Texas Health Steps: Specimen Collection and Handling

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THSteps Specimen Collection and Handling

- Clinical Chemistry Testing | Tips for Successful Specimen Collection | Web Data Services -

 

Getting Started


Getting Started

  • Obtain supplies to collect and ship or mail specimens to the DSHS Laboratory from the Container Preparation Department. DSHS offers THSteps supplies, including postage paid mailing labels and cold shipping boxes with air bills, at no cost to the medical provider. Enrolled THSteps providers may request supplies by telephone at 1 (888) 963-7111 ext. 7661 or (512) 776-7661, or by fax at (512) 776-7672.
  • Review the specimen requirements for the desired test.
  • Collect the appropriate blood specimens in the correct blood collection tubes. For specimens other than blood (e.g., GC/CT), collect the sample with the appropriate specimen collection device.
  • Label the specimens correctly with patient name, date of collection, and a second unique identifier (such as Medicaid number or medical record number); ensure that all information is recorded clearly and legibly on the specimen collection tubes or other specimen collection devices. If a label is used, ensure that it is firmly attached to the specimen to ensure accurate identification.
  • Complete the appropriate submission forms accurately, completely, and legibly. Most submission forms have required fields. Ensure that these fields are completed, and that they are accurate and legible. Make sure that the patient name matches exactly on the specimen and the submission form.
  • Clearly mark the type of specimen being submitted, the test(s) desired, and the payor source on the appropriate submission form.
  • If necessary, complete any required information on the submission form that indicates how the specimen was stored before shipping (e.g., date/time specimen removed from freezer for glucose or cholesterol).
  • For specimens shipped at ambient temperature through the U.S. Postal Service, mail specimens the day of collection or the following day to ensure that specimens are received in the laboratory within the required timeframe for each test. Specimens may be refrigerated overnight before being mailed the following day. NEVER freeze whole blood specimens.
 

Appropriate Minimum and Maximum Fill Volume
Illustrated below with Vacutainer® and Microtainer® MAP K2 EDTA blood collection tubes.

Venous blood collections

Becton Dickinson (BD) 2 mL Vacutainer® K2 EDTA 3.6 mg tube

Photo of three blood collection tubes illustrating minimum and maximum collection levels

This blood collection tube is used for total hemoglobin and lead testing. The tube displayed is the DSHS Laboratory-specified blood collection tube accepted for testing. It is provided by the DSHS Laboratory. The Laboratory will also accept 3 mL and 4 mL tubes from the same manufacturer. The fill volume for each tube is stated at the bottom of the label.

Note the indicator mark on the edge of the label.  Some tubes may have different color labels and markings. The mark on the edge of the label (see arrow on picture) indicates the approximate volume that the tube is designed to collect. Tubes that are designed to draw 3 mLs or 4 mLs will have this mark closer to the top of the tube.

The tubes are displayed to indicate the minimum and maximum acceptable volumes. Use the Purple Top Tube Guide (available from the Container Preparation Department) to assist in obtaining the correct volume for each size of Vacutainer® tubes. NOTE: Do not reproduce the Purple Top Tube Guide; for original copies, contact the Container Preparation Department.

