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 +[[clinical_biochemistry_section|Home]]
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               SAMPLE COLLECTION MANUAL OF LABORATORY SERVICES               SAMPLE COLLECTION MANUAL OF LABORATORY SERVICES
                       SIR T HOSPITAL, BHAVNAGAR                        SIR T HOSPITAL, BHAVNAGAR 
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 CONTROLLED COPY CONTROLLED COPY
  
-**----**+---- 
  
 **II. CONTACT INFORMATION** **II. CONTACT INFORMATION**
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                     Documentary Procedure of Urine Specimen collection                     Documentary Procedure of Urine Specimen collection
- +                     
-* Urine Specimen collection +Random: The normal composition of urine varies considerably during a 24-hour period. Most reference values are based on analysis of the first urine voided in the morning. This specimen is preferred because it has a more uniform volume and concentration, and its lower pH helps preserve the formed elements. Submit a first morning specimen whenever possible. Urine for pregnancy testing should be a first morning voiding, or a random specimen with a specific gravity of at least 1.010. Note the time of collection of the specimen on the test request form and on the label of the container. Submit urine for pregnancy testing in a plastic vial with no preservative. 
-                  +
-**Random:** The normal composition of urine varies considerably during a 24-hour period. Most reference values are based on analysis of the first urine voided in the morning. This specimen is preferred because it has a more uniform volume and concentration, and its lower pH helps preserve the formed elements. Submit a first morning specimen whenever possible. Urine for pregnancy testing should be a first morning voiding, or a random specimen with a specific gravity of at least 1.010. Note the time of collection of the specimen on the test request form and on the label of the container. Submit urine for pregnancy testing in a plastic vial with no preservative. +
 To reduce contamination, the specimen submitted for urinalysis should be a clean catch "midstream sample." Urinalysis specimens must be submitted in a yellow capped urine transport tube containing preservative.   To reduce contamination, the specimen submitted for urinalysis should be a clean catch "midstream sample." Urinalysis specimens must be submitted in a yellow capped urine transport tube containing preservative.  
    
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   - Preservative may have been added to this container. This may be caustic. Please be careful not to spill any of the preservative.    - Preservative may have been added to this container. This may be caustic. Please be careful not to spill any of the preservative. 
    
- 
 ---- ----
  
-                      Documentary Procedure of Safety and Infection Control                                   +                  Documentary Procedure of Safety and Infection Control                                   
 * Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures.  * Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 
    
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   * Practice hygiene for the patient's protection. When wearing gloves, change them between each patient and wash your hands frequently. Always wear a clean lab coat or gown.    * Practice hygiene for the patient's protection. When wearing gloves, change them between each patient and wash your hands frequently. Always wear a clean lab coat or gown. 
   * Sterile venipuncture.    * Sterile venipuncture. 
 +
 +----
 +
 +                   Documentary Procedure of Specimen Handling & Transport 
 +
 +Quality laboratory results begin with proper collection and handling of the specimen submitted for analysis. Correct patient preparation, specimen collection, specimen packaging and transportation are of vital importance. 
 +Specific specimen requirements for each test are provided. Submit the quantity specified for each test requested. Tests will be canceled as "QNS" (Quantity Not Sufficient) when the sample volume is inadequate and will be indicated as such on the report. As a general rule, the volume of blood drawn should equal 2-1/2 times the amount of serum plasma required. For example, to obtain 4mL serum or plasma, draw at least 10mL blood. When inappropriate or insufficient specimens are submitted, the laboratory will store them and contact the requesting facility to request that the specimen be recollected. Documentation of this action will appear on the report. 
 +Specimen Storage: Instructions for storage and transport of specimens for individual tests are listed. All serological samples are stored for 72 hrs and all positive serum samples are stored for 15 days then discarded, all HIV positive serum samples are stored for 3 months as per the NACO guidelines. Maintain the specimen at the temperature indicated for each test until specimens are delivered to the laboratory. Most specimens require refrigeration unless otherwise indicated. Most of the specimens require refrigeration unless otherwise indicated. All other samples are retained for 24 hrs and then kept in hypochlorite for 6 hrs before discarding. 
 +
 +**Specimen Requirements  Blood and Bone Marrow:**
 +* Collect whole blood specimens in EDTA, Heparin or ACD vacutainer tubes. Do not dilute bone marrow aspirate specimens with peripheral blood. 
 +* Maintain at room temperature. Do not refrigerate. 
