Labeling Information and Courses from MediaLab, Inc.

The cerebrospinal fluid sample should be properly labeled with the tube number, patient's name and hospital number. The samples should be transported to the laboratory immediately.

Detection techniques can vary in both direct and amplified methodologies and can include labeling either the probe or the target molecule of interest:Chemiluminescence: Release of light energy at the end of a chemical reaction that is detected by a luminometer. Uses a label such as acridinium ester. Electrophoresis: movement in a matrix such as a gel that is caused by an electrical field.Enzyme: Uses enzyme and substrate principles to label the appropriate target or probe. Can be combined with fluorescence or dyes for detection.Fluorescence: Molecules that emit light at a longer wavelength when excited at a shorter wavelength. Detection techniques include fluorescent staining of nucleic acids as well as fluorescent labeled probes that are measured in a fluorometer or with fluorescent polarization.Radioactivity: Uses a labeling technique where the radioactive label is then measured in a scintillation counter. The earliest assays utilized radioactive decay.

Maintain a heightened awareness for unusual things such as suspicious packages or letters. Some characteristics of suspicious packages and envelopes include the following: Inappropriate or unusual labeling                          Excessive postage                                    Handwritten or poorly typed addresses    Misspellings of common words                Strange return address or no return address                                                  Incorrect titles or title without a name       Not addressed to a specific person                      Marked with restrictions, e.g. “Personal”, “Confidential”, or “Do not x-ray”                      Marked with any threatening language      Postmarked from a city or state that does not match the return address 

These are the relevant components of OSHA standard which are required for each facility: Exposure control plan Preventive measures Hepatitis B vaccination Standard precautions Methods of control Engineering and work practice controls Personal protective equipment Housekeeping Labeling What to do if an exposure incident occurs

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

Locate potentially hazardous chemicals in your workplace. Describe the procedure for obtaining a copy of an MSDS. Recognize chemical labeling and its meaning. Discuss exposure control measures with your supervisor. Locate the MSDS book in your workplace.

The US Department of Transportation (DOT) classifies hazardous materials according to the risks that they pose. There are nine hazard classes: Class 1: Explosives Class 2: Gases Class 3: Flammable liquids Class 4: Flammable solids Class 5: Oxidizers/organic peroxides Class 6: Toxic and infectious substances Class 7: Radioactive material Class 8: Corrosives Class 9: Miscellaneous hazardous materials Within class 6 are two divisions: Division 6.1- poisonous material Division 6.2- infectious substanceA division 6.2 infectious substance is defined as a material known or reasonably expected to contain a pathogen. A pathogen is a microorganism or other agent (e.g., a prion) that can cause disease in humans or animals. The regulations that govern packaging and shipping a class 9, miscellaneous hazardous material, may also need to be reviewed by those who package and ship laboratory specimens. Dry ice is a class 9 hazardous material and, if used, requires special packaging, and specific labeling and marking on the outer package.

A blood specimen is collected from a patient that is suspected of having Hepatitis B. The specimen will be sent via commercial carrier (e.g., Federal Express, DHL, or UPS) to a reference laboratory for further testing. What classification should be used for appropriate packaging and labeling? Work through the Classification Decision Tree.

Packages that contain category A substances must exhibit these labels.Proper shipping name and UN number(Category A label) or Hazard class 6 infectious substance label that includes this statement:In case of damage or leakage, immediately notify public health authority. In the US, notify the CDC 1-800-232-0124 UN package certification markOrientation arrows (if greater than 50 mL)Contact information (Shipper or Consignee Identification)The contact person (usually the shipper), referred to as the "responsible person" by IATA, must be someone who can be reached 24 hours a day, seven days a week (24/7) and can answer questions about the content of the package. The 24/7 number must reach that person directly and not a pager or answering machine/service. If the contact person that you are listing is the person receiving the specimen, be certain that the person is aware you are listing him/her as the contact person and has consented to it.

The first specific PGx testing application most labs are likely to encounter is that used in patients taking warfarin. Recent studies have revealed that the variations seen in patients taking the anticoagulant warfarin are due to PGx factors. The consequences of incorrect warfarin dosing are obviously serious, with inadequate doses predisposing patients to thrombosis and higher doses placing them at risk for hemorrhage. The United States' Food and Drug Administration (FDA) recently approved updated labeling for Coumadin (warfarin sold by Bristol-Myers Squibb). The new labeling suggests that physicians incorporate PGx information into warfarin-dosing regimens for patients. Manufacturers of generic warfarin products are now adding similar labeling.