Remember that the 2 mL Vacutainer® blood collection tubes have a low vacuum as they are designed to draw only 2/uploadedImages/Content/Prevention_and mL of blood. This means that blood will flow more slowly into the tube and the draw may take longer to obtain the desired volume of blood.
There are three options for obtaining the correct volume for the Vacutainer® tubes.
  1. Typical venipuncture technique using a Vacutainer® tube and a multidraw needle. The tube is designed to draw ~2 mL of blood. Do not remove the needle from the vein too soon or the vacuum of the tube will not have sufficient time to draw the correct volume. Once the draw is complete, compare it to the 2 mL diagram on the Purple Top Tube Guide to ensure the volume meets DSHS requirements.
  2. Venipuncture using a “butterfly”collection device with a Vacutainer® tube. Once the “butterfly” device is attached to the tube, the “dead space” in the “butterfly” tubing will evacuate enough of the vacuum in the Vacutainer® tube that it can no longer pull the desired volume. Avoid this problem by using a “waste” or “discard” tube – attach the “butterfly” to the tube and perform the venipuncture; once a small amount of blood is drawn into the Vacutainer®, remove the “waste” or “discard” tube and replace it with a second Vacutainer® that has not had its vacuum compromised. At this point, the second Vacutainer® should pull the correct volume. Again, do not remove the needle from the vein too soon or the vacuum of the tube will not have sufficient time to draw the correct volume. Compare to the Purple Top Tube Guide to ensure the correct volume has been met.
    Another way to perform this action without use of a “waste” or “discard” tube is to attach the blood collection tube to the “butterfly” collection device once blood is flowing into the tubing.
  3. Venipuncture using a syringe and “butterfly” collection device. This option allows the phlebotomist to use the “butterfly” device but uses a syringe of appropriate size to draw sufficient blood in order to meet the fill volume requirement for the blood collection tube to be used. For example, if a 2 mL Vacutainer® will be used, a 3 mL syringe may be used to draw ~2.5 mL of blood. Then, using the Purple Top Tube Guide, the correct amount of blood can be dispensed back into the 2 mL Vacutainer®. If a 3 or 4 mL Vacutainer® will be used, a 5 mL syringe may be used to draw ~3.5 or 4.5 mL of blood, respectively.

^ Top

Fingerstick or heelstick blood collections

Becton Dickinson (BD) Microtainer® MAP 250 µL – 500 µL tube

3 MAP tubes standing

This blood collection tube is used for total hemoglobin and lead testing. The tube displayed is the DSHS Laboratory-specified fingerstick (sometimes called capillary) tube accepted for testing. It is provided by the DSHS Laboratory.

The tubes are displayed to indicate the minimum and maximum acceptable volumes. For this tube, the minimum and maximum acceptable volumes are indicated on the tube by the 250 and 500 µL lines. The blood level must be anywhere between these two lines to be acceptable for fill volume. The target volume is indicated by the 375µL line.

THSteps Unsatisfactory Specimens and How to Avoid Them

The following table is specifically for Clinical Chemistry THSteps tests. Information regarding HIV, RPR, or Gonorrhea/Chlamydia unsatisfactory specimens may be referenced in the Manual of Reference Services (MRS).

Required information on G-THSTEPS/G-1B form
Rejection Statement Explanation or Tip Tests Affected
No date of collection on request form. Please resubmit. Provide an accurate and legible Date of Collection in the space provided in Section 2 on the G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Invalid or incomplete date of collection on request form. Please resubmit. See the Tip above.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Provider did not order test. Please resubmit. Clearly mark the test(s) required in the appropriate section of the G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Provider did not circle from which appliance specimens were removed. Please resubmit. Circle the appropriate appliance (freezer or refrigerator) from which specimens were removed in the bottom right-hand corner of the G-THSTEPS/G-1B form.
  • Cholesterol/Lipid Profile
  • Glucose
Provider did not give date and time specimen was removed from the freezer/refrigerator. Please resubmit providing this information. Please remember to circle from which appliance the specimens were removed. Record the date and time the specimen was removed from the freezer/refrigerator in the bottom right-hand corner of the G-THSTEPS/G-1B form.
  • Cholesterol/Lipid Profile
  • Glucose
Incomplete Form: Required information is missing from submission form. A submission form was received without information in required fields.  Provider did not provide missing information in time for specimen to be processed/tested.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
 

Miscellaneous situations related to G-THSTEPS/G-1B form

Rejection Statement Explanation or Tip Tests Affected
Cannot identify: Two forms submitted with the same identification. Please resubmit. Double-check that each specimen has an appropriately completed G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Name on specimen does not match name on request form. Please resubmit. Label the specimen with the exact spelling of the name, as recorded on the G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Test requested is not available at this laboratory. Please refer to http://www.dshs.state.tx.us/lab/MRS_intro.shtm for testing performed at this laboratory, or call 1 (888) 963-7111 ext. 7430. A test has been requested that is not performed at the DSHS Laboratory. Review the tests on the submission form to determine which test to mark.
  • N/A

