1. This presentation will serve to explain proper procedure for collecting and labeling specimens in the Emergency Department. Ryan Morissette, BSN, RN, CCRN, CEN, CPEN Charge Nurse-Emergency Department University of Colorado Hospital

2. Specimen Collection All specimens should have patient sticker, if/when orders are placed, Lab Zebra label should be placed over top of the white patient label. Verify patient labels against order labels and note same Name, DOB, and MRN. When labeling: hold the blood tube cap in LEFT hand, place label just below cap, reading label Left to Right. Only one patients specimens/stickers should be sent to lab or blood back at one time. No “catching rides” in the same biohazard bag. Policies and procedures can be reviewed for collection and labeling on HUB.

3. Patient Identifiers Patient name (1) Patient DOB (2) Verify MRN (3) If no ID band, acceptable to ask family (4) but should have CTA obtain and place on patient. We need to check as least 2 identifiers Verify information on Lab Zebra label matches patient labels and patient ID band

4. Blood Cultures Blood Cultures should only be obtained from new IV start or by phlebotomy. If these steps are not followed the contamination may cause increased hospital stay and unnecessary treatments and antibiotics. Please perform sample setup for blood cultures at this time. Blood Cultures are always drawn first in blood tube draw order Describe and how you would draw the tubes. Describe how you would label these tubes. Describe how would send these to lab. Describe draw including central line/PICC/Port

5. Blood to LAB Remember order of draw(this is demonstrated for you): Blood Cultures Blue+Purple, Blue, Gold/Red (with or without gel, Green/Green, Lavender/Pink, then others as needed. Describe process for cleansing skin prior to IV start or phlebotomy for blood collection with Chloraprep Demonstrate labeling blood tubes with patient labels and “orders” Zebra label Ensure any “held blood,” is labelled with white patient sticker.

6. Blood to BLOOD BANK All PINK top tubes that are sent to blood bank must have two signatures verifying right patient, right orders, and right orders. These tubes should not be sent to lab, Blood Bank only! These test include: Type and Screen, Type and Cross, ABORh/Ab testing (Any Blood Typing). Please see Blood Tube Education and sign competency after reading.

7. Urine Urine should be collected as aseptically as possible with mid-stream clean catch. Cleansing wipes should be used. If needing to obtain from catheter, withdraw sample from port closest to patient. It may help to clamp outflow to allow urine to build up. Use sterile female kits and obtain sample in provided container. If needing more urine for POCT pregnancy, leave catheter in place and collect more urine into specimen cup. Do not open or place anything in the sterile container.

8. Pelvic Labs The pelvic lab orders should include 3 stickers (BVGS, Trich, and STD (GC/Chlamydia). All three stickers should be sent with two sample tubes to lab for testing. Products of conception should be placed in formalin container, labelled (on container and brown bag) orders obtained for pathology request and walked to lab and placed in refrigerator. Appropriate Fetal Demise (>8wks 20wks) paperwork should be completed as needed and per protocol with help from patient, doctor, chaplain and charge RN. These packets are located at Charge desk.

9. Sputum and Naso/oralpharangeal swabs Depending on type of test, we may be performing sputum collections and or from naso/oropharangeal. Nasal wash can be collected by instilling 1ml of NS (pink bullets) into each nare and then suctioning out with sputum trap. Bronchial secretions can be obtained the same way with ET and inline suctioning. If unsure how to perform, call RT. Examples: Flu/Flu PCR, rapid strep, MRSA

10. Wound Cultures Wounds that we may be culturing may include orthopedic sites, abdominal wounds, pressure ulcers, or any break in skin integrity with signs of infection. The eSwab tube should be used for these tests as it can be used for aerobic, anaerobic, and fastidious bacteria.

11. Stool Stool can generally be collected in sterile specimen cup, however, other tests may require stool collection tubes with additives. C.diff can be collected in sterile cup alone. If orders consist of Ova and Parasites or cultures the stool specific tubes should be used. Fecal Occult Blood (FOB) are in bedside cart.

12. Other body fluids Other fluids we may need to send to lab include CSF-(tubes 1-4) included in LP kit Paracentesis-sterile syringe with sterile cap or sterile tube Thoracentesis-same as above Synovial Fluid-same as above Abscess fluid-same as above

13. Special considerations/Summary Always remember standard and universal precautions when assisting or obtaining biologic samples. Your safety is paramount. Label everything at the bedside in view of the patient If a dual signature is required, verify everything with the second person at the bedside. If you have questions regarding lab testing, procedures, collection, or labeling please consult coworker or charge nurse. Lab x84401 and Blood Bank x84444.

14. Reference (Related policies and procedures) Specimen integrity Peripheral blood collection for laboratory testing Blood Cultures Standard precautions