Because the potential for infectivity of any patient's blood or body fluids cannot be known, safety precautions must be followed for all patients and for all specimens.

Universal Precautions should be followed to reduce the occupational risk of infection. Assume all patients are infected with HBV or HIV and take adequate precautions to protect yourself and anyone else who may be handling the specimen.

• Gloves should be worn while performing any type of specimen collection or handling items contaminated with blood or body fluids.
• Place used needles and other sharp items into a sharps biohazard container for disposal.
• Seal all specimens before transporting. Do not send needles attached to syringes.

Phlebotomy
Obtaining a quality blood specimen is an acquired skill that can seriously affect the results of laboratory tests.

To become truly proficient at this skill, adequate training and practice are required. If you have any questions regarding technique, please call the laboratory.

Fasting
Many chemistry tests require (or prefer) a fasting specimen. Fasting is defined as no food or drink (except water) for 12 hours prior to obtaining a specimen.

The easiest fasting technique is for the patient to avoid eating for a few hours before he/she goes to bed and then having the blood drawn early the next morning, before breakfast. In most cases, the patient should continue taking medications (consult with Physician).

Fasting specimens provide good baseline test information about the patient and reduce the chance that an interfering substance may be present in the sample.

Lipemia (the presence of fats in the blood) is one of the most significant substances that interferes with chemical analyses.

Hemolysis
This is the breakdown of the cell membrane of red blood cells. The released blood cell contents alter the values of many chemistry tests.

Significantly, potassium levels are elevated and glucose levels are decreased.

Hemolysis may be caused by using too small a needle to obtain the sample, drawing blood from a hematoma, inverting tubes too vigorously, leaving the tourniquet on too long, not allowing the venipuncture site to dry thoroughly, or temperature extremes.

Specimen Collection Information
Salem Health Laboratories accepts specimens collected in physician offices and other laboratories. Requisitions and supplies may be ordered by calling Courier Services at 503-561-5390 or fax 503-561-2593.

Accurate test results can be provided only if the specimen collection, identification, storage and transportation are performed following established guidelines. These can have as great an affect on the results as the actual testing and reporting.

Please refer to the Test Catalog for specimen requirements. For questions, call Client Services for assistance 503-561-5390 or 800-562-7542.

1. Non-additive (red top) 7 mL, draw.
2. Coagulation (blue top, sodium citrate) 4.5 mL. or 2.7 mL. draw.
3. Chemistry (green top, lithium heparin, plasma separator tube) 4.5 mL. draw.
4. Hematology (lavender top, EDTA) 4 mL. or 2 mL. draw.
   1. Tubes must be filled in the order of "A" through "D" to prevent contamination by anticoagulants to other tubes.
   2. Blue top tubes must be allowed to fill completely or dilution factors can compromise the specimen and subsequent test results.
   3. After the tubes are filled, invert each tube with an additive 5-10 times to avoid clotting.
   4. As a general rule, the volume of blood drawn should equal 2 1/2 times the amount of serum or plasma required. For example, to obtain 4-mL. serum, draw at least 10-mL. blood.

1. Label the specimen immediately after collection. Do not leave the specimen unlabeled and return to it at a later time. (Use indelible ink.)
2. Accurate results begin with positively identified specimens. Please label specimens with patient’s name and a unique identifier. Patient’s DOS, SSN, or the peel off # label for the requisition are all unique identifiers.
3. After labeling tubes, recheck each tube for proper identification.
4. Specimen label on blood tubes used for transfusion testing (crossmatch) require:
   • Full patient name
   • Patient’s date of birth (DOB) and/or Social Security Number (SSN)
   • Date specimen obtained
   • First initial and last name of collector

1. Verify the physician’s orders.
2. Positively identify the patient according to the Salem Hospital policy #2.24.
3. Obtain the specimen, and label the specimen before leaving the patient’s bedside.
• Last, first name
• Primary unique identifier – Medical Record Number,
• Acceptable alternatives to MRN are date of birth, emergency
• ID number.
• Date and time of collection
• Initials of person collecting the sample
4. Check EACH labeled specimen with the patient’s wristband to make sure the information is identical.

Most specimens for Pathology or Cytology must be placed in a fixative.

Please see the Pathology and Cytology sections of the Test Catalog for specific instructions.