Draw blood in the designated color-coded tube. Immediately mix the blood by inverting gently 8 -10 times. Plasma should be separated by centrifugation for 10 minutes. Consult the CPL Test Directory for specific specimen processing instructions.   Transfer to a properly labeled, plastic vial with the sample type written on the container. Example, EDTA plasma.

Collect blood in a serum separator tube (ST) or plain red top (PR) containing no additives. To obtain 4 mL serum, draw at least a full 10mL tube STs and PRs should be inverted 5 times after collection.  STs should be allowed to clot upright, such as in a rack, for 30 minutes.  PRs should be allowed to clot upright for 60 minutes.  STs and PRs should be centrifuged within 2 hours of collection for 10 minutes.  Serum from a PR should be removed after centrifugation and placed in a transfer tube, clearly labeled with all patient information and specimen type. 

If random urine is required, collect clean-catch urine in a clean container with a leak-proof lid.

A timed urine collection is required for quantitative tests. Accurate test results depend on proper collection and preservation of timed urine specimens. On the day of collection, discard the first voided urine and begin timing the collection. Refrigerate urine during collection. Collect all urine for the time designated. Include the sample collected at the end of the time. Record collection duration. 

Draw blood in the designated anti-coagulant color-coded tube. Immediately mix blood by inverting the tube gently 8-10 times. Unless otherwise specified, submit the tube unopened. 

Place the tissue sample in a suitably sized vial with 10% formalin immediately upon removal by the physician such that there is enough room to accommodate the specimen without distortion.  The specimen should be submitted in a 10:1 ratio (10 parts formalin to 1 specimen). Label the vials collected by the physician with the patient’s name, date of birth, source of the specimen, and date of collection. For breast specimens ensure the cold ischemic time (defined by the time that the specimen is removed from the body to the time that it is placed in formalin) be less than 1 hour.  Document the out of body time as well as the time the specimen is placed in formalin on the requisition. Tissue specimens for lymphoma workup or culture should be sent in sterile saline-dampened gauze or fresh (without fixative).  Tissues for Gout analysis should be sent in 100% alcohol or fresh (without fixative or saline). 

Surgical frozen sections and intraoperative consults with a pathologist can be arranged by contacting the client Account Executive.

Body fluids/Urines: Mix equal amount of Cytolyt® solution with the fluid.  If the sample volume is >50 mL, submit the entire sample to the laboratory immediately.  If a delay in transportation to the laboratory is unavoidable, fluids should be kept refrigerated.  Label the container with the patient’s name, date of birth and specimen body site.

Smears:  In pencil, label slides with the patient’s full name and specimen site.  Fix smears immediately with Cytology spray fixative.  Allow the slides to air dry and place in a cardboard mailer for transport.  Label the container with the patient’s name, date of birth and specimen body site.  Note: If preparing both fixed and unfixed (air-dried) slides, mark the slides accordingly, (i.e., write “air-dried” on unfixed slides. 

CSF: The specimen should be sent without fixative and remain refrigerated until transport.  If a delay of 12 hours or more is expected, place the specimen into Cytolyt® solution.  Label the container with the patient’s name, date of birth and specimen source. 

Fine Needle Aspiration (FNA): For fluid or needle rinse, place the specimen directly into Cytolyt® solution.  Label the container with the patient’s name, date of birth, and specimen body site. 

Anal PapTest:  After specimen collection, rinse the swab/brush as quickly as possible in the PreservCyt® by rotating the device in the solution 10 times while pushing against the PreservCyt® vial wall.  Swirl the device vigorously to further release material.  Discard the device.  Tighten the cap so that the torque line on the cap passes the torque line on the vial.  Label the container with the patient’s name, date of birth, and source (Anal/Rectal).

SurePath:

1. Obtain an adequate sampling from the cervix using spatula/endocervical brush or cervical broom.
2. Insert the brush or broom into the endocervical canal.
3. Apply gentle pressure until the hairs form against the cervix.
4. Maintaining gentle pressure, hold the stem between the thumb and forefinger and rotate the brush/broom five (5) turns clockwise.
5. The entire head of the brush/broom is removed from the handle and placed into a SurePath collection vial. The brush/broom must remain in the vial.
6. Record the patient name and ID number on the vial. The sample will be returned if it is received without proper labeling. In addition, record the patient name and medical history on the cytology requisition.