Unsatisfactory Codes Related to Collection Tube or Specimen

Unsatisfactory codes that will affect an entire mailing container

Rejection Statement Explanation or Tip Tests Affected
Specimen broken in transit. Please resubmit. The specimen was broken during the mailing process. All specimens are possibly contaminated. Add packing material to secure specimens in mailing container.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Specimen leaked in transit. Please resubmit. The specimen leaked during the mailing process. All specimens are possibly contaminated. Ensure that all specimens are securely capped before mailing. For Microtrainer® MAP tubes, ensure the cap is securely on the tube by snapping it into place and twisting.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Laboratory specified tube not used. Please resubmit. For further information, refer to http://www.dshs.state.tx.us/lab/cc_spec-col.shtm#tubeIllustrations or call 1 (888) 963-7111 ext. 7661. The DSHS Laboratory only accepts specified blood collection tubes. Obtain appropriate blood collection tubes and recollect/resubmit specimen.
  • Total Hemoglobin
  • Lead
Cannot identify specimen. Label not attached. Please resubmit. Idenitfying label is not attached to specimen or detached from specimen. Ensure label is securely fixed to blood collection tube prior to mailing.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose

Identification issues for blood collection tube/specimen

Rejection Statement Explanation or Tip Tests Affected
No identification on specimen. Please resubmit. Each specimen must be labeled to ensure correct identification of specimen. Ensure label is securely fixed to blood collection tube prior to mailing.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Cannot identify: Two specimens submitted with the same identification. Please resubmit. Label each specimen appropriately with patient name. Ensure each specimen has an accompanying G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Specimen identification illegible. Please resubmit. Label specimen legibly by writing clearly on the specimen or by applying a label with patient name written or printed clearly.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Name on specimen does not match name on request form. Please resubmit. Label the specimen with the exact spelling of the name, as recorded on the G-THSTEPS/G-1B form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose

Incorrect tube type or specimen submitted

Rejection Statement Explanation or Tip Tests Affected
Must submit anti-coagulated (EDTA) specimen. Please resubmit. Test requested requires a purple-top specimen. Recollect specimen in DSHS-specified K2 EDTA Vacutainer® or Microtainer® MAP.
  • Total Hemoglobin
  • Lead
No filter paper specimen submitted. Must submit Texas DSHS Snap-apart filter paper card for Hemoglobin Electrophoresis testing. Test requested requires a filter paper specimen. NOTE: Contact Container Preparation at (888) 983-7111 ext. 7661 to order filter paper cards. Recollect specimen on DSHS Snap-apart filter paper card, allow to dry, and mail as soon as possible.
  • Hemoglobin Type
Filter paper specimen submitted on improper collection card. Please resubmit. Specimen submitted on filter paper that is not Whatman 903® filter paper. See NOTE above.
  • Hemoglobin Type
Filter paper specimen submitted on expired collection card. Please resubmit. Specimen must be collected on filter paper card prior to expiration date. Check expiration date of filter paper cards. See NOTE above.
  • Hemoglobin Type

Age of specimen

Rejection Statement Explanation or Tip Tests Affected
Specimen too old for testing, greater than 10 days old. Please resubmit. Purple-top specimen submitted for Total Hemoglobin/Lead testing was received greater than 10 days after collection. Day of collection equals Day 1. Recollect specimen and ship the day of collection or the next day.
  • Total Hemoglobin
  • Lead
Specimen too old for testing, greater than 13 days old. Please resubmit. DSHS Snap-apart filter paper card submitted for Hemoglobin Electrophoresis testing was received greater than 13 days after collection. Day of collection equals Day 1. Recollect specimen and ship as soon as specimen is dry.
  • Hemoglobin Type

Specimen integrity

Rejection Statement Explanation or Tip Tests Affected
Specimen decomposed. Please resubmit. Specimen decomposed, unacceptable for testing. Decomposition usually occurs when a specimen is exposed to excessively high temperatures. Avoid dropping specimens in a receptacle that is exposed to direct sunlight or high temperatures. If possible, make a trip to the Post Office and deliver specimens inside the building.
  • Total Hemoglobin
  • Lead
Specimen clotted. Please resubmit.

