Specimen Collection and Handling
Laboratory Test Requests
Using a computer terminal, enter orders using the HIS order entry function. Answer mandatory prompts on the system. Transfer special instructions into the "comment" section. The name of the ordering physician should be entered.
Culture source codes are available by using the Help key at the source prompt.
Make the request on a Laboratory Outpatient Service Requisition (OP2) provided by St. James Healthccare. The following information that must be included:
- Correct patient name
- Date of birth
- Name of the physician ordering test
- Tests to be done (any special instructions)
- Billing information - insurance/Medicare/Medicaid #
- Phone Number
- Social Security Number
- Information relevant to diagnosis - ICD 9 codes
Outpatients should check in at the Admitting Desk before coming to the Patient Service Center.
Collection of Specimens
Prior to specimen collection, review the specimen requirements for each procedure. The accuracy of laboratory testing depends on careful patient preparation, collection, handling, storage, and transportation of specimens.
Draw 1 full, 5 ml, red top Vacutainer tube for up to 2 ml of serum.
Leave tube clot.
Draw 1 full, 4ml, Vacutainer tube containing specified anticoagulant. Gently invert the tube approximately 10 times to ensure proper mixing.
The correct performance of specimen collection is of utmost importance if valid and useful culture results are to be obtained. The primary goal is to obtain infected material from the involved site that contains the etiologic agent (pathogen). Care should be taken to minimize contamination of the specimen with normal skin or mucous membrane flora. Whenever possible, specimens should be collected prior to antibiotic therapy. Specimens should be transported to the lab as soon as possible to minimize loss of viability of the pathogen and overgrowth of contaminating organisms. Use transport media if appropriate. Patient information, including relevant clinical history (underlying disease, disease suspected, symptoms etc.) and antibiotic usage are helpful in evaluation of culture result.
For random urine collections, the preferred specimen is the first urine voided in the morning. This is the most accurate single sample because of the high concentration of various urine constituents. Containers should be clean, closed tightly and labeled for transport.
Assays requiring a 24-hour timed urine collection may require a preservative. Urine containers and preservatives are available from laboratory. Instructions are available to aid patients in proper urine collection procedure.
- Specimen vials, sterile vials, stone containers, culturettes, transport media and request forms are provided upon request.
- In Butte, a courier service is provided Monday thru Friday from 8 am to 4 pm to pick up sample from physician's offices and other designated areas. If you have samples for pick-up and are not on the regular Butte courier schedule or need special procedures routed to the Laboratory please call 723-2600.
- Specimens sent by mail or bus should be handled following the current federal guidelines.
- Where serum is the preferred specimen, clot at room temperature, centrifuge and separate serum (no red blood cells). Seal well to prevent leakage. Refrigerate or freeze depending on test.
- Pack clotted and anticoagulated specimens in such a manner as to avoid hemolysis.
- Freeze tests requiring frozen samples, pack and ship in Styrofoam mailing container with dry ice or by other suitable method to keep sample frozen
- Pack in plastic vial where possible. Place in sealable plastic bag. Pack in accordance with current shipping regulations.
Criteria for Unacceptable Specimens
- Unlabeled specimens are unacceptable. All specimens must have proper identification, including patient's name, date of birth, source of specimen, and date and time of collection. Testing accuracy depends upon careful attention to collection technique and specimen preparation.
- Normally, laboratory procedures will not be run on a hemolyzed blood specimen. If a compromised specimen is accepted, it will be noted on the final report so results can be interpreted cautiously.
- Many assays cannot be carried out on lipemic serum. Check with specific Laboratory department.
- Specimens collected in wrong anticoagulant will be rejected.
- Specimens for microbiological analysis not in a sterile tube or transport media cannot be accepted. Urine and sputum specimens kept at room temperature should be in the laboratory 30 minutes after collection for inpatients; 1 hour for outpatients. Preservative containers are available for outpatients who live out of town. Stool specimens should be collected in special containers. Contac lab for container and directions.
- Specimens that appear contaminated, damaged or have leaked in transit are unacceptable. A repeat specimen will be requested.
- Results are delivered daily, Monday through Friday to local physician's offices, skilled nursing facilities and other designated areas in Butte. Results for out-of-town requests will be faxed.
- Outpatient results will be phone to the physician's office upon request. Outpatient critical values are phoned to physician or designee automatically. Inpatient critical values are phoned to floor.
- Results of laboratory rests will be reported as soon as possible in all cases. Remember, some tests are sent out and others are run according to schedule.
- No results will be given to the patient unless specifically request by physician. Reports are given to the physician or the physician's representative.
St. James Healthcare reserves the right to change any fee without prior notice. Notification of such change will normally be mailed or delivered to interested clients at the time of such change.
The following Laboratory policies are presented to ensure proper requisitioning of laboratory work and to provide instructions for collection and preparation of certain specimens presented to the Laboratory.