Container Information and Courses from MediaLab, Inc.

Important safety precautions must be observed when handling cerebrospinal fluid. The following guidelines apply:Semi-automatic micropipettes and disposable plastic chambers are the safest option for CSF testing. Many laboratories still use the hemacytometer with disposable pipets.If disposable materials are not used, soak contaminated reusable pipets, hemacytometer and coverslip in 70% alcohol or Wexide.All disposable items should be placed in a biohazard container for appropriate disposal.Wash hands thoroughly when the examination is completed.Spinal fluids which are to be discarded must be placed in biohazard containers for appropriate disposal.Careful attention to specimen processing and handling will help ensure that accurate results are obtained.

The following precautions should be observed when working with urinalysis reagent strips: Store strips according to the manufacturer's recommendation.DO NOT expose strips to moisture, volatile fumes, or direct sunlight. Remove only enough strips for immediate use and immediately recap the bottle.Avoid contamination of test strips. Do not touch the test areas with fingers or do not lay the test strips directly on the workbench.DO NOT use discolored strips. Compare the color of the unused strip to the negative area on the color chart provided by the company. The color should be similar.Check the expiration date. Re-label the container with a revised expiration date if the manufacturer states a shortened usage period once the container has been opened.Procedural PrecautionsAlthough the procedure is simple to perform, accurate results depend on careful adherence to manufacturer's directions and adequate quality control.Normal and abnormal controls should be tested whenever a new lot of strips is opened, and at the frequency defined by the laboratory's procedure.If quality control results do not correspond to the published control values, the problem must be resolved before patient samples are tested.High levels of ascorbic acid (Vitamin C) in the urine may inhibit some reagent strip reactions, such as glucose, blood, bilirubin, nitrate and leukocyte esterase. The urine dipstick's package insert will provide information about potential interfering substances, including ascorbic acid.Intensely colored urine may make it difficult to correctly interpret color reactions on the dipstick, as illustrated below. The affected tests should not be reported from the dipstick. It would be necessary to use an alternative method of testing if available.

Using a fresh, well-mixed uncentrifuged urine, hold the reagent strip by the opposite end from the test areas and dip the stick into the specimen so that all test areas are immersed in the specimen. Remove the stick immediately. Prolonged immersion in the sample may wash out the test reagents.Hold strip in a horizontal position and run the edge of the strip against the rim of the urine container or touch the long edge of the strip to absorbent towel or gauze to remove excess urine (do not blot the strip). If you are using a dipstick reader, place the strip immediately onto the tray of the reader.Replace the cap on the container to prevent deterioration of remaining strips.If you are reading the tests manually, proceed with these instructions. Each laboratory may have a slightly different urinalysis procedure for manual chemical reagent strips. However, the procedure below is a general version that should apply to most laboratories.Maintain the strip in a horizontal position to prevent mixing of reagent chemicals and observe the reagent pads at the specified time periods as indicated on the chemical reagent strip container or procedure. Color changes that occur after the stated maximum read time are not valid.Hold the strip close to the chart and compare the colors to read the results. A good light source facilitates accurate reading.Carefully record results on pre-printed worksheets upon observation of each reagent pad result.The video on this page demonstrates correct technique when a dipstick reader is used.

In order to ensure proper stability of the specimen and accurate test results, there are guidelines in place to aid in the appropriate urine processing and transportation. These guidelines include: Ensuring that all urine collection and/or transport containers should be clean and free of debris or interfering substances.Ensuring that the collection and/or transport container has a secure lid and is leak resistant. Leak-resistant containers reduce specimen loss and healthcare worker exposure to the specimen while also protecting the specimen from contaminants.Utilizing urine containers that are made of break-resistant plastic instead of glass.Utilizing urine containers that do not leach interfering substances into the specimen.Utilizing collection containers and/or transport tubes which will not leak within the pneumatic tube system (if one is used within the laboratory facility). A leak-proof device in this situation is paramount.Proper labeling and correct identification should be applied to the collection container or tubes. This includes noting the time the specimen was collected. Remember that urinalysis specimens must be analyzed within 2 hours of collection.Ensuring that there is sufficient volume to fill the tubes and/or perform the test.