 +* Deliver specimens to the laboratory within 24 hours. Obtain and transport Monday  
 +
 +**Stool Specimen Collection (24, 48 or 72-Hour)**
 +  * Special gallon-size containers are available upon request for the collection of stool specimens. Refer to specimen requirements for each analyte. 
 +
 +**Specimen Requirements  Blood and Bone Marrow:**
 +  * Collect whole blood specimens in EDTA, Heparin or ACD vacutainer tubes. Do not dilute bone marrow aspirate specimens with peripheral blood. 
 +  * Maintain at room temperature. Do not refrigerate.    
 +  * Deliver specimens to the laboratory within 24 hours. Obtain and transport Monday through Friday only. 
 + 
 +**Blood sample acceptance criteria** 
 +  - Properly filled Requisition forms. 
 +  - Properly labeled samples. 
 +  - Details on Requisition form should be matched with sample container details 
 +  - Proper Vacutainers  
 +  - Appropriate quantity of sample. 
 +  - ABG sample & Plasma sample should not be clotted 
 +  - Spill over the sample should not be there. 
 +  - Sample will be received within 4 hours of collection. 
 + 
 +**Urine sample acceptance criteria** 
 +  - Properly filled Requisition forms. 
 +  - Properly labeled samples. 
 +  - Details on Requisition form should be matched with sample container details 
 +  - Appropriate quantity of sample. 
 +  - Sample containers should not be open, they should be tightly packed. 
 +  - Sample spillage should not be there. 
 + 
 + 
 +**Blood sample rejection criteria** 
 +  - Improperly filled Requisition forms. 
 +  - Improperly labeled samples. 
 +  - Details on Requisition form is not matched with sample container details 
 +  - Improper Vacutainers  
 +  - Insufficient sample volume / Overfilled sample 6. Clotted sample (Whole blood/Plasma) 
 +  - Spill over sample. 
 +  - Hemolyzed sample. 
 +  - Sample received after 4 hours of collection. 
 +  - Diluted Sample 
 + 
 +**Urine sample rejection criteria**
 +  - Improperly filled Requisition forms. 
 +  - Improperly labeled samples. 
 +  - Details on Requisition form is not matched with sample container details 
 +  - Insufficient sample volume.
 +  - Improper sample container 
 +  - Spill over sample. 
 + 
 +**Sample acceptance Exceptions** 
 +
 +**A.Insufficient sample volume**
 +  * Do not reject the sample.
 +  * Perform as many examinations as possible as per priority. Priority of testing will be decided by the laboratory incharge or consultant. 
 +  * Inform the customer.  
 +  * Enter remarks of insufficient volume in the report  . 
 +  * All pediatric samples with insufficient volume will be received by the laboratory. 
 +
 +**B.Hemolyzed sample**
 +  * Do not analyze SGOT, SGPT, LDH, Potassium, Bilirubin, Ammonia, Hemoglobin, Hematocrit from hemolyzed samples.
 +  * From a less hemolyzed sample Glucose, Cholesterol, Uric acid, Urea, Creatinine, Albumin, Alkaline phosphatase, Total protein, UIBC, Sodium, Calcium can be performed. 
 +  * Take the decision of which parameters can be analyzed from this sample. 
 +  * Enter remarks of Hemolyzed samples in the report
 + 
 +**C.If blood is collected in EDTA Vacutainer:** Bilirubin, Cholesterol, Triglyceride, ALT, AST, Creatinine, Urea can be performed. However it is unsuitable for Coagulation study,Enzyme assay, Hormonal assay & electrolyte analysis or methods that require electrolyte or metallic cofactors. 
 +
 +----
 +
 +           Standard Operating Procedure Of Specimen Handling And  Transport 
 + 
 +Quality laboratory results begin with proper collection and handling of the specimen submitted for analysis. Correct patient preparation, specimen collection, specimen packaging and transportation are of vital importance. 
 + 
 +Specific specimen requirements for each test are provided. Submit the quantity specified for each test requested. Tests will be cancelled as "QNS" (Quantity Not Sufficient) when the sample volume is inadequate and will be indicated as such on the report. As a general rule, the volume of blood drawn should equal 2-1/2 times the amount of serum plasma required. For example, to obtain 4mL serum or plasma, draw at least 10mL blood. When inappropriate or insufficient specimens are submitted, the laboratory will store them and contact the requesting facility to request that the specimen be recollected. Documentation of this action will appear on the report. 
