LABORATORY SERVICE GUIDE - Wilson Health · Bilirubin Scan, Amniotic Fluid À LAB BILAF H Bilirubin, Direct LAB BILD G Bilirubin, Total (Reflexes to Direct) LAB BILT G Bilirubin,

WMH SERVICE GUIDE

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LABORATORY SERVICE GUIDE

Wilson Memorial Hospital Laboratory

915 W. Michigan St.

Sidney, Ohio 45365

498-5312 Main Laboratory

497-5656 WMH Central Scheduling

498-5539 Pathology

498-5349 Laboratory Manager

498-5350 Pathologist

498-5420 Laboratory FAX

498-5555 Central Scheduling FAX

Department extensions:

Blood Bank – 5348

Chemistry – 5346

Hematology – 5397

Microbiology - 5347

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QUICK REFERENCE.................................................................................................................... 4

GENERAL LABORATORY TEST INFORMATION………………………………….………27

REFLEX TEST INFORMATION………………………………………………………….……30

SERVICE POLICY ...................................................................................................................... 33

INPATIENT ORDERS……………………………………………………………………......33

OUTPATIENT ORDERS…………………………………………………………………..…33

STANDING ORDERS…………………………………………………………………….….35

HOURS OF SERVICE…………………………………………………………………….…35

REFERRED WORK................................................................................................................. 35

WALK-IN TESTING ............................................................................................................... 36

INPATIENT REPORT DISTRIBUTION…………………………………………………….36

OUTPATIENT REPORT DISTRIBUTION..………………………………………..……….36

SPECIMEN COLLECTION…………………………………………………………………….38

SPECIMEN LABELING……………………………………………………………………..38

COLLECTING BLOOD SPECIMENS…………………………………………………….…40

VACUTAINERS……………………………………………………………………………...50

ORDER OF DRAW…………………………………………………………………………..51

AMA/CPT PANEL INFO….……………………………………………………………….…52

VENIPUNCTURE WHEN IV ADMINSTRATION IS IN PROCESS.....……………….…...53

MASTECTOMY PATIENTS………………………………………………………………....54

BLOOD BANK SPECIMEN COLLECTION………………………………………………...39

URINE SPECIMEN COLLECTION ........................................................................................ 54

ROUTINE URINALYSIS………………………………………………………………….….54

TIMED SPECIMENS................................................................................................................ 55

BODY FLUIDS ......................................................................................................................... 56

FECES........................................................................................................................................ 57

SPUTUM ................................................................................................................................... 61

SPECIMEN REJECTION POLICY............................................................................................. 62

TRANSFUSION SERVICE……………………………………………………………………..64

ROUTINE PROCEDURES…………………………………………………………………..64

PEDIATRIC TRANSFUSIONS............................................................................................... 69

EMERGENCY TRANSFUSION ............................................................................................. 69

OP TRANSFUSION................................................................................................................. 70

AUTOLOGOUS TRANSFUSION........................................................................................... 70

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AVAILABILITY OF BLOOD ................................................................................................. 71

COMPONENTS ...................................................................................................................... 71

UNEXPECTED ANTIBODIES…………………………………………………………...…74

TYPE AND SCREEN PROCEDURE (T&S) ......................................................................... 74

CORD BLOOD........................................................................................................................ 74

Rh IMMUNE GLOBULIN...................................................................................................... 75

THERAPEUTIC PHLEBOTOMY.......................................................................................... 77

POINT OF CARE TESTING.……………………………………………………………….….78

PATHOLOGY/HISTOLOGY/CYTOLOGY.............................................................................. 79

CYTOPATHOLOGY ............................................................................................................... 79

TISSUE PATHOLOGY............................................................................................................ 80

AUTOPSY ................................................................................................................................ 83

MICROBIOLOGY………………………………………………………………………………84

VIROLOGY…………………………………………………………………………………..90

TOXICOLOGY………………………………………………………………………………….91

REFERENCE RANGES AND CRITICAL VALUES................................................................. 95

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QUICK REFERENCE PATIENT PREPARATION, SPECIMEN ORDER MNEMONICS

THE QUICK REFERENCE that follows includes an alphabetical listing of most commonly used tests and synonyms, with the abbreviations used in the Meditech Hospital and Laboratory Information Systems. Its purpose is to help you make requests or guide you to seek more information that may be necessary or useful. No list of laboratory tests can be complete. Phone us if you need one you cannot find here, or consult the LabCorp Directory of Services for unusual tests. Using the code number of any item in that reference will guarantee correct interpretation and filling of your order.

Pathology orders are not handled electronically. For these, the "LIS Abbreviation" column will show the form number to be used for inpatient work. For outpatient work, use a standard WMH outpatient requisition.

PREPARATION: QUICK REFERENCE

N = No preparation = Reference test

H = Special Handling Refer to Lab Corp book Specimen/Tube:

Call lab or reference book for specimen details B = Blue / Citrate Plasma

F = Fasting required L = Lavender/ EDTA Whole Blood

(Not NPO) Normal P= Pathology G = Lt. Green/ PST Plasma

water intake desirable, Contact Pathology PK = Pink/ EDTA Blood Bank

Consult physician about Department with R = Red/ Plain Serum

medications questions S = Serum Red/Gray (SST)

D = Time sensitive test/ U = Random Urine

Deliver to lab within 1 hr BB= refer to Blood Bank UT = Timed Urine/ 24 hr

training and guidelines

PROCEDURE PREP CAT MNEMONIC SPEC

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5-HIAA (Serotonin) Urine, Quant H LAB 5HIAA UT, H

17-Hydroxyprogesterone LAB 17HYP S

17 Ketosteroids LAB 17KS UT, H

ABO Group BB LAB ABO PK

ABO Group & Rh BB LAB ABORH PK

Absolute Lymphocyte Count (Order CBC) LAB CBC L

Acetaminophen (Tylenol) D LAB ACTM G

Acetone, Qualitative, Serum LAB ACTN G or S

Acetylcholine Receptor Antibodies LAB ACHR S

Acid Fast Culture and Smear LAB AFBC H

Acute Hepatitis Panel (HAVAB, HBCAB, HBSAG, HCVAB) LAB HEPDX S

Adrenocorticotropic Hormone (ACTH) LAB ACTH H

Albumin, Body Fluid LAB ALBBF S

Albumin, Plasma LAB ALB G

Alcohol (Ethanol, ETOH) Diagnostic only LAB ALC H, G

Aldosterone H LAB ALDOS S

Alkaline Phosphatase (ALP) LAB ALK G

Alkaline Phosphatase Isoenzymes, Quantitative F LAB ALKPI S

Allergen Panels - See RAST LAB RAST S

Alpha Fetoprotein, Amniotic Fluid LAB AFPAF H

Alpha Fetoprotein Maternal LAB AFPMS S

Alpha Fetoprotein Tetra Profile LAB AFPT S

Alpha Fetoprotein, Tumor Marker LAB AFPTM H

Alpha Fetoprotein Xtra LAB AFPX S














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Alpha-1-Antitrypsin, Serum LAB A1A S