False Positives:A false positive result may occur in the presence of strong oxidizing agents in the collection container. In random urine specimens from women, a positive result for leukocyte esterase may be due to a source external to the urinary tract. Other urine sediment findings such as bacteria, squamous or renal epithelial cells, lymphocytes or red blood cells do not contain esterases, and would not produce a positive leukocyte esterase test. False Negatives:False negative results may occur in the presence of significant levels of protein or glucose and in urines with high specific gravity which can crenate the white blood cells, leaving them unable to release esterases. Some drugs such as Cephalexin (Kelfex®), Cephalothin Keflin®), Tetracycline, or high concentrations of oxalic acid may also cause falsely decrease leukocyte esterase test results.

The reagent strips must be handled and stored properly in order to ensure that results are accurate. The following precautions should be observed:Store strips according to the manufacturer's recommendation. DO NOT expose strips to moisture, volatile fumes, or direct sunlight (emphasized in the image on the right). Remove only enough strips for immediate use and immediately recap the bottle. Avoid contamination of test strips. Do not touch the test areas with fingers and do not lay the test strips directly on the workbench. DO NOT use discolored strips. Compare the color of the unused strip to the negative area on the color chart provided by the company. The color should be similar. Check the expiration date. Re-label the container with a revised expiration date, if the manufacturer states a shortened usage period once the container has been opened. Reagent strips must be tested periodically (frequency defined by the laboratory) for clinical reactivity with normal and abnormal urine controls. Urine controls are available commercially or may be prepared and preserved in-house.

Use a fresh, well-mixed, uncentrifuged urine. Hold the reagent strip by the opposite end from the test areas and dip the stick into the specimen so that all test areas are immersed in the specimen. Remove the stick immediately. Prolonged immersion in the sample may wash out the test reagents. Hold strip in a horizontal position and run the edge of the strip against the rim of the urine container or touch the long edge of the strip to absorbent toweling to remove excess urine (do not blot the strip). Maintain the strip in a horizontal position to prevent mixing of reagent chemicals. If you are using a dipstick reader, place the strip immediately onto the tray of the reader.Replace the cap on the container to prevent deterioration of remaining strips If you are reading the tests manually, proceed with these instructions:Observe the reagent pads at the specified time periods. Color changes that occur after the stated maximum read time are not valid. Hold the strip close to the chart and compare the colors to read the results. A good light source facilitates accurate reading.

A false positive result may occur in the presence of strong oxidizing agents in the collection container. In random urine specimens from women, a positive result for leukocyte esterase may be due to a source external to the urinary tract. Other urine sediment findings such as bacteria, squamous or renal epithelial cells, lymphocytes or red blood cells do not contain esterases, and would not produce a positive leukocyte esterase test.

Acetest® tablets can be used for the semiquantitation of ketones in urine, serum, or whole blood. However, an assay for serum/plasma beta-hydroxybutyrate (BHB) is very important in the assessment of diabetic ketoacidosis as BHB is the predominant ketone body and the most sensitive marker for detection of acidosis. Because the nitroprusside method (reagent strips and Acetest) do not measure BHB, a specific test for this ketone body is needed.Urine to be screened for ketone bodies using the Acetest method should be tested immediately or refrigerated in a closed container since acetone is lost to the air if the sample is held at room temperature for a prolonged period.

The last type of collection is the observed collection. In this type of collection both the donor and "observer" enter the collection stall. Observed collections afford less privacy in order to guard against the donor using items which are designed specifically to beat the testing process. Under the Department of Health and Human Services mandatory guidelines for Federal workplace drug testing the observer must directly watch the urine go from the donor's body into the collection container. The use of mirrors or video cameras is not permitted.The observed collection is expanded under the Department of Transportation's 49 CFR § 40. After entering the stall the observer requests the donor to: Raise shirt, blouse, dress / skirt as appropriate, above the waist, just above the navel, Lower clothing and underwear to mid-thigh, and, Then turn around to show the observer that the donor does not have a prosthetic device. After the observer has determined that the donor does not have a prosthetic device, the donor is permitted to return clothing to proper position. The observer must personally watch the urine go from the donor's body into the collection container. The use of mirrors or video cameras is not permitted.

