Meadville Medical Center
  • Contact Us
  • Titusville Area Hospital
  • Pay My Bill
  • Services
    • Find a Doctor
      • Patient & Visitors
        • Locations
          • About Us
            • Call Today Call Today
            • Email Us
            • Our Map
            • Menu
              Home
              Services
              Find a Doctor
              Patient & Visitors
              Locations
              About Us
              Medical Professionals
              Patient Portal
              Employee Resources
              Events
              eCards
              Blog
              Contact Us
              Privacy Policy
              Site Map
            • Audiology Center
            • Behavioral Health Services
            • Cancer Treatment
            • Cardiology
            • Dental Care
            • Dermatology
            • Drug & Alcohol Treatment
            • Ear, Nose & Throat
            • Emergency Department
            • Endocrinology
            • Family Medicine
            • Family Planning Services
            • Gastroenterology
            • Home Health
            • Hospice & Palliative Care
            • Hospitalist
            • Internal Medicine
            • Kidney & High Blood Pressure Treatment
            • Laboratory Services
            • Laboratory FAQ
            • Welcome to our Laboratory Services
            • A-List
            • Test Menu
            • Compendiums
            • Custom Panels
            • Tests- Prep Required
            • Patient Collection Guides
            • Special Test Information
            • Therapeutic Drugs
            • Scheduled Collection
            • General
            • Information
            • Forms
            • Education for Offices and Clinics
            • Reference Specimens
            • Specimen Collection
            • Microbiology
            • Pathology
            • Blood Bank
            • Resources
            • Test Drawn by Lab Only
            • Contact Us
            • Massage Therapy
            • Medical Assistance Transportation
            • Mind-Body Wellness Center
            • Nephrology
            • Neurology
            • Nutrition Services
            • OB/GYN
            • Occupational Therapy
            • Orthopedics
            • Pain Management
            • Physical Therapy
            • Physical Rehabilitation Inpatient Services
            • Pulmonology
            • Pulmonology Rehabilitation Services
            • Radiology
            • Resident Physicians/Medical Students
            • Respiratory Care
            • Rural Health Centers
            • Sleep Diagnostic Services
            • Speech Therapy
            • Sports Medicine
            • Surgery
            • Intensive Transitional Care at MMC
            • Intensive Transitional Care at TAH
            • Urgent Care Centers
            • Urology
            • Women, Infants & Children Nutrition Program
            • Vernon Women's Center
            • Workplace Health
            • Wound Clinic
            • J
            • Visitor Policy
            • Meadville Area Free Clinic
            • Physicians Accepting New Patients
            • Quality of Care
            • Patient Portal
            • Community Health Needs Assessment
            • Request Information
            • Billing & Insurance
            • Admissions
            • Preparing for Surgery
            • Population Health Management
            • Drug & Alcohol Treatment Guide
            • Patient Relations
            • Around Town
            • Price Transparency
            • Interpreter Services
            • Send an eGreeting
            • Classes & Events
            • Mill Run Community Pharmacy
            • Titusville Area Hospital Outpatient Physical Therapy
            • Titusville Area Hospital Outpatient Lab
            • Meadville Medical Center Outpatient Lab
            • Titusville Express Care
            • Tionesta Health Center
            • Vernon Express Care
            • Yolanda G. Barco Oncology Institute
            • Oil City Lab
            • Saegertown Medical Associates
            • Outpatient Diagnostic Imaging
            • COVID-19 & Flu Evaluation Center
            • Oil Valley Internal Medicine
            • Valley Dental Center
            • Titusville Area Hospital Cardiac Rehabilitation
            • Oil Valley Internal Medicine Associates
            • Conneaut Valley Health Center
            • Oak Street Pediatrics
            • TAH Physician Clinics
            • Otolaryngology (ENT) Clinic
            • Poplar Street Medical Arts
            • Titusville Area Hospital
            • Meadville Pain Management
            • One Vernon Place
            • Hospice of Crawford County
            • Mind Body Wellness Center
            • MMC Foundation
            • Liberty Street Facility
            • Meadville Dermatology and Skin Surgery Institute
            • Meadville Community Health Center
            • Grove Street Facility
            • Cambridge Springs Health Center
            • Conneaut Lake Health Center
            • Alden Street Facility
            • Visitor Code of Conduct
            • Why MMC?
            • Mission & Vision
            • MMC Foundation
            • Awards
            • Administration
            • Board of Directors
            • MMC Auxiliary
            • Careers
            • Physician Opportunities
            • Volunteers
            • News
            • Contact Us
            814.333.5000
            Search Close
            Services Laboratory Services Welcome to our Laboratory Services Reference Specimens Specimen Collection

