIONS

LISTING OF SPECIMEN COLLECTION CONTAINERS

Test

Tube Color/Container

Comments

24 Hour Urine Chemistries

24 Hour Container May need preservative - call (724) 287-4781 ext. 4666 or 4608 for details. See specimen collection instructions in the Laboratory Policy manual, Phlebotomy section, “Instructions for the Collection of 24 Hour Urine Specimens.”

SPECIMEN COLLECTION

For PAP smear collection (Thin Prep vials) – contact VA Butler Healthcare Women’s Health Coordinator at (724) 285-2756 for collection supplies.

Purple/Lavender:

Vacutainer Brand with Hemogard Closure Whole Blood Tubes with Spray-Dried EDTA(K2) 7.2mg (Plastic)

4.0 Ml Draw, Size 13x75 mm

Vacutainer Order Number: 367861

Blue:

Vacutainer Brand with Hemogard Closure Tubes with 0.105M Buffered Sodium Citrate3.2%, Silicone Coated for Coagulation Studies (Glass)

4.5 Ml Draw, Size 13x75 mm

Vacutainer Order Number: 369714

PPT:

Vacutainer Brand with Hemogard Closure Sterile plastic Plasma Preparation Tubes with K2E anticoagulant

5.0 Ml Draw, Size 13x100 mm

Vacutainer Order Number: 362788

Due to total laboratory automation in the Core Laboratory, it is MANDATORY that the following SST tube be used for specimen collection:

Serum Separator (SST):

Vacutainer Brand with Hemogard Closure

Serum Separation Tubes, Polymer gel/Silica activator (Plastic)

5.0 Ml Draw, Size 13x100 mm

Vacutainer Order Number: 367986

Affirm® VPIII Ambient Temperature Transport System, 100/SP Once specimen is collected, it must be received by the Butler VA Laboratory within 72 hours. Date & time of collection must be provided on the collection label of the specimen.

Part Number: 446255 Price: $135.00/SP Vendor: Becton Dickinson Diagnostic Systems 7 Loveton Circle, Sparks, MD 21152

LABORATORY PANELS/PROFILES

1. Basic Metabolic Panel, Chem 8

Chloride

2. Comprehensive Metabolic Panel, Chem 14

Total Protein

3. Hepatic Function Panel, Liver + GGT

4. Electrolyte Panel, Chem 4 Sodium Potassium Chloride Carbon Dioxide (CO2) Anion Gap Bicarbonate

5. Lipid Profile Cholesterol, Total HDL Cholesterol LDL Cholesterol, Calculated Triglycerides Measured LDL Cholesterol if Triglycerides are >400 mg/Dl

6. Iron Panel Iron

TIBC

% Saturation

7. Thyroid Panel T4 Free T4

TSH

8. Complete Blood Count (CBC/DIFF/PLT)

Lymphocytes %

9. Coagulation Panel Protime (PT)

INR

10. Urine Electrolytes Sodium Potassium Chloride

11. Urine Drug Screen

INDIVIDUAL TESTS INCLUDED IN THE LABORATORY PANELS/PROFILES:

1. Basic Metabolic Panel, Chem 8

Chloride

2. Comprehensive Metabolic Panel, Chem 14

Total Protein

3. Hepatic Function Panel, Liver + GGT

4. Electrolyte Panel, Chem 4 Sodium Potassium Chloride Carbon Dioxide (CO2) Anion Gap Bicarbonate

5. Lipid Profile Cholesterol, Total HDL Cholesterol LDL Cholesterol, Calculated Triglycerides Measured LDL Cholesterol if Triglycerides are >400 mg/Dl

6. Iron Panel Iron

TIBC

% Saturation

7. Thyroid Panel T4 Free T4

TSH

8. Complete Blood Count (CBC/DIFF/PLT)

Lymphocytes %

9. Coagulation Panel Protime (PT)

INR

10. Urine Electrolytes Sodium Potassium Chloride

12. Urine Drug Screen

SPECIMEN COLLECTION INSTRUCTIONS

It is essential to have a sufficient volume of specimen to perform all of the ordered tests. Please follow the “Blood Collection Tubes: Order of Draw” that can be found in the online Laboratory Policy manual, in the Phlebotomy section. All specimens must be labeled with the appropriate barcode label. The appropriate barcode labels automatically computer-generate when the patient’s laboratory test orders are accepted in VISTA. The number of barcode labels generated depends on the number of tests ordered, specimen collection tube, and the volume of specimen required to perform the testing.

The barcode label for the laboratory test panels will provide the correct tube information in regards to the correct color of the tube that should be collected. Please follow the “Blood Collection Tubes: Order of Draw” that can be found in the online Laboratory Policy manual, in the Phlebotomy section for the correct color of the tube that is to be drawn. This information can also be found in the “Laboratory Test Information” section that is available in CPRS when the Tools button is selected. Information on any special specimen collection instructions i.e. specimens that need to be collected & maintained protected from light, specimens that must be separated from the cells & the serum and/or plasma transferred to a pour off tube, etc. can also be found here.