The term "shy bladder" refers to a situation where the donor is unable to provide the sufficient amount of urine required for a drug screen.If the donor indicates upon arrival at the collection site that he or she cannot provide a specimen, the collector should begin the collection process anyway and have the donor make an attempt to provide a specimen. If after an attempt the donor cannot provide a specimen or can only provide a specimen of insufficient volume, the donor must be instructed not to leave the collection site and to do so will be considered a refusal to test. The donor should be monitored either by the collector or by another member of the collection site staff. The donor should be encouraged to drink up to 40 ounces of fluid reasonably distributed over a period of up to three (3) hours, or until the donor can provide a sufficient amount of urine, which ever comes first. If no specimen is provided on the first attempt, the same collection container may be used for the next attempt. The donor may keep possession of the container during the waiting period. The same CCF is used.

In an observed collection, the observer must be the same gender as the donor. If an observed collection must be made, and the collector is not the same gender as the donor, it is the responsibility of the collector to locate someone who is the same gender as the donor to act as the observer. If the collector is not the observer, the donor can not hand the specimen to the observer but must only hand it to the collector. It is, however, the responsibility of the observer to make sure the donor directly hands the specimen to the collector.

Procedural Step Comment Caution Greet and positively identify patient Always use at least two patient identifiers to ensure positive patient identification. Never rely on name placards that are placed on or near the patient's bed or crib to identify the patient. If there is a discrepancy in identification, do not proceed until the discrepancy is resolved. Explain the procedure If the patient is a small child, be at eye level when explaining the procedure. Also explain the procedure to the parent(s). If the patient is aware of what will be happening there is less chance of the patient suddenly jerking away his/her hand when the puncture occurs. Position patient appropriately An outpatient who is a small child should sit on the parent's lap. If necessary, seek assistance for finger puncture if the patient is a small child. Cleanse hands and put on gloves Use soap and water or alcohol-based gel to cleanse hands. Cleanse hands before donning gloves and after removing gloves. Warm puncture site if needed Use the method that is approved by the laboratory for prewarming the puncture site. Never use a moist cloth that has been heated in a microwave as this may cause injury to the patient. Gather appropriate equipment Only have needed equipment at hand. Keep track of ALL equipment to prevent patient injury. Cleanse the puncture site Use 70% isopropanol unless the patient is sensitive to alcohol. Allow the site to air dry. Performing the puncture before the alcohol has dried may hemolyze the blood specimen. Securely grasp and puncture finger Puncture the side edge of the fleshy pad of fingertip. Avoid extreme side and tip of finger. Discard puncture device into appropriate container Puncture device should be discarded into a sharps container that is puncture-proof, has rigid sides, and has a lid Do not discard puncture devices into regular trash or biohazard bags. Injury to personnel who handle these bags may occur. Wipe away the first drop of blood Use slight pressure to facilitate blood flow. The first drop of blood contains tissure fluid that may contaminate or dilute the blood specimen and affect test results. Collect blood into container Allow blood to flow freely into the collection device. Tap the container gently on a hard surface to move blood further down into the tube if necessary. Do not "milk" the finger or scrape the collection device across the finger to obtain specimen; both actions may cause the specimen to hemolyze. Mix specimen immediately upon completion of the collection. Apply pressure to the puncture site to stop the bleeding. Use gauze to apply pressure to the puncture site. It is not advisable to apply an adhesive bandage over the skin puncture site if the child is less than two years old as the child may place the bandage in his/her mouth. Label specimen Specimen must be labeled in the presence of the patient. Unlabeled specimens will be rejected by the laboratory.

