Specimen Collection and Handling Guidelines

For All Specimens:

  1. Specimen Labels

    1. All specimens should be labeled at the time of collection with at least two patient identifiers.

      1. The patient’s name (full last name, then full first name or initial) or a unique ID code is always required.

    2. The second patient identifier may be one of the following:

      1. Date of birth (month/date/year)

      2. Other unique patient identifier that is also on the test requisition, e.g. office ID code or file number

      3. Arbor Diagnostics, Inc. requisition number or specimen barcode label

      4. Other barcode labels can be used if barcode matches the unique identifiers on the printed requisition (the barcode does not need to be human readable)

    3. If glass slides are submitted, use a pencil for labeling the frosted end, with the patient’s
      last name, first initial and DOB.

    4. When submitting a specimen in a container other than the tube used to draw the sample (e.g., transfer vials), also indicate specimen type on the label (e.g., serum, plasma, urine, etc.).

    5. When submitting specimens for microbiological testing (e.g., cultures, bacterial antigen, microscopic examination), the nature and anatomic source of the sample and the specific organism(s) to be detected, if any, should be specified.
  2. Test Requisition

    1. Specimens must be accompanied by a paper requisition, prepared either by hand or printed from an electronic ordering system. The requisition, at a minimum should contain the following information:

      1. Adequate patient identification information (e.g., name, address, telephone number, medical record number)

      2. Patient gender

      3. Patient date of birth, or age

      4. Name and address of physician ordering the test

      5. Test(s) requested

      6. Date of specimen collection, when appropriate

      7. Source and type of specimen and time of collection, when appropriate

      8. Clinical information, when appropriate

    2. Complete the “Patient Information” and “Insurance Information” sections on the requisition.

    3. Select the tests to be performed. Legibly print patient information and indicate with a check mark which party will be responsible for payment in the “Bill To” section of the requisition. Enter the ICD diagnosis code that reflects the patient’s symptoms, condition, or diagnosis and provide medical justification for the tests ordered. Complete billing information.

Improperly labeled specimens will be rejected.

  1. Packaging

    1. The following are the minimum specimen packaging guidelines that should be followed when submitting specimens.

      1. Ensure that all specimen container caps and lids are properly tightened to prevent leakage.

      2. Properly complete the requisition.

      3. Collect the specimen(s) and transfer to a proper transport container, if needed. Double check the specimen container to ensure that the device is not beyond its stated expiration date.

      4. If using a manual test requisition, remove a -self–stick label from the bottom of the pre-printed paper test requisition and affix this label to the specimen transport container. Place on the container so that the label does not cover the handwritten patient name.

      5. Fold the top copy (original) of the test requisition in half widthwise (top to bottom) with the patient’s name and bar code facing out. Retain the second copy for your files.

      6. The specimen transport bag has two pouches. Place the specimen container(s) in the front pocket. Insert the requisition into the rear pocket with the bar code visible in the bottom corner of the bag.

      7. Frozen specimens should be transported in plastic -screw–cap containers only. Frozen specimens must be placed in a separate specimen bag along with a separate test requisition. Frozen specimens cannot be split for other tests. If more than one test is ordered on a single frozen sample, we will call you to authorize which of the tests ordered you want performed before testing can proceed.

  2. Supplies

    1. Certain supplies necessary to draw and submit specimens for analysis by Arbor Diagnostics, Inc. are provided to customers as part of our testing services.

    2. Type and quantity of items must correlate to the number of specimens submitted to Arbor Diagnostics, Inc. for testing.

    3. Specimen collection devices supplied by Arbor Diagnostics, Inc. are to be used only for the collection of specimens for processing by Arbor Diagnostics, Inc.

    4. Such supplies are not to be used to store or dispose of biological materials, including sharp instruments, or for any activity not connected with the collection of specimens for processing by Arbor Diagnostics, Inc.