Alpha-1-Antitrypsin, Stool LAB A1AST

ALT (Alanine Amino Transferase, GPT) LAB SGPT G

Aminophylline (see Theophylline) LAB THEO G

Amitriptyline (Nortriptyline) H LAB AMNO R

Ammonia, Blood (need full unopened G tube on ice) H LAB AMON H, G

Amniotic Fluid Cytogenetics H LAB CYTOG H

Amniotic Fluid Cytogenetics and AFP LAB CYAFP H

Amniotic Fluid, Lamellar Body Count H LAB LAMB H

Amylase, Body Fluid LAB AMYBF H

Amylase, Plasma LAB AMY G

Amylase, Total Urine LAB AMY24UR UT, H

Amylase, Urine Concentration LAB AMYU U

ANA (Antinuclear Antibody) LAB ANA S

ANCA (Antineutrophil Cytoplasmic Antibody) Profile LAB ANCA S

Angiotensin Converting Enzyme LAB ACE S or G

Antibody Screen (Indirect Coombs) BB LAB ABSCR PK, R

Anticardiolipin Antibodies, IgG, IgM LAB ACA S

Anti-DNA, Double Strand LAB DSDNA S

Anti-Endomysial Antibody IgA LAB AEMAB S

Anti-Extractable Nuclear Antigen LAB ANTIEX S

Anti-Helicobacter IgG LAB AHELG S

Anti-Mitochondrial AB Quant LAB AMA S

Antineutrophil Cytoplasmic Antibody Profile (ANCA) see LAB ANCA S














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labcorp book page 114 for included tests

Antineutrophil Cytoplasmic Antibody Profile (ANCA) see labcorp book page 114 for included tests

LAB ANCAPROF S

Antinuclear Antibody LAB ANA S

Antinuclear Antibody with Titer LAB ANAWTITER S

Anti-Smooth Muscle AB Quant LAB SMAB S

Antistreptolysin-O (ASO) LAB ASLOS S

Antithrombin III (ATIII) Functional LAB AT3 H, B

APTT (Activ. Partial Thromboplastin Time) LAB PTT H, B

AST (Aspartate Aminotransferase, GOT) LAB SGOT G

B-12 & Folates LAB B12F S

Basic Metabolic Panel (Incl GLUC, BUN, CREA, CA, NA, K, CL, TCO2) N or F LAB MPB G

Beta-2 Microglobulin LAB BETA2M S

Bilirubin Scan, Amniotic Fluid LAB BILAF H

Bilirubin, Direct LAB BILD G

Bilirubin, Total (Reflexes to Direct) LAB BILT G

Bilirubin, Total & Direct LAB BILTD G

Bleeding Time LAB BLTM H

Blood Grouping, Blood Typing LAB ABORH L, PK, or R

Body Fluid Cell Count LAB CCBF H

Bone Marrow Biopsy Form 36 P

BNP(Brain Natriuretic Peptide) LAB PBNP G

BUN (Blood Urea Nitrogen) P LAB BUN G














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C. difficile Antigen & Toxin MIC CDTAG H

Calcitonin F LAB CAL F, H!

Calcium, Total Urine LAB CA24UR UT, H

Calcium, Ionized F LAB CAI S, H

Calcium, Plasma LAB CA G

Calcium, Urine Concentration LAB CAU U

Calculus Analysis LAB CALCU H

Cancer Antigen 125 LAB CA125 S

Cancer Antigen 15-3 LAB CA15-3 S

Cancer Antigen 27-29 LAB C2729 S

Carbamazepine (Tegretol) D LAB CARB G

Carbohydrate Antigen 19-9 LAB CA199 S

Carbon Dioxide, Total Plasma LAB CO2 G

Carcinoembryonic Antigen (CEA) LAB CEA S

Catecholamines, Fractionated, Urine H LAB CATFU UT, H

CBC With Reflex Smear/Diff LAB CBC L

CBC With Automated Diff LAB CBCWO L

CBC With No Differential LAB CBCNODIFF L

CEA (See Carcinoembryonic Ag.) LAB CEA S

Cell Block, Body Fluid (See Cytology) FORM 36 P

Cell Count, Body Fluid LAB CCBF H

Cell Count, Spinal Fluid LAB CCCSF H

Cellophane Tape Prep H MIC PIN H

Ceruloplasmin, S H LAB CERUL H, R

Chlamydia Antigen, DNA Probe LAB CHLAM H














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Chlamydia/GC, DNA Probe LAB CHLGC H

Chlamydia Rapid Immunoassay LAB CHLAMR H

Chloride, Cerebrospinal Fluid LAB CLCSF H

Chloride, P LAB CL G

Chloride, Total Urine LAB CL24UR UT, H

Chloride, Urine Concentration LAB CLU U

Cholesterol, Total LAB CHOL G

Cholinesterase, Serum (Pseudocholinesterase) LAB PCHE H, S

Chromosome Analysis (See Cytogenetics)

CK (Creatine Kinase) & CKMB Isoenzyme LAB CPK G

CK Total LAB CK G

Clomipramine, S (Anafranil) LAB CLOM R

Clonazepam LAB CLO R

Clostridium difficile Toxin MIC CDTAB H

CMV Antibodies Quantitative IgG LAB CMV IGG S

CMV Antibodies Quantitative IgM LAB CMV IGM S

CO2 (TCO2 incl in Electrolytes) LAB CO2 G

Complement (C3) LAB C3 R

Complement (C4) LAB C4 R

Complement (CH50) LAB CH50 S

Complete Blood Count (See CBC) LAB CBC L

Comprehensive Metabolic Panel (Incl GLUC, BUN, CREA, NA, K, CL, TCO2, CA, GOT, GPT, TP, ALB, TBIL, ALP)

N or F LAB MPC G

Coombs, Direct (AHG) LAB DAT PK or L

Coombs, Indirect (Antibody Screen) LAB ABSCR PK or R














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Cord Blood Hold LAB CORHO PK or R

Cord Blood Workup (ABO, Rh, Direct Coombs) LAB CORDW H

Cortisol, Serum LAB COR S

Cortisol, Urine, Free LAB CORTU UT, H

C-Peptide F LAB CPEP H

CPK (See CK) LAB CK G

C-Reactive Protein (CRP) LAB CRP G

C-Reactive Protein Cardiac, Ultrasensitive LAB CARDIACCRP G

Creatinine Clearance LAB CRCL S & UT, H

Creatinine, Plasma LAB CRE G

Creatinine, Urine Concentration LAB CREU U

Creatinine, Urine Total LAB CREA24UR UT, H

Crossmatch BB LAB T&C PK, BB

Cryoprecipitate BB LAB CRYO PK,BB

Cryptococcus Antigen, Spinal Fluid LAB CRYCSF H

Crypto & Giardia Antigen IA LAB MISRE H

Crypto Antigen LAB MISRE H

Crystal ID for Uric Acid, Polarized Light LAB CRYID H

Culture, Abscess MIC ABSC H

Culture, Anaerobic MIC ANC H

Culture, Blood (Anaerobic and Aerobic) x1 MIC BC1

Culture, Blood (Anaerobic and Aerobic) x2 MIC BC2

Culture, Body Fluid MIC BFC H

Culture, Bone MIC BNC H

Culture, Bronchial Brushings MIC BAC H














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Culture, Bronchoalveolar Lavage MIC BALC H