 +**Specimen Storage**: Instructions for storage and transport of specimens for individual tests are listed. All serological samples are stored for 72 hrs and all positive serum samples are stored for 15 days then discarded, all HIV positive serum samples are stored for 3 months as per the NACO guidelines. Maintain the specimen at the temperature indicated for each test until specimens are delivered to the laboratory. Most specimens require refrigeration unless otherwise indicated. Most of the specimens require refrigeration unless otherwise indicated. All other samples are retained for 24 hrs and then kept in hypochlorite for 6 hrs before discarding.
 +
 +**Stool Specimen Collection (24, 48 or 72-Hour)**  
 +Special gallon-size containers are available upon request for the collection of stool specimens. Refer to specimen requirements for each analyte.
 +
 +**Specimen Requirements  Blood and Bone Marrow:** 
 +  * Collect whole blood specimens in EDTA, Heparin or ACD vacutainer tubes. Do not dilute bone marrow aspirate specimens with peripheral blood. 
 +  * Maintain at room temperature. Do not refrigerate. 
 +  * Deliver specimens to the laboratory within 24 hours. Obtain and transport Monday              through Friday only. 
 +    ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/SHT)2/3''
 +     
 +**Provide the following information on the Test Request Form** 
 +  -   Patient name, sex and age 
 +  -   Patient Social Security
 +  -   Identification number 
 +  -   Collection time 
 +  -   Collection date 
 +  -   Sample origin or location 
 +  -   Ordering physician 
 +  * Send 1 or 2 unstained, air dried blood or bone marrow smears. 
 +**HISTOPATHOLOGY SAMPLE COLLECTION AND TRANSPORTATION** 
 +  - 10% Formalin must be taken from Histopathology Laboratory or prepared in Operation theatre by the following formula:                                                                                                                Method for preparation of 10%formalin:                                                                                              
 +40%formaldehyde:100ml + Tap water:900ml                                                    
 +  - Immediately after removal of organ/biopsy, it should be put in a wide mouthed screw-capped specimen jars of plastic containing 10%formalin fixative.                                             
 +  - Volume of 10%formalin should be 10 times the volume of tissue.
 +  - The histopathology requisition form should be complete with following details                           name of the patient, age, sex, requisition no., ward no., name of the incharge Doctor, history or clinical diagnosis, nature of the specimen, date of operation.                                            
 +  - Specimens are sent to the Central Pathology Laboratory-transported by hospital class IV staff or patients only in case of OPD patients, between 9a.m.-5p.m.in a capped bottle of suitable size in formalin.                                                                                                                           
 +  - On receipt of specimen/biopsy, details are verified by the technical assistant and if necessary, returned for correction.                                                                                                              
 +  - If all details are okay, then details are entered in receiving register and a card is given to OPD patients except skin and ENT patients indicating date and time for collection of report form histopathology laboratory.                                                                                                      
 +  - Specimens are transported to histopathology laboratory in a closed container along with forms by class IV and on-duty driver at 12 noon and 4.30pm.                                                      
 +  - On arrival to histopathology laboratory, specimens and forms are again cross checked by laboratory assistant or technician.                                                                                                         
 +  - If all details are okay, then specimen is opened, verified, the formalin changed and transported in new bottle by technical assistant/technician if **a.** Foamy,**  b.** Reddish,** c.** Top up with formalin if not 10 times the volume of the tissue,   ** d** .If organ is too large for container or, **e.** If container is cracked or not closing properly.               
 +  - Receipt details are entered in the Histopathology receiving register. 
 +
 +**Storage of Histopathology specimens:** All specimens of histopathology are routinely stored for 3 months and afterwards they are discarded. 
 + 
 +              CYTOPATHOLOGY SAMPLE COLLECTION AND TRANSPORTATION 
 + 
 +^ ^Fluid^^Pap^
 +|Collection Timing|Routine|8:00 am to 4:00 pm Transfer within 1 hour|During OPD timing|
 +| |Saturday|8:00am to 12:00 pm. Transfer within 1 hour| |
 +| |Sunday& Holidays|Avoid collection.If required to collect, aliquot and keep in ward refrigerator at 2-8 C and transport at 9:00 am on next working day| |
 +|Amount|Ideal is 10 ml directly from tapping line. Minimum 2 ml. If taken from receptacle, aliquot should be mixed well||1 slide endocervix 1 slide ectocervix |
 +|Container|Closed cap bottle. BAL fluid in BAL container||Either in wide mouthed closed bottle or wrapped in paper|
 +|Transport|To be sent to laboratory within 1 hour of collection Ward Ayah or servant will bring to laboratory along with requisition||Patient will bring bottle with slides or dried slides (wrapped) to cytology laboratory| 
 +|Receiving|*R1 will receive it. Check the demographics and sign the register.||*R1 will receive the slides, check requisition form and give pap number on case paper.| 
 +|Responsibility|Collection| Clinical Resident/Consultant| Clinical Resident/Consultant|  
 +|              |Transport| Class IV of ward| Class IV of OPD/Patient’ relative|
 +|              |Receiving| R1 Pathology | R1 Pathology|  
 +  
 +                    ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/RSH)1/1''
 + 
 +**7.1 STANDARD OPERATING PROCEDURE OF RECEIVING ROUTINE SPECIMENS IN HISTOPATHOLOGY** 
 +  * The histopathology requisition form should be complete with following details -name of the patient, age, sex, requisition no., ward no., name of the incharge Dr, history or clinical diagnosis, nature of the specimen, date of operation. 