Department: Molecular

  1. Copan E-Swab (GBS)

    1. Preparation of the Patient:

      1. Open the ESwab sample collection pouch and remove the tube and swab.

      2. Collect the sample from the patient.

      3. Unscrew and remove the cap from Eswab tube making sure not to spill the medium.

      4. Insert the swab into the tube until the red marked breaking point is at the level of the tube opening.

      5. Bend and break the swab at the red marked breaking point holding the tube away from your face.

      6. Discard the broken handle part of the swab shaft into an approved medical waste disposal container.

      7. Replace cap on the tube and secure tightly.

      8. Write patient information on the tube label or apply patient identification label.

    2. Type of Collection Container/Amount:

      1. One Copan ESwab (480C) with one swab present inside transport tube.

    3. Transport:

      1. ESwab should be transported directly to the laboratory, preferably within 2 hours of collection to maintain optimum organism viability.

      2. If immediate delivery or processing is delayed, then specimens should be refrigerated at 4 – 8ºC or stored at room temperature (20 – 25°C) and processed within 48 hours.

    4. Clinical Data:

      1. Penicillin allergic (Yes or No)

      2. Weeks pregnant

  2. Aptima Multitest Swab

    1. Preparation of the Patient – Vaginal (CT/NG/Trich)

      1. Partially peel open the swab package. Remove the swab. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new Aptima Multitest Swab Specimen Collection Kit.

      2. Hold the swab, placing your thumb and forefinger in the middle of the swab shaft covering the score line. Do not hold the swab shaft below the score line.

      3. Carefully insert the swab into the vagina about 2 inches (5cm) past the introitus and gently rotate the swab for 10 to 30 seconds. Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.

      4. While holding the swab in the same hand, unscrew the cap from the tube. Do not spill the contents of the tube. If the contents of the tube are spilled, use a new Aptima Multitest Swab Specimen Collection Kit.

      5. Immediately place the swab into the transport tube so that the score line is at the top of the tube.

      6. Carefully break the swab shaft at the score line against the side of the tube.

      7. Immediately discard the top portion of the swab shaft.

      8. Tightly screw the cap onto the tube.

    2. Preparation of the Patient – Lesions (HSV-1 & -2)

      1. Partially peel open the swab package. Remove the swab. Do not touch the soft tip or lay the swab down. If the soft tip is touched, the swab is laid down, or the swab is dropped, use a new Aptima Multitest Swab Specimen Collection kit.

      2. Hold the swab, placing your thumb and forefinger in the middle of the swab shaft covering the score line. Do not hold the swab shaft below the score line.

      3. If needed, expose the base of the lesion to access fluid.

      4. Vigorously swab the base of the lesion to absorb fluid, being careful not to draw blood. Withdraw the swab without touching any other site outside the lesion.

      5. While holding the swab in the same hand, unscrew the cap from the tube. Do not spill the contents of the tube. If the contents of the tube are spilled, use a new Aptima Multitest Swab Specimen Collection kit.

      6. Immediately place the swab into the transport tube so that the score line is at the top of the tube.

      7. Carefully break the swab shaft at the score line against the side of the tube.

      8. Discard the top portion of the swab shaft.

      9. Tightly screw the cap onto the tube.

    3. Type of Collection Container/Amount:

      1. One Aptima Multitest Swab with one swab present inside transport tube.

    4. Transport:

      1. After collection, transport and store the swab in the swab specimen transport tube at 2°C to 30°C.

  3. Aptima Urine

    1. Preparation of the Patient (CT/NG/Trich):

      1. The patient should not have urinated for at least 1 hour prior to specimen collection.

      2. Direct patient to provide a first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup free of any preservatives. Collection of larger volumes of urine may result in rRNA target dilution that may reduce test sensitivity.

        1. Female patients should not cleanse the labial area prior to providing the specimen.

      3. Remove the cap and transfer 2 mL of urine into the urine specimen transport tube using the disposable pipette provided. The correct volume of urine has been added when the fluid level is between the black fill lines on the urine specimen transport tube label.