Submit the sample to the laboratory at room temperature.

Note: For the lists of acceptable and unacceptable lubricants, please review the following link: http://www.cpllabs.com/lubricants-for-pap-and-sti

ThinPrep:

1. Obtain an adequate sampling from the cervix using spatula/brush or broom.
2. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.
3. Push gently and rotate the broom in a clockwise direction five (5) times.
4. Rinse the broom into the vial by pushing the broom into the bottom of the vial ten (10) times, forcing the bristles apart.
5. Swirl the broom vigorously to further dislodge material.
6. Discard the collection device. Do not leave collection device in the vial.
7. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
8. Record the patient name and id number on the vial. The sample will be returned if it is received without proper labeling. In addition, record the patient name and medical history on the cytology requisition. Submit the sample to the laboratory at room temperature.

Note: For the lists of acceptable and unacceptable lubricants, please review the following link: http://www.cpllabs.com/lubricants-for-pap-and-sti

Tissue Biopsy:  Place tissue sample in a vial with 10% formalin. Label the samples collected by the physician with the patient’s name, date of birth, source of the specimen, and date of collection.

Acid Fast Culture and Smear:
Collect specimen in a container and hold at refrigerated temperature until courier pickup. No preservative is necessary.

Acid Fast Smear:

• Sputum: 5 to 10 mL of early morning expectorant from a deep cough.
• Tissue: 2 grams of unfixed tissue in small amount of sterile saline.  Indicate source.  Store refrigerated.
• Body fluids: 15 to 10 mLs of body fluid or lower respiratory fluid in sterile container.  Indicate source.  Store refrigerated.
• Exudate, aspirate, lesion material or ocular fluid: 1 mL in a sterile container.  Indicate source.  Refrigerate. 
• NOTE: Swabs are not acceptable for AFB culture or smear testing.

Aerobic (routine, wound) Culture:
Swab: Submit an eSwab culture transport container and indicate source. 

Anaerobic Culture:
Be sure the specimen is from a suitable anaerobic sterile body site or a deep body cavity. Send an eSwab culture transport container promptly for optimal recovery of pathogens. Indicate source. 

Blood Cultures:

Ideally, 20 mL of blood is drawn and split between an aerobic bottle and an anaerobic bottle. For pediatric draws, 1 to 2 mL blood may be submitted in anaerobic bottle. Use the following aseptic technique:

• Clean the blood collection site with alcohol with a scrubbing motion
• Disinfect the site with Povidone-iodine prep and allow it to air dry 1 to 2 minutes.
• Clean the diaphragm of the bottles with alcohol.
• Do not touch the phlebotomy site after disinfection.
• Draw blood with the appropriate venipuncture equipment
• Mix the bottles by inversion 8-10 times to prevent blood from clotting.
• Remove iodine from the patient's arm with alcohol.

Sputum Culture:
Submit sputum expectorated by deep cough into a sterile container.

Stool Culture:
Submit fresh stool specimen uncontaminated by urine in a vial containing Cary Blair transport media.

Urine Culture: 
Urine placed in a gray-top transport tube is preferred. Urine collected in a sterile container is also acceptable. Directions for proper collection:

1.  Females should clean the periurethral area with antibacterial disposable cloth. 
2. Males should clean the glans penis area with antibacterial disposable cloth.
3. Allow the initial flow of urine to commence and then collect a midstream portion into a sterile container.
4. Submit sealed container refrigerated or transfer the urine to a gray-top preservative tube at room temperature. Note: If the urinalysis is also ordered, an unpreserved sample should be submitted for that test. Susceptibility testing is not routinely performed on voided specimens with mixed urogenital flora or colony counts below 10,000 CFU/mL.

Vaginal Culture: 
Specimens should be submitted on a culture swab immersed in transport media.  For Group B Streptococcus pregnancy testing, screen at 36-38 weeks gestation; with a single swab, sample vagina then rectum. For penicillin-allergic patients, submit request with appropriate test code.

Viral Culture: 
Body fluid in a sterile container or sterile swab immersed in viral transport media is required. Indicate source. Refrigerate.