 +  * Specimen should be received only if sent in formalin. 
 +  * Note the date of receipt of specimen. 
 +  * After checking all the details give histopathology no. to jar. 
 +  * Ask history from patient’s relatives if that found on requisition slip is inadequate. 
 +  * Give receipt no. and date of issue of report to the patient. 
 +  * Formalin and container should be changed s o s if.. 
 +  - if  foamy. 
 +  - Reddish. 
 +  - Top up with formalin if not 10times the volume of the tissue. 
 +  - If organ is too large for container or if container is cracked or not closing  properly. 
 +
 +
 +                 ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/FSCP)1/1''
 +
 +**7.2 STANDARD OPERATING PROCEDURE OF FNAC SAMPLE COLLECTION PROCEDURE**
 +
 +  * Procedure is usually performed in sitting position in chair. For Thyroid lesion usually lying down position with pillow under the shoulder is preferred.
 +  * Examine the swelling in terms of Location, Size, Shape, Consistency, Tenderness, Mobility and  Movement.
 +  * Clear the area of swelling with skin disinfectant.
 +  * Allow it to evaporate. Explain the procedure to the patient.
 +  * Insert the needle (No. 23G) with 10 cc syringe within the target tissue.
 +  * Pull the plunger to apply negative pressure.
 +  * Move the needle back and forth inside the target tissue.
 +  * Release the negative pressure while needle remains in target tissue after obtaining the sample in the hub.
 +  * Withdraw the needle.
 +  * Put dry cotton swab with gentle pressure over the puncture site.
 +  * Detach the needle.
 +  * Take out material from the needle on the clean dry glass slide.
 +  * Make a smear by using another glass slide.
 +  * Fix the smear immediately in methanol for H & E stain( for Giemsa stain-air dry smear and then fix).
 +  * Write the identity number on the slides and Stain the smear.
 +
 +              ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/SRC)1/5''
 +
 +**7.3 SAMPLE REJECTION CRITERIA BLOOD SAMPLE REJECTION CRITERIA**
 +  * Improperly filled forms.
 +  * Improperly labeled samples.
 +  * Inappropriate quantity of sample.
 +  * Clotted sample (in Pathology Section)
 +  * Spill over sample.
 +  * Hemolyzed sample.
 +  * Sample received after 4 hours of collection.
 +  * Diluted Sample
 +  * Improper Vacutainers 
 +
 +**CRITERIA FOR SAMPLE REJECTION IN HISTOPATHOLOGY**
 +  * Grossly autolysed specimen
 +  * Sample sent without 10/ formalin 
 +  * Container sent without tissue
 +  * Quantity of formalin should be approx . 10 times of tissue
 +  * Appropriate size of container
 +  * Incomplete sample labeling
 +  - Patient’s Name , Reg. no, Ward
 +  - Specimen name
 +**Incomplete requisition form**
 +  - Patient’s Name, Reg. no, Ward/Unit
 +  - Name of unit Incharge
 +  - Related history and investigation
 +  - Clinical diagnosis
 +  - Specimen name
 +  - Name and signature of authorized person
 +
 +**FNAC REJECTION CRITERIA**
 +
 +  * Incompletely filled up form.
 +  * Smears not properly labeled.
 +  * Smears are not properly spread.
 +  * Smears containing clots.
 +  * Smears (Material) diluted with blood.
 +  * Smears not properly fixed.
 +
 +         ''STANDARD OPERATING PROCEDURES (LSSTH/SCM/SOP/SRC)2/5''
 +
 +**REJECTION CRITERIA OF MICROBIOLOGY SPECIMENS**
 +
 +**Purpose:** To provide Microbiology specimen rejection criteria & the procedure to follow when rejecting specimens for process.