      4. Re-cap the urine specimen transport tube tightly.

    2. Type of Collection Container/Amount:

      1. One Aptima Urine tube between black fill lines

        1. If urine is over the max fill line or under the minimum fill line, the specimen will be rejected.

    3. Transport:

      1. After collection, transport the processed urine specimens in the Aptima urine specimen transport tube at 2°C to 30°C and store at 2°C to 30°C.

      2. Urine samples that are still in the primary collection container must be transported to the lab at 2°C to 30°C. Transfer the urine sample into the Aptima urine specimen transport tube within 24 hours of collection. Store at 2°C to 30°C.

  4. ThinPrep (CT/NG/Trich/HR HPV/HPV GT/ All Vaginal Panels)

    1. Please see Cytology ThinPrep Pap Test for detailed information

    2. Vaginal Panels include a combination of the following targets:
      1. Candida krusei
      2. Candida albicans
      3. Candida parapsilosis/Candida tropicalis
      4. Candida glabrata
      5. Gardnerella vaginalis
      6. Mycoplasma genitalium
      7. Mycoplasma hominis
      8. Ureaplasma urealyticum
      9. Atopobium vaginae
      10. Mobiluncus curtisii
      11. Mobiluncus mulieris
      12. Prevotella bivia
      13. Bacteroides fragilis

Department: Cytology

  1. ThinPrep Pap Test

    1. Preparation of the Patient (Broom-Like Device Protocol):

      1. To obtain an adequate sample from the cervix using the broom-like device, insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Hold the stem between the thumb and forefinger. Maintain gentle pressure and rotate the broom five times in a clockwise direction.

      2. Rinse the broom as quickly as possible into the vial solution by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart.

      3. Swirl the broom vigorously to further release material. Discard the broom.

      4. Tighten the vial cap so the torque line on the cap passes the torque line on the vial.

    2. Preparation of the Patient (Spatula Protocol):

      1. Select contoured end of the plastic spatula and rotate 360 degrees around the entire exocervix while maintaining tight contact with exocervical surface. Remove spatula.

      2. Rinse the spatula as quickly as possible into the vial solution by swirling the spatula vigorously in the vial 10 times. Discard entire spatula.

      3. Tighten the vial cap so the torque line on the cap passes the torque line on the vial.

    3. Preparation of the Patient (Endocervical Brush Protocol):

      1. Obtain an adequate sample from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottom-most fibers remain exposed. Slowly rotate ¼ – ½ turn in one direction. Do not over-rotate.

      2. Rinse the brush as quickly as possible in the vial solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. Swirl the brush vigorously to further release material. Discard entire brush.

      3. Tighten the vial cap so the torque line on the cap passes the torque line on the vial.

    4. Type of Collection Container/Amount:

      1. One ThinPrep Specimen

        1. Do not pour solution out of vial ~ 20mL of PreservCyt Solution

    5. Transport:

      1. Transport at 15°C to 30°C

    6. Clinical Data:

      1. Source

      2. Last Menstrual Period (LMP)

      3. Pertinent Clinical History

    7. Restrictions:

      1. Ideally collect Pap smear two weeks after the first day of the last menstrual period.

      2. The patient should be instructed not to use vaginal medications, lubricants, spermicides, or douches 48 hours prior to the collection of the Pap smear.

      3. The patient should also refrain from intercourse 24 hours prior to the collection of the Pap smear.

Department: Microbiology

    1. Copan ESwab or MSwab (Vaginal, GBS, Wound, Lesion and Throat Cultures)

      1. Preparation of the Patient:

        1. Peel open the kit package and remove the tube of medium and inner pouch containing the sterile swab applicator.

        2. Remove the swab applicator from its peel pouch and use to collect the specimen. During sample collection when handling the swab applicator, the operator must not touch the area below the breakpoint indication line; that is the area from the line to the tip of the nylon flocked swab, as this will lead to contamination of the applicator shaft and the culture thus invaliding the test results.