            Reference Specimens

            • Specimen Collection
            • Microbiology
            • Pathology
            • Blood Bank
            • Resources
            • Test Drawn by Lab Only

            Specimen Collection

            General Information

            Specimen Collection

            Laboratory test results are dependent on the quality of the specimens submitted. It is important that all specimens and order forms be properly and completely labeled. The label should include:

            • Patient's name
            • Patient date of birth
            • Date
            • Time of collection
            • Initials of the phlebotomist
            • Origin (source) when applicable

            If there is any doubt or question regarding the type of specimen that should be collected, it is imperative that Meadville Medical Center Laboratory be called to clarify the order and sample requirements.
            It is important that the specimen be stored at the proper temperature (ambient, refrigerate, or frozen) until it is transported to the laboratory.
            All specimens are to be placed in special biohazard zip-lock bags for transport. Please secure all lids tightly before transporting. If the specimen is frozen, label the bag with a “Frozen” sticker. The request form is to be completed in entirety and placed in the outer pouch. (See Preparation for Transport later in this section.)

            Blood Collection, General Information

            Definitions That May Be Helpful:
            Anticoagulant A substance that prevents blood from clotting.
            Hemolyze The rupturing of the red blood cells in the specimen. This can often interfere with accurate analysis of blood chemistries. Avoid hemolysis as it interferes with many tests.
            Plasma The fluid part of anticoagulated blood after it has been separated from the cells.
            Serum The yellow fluid that is separated from the cells when blood is clotted and centrifuged.
            Whole blood Blood that has an anticoagulant and is not separated by centrifuging.

            Basic phlebotomy guidelines:

            Correct Order of Draw - It is very important to collect blood tubes in proper sequence to avoid contamination and anticoagulant carry-over to the next tube drawn. Please refer to chart in educational module, Collecting Blood Specimens.

            Inversion of Tubes - In general, all the tubes are to be mixed well by gently inverting several times after filling with blood. Tubes are full when the vacuum quits drawing blood into the tube.

            Plasma - Draw a sufficient amount of blood with the indicated anticoagulant to yield the necessary plasma volume. Gently mix the blood collection tube by inverting six to ten times immediately after collection. Never shake the tubes to mix. Shaking will fragment the blood cells and could result in false abnormal hematology findings. If required, separate plasma from cells by centrifugation within 20-30 minutes.

            Serum - Draw a sufficient amount of blood to yield the necessary serum volume. Serum volume is approximately half of the whole blood volume. Invert the tube several times to activate the clotting. Let stand for 20-30 minutes, or until a clot is well formed. Centrifuge for ten minutes. If frozen serum is required, pour off serum into plastic vial and freeze.

            Syringe Collection - If using a syringe to collect the blood, it is best to fill the tube through the stopper. If the stopper has been taken off, it may slide loose at a later time, resulting in a blood spill.

            Whole Blood - Draw a sufficient amount of blood with the indicated anticoagulant. Gently mix the blood collection tube by inverting six to ten times immediately after collection.

            Specimen Collection Tubes

            The following is a brief overview of the requirements involved for collecting blood specimens. Each of the different tubes has individual characteristics. In general, all the tubes are to be mixed well by gently inverting several times after filling with blood. Tubes are full when the vacuum quits drawing blood into the tube.

            Serum type tubes

            Red-Top Tube
            This tube is a plain Vacutainerâ containing no anticoagulant, used for collection of serum specimens. Tests using this tube may include therapeutic drugs, selected chemistry tests and some blood bank procedures. Any chemistry sample may be collected in these tubes. However, the yellow-top SST tubes are superior as the serum is automatically separated. When a test is designated to be collected in a red-top tube, an SST tube should not be substituted. The gel barrier may interfere with analysis.