Culture, Bronchial Washings MIC BWC H

Culture, Catheter Tip MIC CTIP H

Culture, CSF MIC CSFC H

Culture, Ear MIC EARC H

Culture, Eye MIC EYEC H

Culture, Fungus, Blood MIC FCBLD H

Culture, Fungus, Body Fluid MIC FCBF H

Culture, Fungus, CSF MIC FCCSF H

Culture, Fungus, Other MIC FCOTHER H

Culture, Fungus, Skin, Hair, Nail MIC FCS H

Culture, Fungus, Sputum MIC FCSP H

Culture, Fungus, Stool MIC FCSTL H

Culture, Fungus, Urine MIC FCUR H

Culture, GC only MIC GC H

Culture, Genital MIC GENC H

Culture, Gp B Strep Screen MIC GBSC H

Culture, H. pylori Urease MIC HPYL H

Culture, Nasopharyngeal MIC NPC H

Culture, Nose MIC NOSEC H

Culture, Sputum MIC SPUC H

Culture, Stool MIC STC H

Culture, Throat MIC THC H

Culture, Urine MIC UC H

Culture, Urogenital MIC GENC H














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Culture, Wound MIC WNDC H

Cyclosporine, Blood LAB CYCLO L

Cytogenetics & AFP, Amniotic Fluid LAB CYAFP H

Cytogenetics, Amniotic Fluid H LAB CYTOG H

Cytogenetics, Blood H LAB CGBLD H

Cytogenetics, Tissue LAB CGTIS H

Cytopathology Form 36 P

D-Dimer LAB DIMER B

Depakene (See Valproic Acid) D LAB VALP G

DHEA LAB DHEA S

DHEA Sulfate LAB DHEAS S

Differential (Manual) WBC LAB DIFF L

Digitoxin LAB DIGI R

Digoxin (Lanoxin) D LAB DIG G

Dilantin (Phenytoin) D LAB PTN G

Direct Coombs LAB DAT L or PK

Disopyramide (Norpace) LAB DIS R

Drug Abuse Screen, Urine LAB DABSU U

Drug Screen, Rapid, Urine LAB UDS U

EB Virus Acute Infection Antibodies Profile-See LabCorp book test number 216655 LAB EBVAP S

EB Virus Antibodies, EA IgG –See LabCorp book test number 096248 LAB EBVEAAB S

EB Virus Antibodies, VCA IgG –See LabCorp book test number 096230 LAB EBVCG S

EB Virus Antibodies, VCA, IgM-See LabCorp book test number 096735 LAB EBVCM S














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Electrolytes, Plasma (Incl NA, K, CL, TCO2) LAB LYT G

Electrophoresis, Hemoglobin (Fractionation) LAB HGBFRA L

Electrophoresis, Serum Protein LAB PREPS S

Eosinophil Count, Absolute (Order CBC) LAB CBC L

ESR (Sedimentation Rate)-Stable for 4 hrs at room temp, 24 hrs if refrigerated LAB ESR L

Estradiol LAB EST S

Estrogens, Total LAB ESTRO S

Estrone LAB ESTRONE S

Ethanol, Medicolegal (ETOH) LAB ETCOC H

Ethanol, Plasma, Diagnostic only LAB ALC G, H

Factor V Leiden Mutation LAB F5LEI L

Fat, Fecal MIC STFF H

Fe++ (See Iron) LAB FE S

Ferritin LAB FERRI S

Fetal RBC Screen LAB FSCR L, H

Fresh Frozen Plasma, 1 unit LAB FFP1 PK, BB

Fresh Frozen Plasma, 2 units LAB FFP2 PK, BB



Fibrin Degradation Products (FDP) See D-dimer LAB DIMER B

Fibrinogen Activity LAB FIB B

Fetal Fibronectin LAB FETFIB H

Fine Needle Aspirate Cytology Form 36 P

Folates LAB FOL S














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Folates and Vitamin B12 LAB B12F S

Free T3 (FT3, Free Triiodothyronine) LAB FT3 G

Frozen Section Form 36 P

FSH (Follicle Stimulating Hormone) LAB FSH S

FT4 (Free T4, Free Thyroxine) LAB FT4 G

FTA (Fluorescent Treponemal AB) LAB FTABS S

Fungus Culture MIC FCOTHER H

Fungus Culture, Blood MIC FCBLD H

Gabapentin (Neurontin) LAB NRNTN R

Gastric Occult Blood LAB GOCBLD H

Gastrin, S F LAB GAS S, F, H

Gentamicin (Garamycin), Peak D LAB GENP G, H

Gentamicin (Garamycin), Random LAB GENR G

Gentamicin (Garamycin), Trough D LAB GENT G, H

GGT (Gamma Glutamyl Transferase, GT,) LAB GGT G

Giardia Lamblia Antigen LAB MISRE H

Glucose Post 50 Grams LAB GLUCPOST50 G

Glucose Post 75 Grams LAB GLUCPOST75 G

Glucose Tolerance (GTT), 2 Hour F LAB GTT2

Glucose Tolerance, 3 Hour F LAB GTT3



Glucose, Body Fluid LAB GLUBF G, U, CSF

Glucose, Cerebrospinal Fluid LAB GLUCSF CSF

Glucose, Random D LAB GLU G














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Glycohemoglobin (Hgb A1C) LAB HGBA1C L

Gonococcus (GC) Culture MIC GC H

GOT (AST, SGOT) LAB SGOT G

GPT (SGPT, ALT) LAB SGPT G

Gram (Stain) Smear MIC GS H

Group A Streptococcal Antigen Screen LAB SS H

Group B Strep Culture MIC GBSC H

Haptoglobin LAB HAP S

HCG Serum Qualitative LAB HCGS S

HCG Urine Qualitative LAB HCGU U

HCG, Serum Quantitative LAB HCGQ G

HDL (High Density Lipoprotein Cholesterol) F LAB HDL G

Hematocrit (See also Microhematocrit) LAB HCT L

Hemoglobin LAB HGB L

Hemoglobin & Hematocrit LAB H&H L

Hemoglobin A1C LAB HGBA1C L

Hemoglobin Electrophoresis(Fractionation) LAB HGBFRA L

Hemoglobin S (Sickle Cell) LAB HGBS L

Hepatic Function Panel-includes Alb,TP,Alk Phos,AST,ALT, T.Bil, D. Bil LAB LIVER G

Hepatitis A Antibody, IGM LAB HAVM S

Hepatitis A Antibody, Total LAB HAVAB S

Hepatitis A Antibody, Total/IGM LAB HCVAB S

Hepatitis B Core Antibody, IGM LAB HBCIGM S

Hepatitis B Core Antibody, Total LAB HBC S














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Hepatitis B Surface Antibody LAB HBSAB S