          1. Vaginal:

            1. Wipe away old secretions/discharge.

            2. Obtain secretions from the mucosal membrane of the vaginal wall with a sterile swab/

          2. Vaginal/rectal (For GBS):

            1. Insert sterile swab 2cm into vagina, rotate swab.

            2. Insert the same swab 1cm into anus and rotate swab.

          3. Wound:

            1. Remove surface exudate by wiping with sterile saline or 70% alcohol.

            2. Using a sterile swab pass deep into the wound to firmly sample the wound’s “fresh border.”

          4. Lesion:

            1. While pressing the base of the lesion, firmly rub base with a sterile swab to collect fluid.

          5. Throat:

            1. Depress tongue with a tongue depressor.

            2. Sample the posterior pharynx, tonsils, and inflamed areas with a sterile swab.

        3. After the swab sample is taken from the patient, break the swab off into the tube as follows:

          • With the other hand grasp the swab shaft at the very end with the thumb and first finger

          • Lean the part of the shaft with the breaking point against the rim of the tube

          • Bend the swab shaft at a 180 degrees angle to break if off at the colored ink breakpoint mark.

          • Discard the broken handle part of the swab shaft into an approved medical waste disposal container.

        4. Replace cap on the tube and secure tightly

      2. Type of Collection Container/Amount:

        1. One Copan ESwab (480C) with one swab present inside transport tube.

      3. Transport:

        1. ESwab should be transported directly to the laboratory, preferably within 2 hours of collection to maintain optimum organism viability.

        2. If immediate delivery or processing is delayed, then specimens should be refrigerated at 4 – 8ºC or stored at room temperature (20 – 25°C) and processed within 48 hours.

      4. Clinical Data:

        1. Source

        2. Pertinent Clinical History

        3. (GBS Only) Penicillin allergic (Yes or No)

        4. (GBS Only) Weeks pregnant

    2. UA Preservative tube (tiger top) and C&S tube (grey top) (Urine Cultures)

      1. Preparation of the Patient:

        1. Patients should be directed by clinic staff to provide a midstream urine specimen.

          1. While holding the labia apart, begin voiding.

          2. After several milliliters has passed, collect a midstream portion without stopping the flow of urine.

          3. The midstream portion is used for bacterial culture.

        2. A clinic staff member will obtain the urine cup from patient.

        3. Submerge tip of the transfer straw in specimen.

          1. Push C&S Preservative tube (grey top) into the transfer
            straw.

            1. Hold in position until flow stops.

            2. Remove tube, leaving transfer straw in specimen container.

            3. Shake tube vigorously

          2. Push UA Preservative tube (tiger top) into transfer straw
            completely.

            1. Hold in position until flow stops.

            2. Remove tube, leaving transfer straw in specimen container.

NOTE: The tubes must be filled to the minimum fill line and not exceed the maximum fill line, in order to maintain the proper additive to urine ratio.

      1. Invert UA Preservative tube 8-10 times to mix the sample.

      2. Dispose of transfer straw in sharps container and urine cup in
        trash.

    1. Type of Collection Container/Amount:

      1. UA Preservative tube (tiger top) and C&S tube (grey top).

    2. Transport:

      1. A Preservative Tube (tiger top)

        1. UA Preservative tube is to be sent to the laboratory within 72 hours. Specimen can be kept at room temperature for 72 hours.

      2. C&S Preservative tube (grey top)

        1. C&S Preservative tube is to be sent to the laboratory within 48 hours. Specimen can be kept at room temperature for 48 hours.

    3. Clinical Data:

      1. Source

      2. Pertinent Clinical History

Department: Clinical Pathology

  1. Preparation of the Patient:

    1. Position the patient with the arm extended to form a straight-line from shoulder to wrist.

    2. Select the appropriate vein for venipuncture.

      1. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary.

    3. Apply the tourniquet 3-4 inches above the collection site.

    4. Clean the puncture site by making a smooth circular pass over the site with the 70% alcohol pad, moving in an outward spiral from the zone of penetration. Allow the skin to dry before proceeding.

    • Perform the venipuncture with a hub and needle.

      1. Attach the appropriate needle to the hub by removing the plastic cap over the small end of the needle and inserting into the hub, twisting it tight.