            Yellow-Top Serum Separator Tube (SST)
            This tube contains a clot activator and a serum gel separator, used for various laboratory tests, including the majority of chemistry tests. Invert the tube six to ten times in order to activate the anticoagulant.

            Plasma and whole blood tubes

            Blue-Top Tube (Sodium Citrate)
            This tube contains sodium citrate as an anticoagulant, used for collection of blood for coagulation studies. NOTE: It is imperative that the tube be completely filled. The ratio of blood to anticoagulant is critical for valid coagulation studies. Immediately after draw, invert the tube six to ten times in order to activate the anticoagulant.

            Gray-Top Tube (Potassium Oxalate/Sodium Fluoride)
            This tube contains potassium oxalate as an anticoagulant and sodium fluoride as a preservative, used to preserve glucose in whole blood and for some special chemistry tests. The minimum volume should not be less than 1.0 mL due to the anticoagulant present in the tube.

            Green-Top Tube (Lithium Heparin)
            This tube contains lithium heparin, used for the collection of heparinized plasma or whole blood. The minimum volume should not be less that 1.0 mL due to the anticoagulant present in the tube.

            Green-Top Tube (Sodium Heparin)
            This tube contains sodium heparin, used for the collection of heparinized plasma or whole blood for special tests. The minimum volume should not be less than 1.0 mL due to the anti-coagulant present in the tube.

            Lavender-Top Tube (EDTA)
            This tube contains EDTA as an anticoagulant, used for most hematological procedures. Mix the tube well to dissolve the powdered anticoagulant. The blood level should at least reach the bottom of the tube’s label.

            NOTE: Never shake the tubes to mix. Shaking will fragment the blood cells and could result in false abnormal hematology findings.

            Light Yellow-Top Tube (ACD)
            This tube contains ACD, used for the collection of whole blood for special tests.
            NOTE: This tube is very similar in appearance to the SPS tube. Read the label for verification of correct anticoagulant.

            Light Yellow-Top Tube (SPS)
            This tube used for the collection of blood cultures contains, SPS, is always drawn first to avoid bacterial contamination.
            NOTE: This tube is very similar in appearance to the ACD tube. Read the label for verification of correct anticoagulant.

            Pink-Top Tube (EDTA)
            This tube contains EDTA as an anticoagulant, used for most blood bank procedures. Mix the tube well to dissolve the powdered anticoagulant.

            Royal Blue-Top Tube
            There are two types of royal blue-top Monojectâ tubes, one with the anticoagulant EDTA and the other plain. These are used in the collection of whole blood or serum for trace element analysis. Refer to the individual metals in the specific test listing to determine the tube type necessary.

            Tan-Top Tube (Sodium Heparin)
            This tube is lead-free and thus used for collection of blood lead levels.

            White-Top Tube (K2 EDTA)
            This plasma preparation tube (PPT) contains a gel barrier in the plastic tube. After centrifugation the plasma may be frozen without opening the tube.

            Miscellaneous tubes

            Microtainers
            These are designed for fingersticks, which are commonly used for children or other difficult venipunctures. (Some vials may contain a powdered form of the anticoagulant. This must not be shaken out as the vial is being mixed.)

            • Peach/red - no anticoagulant
            • Yellow top; Amber tube - no anticoagulant, protects specimen from light.
            • Green - heparinized anticoagulant
            • Lavender - EDTA anticoagulant

            NOTE: All hematology collections (CBC, hemoglobin, hematocrit, etc.) must be well mixed. Any clotting will cause the results to be invalid. When collecting the specimen and the blood flow is slow, cap the vial and mix quickly midway through the blood collection. This will help prevent a clot formation. Mix again at the completion of the collection. The minimum collection is at the second purple line (500 ml).

            Pediatric Tube (Half-draw)
            The half-draw tubes, which have clear lids, are designed for children or patients who are difficult to draw. These tubes contain a smaller amount of vacuum, thus less trauma to the vein. Because of the reduced amount of anticoagulant, as well as vacuum, it is important not to overfill these tubes. This is possible if filled by a syringe. Overfilling could cause rejection of the specimen. On some tubes, the proper fill line is marked with small blocks halfway up the edge of the label.