When blood is collected into a microcollection container that has an anticoagulant, it is important that the container is filled to the appropriate level. The device should then be capped and the blood mixed well immediately following collection of the specimen. The manufacturer of the containers that are used specifies what is considered adequate mixing and the laboratory's collection procedure should be based on these recommendations. Mixing involves a gentle tapping on a hard surface to move the blood further down into the tube during collection and then capping the tube upon completion of the collection so that the tube can be mixed end-over-end for the specified number of times as shown in the image on the right. The correct fill is also important. A container that is overfilled will not be properly anticoagulated and clots may form that will affect the laboratory test results. A container that is underfilled may not contain sufficient specimen to perform the test(s) or the excess anticoagulant may interfere with the test. For example, excess anticoagulant could cause morphologic changes in blood cells.

The fingerstick device should be held firmly against the puncture site. To obtain the best capillary specimen using the finger, align the puncture device perpendicular (horizontal) to the whirls of the fingerprint. This cross-cut of the fingerprint whirls causes the blood to bead at the puncture site, allowing the phlebotomist to efficiently collect the drops of blood into the container. This image illustrates the correct position of the cut in relation to the fingerprint lines.If the puncture is made parallel to the fingerprint whirls (as shown below), the blood will not bead but rather it will travel down the channels between the lines of the fingerprint. This makes it difficult to collect the blood into the container. The phlebotomist may inadvertently "scrape" the blood from the skin while filling the container, resulting in hemolysis and/or clotting of the specimen.The tip of the finger should be avoided. Puncturing the fingertip may cause unnecessary discomfort to the patient.

A variety of disposable skin puncture devices are available that will ensure a safe procedure when used properly. Most devices have a spring loaded feature for the blade or the lancet. Once activated, the lancet will automatically puncture the skin using a quick motion. The lancet will immediately retract back into the housing of the device. This design eliminates the possibility of accidental needlestick injury to the phlebotomist. All devices are single use only and must be disposed of in an approved sharps container immediately after activation. An example of an approved sharps container is shown below.It is very important for the phlebotomist to use the puncture device that is designed specifically for the procedure to be performed. Lancets are manufactured to ensure incisions to a safe depth and length. A special lancet designed for use on babies less than 5 pounds is available and should always be used when performing a heelstick on a premature infant. A lancet designed for puncture of a finger should not be used for the puncture of a heel. A heel incision device is set to a maximum penetration depth of 2.0 mm (some facilities may require even shallower penetration for premature infants). Fingerstick devices may exceed this maximum depth of penetration that is allowed for an infant heel puncture. The image on the left illustrates a lancet style that is typically used for fingersticks. the image on the right is one style of puncture device that is used for heelsticks.

Some specimens routinely collected for testing by using a capillary puncture are adversely affected by exposure to light. One example is a specimen collected for bilirubin testing that is obtained from a newborn. When obtaining the specimen for this testing, it is important for the phlebotomist to recognize the effect of light on the specimen. Room light or sunlight can metabolize the bilirubin in the specimen to a different compound. This will cause a falsely lower bilirubin level. A neonatal bilirubin specimen should be obtained in a dark-colored (amber) container. Alternately, a clear or white container can be immediately wrapped in aluminum foil following the blood collection, preventing the blood from exposure to light.

While microwave use in the laboratory is considered to be relatively safe, the following safety precautions should be taken to prevent high doses of exposure to microwaves and personal injury: Periodically inspect and clean door seals and hinges. Use a microwave leakage detector to check for microwave leakage from the door seals on a regular basis. Always handle containers with potholders or thermal mitts. Never operate the microwave without a minimum volume of microwave-absorbing material inside the container. Never heat food in a microwave oven used for laboratory procedures.