      2. Remove plastic cap over needle and hold bevel up.

      3. Pull the skin tight with your thumb or index finger just below the puncture site.

      4. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and enter the vein in one smooth motion.

      5. Holding the hub securely, insert the first vacutainer tube following proper order of draw into the large end of the hub penetrating the stopper. Blood should flow into the evacuated tube.

      6. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand.

      7. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle.

      8. If multiple tubes are needed, follow the proper order of draw. DO NOT SHAKE OR MIX VIGOROUSLY. Gently invert tube to allow proper mixing.

      9. Place a gauze pad over the puncture site and remove the needle.

      10. Immediately apply slight pressure immediately after the needle is removed.

      11. Apply a fresh bandage, gauze or tape.

    • Venipuncture procedure using a syringe:

      1. Place a sheathed needle or butterfly on the syringe.

      2. Remove the cap and turn the bevel up.

      3. Pull the skin tight with your thumb or index finger just below the puncture site.

      4. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion.

      5. Draw the desired amount of blood by pulling back slowly on the syringe stopper.

      6. Excessive suction or repeatedly creating and releasing the suction will cause hemolysis.

      7. Extended collection time will cause platelet activation.

      8. Release the tourniquet.

      9. Place a gauze pad over the puncture site and quickly remove the needle.

      10. Gently invert tubes according to order of draw.

      11. Dispose of the syringe and needle as a unit into an appropriate sharps container.

  1. Centrifugation

    1. Physicians treat medical conditions based on lab results and accurate Laboratory testing is dependent upon a quality sample. Recollection of unacceptable specimens is not good patient care nor is it good customer service.

    2. Recollection The SST™ must properly clot prior to centrifugation for at least 15 minutes.

    3. Red top tubes must properly clot prior to centrifugation for at least 15 minutes.

    4. Centrifugation is required within 2 hours, prefer 1 hour.

    5. Centrifugation should achieve a clear separation of cells and plasma/serum.

    6. Centrifuge tubes for at least 15 minutes but no more than 20 minutes at 3,000-3,800 RPM.

    7. If centrifuge does not have a timer, watch time carefully to avoid over or under centrifuging.

  2. Transport:

    1. Refrigerated: Cooler bags. Specimens should not have direct contact with the cooler bags. Cells can become damaged.

    2. Frozen: Dry ice can be utilized. Frozen specimens should not be more than ¾ full and only plastic vials should be used.

  3. Clinical Data:

    1. Source

    2. Pertinent Clinical History

    3. (ABO/Rh) Blood type if known

    4. (ABO/Rh) Transfusion, if applicable

    5. (ABO/Rh) Date of last RhoGAM shot

  1. K2 and/or K3 Lavender – Contains EDTA anti-coagulant. (Used for CBC, ESR, Abo/Rh, and Antibody Screens)

    • Whole blood – send filled tube. If needed, draw third.
      1. If suspected positive antibody or titer, collect two
    • Plasma – transfer to plastic vial and label with patient’s name and “EDTA plasma”.

      1. If suspected positive:

        1. HIV Combo PT Elecsys (along with SST)

        2. HBsAg Elecsys (along with SST)

        3. GC HIV Combo Ag/Ab EIA (along with SST)

        4. GC HBsAG EIA (along with SST)

  2. Serum Separator tube (SST) – Contains gel-barrier. (RPR, Plateli Toxo IgM, Anti HBc IgM, GC
    HBsAG EIA, CMV IgG and IgM EIA, Rubella IgG EIA, Rubella IgG Elecsys, Toxoplasma IgG
    EIA, VZV IgG EIA, Captia Syphilis IgG, GC HIV Combo Ag/Ab EIA, HSV-1 and HSV-2 IgG
    Elecsys, AMH Elecsys, HCG+beta Elecsys, Anti-HCV G2 Elecsys, HIV Combo PT Elecsys,
    HBsAg Elecsys, Estradiol, FSH, T3, FT3, FT4, T4, LH, Prolactin, Progesterone and TSH.)