            Special Collection Tubes
            Some tests require specific tubes for proper analysis, (such as metals). Please contact Meadville Medical Center Laboratory prior to patient draw to obtain the correct tubes as identified in the individual test listings.

            Stool Collection, General Information

            Below is our policy for the submission of stool specimens.

            Clostridium Difficile

            Optimum specimens are from fresh diarrheal stool. Non-diarrheal specimens will not be tested.
            One stool specimen positive for C. difficile is sufficient for diagnosis. Up to three stool specimens per week may be submitted for testing, though no more frequent than one every 24 hours.

            Cryptosporidium and Giardia Antigen
            Antigen tests are more sensitive than conventional ova and parasite exam for the detection of Giardia and Cryptosporidium; therefore it is only necessary to submit one specimen. If antigen tests are negative, additional specimens may be submitted. The laboratory will keep a portion of the specimen in preservative for up to 5 days if traditional ova and parasite exam is desired on antigen negative specimens. Stool samples submitted in PVA fixative are not acceptable for antigen testing. SAF and MIF preserved specimens, and unpreserved specimens are acceptable.

            Ova and Parasites

            A maximum of three specimens should be submitted, one every other day. If a patient has been hospitalized for three or more days, ova and parasite may not be ordered. The likelihood of acquiring infection by parasitic agents during hospitalization is extremely low.
            Cryptosporidium and Giardia antigen test will be ordered unless a pertinent travel history or medical condition is specified by the ordering physician.

            Stool Culture
            Up to three stool specimens per week may be submitted for testing, though no more frequent than one every 24 hours. If a patient has been hospitalized for three or more days, stool cultures may not be ordered.
            Organisms detected include Campylobacter, E. coli 0157, Salmonella and Shigella. The following organisms will be reported if found in predominance; Pseudomonas, Aeromonas, Bacillus, Plesiomonas, Staph aureus and yeast. Examination of the stool for other enteric pathogens such as Yersinia will be done by special request. Cultures for Vibrio are forwarded to a reference lab.

            Urine Collection, General Information

            Clean Catch Urine Collections

            1. Wash hands thoroughly.
            2. Care must be taken to avoid bacterial contamination of the specimen container. After removing the lid, place it on a flat surface with the inside facing up. Do not touch the inside of the specimen lid or the container. Any contact by your skin may cause a bacterial contamination that may interfere with the test.
            3. Open the towelette package. Unfold the towelette.
            Females - Using one stroke, wash by wiping the urinary area from the front to the back.
            Males - Using one stroke, wash by wiping the urinary area from top to bottom.
            4. Start to urinate directly into the toilet. While urinating, pass the collection cup into the stream of urine. Do not fill the specimen cup to the top. Remove the cup before the stream of urine has stopped.
            5. Screw the cap securely on the container.
            6.Place the label on the cup after securely closing the lid. Do not put label on the lid.
            7. Refrigerate specimen immediately if unable to deliver specimen to lab promptly. Deliver the refrigerated culture to the lab within 12 hours. If a urinalysis is also ordered, the specimen must be delivered to the lab within 2 hours if unpreserved.
            8. If preservative tube is used, the specimen is stable at room temperature up to 72 hours.

            Preservative (Urinalysis & Culture)

            If using the blue-capped preservative tube available from Meadville Medical Center Laboratory, refrigeration is not necessary. The urinalysis/culture preservative system contains a mercuric oxide-based tablet and has a maximum fill capacity of 10 mLs. Please fill to the maximum fill line. Shake specimen to dissolve the tablet and label the specimen tube.

            NOTE:
            Urinalysis preservative system is stable up to 72 hours without refrigeration.
            Preservative tubes are NOT acceptable for common urine chemistry tests.

            Random Collections

            For routine analysis and microscopic evaluation, have the patient void into a clean container. A clean-catch specimen is preferred. The specimen should be capped, labeled and refrigerated. If specimen is not transferred into a urine preservative tube, it must be transported to the lab within 2 hours.

            24-Hour Urine Collections

            For detailed collection information refer to the specific test ordered in the Patient Information section in the back of manual.