Purple-top specimen was clotted. Clotting occurs at the time of collection; a specimen does not clot as it ages.

  • To avoid clotting of a venous specimen, mix immediately after collection. Ensure that blood comes in contact with the entire inner surface of the tube. Mix thoroughly for at least 2 minutes.
  • To avoid clotting on a fingerstick specimen, ensure hands are warm to encourage blood flow to the fingers. Wipe away the first drop of blood and avoid scraping the site which stimulates clotting. If necessary, mix during collection by tapping on the counter or shaking slightly. After collection, mix the tube thoroughly, ensuring that blood comes in contact with the entire inner surface of the tube. Mix thoroughly for at least 2 minutes.
  • Total Hemoglobin
  • Lead
Specimen unsuitable for testing. Please resubmit. Specimen was compromised in some way and is unacceptable for testing. Call the Laboratory at (888) 963-7111 ext. 6236 to learn the reason for unacceptability.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Filter paper specimen appeared contaminated or discolored. Please resubmit. Filter paper specimen appeared compromised in some way. NOTE: After collection, allow filter paper to dry completely before mailing. Fold specimen at score line and tuck into flap to protect filter paper, before mailing. Place filter paper specimen with submission forms between inner plastic liner and outer cardboard mailing container.
  • Hemoglobin Type
Incomplete elution of blood from filter paper. Please resubmit. Blood was not able to be eluted from filter paper to perform testing; specimen possibly compromised in some way. See NOTE above.
  • Hemoglobin Type
Filter paper specimen damaged during transport to Laboratory. Please resubmit. Filter paper specimen appeared damaged in some way, preventing specimen from being tested. Recollect specimen and place with submission forms between inner plastic liner and outer cardboard mailing container.
  • Hemoglobin Type
No blood on filter paper card. Please resubmit. Drop blood on 2-3 circles on filter paper card. Label with patient name and date of collection. Allow filter paper to dry completely before mailing.
  • Hemoglobin Type

Specimen volume requirements

Rejection Statement Explanation or Tip Tests Affected

Specimen quantity not sufficient. Please resubmit.

*See the pictures above for a visual depiction. This is a guide for the appropriate volume needed for Vacutainer® tubes.

Specimen volume in purple top (K2 EDTA) tube did not meet minimum fill volume requirements, OR volume of serum was insufficient to perform testing. NOTE: Refer to Purple Top Tube Guide for a depiction of the appropriate volume for BD Vacutainer® tubes. Review volume stated on label of purple top K2 EDTA blood collection tube used to ensure accurate volume is obtained. Purple top, EDTA:
  • Total Hemoglobin
  • Lead
Serum from Red Top:
  • Cholesterol/Lipid Profile
  • Glucose (red top)
Specimen fill volume exceeded. Please resubmit. Specimen volume in purple top (K2 EDTA) exceeded the maximum fill volume requirements. See NOTE above.
  • Total Hemoglobin
  • Lead
Insufficient blood on filter paper card. Please resubmit. Insufficient blood dropped on DSHS Snap-Apart filter paper card to perform testing. Drop blood on 2-3 circles on filter paper card, ensuring complete saturation, and resubmit.
  • Hemoglobin Type

Shipping errors

Rejection Statement Explanation or Tip Tests Affected
Specimen was received at ambient temperature.  Please resubmit cold specimen. Specimen requirements mandate a cold serum specimen. Refer to the DSHS Laboratory website for further information:  www.dshs.state.tx.us/lab/serumSpecimenCriteria.shtm
  • Cholesterol/Lipid Profile
  • Glucose
Plasma was received at ambient temperature greater than 24 hours from time of collection. Please resubmit. Plasma must be frozen and received cold. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430. Specimen for glucose testing must be received cold. NOTE: Recollect specimen in gray top tube, remove plasma within 24 hours after collection, and freeze until shipped. Upon shipping in cold shipping box, include sufficient cold packs to ensure specimen is received cold.
  • Glucose

Whole blood was received greater than 24 hours from time of collection. Please resubmit. Plasma must be frozen and received cold. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430.