While microwave use in the laboratory is considered to be relatively safe, the following safety precautions should be taken to prevent high doses of exposure to microwaves and personal injury:Periodically inspect and clean door seals and hinges.Use a microwave leakage detector to check for microwave leakage from the door seals on a regular basis.Always handle containers with potholders or thermal mitts.Never operate the microwave without a minimum volume of microwave-absorbing material inside the container.Never heat food in a microwave oven used for laboratory procedures.

A chemical attack involves poisonous vapors, aerosols, liquids, or compounds. A terrorist might spread harmful chemicals with a bomb; spray from aircraft, boats, or vehicles; pour the chemicals into water or onto food; or leave a container of poisonous chemical in a confined public space.

Joe has worked in the Blood Bank for 10 years. He will retire next week and Sara will fill his position. One of the tasks that Joe routinely performed was replacing the 10 liter saline cube located on the technical workbench. However, Sara realizes that she cannot safely lift the 10 liter cube and place it on the benchtop.An employee's stature and lifting capabilities are important variables in a physical task. Since the employee cannot physically change, other solutions must be considered. This situation is easily resolved by changing the size of the container in use. Ergonomic solutionThe Blood Bank will begin using 5 liter saline cubes that can be easily lifted by all members of the staff. The Blood Bank will also acquire a cart or hand truck for other heavy items. This scenario demonstrates that a change in staff may require ergonomic action to prevent injury.

Do not leave test orders or test results in areas where they can be viewed by patients.Do not discuss test results or any patient information in areas where patients can overhear the conversation. Be careful not to discuss confidential information on the telephone where patients can overhear the conversation.Do not provide supplies to physician offices other than those usually provided by the laboratory. Document any supplies given to an office.Do not supply items that the office can use for testing (e.g. urine dipsticks). Do not allow offices to dispose of biohazard waste or sharps in the waste containers paid for by the laboratory.

In addition to instilling a consciousness about movement from one area to the next, other work skills are critical and key to obtaining accurate results:Aseptic techniquePipetting skillsAseptic technique Due to the sensitivity of molecular assays, there is little margin for error. Cross contamination from specimens with large numbers of organism/target nucleic acid can result from the slightest deviation in aseptic technique. The use of aerosol barrier pipette tips and positive displacement pipette devices go a long way in preventing aerosol contamination, but do not replace the attentiveness of the technologist during each transfer of specimen material. When working with specimens, only one specimen container should be opened at a time.Pipetting skills Although more and more assays are being introduced with pre-prepared master mixes, invariably some reagent preparation is required. This often entails the transfer of very small volumes, which leaves no margin of error during pipetting. Attentiveness to accuracy of pipetting is a must.

Engineering controls are devices that isolate the worker from the hazard of exposure.Examples include: Self-sheathing needles (top image on the right)Sharps disposal containers (bottom image on the right) Disposable resuscitation bags Biological safety cabinets Hand washing facilitiesProper use of engineering controls in your workplace will help protect you from bloodborne pathogens.

Place blood and other infectious specimens ... first in an appropriate sealed container and then in a secondary red or biohazard-labeled bag. Or place them in the facility-approved tray for transport within the institution.

Sharps disposal containers must be rigid, puncture-resistant, leakproof, and closable. They should be easily accessible in areas where sharps are used. Sharps containers should not be filled more than three-fourths full to prevent accidental needlestick injury.The containers must be labeled with the biohazard label or be color-coded to indicate they contain biohazardous materials.

The following do not require biohazard labeling: Units of blood, blood components, or blood products that are released for transfusion or other clinical use and are labeled as to their contentsIndividual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment, or disposal

Engineering Controls are devices which isolate the worker from the hazard of exposure.Examples: Self-sheathing needles Sharps disposal containers Disposable resuscitation bags Microbiological safety cabinets Proper use of engineering controls in your workplace will help protect you from bloodborne pathogens.

Place blood and other infectious specimens ... first in an appropriate sealed container and then in a secondary red or biohazard labeled bag. Or place them in a compartmentalized tray for transport within the institution.