Hepatitis B Surface Antigen LAB HBSAG S

Hepatitis B Surface Antigen, Source (No Charge) LAB HBSAGNC S

Hepatitis C Antibody LAB HCVAB S

Hepatitis C Antibody, Source (No Charge) LAB HCVABNC S

Hepatitis Panel, Acute (HEPAB, HBCAB, HBSAG, HCVAB) LAB HEPDX S

Herpes Simplex Virus I & II IgG, w Reflex to Type Specific LAB HSVGB S

Herpes Simplex Virus I and II by PCR (CSF, Tissue, Swab) H LAB HSVPCR H

Herpes Simplex Virus Culture H LAB HSVC H

Heterophile (Order Inf Mono Aggl) LAB MONO S

HIV-1 (HIV AB), Source (No Charge) LAB HIVNC S

HIV-1 (Human Immunodeficiency Virus AB) w Reflex Western Blot LAB HIV S

HLA-B27 LAB HLA H

Homocysteine, Plasma F LAB HOMOC L, H

IgG Panel, CSF LAB CSFGP CSF

Immunoelectrophoresis, Serum F LAB IEPS S

Immunoelectrophoresis, Urine LAB IMEU U

Immunoglobulin A (IgA), Quantitative LAB IGA S

Immunoglobulin D (IgD), Quantitative LAB IGD S Immunoglobulin E (IgE), Quantitative LAB IGE S Immunoglobulin G (IgG), Quantitative LAB IGG S Immunoglobulin M (IgM), Quantitative LAB IGM S Immunoglobulins G, A, M, and E, Quant LAB IGAME S














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Indirect Coombs (Antibody Screen) LAB ABSCR PK, R

Infectious Mononucleosis Aggl. LAB MONO S,G or L

Influenza A&B Antibody Detection LAB INFLA&B H

INR (International Normalized Ratio) Order Prothrombin Time LAB PROTM B

Insulin LAB INS S

Insulin-Like Growth Factor I (Somatomedin-C) LAB IGF1 S

Ionized Calcium LAB CAI S, H!

Iron, S LAB FE S

Iron, S, & Binding Capacity (TIBC) LAB IR&BC S

Iron, Total LAB FE S

Iron, Total & Binding Capacity LAB IR&BC S

K+ (Potassium), Plasma LAB K G

Ketones (Acetone), Plasma LAB ACTN G or S

KOH Prep, Hair, Skin & Nail MIC KOHHSN H

KOH Prep, Other MIC KOH H

Lactic Acid LAB LAC Gray on ice

Lamotrigine (Lamictal) LAB LAMCT R

Lanoxin (See Digoxin) D LAB DIG G

Larvae (visible) skin scrapings MIC MACRO EXAM

LDH (Lactic Dehydrogenase), Body Fluid LAB LDHBF H

LDH (Lactic Dehydrogenase), CSF LAB LDCSF H

LDH (Lactic Dehydrogenase), Plasma LAB LDH G

LDH Isoenzymes LAB LDHISO S

LDL Cholesterol, Direct F12Hr LAB CLDL G














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Lead, Blood, Adult LAB LEADAD L

Lead, Blood, Pediatric LAB LEADC L

Legionella DFA LAB LEGDFA H

Legionella Urinary Antigen LAB MISRE U

Leuko-Reduced PRBC 1 Unit BB LAB PC1LR BB

Leuko-Reduced PRBC 2 Units BB LAB PC2LR BB





Lice skin scrapings MIC MACRO EXAM

Lipase, Body Fluid LAB LIPBF H

Lipase, Plasma LAB LIP G

Lipid Panel (Cholesterol, Triglyceride, HDL, LDL, LDL) F 12hrs LAB LIPID G

Lithium LAB LITH S

Liver Function Panel –See Hepatic Function Panel LAB LIVER G

Lupus Anticoagulant H LAB LA B, H

Luteinizing Hormone LAB LH S

Lyme Disease Antibody, IgM LAB LYMEIGM S

Lyme Disease Antibody, Total LAB LYME S

Macro Exam, Arthropod MIC MACRO-EXAM

Magnesium (Mg++), P LAB MG G

Metabolic Panel, Basic (Incl GLUC, BUN, CREA, CA, NA, K, CL, TCO2) N or F LAB MPB G














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Metabolic Panel, Comprehensive (Incl GLUC, BUN, CREA, NA, K, CL, TCO2, CA, GOT, GPT, TP, ALB, TBIL, ALP)

N or F LAB MPC G

Metanephrines, Urine, Quantitative LAB METU UT, H

Methicillin Resistant Staph Aureus Culture MIC MRSAC H

Microalbumin 24 Hr U LAB MAL24 UT, H

Microalbumin Concentration U LAB MALBU U

Microalbumin/Creatinine 24 Hr U LAB MAC24 UT, H

Microalbumin/Creatinine Ratio U LAB MACRR U

Miscellaneous Reference Test LAB MISRE

Miscellaneous Reference Test 2 LAB MISRE2





Mites skin scrapings MIC MACRO EXAM

Mixing Study LAB MIXST B

Mono Test LAB MONO L or G

Mycoplasma Antibodies, IGG & IGM LAB MYCAB S

Mysoline (Primidone) LAB PRIM R

N. gonorrheae DNA Probe LAB NGPRB H

Na+ (Sodium) LAB NA G

Neurontin (Gabapentin) LAB NRNTN R

NH3 (See Ammonia) LAB AMON G, H














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Nortriptyline, (Aventyl), Serum LAB NOR R