    • Serum – allow blood to clot and centrifuge tube. If needed draw second.

  3. Light Blue – Contains sodium citrate anticoagulant. (PT/INR, PTT, Fibrinogen and DDimer)

    • Plasma (Frozen) – transfer to plastic vial within two hours of collection and label with
      “citrate plasma.”

    • Whole blood (received within 4 hours)– send filled tube. Used for coagulation testing. If
      needed draw first.

Department: Histology

  1. Preparation of the Patient:

    1. Biopsy site should be cleaned and prepared as appropriate for the site. Click on the links below for additional collection and handling information pertaining to the individual biopsy types.

      1. Soft Biopsy: Exocervix or lower genital tract biopsy

        1. https://histologics.com/softbiopsy.html

        2. The SoftBiopsy® design is a special device used to non-surgically acquire an exocervical biopsy.

        3. The tip is snapped free of the handle and submitted in the formalin vial.

        4. Please thoroughly read the instructions for the SoftBiopsy® kit to ensure accurate specimen collection.

      2. Soft ECC: Endocervical curettage

        1. https://histologics.com/soft-ecc.html

        2. https://histologics.com/soft-ecc-s.html

        3. The SoftECC® design is a special device used to non-surgically acquire an endocervical biopsy.

        4. The tip is snapped free of the handle and submitted in 10% Neutral Buffered Formalin (NBF) or Carson Millonig’ formalin.

        5. Please thoroughly read the manufacturer’s instructions for the SoftECC® kit to ensure accurate specimen collection.

      3. Loop Electrosurgical Excision procedure: LEEP

        1. The transformation zone and/or lesional area of cervix is removed with a heated wire loop.

        2. Place into 10% Neutral Buffered Formalin (NBF).

        3. Use 40 mL or 60 mL size vial, depending on the size of the excision.

      4. Cervical Punch: Punch biopsy

        1. A small tissue sample is punched from the cervix and placed into 10% Neutral buffered formalin or Carson Millonig’ formalin.

      5. Cervical Conization: Cone Biopsy

        1. The transformation zone is surgically removed and placed into 10% Neutral Buffered Formalin (NBF).

        2. Use 60 mL size vial for adequate fixation.

      6. Endometrial Biopsy: Endometrium

        1. A sample of the endometrium is taken using a Pipelle, curette, or other biopsy device, and is placed into 10% Neutral Buffered Formalin (NBF).

        2. Use a 40 mL or 60 mL size vial (20x volume of formalin to volume of the biopsy required for proper fixation).

      7. Tissue Biopsy, NOS

        1. Indicate biopsy site and submit tissue in 10% Neutral Buffered Formalin (NBF).

      8. Endocervical Curettage

        1. A curette is used to scrape the lining of the endocervical canal.

        2. Place tissue is placed in 10% Neutral Buffered Formalin (NBF) or Carson Millonig’ formalin.

      9. Vulva Biopsy

        1. A small area of the vulva is removed and placed into 10% Neutral Buffered Formalin (NBF) or Carson Millonig’ formalin.

      10. Vaginal Biopsy

        1. A small area of the vagina is removed and placed in 10% Neutral Buffered Formalin (NBF) or Carson Millonig’ formalin.

  2. Transport:

    1. Transport at 15°C to 30°C

  3. Clinical Data:

    1. Source

    2. (LEEP) Orientation

    3. Pertinent Clinical History

  4. Restrictions:

    1. Hemostatic solutions, such as Monsel’s solution, should NOT be applied until after all
      biopsies are taken, as these chemicals cause a coagulative artifact that severely limits
      microscopic evaluation of the tissue.

Specimen Reference Guide

Aptima Urine Specimen Transport Tube

Aptima Urine Specimen Transport Tube

Available Tests: Chlamydia trachomatis and Neisseria gonorrhoeae

Aptima Unisex Swab

Aptima Unisex Swab

Available Tests: Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis

ThinPrep Pap Test

ThinPrep Pap Test

Available Tests: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis,
High-risk HPV, and HPV genotypes 16 18/45