Contaminated sharps must be placed in puncture resistant, leak-proof, closable, biohazard labeled containers.These must be closed when only three quarters full, to prevent sharps from sticking out of the opening, and must be disposed of properly.

The following do not require biohazard labeling: Blood products in clinical use Individual specimen containers However, they are subject to Standard Precautions.

Small spills (as defined by your facility) may in most instances be handled by laboratory or other employees. However, if you experience symptoms of overexposure during the clean up, such as burning eyes, or throat irritation, immediately leave the cleanup area and get help from your institution's Spill Response team or other designated persons.Major spills (as defined by your facility) will usually require immediate assistance from the Spill Response team or other designees. There are several ways to clean up small spills, two of which are described below:1. Dike up the formaldehyde with absorbent pillows. Then dispose of these pillows in a sealed, formaldehyde-labeled container. 2. A chemical that reacts with and neutralizes formalin may be used to treat the spill.Your supervisor will show you the location of these emergency spill clean-up materials or discuss alternative procedures. Be sure to follow your own institution's policies and procedures in regard to formalin spills.

When formalin containers are transported, they must be secured with a top and placed so as to avoid tipping during transport. It is also advisable to place the primary containers in a secondary container to further reduce the risk of spills.

Formaldehyde has a manufacturer's label on its container indicating the hazards associated with it.Read this label carefully!

There was no guarantee that workers would be told about the chemical hazards they might face on the job. Container labels and warning sheets did not always give enough information on potential hazards, what to do in an emergency, or where to turn for help.

Manufactured packaging Follow the manufacturer's instructions if you are using manufactured packaging. Maintain copies of packaging instructions for at least one year. Outer packaging that is used to ship Category A substances must meet manufacturing and performance specifications set by the United Nations. Packaging that meets these specifications are marked by a "UN" in a circle, a series of letters and numbers that indicate the type of package, class of goods the package is designed to carry, manufacturing date, authorizing agency, and the manufacturer. An example is shown below. This packaging is available from commercial sources with preprinted UN information. The strict, outer packaging regulations do not apply to Category B packages.Reusing a containerIf you will be reusing a container, remove all irrelevant labels and markings. Use durable labels of the proper size; letters and numbers must be at least 6 mm high. Affix hazard labels securely to one side of the package, adjacent to relevant markings. Do not overlap labels. A package can be re-used if there was no leakage during the previous transport.

All biohazard needle disposal containers are marked with a "full" line at about ¾ of the box's volume. Therefore, needles should never be sticking out of the top of the container. Julie should never have attempted to put the needle into an overly full container. The needlestick safety and prevention act requires the use of butterflies with built in safety devices. However, they are only effective if properly activated. When disposing of a butterfly needle, hold its "wings" with one hand, and the hub at the opposite end of the tubing with your other hand to prevent the needle from recoiling. Butterflies should be used with extra caution since they are the number one cause of needle stick injuries.Relevant topics:Needle disposal, Sharps disposal containers, Butterfly needles with safety 1, Butterfly needles with safety 2, Needle-stick injuries, Built-in safety features, Angel Wing™ safety butterfly, Punctur-Guard™ safety butterfly

All sharps must be disposed in appropriate sharps disposal containers. These are usually available in patient rooms, but may also be available on the phlebotomy tray depending on your institution's policies and procedures.

After collecting the blood specimen into a syringe, properly activate the appropriate safety device, and dispose of the needle in a sharps container.Attach the syringe to a blood transfer device by twisting the needle tip into the hub of the device.Push a vacuum blood collection tube into the holder of the transfer device, and let the tube fill to the appropriate level.

All needles & other sharps must be disposed of in approved sharps disposal containers. Other contaminated waste must be discarded in an appropriate red biohazard bag or waste receptacle.

Label the tubes appropriately and seal their tops with tamper-evident strips.Complete the chain of custody form and other paperwork as directed. Place paperwork and specimens in the appropriate container, and apply the required seals in the presence of the donor.