Occult Blood, Fecal LAB OCBLD H

Occult Blood, Gastric LAB GOCBLD H

Osmolality, Serum LAB OSMO S

Osmolality, Urine LAB OSMOU U

Ova & Parasites LAB O&P H

Oxalates, Urine Total LAB OXA24 UT, H

Pap Smear (Cytology) Form 36 H

Parathyroid Hormone (PTH), Intact F LAB PTHI S

Partial Thromboplastin Time (PTT) LAB PTT B, H

Pathology Form 36 P

PH, Body Fluid LAB PHBF H

pH, Fecal MIC PH-STOOL 1Gm, H

PH Urine LAB PH URINE

Phenobarbital (Luminal) LAB PHNO G

Phenytoin (Dilantin) D LAB PTN G

Phosphatase, Alkaline LAB ALK G

Phosphorus (P++), P LAB PHOS G

Phosphorus, Urine Concentration LAB PHOSU U

Phosphorus, Urine Total LAB PHOS24UR UT, H

Pinworm Exam, Cellophane Tape Prep H MIC PIN H

Placental Estriol LAB ESTRI S

Platelet Count LAB PLT L

Platelets, Apheresed (equivalent to 5 random donor units) BB LAB PLTSAPH BB














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Potassium, CSF LAB KCSF H

Potassium, Plasma (K+) D LAB K G

Potassium, Urine Concentration LAB KU U

Potassium, Urine Total LAB K24UR UT, H

Prealbumin, S LAB PREALB S

Pregnancy Test (HCG) Serum Qualitative LAB HCGS S

Pregnancy Test, Urine Qualitative LAB HCGU U

Primidone (Mysoline) LAB PRIM R

Procainamide (Pronestyl) LAB PROC R

Progesterone, Serum LAB PROG S

Prolactin LAB PROL S,H

Prostate Spec Ag, Free/Total Ratio LAB PSAFT S

Prostate Specific Antigen Screen, Total LAB TPSASC S

Prostate Specific Antigen, Total (PSA) LAB TPSA S

Protein C, Functional LAB PNCF B, H

Protein Electrophoresis, 24 Hr Urine LAB PEU24 UT, H

Protein Electrophoresis, Serum LAB PREPS S

Protein S, Functional LAB PNSF B, H

Protein, Body Fluid LAB PRBF H

Protein, CSF H LAB PRCSF CSF

Protein, Plasma, Total LAB TP G

Protein, Urine, Total 24 Hour LAB TP24UR UT, H

Protein, Urine Total Random LAB TPU

Prothrombin Time LAB PROTM B, H

Pseudocholinesterase, S LAB PCHE S, H














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PT (See Prothrombin Time) LAB PROTM B

PTH INTACT (See Parathyroid Hormone) F LAB PTHI S

PTT (See APTT) LAB PTT B

Quinidine LAB QUIN R

RA (Rheumatoid Arthritis) Factor w Titer LAB RA S

RAST Panel Mini LC 065052 LAB RAST S, H

Red Cell Count LAB RBC L

Red Cell Indices LAB HGRM L

Reducing Substance, Fecal MIC RS-STOOL 1Gm, H

Renal Panel (Incl BUN, CREA, LYT, ALB, CA, P, GLUC) LAB RENAL G

Renin, Plasma LAB REN 2L, H

Respiratory Syncytial Virus (See RSV) LAB RSVAG washing

Reticulocyte Count LAB RETIC L

Rh Antibody (Indirect Coombs) BB LAB ABSCR PK,BB

Rh Factor (Rh Type) BB LAB RHD PK,BB

Rh Immunoglobulin Workup (RhoGAM workup) Antepartum LAB RHIGWA PK or L

Rh Immunoglobulin Workup (RhoGAM workup) Postpartum BB LAB RHIGWP PK or L

Rheumatoid Factor (RA, RF) LAB RA S

Rotavirus Antigen LAB MISRE H

RPR (Rapid Plasma Reagin) LAB RPR S

RSV Antigen by Direct Fluorescent AB LAB RSVABDFA H

RSV Antigen Screen EIA LAB RSVAG washing

Rubella AB, IgG, Quantitative LAB RUB S














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Rubeola IgG, AB, Quantitative LAB RUBE S

Salicylate LAB SAL S

Scabies skin scrapings MIC MACRO EXAM

Sedimentation Rate (ESR) LAB ESR L

Semen Exam, Fertility H LAB SEFER H

Semen Exam, Post-Vasectomy H LAB SEPV H

Serotonin Metabolite (5-HIAA) Urine, Quantitative 24 Hr LAB 5HIAA UT, H

Serotonin, S LAB SEROT R, H

SGOT (AST, GOT) LAB SGOT G

SGPT (ALT, GPT) LAB SGPT G

Sickle Cell Exam (Hemoglobin S) LAB HGBS L

Sjogren's Antibodies (Incl Anti-SS-a and Anti SS-b LAB SJOGANT S

Smear, Acid-Fast (TB) MIC AFBSM H

Smear, Fecal WBC MIC SMWBC H

Smear, Fungus MIC FS H

Smear, Gram Stain MIC GS H

Smear, India Ink MIC II CSF

Smear, KOH, Hair, Skin, Nail MIC KOHHSN H

Smear, Wet Mount MIC WETP H

Sodium (Na+), Plasma LAB NA G

Sodium, CSF LAB NACSF H

Sodium, Urine Concentration LAB NAU U

Sodium, Urine Total LAB NA24UR UT, H

Specific Gravity, Body Fluid, Refractometer LAB SGBF














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Stones, Urinary (Calculus Analysis) LAB CALCU H

Stool Fat MIC FF H

Streptococcus Gp A Antigen Screen LAB SS H

Streptococcus Gp B (See Group B Streptococcus) MIC GBSC J

Streptococcus pneumoniae antigen urine LAB MISRE U

Streptococcus pneumoniae antigen CSF LAB MISRE CSF

STS (Serologic Test for Syphilis) LAB RPR S

Surgical Pathology (Gross & Microscopic) Form36 P

T3 Hormone LAB T3HRM G

T3 Hormone, Free LAB FT3 S, H

T3 Uptake LAB T3U S,H

T4, Free LAB FT4 G, H

T4, Total LAB T4 G

T7 (FTI) LAB T7 S, H

Tacrolimus LAB TACRO L

Tegretol (Carbamazepine) D LAB CARB G

Testosterone Total LAB TEST S

Testosterone, Free LAB TESTF S

Theophylline (Aminophylline) LAB THEO G

Thyroglobulin Antibody LAB THYATG S

Thyroglobulin, Quantitative LAB THYG S

Thyroid Peroxidase Antibody LAB TPO S

Thyroid Stimulating Hormone (See TSH)

Thyroxine, Free (FT4) LAB FT4 G

Thyroxine, Total (T4) LAB T4 S, H














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Tobramycin Peak D LAB TOBP G, H

Tobramycin Random D LAB TOBR G

Tobramycin Trough D LAB TOBT G, H

Total Iron Binding Capacity (TIBC) LAB IR&BC S

Total Lymphocyte Count (Order CBCWO) LAB CBCWO L

Total Protein - See Protein

Transferrin LAB TRANS S

Transfusion Reaction Workup LAB TRW See form

Triglycerides F LAB TRIG G

Troponin-I LAB TROP G

TSH (Thyroid Stimulating Hormone) Reflexes to FT4 LAB TSH G

TSH (Thyroid Stimulating Hormone) Without Reflex FT4 LAB TSHWO G

T-Uptake (T3U) LAB T3U S, H

Tylenol (See Acetaminophen) D LAB ACTM G

Type & Crossmatch BB LAB T&C PK, BB

Type & Screen BB LAB T&S PK,BB

Type (ABO) BB LAB ABO PK

Type (Rh) BB LAB RHD PK

Urea Nitrogen (BUN) LAB BUN G

Urea Nitrogen, Urine Total LAB BUN24UR UT, H

Urea Nitrogen, Random Urine Concentration LAB BUNU U

Uric Acid Crystals, Polarized Light LAB CRYID H

Uric Acid, Body Fluid LAB URICBF H

Uric Acid, Plasma LAB URIC G

Uric Acid, Random Urine Concentration LAB UAU U














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Uric Acid, Urine Total LAB URIC24UR UT, H