When the results on Mr. John Ready were called to the nurse, she was very surprised that the result of his CBC was normal. The nurse explained to the lab tech that Mr. John Ready had a known diagnosis of lower GI bleeding. His hemoglobin had been very low for the past 24 hours because of the internal bleeding, and she thought it was very surprising that his hemoglobin had normalized so quickly without having received a blood transfusion. Mr. Ready’s doctor decided the patient should be redrawn to ensure a correct result. The nurse further questioned if the phlebotomist could possibly have drawn the wrong patient because earlier that day Mr. Ready had been moved to room 831, and room 825 was presently occupied by a patient named Walter Redding. If Julie had checked the patient’s armband, she would have realized that the patient in 825 was the wrong patient.Relevant topics:Importance of patient ID, Patient identification continued, Specimen labeling, Specimen labeling Continued, Blood bank specimens

Label specimens at the bedside according to your institution’s standard procedures, or apply preprinted labels.Proper labeling is the single most critical task you are asked to perform.

Positively identify the patient in the usual manner.Collect a venous blood specimen in a red top tube.Complete the specimen label and the detachable armband stub before removing them from the card.Initial, date, and time the stamped specimen label (shown on upper right), and attach it securely to the blood specimen.

Labeling errors are the most common cause of incorrect laboratory results.If detected, the incorrectly labeled specimen will be rejected.If undetected, it will produce incorrect results which might adversely affect your patient’s care. 

Labeling of blood bank specimens is even more critical than labeling of other specimen types.If a patient gets the wrong unit of blood, a serious or even fatal transfusion reaction may occur.

Hidden errors are those that cannot be detected or corrected by the laboratory analyst prior to testing. Most often these errors can be prevented by the phlebotomist following correct venipuncture procedure for every procedure, every time.Hidden errors include hemoconcentration, incorrect order of draw, and (the most serious of all errors) misidentification of patient or specimens. Because these errors often are unknown, the analyst may inadvertently report erroneous patient results which could be harmful to the safety and well-being of the patient. Condition What is it? How does it happen? What is the Result? Hemoconcentration Blood pools at site of venipuncture Tourniquet is applied for a prolonged period of time Test results may be inaccurate because blood components move between blood and tissues Pouring Blood between tubes Mixing contents of two or more tubes Removing top of tube to combine contents of one tube with another Inaccurate test results due to over or under dilution or incorrect anticoagulant Clots form due to lack of mixing Patient may have to be redrawn Incorrect patient identification and incorrect specimen labeling Using the wrong name to label a specimen Failure to positively identify EVERY patient using 2 unique identifiers BEFORE beginning venipuncture Failure to label EVERY specimen in the presence of the patient Failure to concentrate fully on the task Results reported to caregiver for wrong patient Compromises patient care; may be life-threatening

Each tube used for blood collection is labeled by the manufacturer with important information. This information includes: tube volume in milliliters (mL), expiration date, lot number and, if applicable, the type of additive that is in the tube. Tube volume: Each tube contains a vacuum that allows a specific amount of blood to enter the tube. In a tube that contains an anticoagulant, the amount of blood that is drawn into the tube will establish the correct blood to anticoagulant ratio. Tubes not filled to the correct volume (over-filled or under-filled) may cause inaccurate test results. Expiration Date: An expiration date is stamped on all blood collection tubes. The tube manufacturer determines this date based on its studies of vacuum maintenance and anticoagulant effectiveness. The expiration date should be checked routinely; tubes that are past the expiration date should be discarded.If a blood collection tube is used past its expiration date, the vacuum may not draw the amount of blood needed to fill the tube completely. Short-filled tubes may not be acceptable for testing and the specimen would have to be recollected. If the tube contains an anticoagulant, it may not work effectively (may not prevent the blood from clotting). Lot Number: A lot number listed on the tube identifies a specific group of tubes that were manufactured at the same time. This information is important to know if a problem is identified with several collection tubes. If the defective tubes are all part of the same lot number, the manufacturer should be notified for replacement of the tubes. Additive: Most blood collection tubes contain a type of additive or chemical that, when mixed with the blood, will yield a specimen acceptable for testing. The various types of additives that are contained in blood collection tubes are discussed on the following page.