All specimens must be labeled in the presence of the patient at the time of collection. Inaccurate or incomplete labeling may result in rejection of the specimen by the laboratory. Unlabeled specimens will automatically be rejected by the laboratory. When labeling a specimen for the laboratory, the following information must be included: Patient's first name and last name Hospital medical record number, date of birth or alternate unique patient number Collector's ID Time the specimen was collected Date the specimen was collectedA phlebotomist must NEVER pre-label specimen containers. This can result in specimen mix-up and potentially disastrous consequences for the patient.

Check for any special handling requirements. For example, should the specimen be placed on ice or protected from light? Make certain to enclose all specimens in biohazard bags or designated containers if they will be transported.

Other aspects of specimen collection that must be considered are the temperature of the specimen and the time needed to transport it to the laboratory.Ideally, the specimen should be collected in a room at the testing site.If onsite collection is not possible:The specimen should be kept between 20 -37°C (room temperature to body temperature) from the time of collection until it arrives at the laboratory. This can be facilitated by holding the container close to the body, for example by carrying it in an inside pocket.Semen should arrive at the laboratory as soon as possible after collection, preferably within one hour.The man should record the time of semen production.The report should note that the sample was collected at a location outside the laboratory.

In order to test collection containers for sperm collection, the sperm must be held in the container for several hours to ensure that neither the numbers nor motility are adversely affected. Numbers will decline if the sperm adhere to the container. Motility will decline if the container is toxic. One method of testing involves removing sperm from semen. The specimen would be centrifuged and the sperm pellet diluted in a small volume of culture medium containing an energy source and at least 0.5% of a protein, such as serum albumin. The processed sperm specimen would be placed in the container to be tested. Total count and motility of the sperm would be tested at the start of incubation and 24 hours later. The container is non-toxic if the motility at the end of 24 hours is no less than 50% of the original value.

Some laboratory tests are so specialized that they require the use of special collection tubes to prevent erroneous results.Some examples of special requirements include:Laboratory TestConsiderationsHeavy metalsBlood collection container material must be free of heavy metalsTissue typingSample may need to be collected in preservative solutionBlood culturesSpecimens must be collected in bottles containing nutrient media to promote growth of bacteria within the bottle. Genetic studiesSpecial tubes may be needed to preserve DNA and/or RNA It is the responsibility of the phlebotomist to be aware of special requirements for certain tests. If the correct collection tube is not known then the phlebotomist MUST refer to the specimen collection manual or ask the appropriate laboratory worker to obtain the information. It is also imperative that the phlebotomist obtain and use only the correct equipment and not substitute something that is "close". This could affect the test results and the safety of the patient.

A urine specimen for urinalysis should be collected in a clean, dry, disposable container. If the sample is to be cultured, the container must be sterile. The preferred method is the " midstream clean catch" collection. The external genitalia are cleansed with a mild antiseptic solution. The first part of the urine stream is discarded while collecting only the midstream portion of the urine.

Transfusion-associated graft versus host disease (TA-GVHD) is generally unresponsive to medical treatment. Hematopoetic stem cell transplantation has been successful in rare instances. Gamma-irradiation of blood components containing viable lymphocytes is effective in preventing TA-GVHD. Irradiation is recommended for all Whole Blood, Red Blood Cell (RBC), Platelet, and Granulocyte transfusions to patients at risk. Patients at risk include neonates less than four months, patients with an acquired or congenital immunodeficiency, or patients receiving a directed donation from a family member. Irradiation prevents proliferation of donor lymphocytes with a required dose of 25 Gy to the mid plane of the blood container and a minimum of 15 Gy elsewhere. The dosage must not exceed 50 Gy to prevent harm to the patient from irradiation. Irradiation of blood can result in a decreased survival of red cells and a leakage of potassium from intracellular stores. Because of this, red cell units may only be stored for up to 28 days following irradiation. No reduction in storage time is required for platelets. Because Fresh Frozen Plasma (FFP) and Cryoprecipitate do not contain cells, irradiation is not required to prevent TA-GVHD in patients at risk.