            Some 24-hour urine tests require a preservative. If an additive is needed, please notify the lab. We will prepare the container according to the proper requirements. Please be careful that this preservative does not come in contact with your patient’s skin. If a splash does occur, wash the affected area with large amounts of water. Use a separate container to collect the urine sample and then pour the urine into the 24-hour container. This will help to control splashing of the preservative.

            Care should be taken when collecting a 24-hour urine. It is essential that all the urine passed during a 24-hour period is totally collected. If the collection is not complete, our reference values are not valid. Use the following procedure for the correct specimen collection and preparation.

            1. Warn the patient of the presence of potentially hazardous preservatives in the collection container. Preservative type and quantity must be written on the bottle.
            2. Label the container with the patient's name prior to collecting the specimen.
            3. Instruct the patient to discard the first morning specimen and to record the time of voiding.
            4. The patient should collect all subsequent voided urine for the remainder of the day and night.
            5. Collect the first morning specimen on day two at the same time as noted on day one.
            6. The collection is now complete and the sample may now be delivered to the laboratory for processing.

            During the collection period, it is important that the urine sample be kept cold. Urine may be stored in a refrigerator, an ice chest, or in a pail of ice to prevent the growth of bacteria in the sample.

            NOTE:

            If two tests requiring different additives are ordered on the same patient, contact the lab. A special container will be provided to accommodate this special collection need.

            Please refer to the “Patient Information” section in back of this manual. There you may review an array of hand out sheets for many 24-hour urine tests. These sheets are designed to be photocopied and given to the patient before collecting their specimen.

            24 Hour Urine Tests Not Requiring an Additive

            • Aminolevulinic Acid
            • Calcium
            • Chloride
            • Citrate
            • Cortisol Free
            • Creatinine Clearance, Serum and Urine
            • Creatinine
            • Cystine
            • Electrolyte
            • Microalbumin
            • N-Telopeptide-Collagen Cross-Linked
            • Phosphorus
            • Potassium
            • Protein, Total
            • Sodium
            • Urea Nitrogen
            • Uric Acid

            24 Hour Urine Tests Requiring an Additive

            • 5-Hydroxyindoleacetic Acid (5-HIAA)
            • 17-Ketosteroid
            • Catecholamine Fractionated
            • Homovanillic Acid (HVA)
            • Magnesium
            • Metanephrines
            • Oxylate
            • Vanillylmandelic Acid (VMA)

            Preparation for Transport

            Centrifuge All red-top and SST tubes must be completely clotted prior to centrifuging. Pair tubes of equal volume to be placed opposite of each other in centrifuge holders. Perfect balance is necessary to prevent tube breakage. A “balance tube” of water may be used to equal volume of the tubes to be spun. Unless otherwise indicated, spin for 10 minutes.

            Separating
            SST tubes contain a gel separator that provides a barrier. No additional steps are necessary after centrifugation. For plasma or frozen specimens, label plastic vial with needed patient information. Using plastic pipette, remove plasma or serum from tube, placing it into vial.

            Packaging

            Place specimen in zip-lock Biohazard bag and seal securely. If specimen is STAT or FROZEN please apply appropriate label to outside of bag.
            Place form(s) in outer pouch of bag.
            NOTE:
            All specimens must be placed in a bag for delivery.
            If patient has urine and blood, place urine in separate biohazard bag, secure, and place in biohazard bag with blood.

            Temperature Storage
            MMC Lab is required to maintain proper storage and transport temperatures for all sepcimens from time of collection to time of analysis to ensure specimen integrity. Please view theTemperature Control Requirements within the Education module.
            NOTE: Do not freeze glass Vacutainer® tube.

            Universal Precautions

            The information listed below is given only as a guideline. The information is not all-inclusive.

            Hazard Identification

            The following areas are to be identified with a Biohazard sticker:

            • Refrigerators or freezers containing laboratory specimens
            • Waste containers used for body substances (the containers should have closeable lids)
            • Centrifuge
            • Disposable sharps containers
            • Phlebotomy trays
            • Transport container

            Personal Safety

            Hepatitis B vaccine should be provided to all employees having occupational exposure to bloodborne pathogens.