Urinalysis With Microscopic LAB UA&MIC U, H

Urinalysis Without Microscopic LAB UAWOMIC U, H

Urinalysis With Reflex Culture LAB UAREFLEX U,H

Urinalysis, Routine w Reflex Microscopic LAB UA U, H

Urine Drug Screen, Rapid LAB UDS U

Vaginitis/Vaginosis DNA Probe LAB BVVAGPANEL AFFIRM

Valproic Acid (Valproate, Depakene) D LAB VALP G,

Vancomycin, Peak D LAB VANP G

Vancomycin, Random D LAB VANR G

Vancomycin, Trough D LAB VANT G

Vanillylmandelic Acid (VMA), 24 Hr Urine LAB VMAU UT, H

Varicella-Zoster IgG AB LAB VZ S

Viral Culture, General LAB GVC H

Vitamin B12 LAB VITB12 S

Vitamin B-12 & Folates LAB B12F S

WBC (White Blood Count) LAB WBC L

WBC Smear (Usually for fecal WBC) MIC SMWBC H

Wet Prep MIC WETP H

Original – 12/96

Revised – 12/98, 07/03, 04/05, 04/07,06/07,08/08,09/08,02/09,06/09,04/11

WMHL Service Guide 27

GENERAL LABORATORY TEST INFORMATION

ORAL GLUCOSE TOLERANCE TESTING

The following list is the available testing options offered in the laboratory:

1. One-hour test using a 50-gram glucose load

2. 2 hr glucose tolerance using a 75 gram glucose load

3. 3 hr glucose tolerance using a 75 gram glucose load

4. 3 hr gestational glucose tolerance using a 100 gram glucose load

The patient should be fasting for 12 hours prior to testing. The laboratory will collect blood and perform a fasting glucose before giving the glucose test beverage. If the fasting glucose is >200 mg/dL, the physician will be notified before proceeding with the test.

HIV TESTING –Consult current WMH policy on informed consent before ordering test.

For anonymous HIV testing, the patient must be referred to:

Allen County Health Department AIDS Outreach Office

219 E. Market St., Lima Montgomery County Health Department

Tel 419 228 4457 Tel 937 496 7133

The requesting individual may also be informed of the Ohio AIDS Hotline, 800-332-2437.

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PARTIAL THROMBOPLASTIN TIME

When used for heparin therapy monitoring, order test according to the following:

Continuous IV Infusion - Before, at 6, and at 12 hours after start, and at 24-hour intervals thereafter. The dose should be adjusted to maintain a PTT of about 1½ times normal.

Intermittent IV Injection (4 hour interval) - Dose should be adjusted to give a PTT of 1½ times normal at 15-20 minutes before the next injection.

The PTT may be affected by high coumadin dosages.

PROTHROMBIN TIME - Exact sampling times are unnecessary because of the long half-life of coumadin, but heparin will interfere if plasma concentration is >0.4 U/ml, so that the test should be done at least 5 hours after IV heparin dose and 24 hours after subcutaneous dose to assure good results. Anticoagulant effect of coumadin is usually delayed for 10-12 hours after administration, and full response requires several days.

THERAPEUTIC DRUG MONITORING -Below is listed the order status choices for therapeutic drug monitoring: Random is a choice should the test be ordered at some time other than Peak or Trough.

Trough samples should be drawn just prior to infusion of the next dose.

Peak levels should be drawn according to pharmacy requirements.

See manufacturer's or other literature for recommended sampling times and always state a time for sample collection accordingly. Results obtained and/or effects of any given therapeutic are affected by time and route of administration, sampling time, patient condition, individual patient response, and drug interactions.

Where peak and trough assays are required, consult the literature (PDR, package insert, TDM guide texts) or Pharmacy to determine the proper sampling time or dosing protocol. Be careful to order the correct item – Peak, Trough, or Random – so that this information will appear on the report, and with the correct reference range.

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Peak Assay Recommended Draw Time After: Drug: Oral Dose IM 30 Min IV 60 Min. IV

Gentamicin 45-60 min 30 min 30 min

Tobramycin 60 min 30 min 30 min

Vancomycin 60 min 2 Hrs

Digoxin 8 Hrs. 4 Hrs

Original 12/96

Revised – 12/98, 07/03, 04/05, 04/07, 07/09,05/10

Reviewed-04/11

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REFLEX TEST INFORMATION Reflex testing is used in some cases where results of a procedure indicate the need for further analysis. Reflex algorithms are established by the medical director through consultation with and concurrence of the medical staff. Reflex test information is reviewed annually on the laboratory CQI report by the medical staff.

COMPLETE BLOOD COUNT WITH REFLEX DIFF - The CBC includes RBC, Hemoglobin, Hematocrit, Indices, PLT, WBC, and 5-part automated WBC Differential. A peripheral smear may be reviewed based on instrument-produced flagging. A Manual Differential may be performed due to the presence of immature forms (blasts, promyelocytes, myelocytes, metamyelocytes), when some of all of the electronic differential is not resulted by the instrument, or when specifically ordered by the physician.

COMPLETE BLOOD COUNT WITH AUTOMATED DIFFERENTIAL-The CBC with Automated Differential includes the same parameters as the CBC but with no reflex manual differential. A Manual Differential may be performed due to the presence of immature forms (blasts, promyelocytes, myelocytes, metamyelocytes), when some of all of the electronic differential is not resulted by the instrument, or if specifically ordered by the physician.

A pathologist review(PATHR) may be separately ordered but is a reflex order when:

1. Peripheral Smears show:

_ Any blasts of any cell line or malignant cells.

- Leukocytes with immature granulocytes (blasts, promyelocytes, myelocytes, metamyelocytes) with basophilia AND with a count >25,000.

- Atypical lymphocytes resembling blasts

- Marked microcytosis (MCV <70)

- Malarial or other parasites

- Any other abnormality that may be considered "unusual" or unidentifiable by the technologist

2. Any other results that the technologist feels are sufficiently abnormal to warrant a review by the Pathologist, i.e. if the results are not consistent with an obvious diagnosis.

COMPLETE BLOOD COUNT WITH NO DIFFERENTIAL-A CBC with no Differential is available.

COMPLETE BLOOD COUNT AND MANUAL DIFFERENTIAL- A CBC and manual differential is available.

PERIPHERAL SMEAR REVIEW/PATHOLOGIST REVIEW FOR SMEARS- An order for a peripheral smear review where the CBC was performed previously elsewhere necessitates a concurrent on-site CBC with automated diff, especially for pathologist review.

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MICROBIOLOGY CULTURES – All positive cultures will get identification and sensitivity where indicated.

RAPID GROUP A STREPTOCOCCAL ANTIGEN TEST – A throat culture will be set up on all negative antigen tests.

THYROID STIMULATING HORMONE WITH REFLEX FREE T4 -A reflex FT4 will be performed when TSH values fall outside the current reference range.

A Thyroid Stimulating Hormone and Free T4 are available for order individually.

REFLEX LIPID PANEL– When the triglyceride is greater than 400 mg/dl, a direct-measured LDL is performed.

A LIPID PANEL with no reflex is available for order.

URINALYSIS WITH REFLEX TO MICROSCOPIC & REFLEX CULTURE – A urine microscopic will be performed when a urinalysis meets the following criteria: Protein >30 mg/dl, Hemoglobin- trace in male and small in female, positive nitrite or leukocyte esterace. A culture will be performed with a positive nitrite and/or leukocyte esterase.