Specimen for HCV testing i.e. HCV Antibody testing, HCV Genotype, HCV Viral Load have been combined into the HCV Panel which includes the above mentioned tests. Specimen collection & processing instructions can be found in the previous section “List of Specimen Collection Containers Utilized by VA Butler Healthcare” or can be found in “Laboratory Test Information” section that is available in CPRS when the Tools button is selected.

Urine cultures must be collected in a separate urine cup than other tests on urine. Instructions for the collection of urine cultures can be found in the previous section “List of Specimen Collection Containers Utilized by VA Butler Healthcare”of this document or in the “Laboratory Test Information” section that is available in CPRS when the Tools button is selected. Urine specimens that are collected for urine cultures must be collected in an asecptic manner. If a urinalysis and urine culture are ordered a single urine specimen may be submitted but the specimen that is submitted should be collected in a sterile manner. This single urine specimen can be tested for both the urine screen that is required for the urine culture & for the urinalysis testing. There must also be an adequate volume of urine specimen submitted i.e. at least 10-15 mls of urine. The caps on the urine cups must be tightly closed so that the specimen does not leak.

SPECIMEN PROCESSING INSTRUCTIONS

Please see CBOC section of the online Laboratory Policy manual, select “CBOC Phlebotomy” section, and then select “CBOC Specimen Collection, Processing & Delivery” section for instructions.

In accordance with CLIA and CAP standards, VA Butler Healthcare Laboratory will need Contractor to provide documentation that the centrifuge is operating at 3000 RPM and that the speed is checked with a tachometer every six (6) months. VA Butler Healthcare BioMed Department will perform the periodic RPM checks. Centrifuge maintenance logsheets should also be maintained by the CBOCs.

SHIPPING MANIFEST AND SPECIMEN PACKAGING

It is required that a shipping manifest be completed for the specimens collected on the patients. The required information on the manifest includes: full patient name, full SSN, date, order numbers for all of the tests ordered, a list of the tests ordered, and the type and number of specimens sent to VA Butler Healthcare Laboratory. It is very important to record all of the order numbers to ensure that the laboratory does not miss tests during the specimen receiving process. Patient orders that were accessioned but no specimen was obtained, must be cancelled in VistA by VA Butler Healthcare Lab – please call the Lab if this is necessary. The shipping manifest may be either computer or manually generated. Templates of shipping manifests are included with these instructions.

All blood specimens collected per patient should be lined up into one row of a specimen rack. There may be several pages for each daily manifest so that each page should be numbered. Package all of the specimen bags and corresponding pages into a larger biohazard bag for shipment.

In order to prevent contamination due to leaking, urine specimens must be packaged separately from blood specimen collection tubes. Secure the lid and place each urine cup in an individual biohazard bag (parafilming of urine cups is not acceptable). The laboratory will reject urine specimens that leak in transit and any other specimens contaminated with urine.

WAIVED TESTING TEST SYSTEMS/INSTRUMENTS AND REAGENTS

Urinalysis w/o Microscopic:

Siemens Multistix 10 SG 100 strips/vial

Sentry Urine Dipstick control (set of 2) –Nerl Laboratories Pregnancy Testing (visual color comparison):

SureVue Urine HCG Kit 30 tests/kit - ThermoFisher Healthcare Catalog# 23900526 Sentry Urine Dipstick control (set of 2) –Nerl Laboratories

Occult Blood, Feces (1-3):* Beckman Coulter Hemoccult II Sensa Tricard 40 patient kits + 2 developer/kit Beckman Coulter Hemoccult Sensa Single Card 100/box

Whole Blood Glucose:

Roche Inform Glucose Meter – Roche Diagnostics Accu-Chek Comfort Curve Test Strips 50 strips/vial Accu-Chek Comfort Curve Glucose Control Solutions – Set of 2 levels Roche Lancets

Glycosylated Hemoglobin (A1C):

Siemens DCA 2000 Hemoglobin (A1C) Analyzer Siemens Reagent Cassette #5035 -10/box Siemens Hemoglobin A1C Controls – 2 Normal and 2 Abnormal/box

Prothrombin Time/INR:

Roche Coaguchek XS or XS Plus Meter – Roche Diagnostics Roche Coaguchek XS PT Strips – 2 (24 ea)/box Roche Coaguchek XS PT Controls

Vaginal KOH-VA Butler Healthcare will provide KOH solution-CBOC to provide swab, slides, and coverslips Vaginal Wet Prep-CBOC to provide swab, slides and coverslips Vaginal pH- VA Butler Healthcare will provide pH paper