Whole blood older than 24 hours after collection is unacceptable for glucose testing. See NOTE above.
  • Glucose
Plasma or serum was received greater than 48 hours from time of collection and specimen was not frozen. Please resubmit. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430. Plasma or serum for Cholesterol/Lipid Profile/Glucose must be frozen and shipped cold. NOTE: Recollect red top tube, remove serum within 2 hours of collection, and freeze until shipped OR recollect gray top tube, remove plasma within 24 hours of collection, and freeze until shipped. Ship with sufficient cold packs to ensure specimen is received cold.
  • Cholesterol/Lipid Profile
  • Glucose

*Red top (serum) acceptable for Cholesterol/Lipid Profile or Glucose

*Gray top (plasma) acceptable for Glucose ONLY
Specimen was received at ambient temperature due to inadequate cold packs. Please resubmit. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430. Specimen for Cholesterol/Lipid Profile/Glucose must be received cold. See NOTE above.
  • Cholesterol/Lipid Profile
  • Glucose
Serum was received at ambient temperature greater than 8 hours from time of collection. Please resubmit. Serum must be frozen and received cold. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430. Serum for Cholesterol/Lipid Profile/Glucose must be frozen and shipped cold. See NOTE above.
  • Cholesterol/Lipid Profile
  • Glucose
Whole blood was received greater than 2 hours from time of collection. Please resubmit. Serum must be frozen and received cold. For shipping instructions, refer to http://www.dshs.state.tx.us/lab/MRS_shipping.shtm or call 1 (888) 963-7111 ext. 7430. Serum for Cholesterol/Lipid Profile/Glucose must be frozen and shipped cold. See NOTE above.
  • Cholesterol/Lipid Profile
  • Glucose

Miscellaneous rejections

Rejection Statement Explanation or Tip Tests Affected
Specimen submitted in expired blood collection tube. Please resubmit. Specimen was collected and submitted in a blood collection tube that was past its expiration date. Recollect specimen, ensuring that blood collection tube is not expired.
  • Total Hemoglobin
  • Lead
Specimen not received. Please resubmit. Be sure to include specimen in mailing container with submission form.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose

Submitter cancelled test request.

Submitter called laboratory and cancelled test request or cancelled test through Remote Data Services. A report is sent to document disposition of specimen in laboratory’s database.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Laboratory accident. Please resubmit. Specimen compromised or destroyed in laboratory due to laboratory staff error. Recollect specimen and resubmit.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Specimen was received greater than 48 hours from time of collection due to courier failure. Please resubmit. Specimen rejected because it was too old for testing, due to courier failure. Recollect specimen.
  • Cholesterol/Lipid Profile
  • Glucose
Please resubmit to confirm abnormal lead value. Insufficient specimen to confirm abnormal lead value. Recollect specimen, ensuring sufficient volume of specimen is submitted to complete testing.
  • Lead
Please resubmit to confirm abnormal hemoglobin. Insufficient specimen to confirm abnormal total hemoglobin value. Recollect specimen, ensuring sufficient volume of specimen is submitted to complete testing.
  • Total Hemoglobin
Inconsistent results. Please resubmit. Specimen giving inconsistent results. Unable to determine accurate laboratory result. Recollect specimen, ensuring appropriate collection and shipping methods to maintain integrity of specimen.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Specimen was delayed in transit. Please resubmit. Specimen was received after significant delay in transit, resulting in specimen being too old for testing. Recollect and resubmit specimen.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Specimen not tested due to courier failure. Please resubmit. Specimen was rejected because it did not meet pre-analytical requirement due to a courier failure. Recollect specimen.
  • Total Hemoglobin
  • Hemoglobin Type
  • Lead
  • Cholesterol/Lipid Profile
  • Glucose
Last updated October 30, 2014