URINALYSIS WITH REFLEX TO MICROSCOPIC -A urine microscopic will be performed when a urinalysis meets the following criteria: Protein >30 mg/dl, Hemoglobin- trace in male and small in female, positive nitrite or leukocyte esterace.

URINALYSIS AND MICROSCOPIC WITH REFLEX CULTURE- A culture will be performed with a positive nitrite and/or leukocyte esterase.

A Urinalysis and Microscopic and a Urinalysis without Microscopic are available for order.

BLOOD BANK TESTING

ANTIBODY SCREEN – All positive antibody screens will get antibody identification testing.

CORD BLOOD TESTING-A reflex ABO, Rh and Antibody Screen may be performed on the baby’s mother, if the cord blood has a positive DAT for aid in the interpretation of the positive DAT.

CRYOPRECIPITATE-Any cryoprecipitate order will have a blood type performed using a blood bank specimen where the patient has the corresponding blood bank armband.

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FRESH FROZEN PLASMA – Any fresh frozen plasma order will have a blood type performed using a blood bank specimen where the patient has the corresponding blood bank armband.

PLATELETS- Any platelet order will have a blood type performed using a blood bank specimen where the patient has the corresponding blood bank armband. When an apheresed platelet unit is not available, a 5 pack of random donor platelets may be substituted. All platelet products that are HLA-selected or crossmatch compatible MUST be irradiated prior to shipment. This is automatically done by Community Blood Center.

RBC ORDERS-Any orders for RBC’s will include a Type & Crossmatch if a Type and Screen or Type and Crossmatch were not previously done on a current valid specimen.

RHOGAM WORKUP-Testing will be determined in the blood bank based on the reason and on the patient’s gestational age. It may include an ABO and/or Rh type, antibody screen, fetalscreen, and Kleihauer-Betke fetal hemoglobin stain test on the mother’s specimen. For positive fetal screens a Kleihauer-Betke test will be performed and the number of vials of RhoGam will be issued based on the Kleihauer-Betke results.

TRANSFUSION REACTION WORKUP- Initial testing includes a blood type and DAT on the post reaction specimen. A blood culture may be collected if the patient’s temperature increases four degrees farenheit or bacterial contamination is suspected. Further testing will be determined in the blood bank based on these results and consultation with the pathologist.

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Original 12/96

Revised 12/98, 07/03, 04/05, 04/07,02/08,08/08,02/09,07/09,01/10, 01/11, 12/11

SERVICE POLICY INPATIENT ORDERS

Requests for most laboratory work are made directly in the Meditech Order Entry System. Be especially aware of the following:

PATIENT DEMOGRAPHICS - Always be sure of correct patient identification and account.

PRIORITY - THE HOSPITAL AND LABORATORY INFORMATION SYSTEMS RECOGNIZE THREE LEVELS OF PRIORITY:

ROUTINE work is collected and/or run with the next regular batch.

STAT is that which is both immediately and vitally necessary to the welfare of the patient, and takes precedence over all other matters and results are expected within 1 hour. The following microbiology tests will be reported stat: Gram stains, wet preps, Koh and rapid kit testing. Any reference laboratory test that a stat result is necessary will need to have special arrangements. A red line is to be marked on the specimen label to flag it as a stat.

URGENT is understood to mean that results are needed and expected within 2 hours. A blue line is to be marked on the specimen label to indicate it is urgent.

Call Result Comments – In order to document physician orders appropriately any request for call results will be taken from the chart and placed in the comment section of the order by the nursing unit. The laboratory reports containing the comment section indicating call results to……. print to the floors immediately upon completion. For efficiency and in cooperation with the nursing units the laboratory will not call any results with the call results to…….in the comment section. The laboratory will only call critical values to the nursing units.

PATHOLOGY work is NOT ordered in the information system, but on paper requisitions (form 36).

MISCELLANEOUS TESTS that cannot be found in the system can be ordered using the tests MISRE, MISRE2, MISRE3, MISRE4, MISRE5 AND MISRE6 for Miscellaneous Reference Test. Refer to the LabCorp Directory of Services, obtainable through our Laboratory, for tests not found in the Order Entry system. Enter the test's name and number in the comment section when ordering the MISRE.

OUTPATIENT ORDERS

Laboratory work may be performed only by a written, signed order from a licensed physician, nurse practitioner, podiatrist, dentist or chiropractor as stated in the hospital Administrative Manual Policy and Outpatient Registration Policy Manual. Faxed orders for laboratory work can be faxed to Central Scheduling at 937-498-5555. For add on orders where the specimen is already in the laboratory fax the order to the laboratory at 937-498-5420. Signed orders directed to the laboratory must be received in hand, by mail, by fax, or other electronic means using electronic signature. Telephone/verbal orders will be accepted only from the responsible practitioner and when it is not practical for the order to be given in writing. These must be written on the original order, each addition indicating the physician and the recipient, e.g., “Anna

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Leisser/T.O. Dr. Sydenham.” Verbal order requisitions are forwarded to Medical Records to obtain final documentation.

Laboratory requisitions solicits the following information:

1. The patient’s name or unique patient identifier.

2. The sex and age or date of birth of the patient.

3. The test(s) to be performed.

4. The source of the specimen, when appropriate

5. The date and, if appropriate, time of specimen collection

6. For Pap smears, the patient’s last menstrual period, and indication of whether the patient had a previous abnormal report, treatment, or biopsy.

7. Any additional information relevant and necessary for a specific test to ensure accurate and timely testing and reporting of results, including interpretation, if applicable.

Orders are retained in the Medical Records department.

Each outpatient laboratory test must be ordered individually except in the cases of organ/disease-specific panels described in the current AMA Current Procedural Terminology. Upon receipt of non-specific orders (e.g., "liver enzymes") the order must be clarified before proceeding.

The diagnosis, or ICD-9 code, indicating the medical necessity of each ordered test must be provided with the order. Advance Beneficiary Notices (ABN) are required for Medicare/Medicaid (only) outpatient tests having a Local Medical Review Policy (LMRP) in effect. The ABN is to be signed at registration before a specimen is taken.

THE HOSPITAL AND LABORATORY INFORMATION SYSTEMS RECOGNIZE THREE LEVELS OF PRIORITY:

ROUTINE work is collected and/or run with the next regular batch.

STAT is that which is both immediately and vitally necessary to the welfare of the patient, and takes precedence over all other matters and results are expected within 1 hour. The following microbiology tests will be reported stat: Gram stains, wet preps, Koh and rapid kit testing. Any reference laboratory test that a stat result is necessary will need to have special arrangements. A red line is to be marked on the specimen label to flag it as a stat.

URGENT is understood to mean that results are needed and expected within 2 hours. A blue line is to be marked on the specimen label to indicate it is urgent.

The term "PHONE RESULTS" does not imply any special priority in analysis, and the work is run routinely unless otherwise specified. Results are phoned as soon as available, as opposed to simply reporting through regular paper distribution channels.