            Safety Procedures

            General Cleaning
            Work areas in which blood is processed are to be cleaned with a 10% dilution of household bleach. The bleach mixture is to be fresh daily. Areas are to be cleaned at the end of each day or after they have been contaminated.

            Handwashing
            Frequent handwashing is an important safety precaution. Hands are to be washed:

            • • After completion of laboratory-related work
            • • After removing gloves
            • • Before and after all other activities which entail hand contact with mucous membranes or breaks in the skin
            • • Immediately after accidental skin contact with blood, body fluids or tissues
            • • If the contact occurs through a break in the gloves, the gloves are to be immediately removed and the hands washed thoroughly.

            Blood Spills
            The following procedure is recommended for decontaminating blood spills:

            1. Wear gloves, (heavyweight, such as are used for dishwashing), and a disposable gown.
            2. Absorb the blood with paper towels.
            3. Using a detergent solution, clean the spill site of all visible blood with paper towels.
            4. Wipe down the spill site with paper towels soaked in a fresh 10% dilution of household bleach. (Bleach solutions are less effective in the presence of a high concentration of protein. Therefore, remove as much liquid blood or serum as possible before decontaminating or disinfecting.)
            5. Place the contaminated material in a biohazard container.

            10% Formalin Spills
            For your safety information, we have included Formalin Material Safety Data Sheets (MSDS). They are located in the “Additional Information“ section in the back of this manual. Most Pathology specimens contain formalin.

            10% formalin is considered to be a toxic substance, causing respiratory tract problems. Care is needed when cleaning up a spill.

            • 1. Wear gloves, disposable gown, face mask and face shield.
            • 2. Using the Polyform F®, pour the granules to encircle the spill, creating a “dam”.
            • 3. Sprinkle the Polyform F® granules to completely cover the spill.
            • 4. Wait several minutes until the formalin has gelled. Remove the remains with the scoop and scraper.
            • 5. Dispose of all contaminated material and specimen matter directly into a biohazard container.
            • 6. If necessary, wipe up remains with paper towels. You may spray the area with Formalex® or a detergent to aid you in cleaning the remaining residue. (The formalin has already been neutralized at this time.)
            • 7. If formalin is spilled on a rug, rinse the spill with large amounts of water.

            Safety Equipment

            Sharps Container
            Used, disposable needles and other sharps are to be placed into a rigid, plastic, puncture-resistant disposable container with a lid. The container is to be clearly marked “Biohazard”.

            Vacutainer Needles
            Disposable single-use, locking, needle adapters are required and are to be disposed in the sharps containers. Prior to disposal, press orange guard against a hard surface, locking it around the needle.

            Butterfly - Prior to disposal, slide clear plastic guard over exposed needle.

            NOTE: As a required safety precaution, needles must never be recapped.

            Gloves
            • Gloves are to be worn when it can be reasonably anticipated that the employee may have hand contact with blood or other potentially infectious material.
            • Gloves are to be worn when procuring blood specimens and changed between patients.
            • Gloves are to be worn when processing blood. This is especially important when separating serum or plasma, and transferring specimens into tubes.
            • Replace worn gloves if they become grossly contaminated with blood.

            Facial Protection
            Facial protection is to be used if any splashing may occur. Splashing may result when removing rubber stoppers from specimen tubes. (Covering the tube with a gauze pad while removing the stopper may help minimize splashing.) The gauze pad is to be discarded into the biohazard waste container after use.

            What Are You Looking For?

            • Pay My Bills

            • Donate

            • Request Information

            • Medical Professionals

            • Careers

            • Patient Portal

            Helpful Links

            • About Us
            • Careers
            • Notice of Privacy
            • Employee Resources
            • Find a Doctor
            • Locations
            • Medical Professionals
            • Patients & Visitors
            • Patient Portal
            • Pay My Bill
            • Privacy Policy
            • Non-Discrimination Notice
            • Site Map
            • Titusville Area Hospital
            • Volunteer
            Address: 751 Liberty St., Meadville, PA 16335
            View Map [+]


            Phone: MMCHS - 814.333.5000
            Titusville - 814.827.1851
            Meadville Medical Center
            Meadville Medical Center © 2017 All Rights Reserved.
            Powered by Scorpion Healthcare