 +
 +**General Principle:**
 +Proper collection & transport of specimens is critical to the quality of results produced by the microbiology Laboratory & cannot be overemphasized. The validity of all diagnostic information produced in the lab is contingent on the quality of the specimen received. Consequences of poorly collected and/or poorly transported specimens include failure to isolate the causative organism, and recovery of contaminants or normal flora could lead to improper treatment of the patient. The saying is “garbage in—garbage out”.
 +
 +**General Consideration:**
 +When a specimen is received in the laboratory, it is subjected to scrutiny & must meet certain minimum requirements before being accepted for testing.
 +A specimen shall not be rejected until appropriate efforts have been made to correct the problem, but it may be rejected for failing to meet acceptability criteria.
 +If, needed the specimen is rejected, it is listed on the microbiology disposition log for rejected specimens, along with reason for rejection & documentation of notified personnel.
 +
 +**Rejection criteria:**
 +A. //SPECIMEN RECEIVED WITHOUT A LABEL OR WITH AN IMPROPER LABEL//
 +  * At a minimum, specimen label must include patient name & reg. no. as the two patient identifiers.
 +  * Call unit, ward or person responsible & notify of the problem.
 +  * If any doubt exists as to origin of specimen, reject & order recollection.
 +B.//SPECIMEN IMPROPERLY COLLECTED OR TRANSPORTED//
 +  * Check with person responsible for collection to determine reason for deviation from procedure. Give instruction in the proper method of collection & transport to prevent repetition of the error. 
 +
 +C.//SPECIMEN CONTAINER EXHIBITS GROSS EXTERNAL CONTAMINATION OR LEAKING SPECIMEN//
 +  * Container exteriors must be clean & free of gross contamination. Leaking specimens indicate integrity of the specimen has been compromised & puts transport & laboratory personnel at risk.
 +
 +D.//SPECIMEN NOT OF SUFFICIENT QUANTITY//:If specimen has multiple orders, request priority listing of tests.
 +
 +E.//SPECIMEN MUST BE RECEIVED IN A TIMELY MANNER// Order recollection if specimen has exceeded recommended limits for transport.
 +
 +^Sr. No.^Specimen type^Test^Rejection Criteria^Report Comment^
 +|1|Stool|C&S|1.Not submitted in enteric pathogen transport media. 2.Multiple specimens collected from the same in-patient the same day(only one specimen per patient per test per day is to be processed).3.All formed stools except when S. typhi requested.|1.Specimen not received in enteric transported medium.2.Multiple specimens received. Only the most recently collected specimen has been processed.3.Formed stool received. Test cancelled.|
 +|2|Sputum|C&S|More than 25 squamous epithelial cells/lower power field|Greater than 25 squamous epithelial cells per low power field.|
 +|3|Urine|C&S|  * Condom catheter  * Foley catheter tips & bags  * Leaking specimens  * Inappropriate/swabs/non sterile container  * > 24 hr delay before specimen received  * Duplicate specimens (more than one processed urine within 24 hrs)|“Specimen unsuitable for culture…. Because of….add qualifier.”|
 +|4|Dry swabs|C&S|If received in the lab > 1 hr after collection.|“Specimen not received in transport medium & was in transit for > 1 hr.”|
 +|5|Blood cultures, tissues, Sterile body fluids e.g. CSF|C&S|If received in the lab > 48 hr after collection.| Process specimen. EnterReport Comment:”Specimen was received in the lab>48 hrs after it has been collected; results should be interpreted accordingly.”|
 +|6|All specimen type except: Tissue Sterile, body fluid,Brain & liver abscess, Aspirated pus, Bone & soft tissue biopsies with diagnosis of gas gangrene, necrotizing fasciitis or necrotizing cellulitis |Anaerobic culture| Not submitted in special anaerobic transport media.| “No Anaerobic swab received; anaerobic culture not done.”|
 +|7|Blood | For serology|* Sample hemolysed.* Not submitted in Red vacuette| * So kindly repeat the sample.” * Please collect blood in Red vacuette.|
 +
 +
 +
 +
 +^ Name of Laboratory : Laboratory Services Sir T. Hospital (LSSTH),Bhavnagar ^^^
 +^**Document Name**: Documented procedure for primary sample collection & handling(Sample collection manual)^^^
 +^**Unique ID**: LSSTH/B/Central/DP/7.2.4/22^^^
 +^Issue No. : 01^Issue Date :30/04/2024^Copy No. :01^
 +^Authorized by:Laboratory director^ Review Date:23/09/2024^Reviewed by:Deputy Quality Manager^
 +