Be sure to instruct the patient as to test preparation or specimen collection, laboratory hours, and where to report for testing (Registration). Note on the requisition any special priorities or instructions. We cannot give results to patients or send copies to other physicians unless instructed to do so by the ordering physician.

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STANDING ORDERS

Standing orders for laboratory outpatient testing may be in effect for no more than a six-month period and are monitored by the registration department. Patients whose orders have expired will be refused laboratory testing. Standing orders must have start and stop dates, with a stated frequency. “PRN” orders, or orders without a stated frequency, cannot be accepted.

HOURS OF SERVICE

The laboratory provides services 24 hours daily to all inpatient areas.

The outpatient hours are:

6:00AM - 6:00PM Monday-Friday

7:00AM - 12:00 PM Saturday

Closed Sundays & Holidays.

NOTE: If a patient is being seen outside our regular outpatient hours we recommend the physician calls the Laboratory in advance, and leaves instructions. If this is at a time when Registration is closed, the order will need to be faxed to the laboratory (498-5420) or send it with the patient with the necessary contact information.

Certain testing is not available on weekends, evenings, nights, and holidays. These include:

BIOPSY ASSISTANCE OR EXAM

BONE MARROW

SEMEN EXAM

REFERRED WORK

As approved by the Medical Staff, reference laboratories will be selected by the Laboratory Medical Director and Laboratory Manager. Selection criteria will include available procedures, quality of testing, transport, turnaround time, report quality, communications, price, billing, business practices, and customer service. The Medical Staff will be advised of changes in this regard.

Referral of testing versus testing in-house is based on cost, transportability of specimen, and turnaround time required.

Charges for referred testing are made to the patient by Wilson Memorial Hospital.

Our regular reference laboratory is Laboratory Corporation of America (LabCorp). The Laboratory can be contacted for normal turnaround time for these and other referred tests.

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The LabCorp Directory of Services is provided to the nursing units, and to any physician's office on request. This reference lists available non-routine tests, with their uses, methods, and preparations. Use of the LabCorp test number on the order will guarantee having the exact test requested.

WALK-IN TESTING

The same health screening tests that traditionally have been available only at certain times and places are offered daily, during regular OP service hours and without need for a physicians order. These currently include glucose, HgbA1C, cholesterol, lipid profile, blood grouping, fecal occult blood, urine pregnancy, TSH, PSA, Vitamin D, Calcium, Anemia Screen, Men’s Health Profile and Women’s Health Proile. The tests are done at discounted prices on a cash-only basis. Results are forwarded to the patient only. Critical results will be communicated to the patient and to the pathologist.

SPECIMEN COLLECTION POLICY

Clinical laboratory personnel are skilled in all aspects of blood collection from typical sites, with the exception of indwelling catheters. While they may provide instructions for collection of specimens of other types, laboratory personnel are not trained for or charged with other patient handling or invasive procedures. Neither may they collect other specimens, including legal evidence material, nor assist or directly observe patients in collection of urine, feces, culture material, etc.

INPATIENT REPORT DISTRIBUTION

Emergency and Interim (temporary) general laboratory reports are printed ("broadcast") at nursing units when work on a specimen is complete and certified.

Cumulative reports are printed nightly at the nursing unit for all previous days. These replace all previous interims and cumulatives. Only broadcast reports for the current day and the most recent cumulative are to be retained.

Results Inquiry can be made in the Patient Care Inquiry (PCI) system through connected remote PC's immediately after certification of results. If the report is not in the information system, it does not yet exist. Values outside the reference range are flagged with an H when high and L when low. A C appears when the result is in the critical range.

Inpatient reports are directed to the current patient location. If a patient is moved from the ordering location, the reports will go to the new location. The ordering location can access results through the Patient Care Inquiry (PCI) system.

OUTPATIENT REPORT DISTRIBUTION

Laboratory reports are routinely given to the outpatient’s providers as listed in the registration data upon completion of testing. Test results will be furnished directly to the patient or others only when specified in the written order for the test. Other requests or court orders for patient information will be referred to Medical Records, where copies of all reports are maintained.

Exceptions to the above:

Test results derived under the "Walkin Testing" program are reported only to the patient.

Results of HIV testing ordered by the Shelby County Common Pleas Court Administrator are reported directly to the Shelby County Common Pleas Court Administrator.

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Results of employee health tests, tests performed under hospital infection control policy, or positive communicable disease tests reportable under Ohio law are made known to the hospital Employee Health Nurse/Infection Control Officer.

Telephoned reports will be made only in case of emergency or unusual cases. Our staff is expected to verify the identity of anyone requesting results. Please be prepared to give the following information when requesting a report: the patient’s full name, date of birth, name of the test, and date performed. If we are giving a result we ask that you repeat back the stated test result for confirmation.

REFERENCE LABORATORY reports are delivered electronically to the physician’s office/patient location. For occasional reference laboratory reports not interfaced to the Meditech system, these will be manually faxed/distributed by the reference laboratory or following receipt in our laboratory.

CORRECTED REPORTS will be issued whenever an error is made. The corrected report will be identified as such with a well-documented explanation for the error on the report. Communication will be made to the physician, office staff or patient location.

Original – 12/96

Revised 12/98, 07/03, 04/05, 08/12/05,10/06,02/07,10/07,03/08,06/09,04/11,12/11

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SPECIMEN COLLECTION

SPECIMEN COLLECTION POLICY

Clinical laboratory personnel are skilled in all aspects of blood collection from typical sites, with the exception of indwelling catheters. While they may provide instructions for collection of specimens of other types, laboratory personnel are not trained for or charged with other patient handling or invasive procedures. Neither may they collect other specimens, including legal evidence material, nor assist or directly observe patients in collection of urine, feces, culture material, etc.

SPECIMEN LABELING FOR GENERAL LABORATORY

SEE PATHOLOGY/HISTOLOGY/CYTOLOGY AND MICROBIOLOGY SECTIONS

FOR SPECIMEN LABELING IN THESE DEPARTMENTS

FOR ALL BLOOD BANK SPECIMENS: REQUIRES APPROVED

COLLECTORS, SPECIAL LABEL GUIDELINES, AND UNIQUE PATIENT

IDENTIFIERS. SEE THE BLOOD BANK TRAINING AND REFERENCE

GUIDELINES FOUND ON ALL NURSING FLOORS.

Specimen labeling requirements include:

The blood sample shall be positively identified at the time of collection before leaving the patient’s side.

Outpatient Specimens

Each specimen must be labeled while in the patient’s presence immediately following specimen collection by comparing full name and DOB from Meditech specimen labels and registration paperwork. For Meditech generated labeled specimens the collection time and phelebotomist’s initials are put on each specimen. Handwritten labels will include the patient’s last name, first name, medical record number or DOB, date & time of collection and phlebotomist’s initials.

In-house Patients specimens

Specimens will be identified using full name and medical record number.

Specimens from unidentified patients

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Given or assigned name with Emergency ID Band number and assigned Medical Record number. 1

When Meditech is updated by the Admissions Module all information and previous specimen information is automatically documented in the Laboratory Meditech Module. Per the ED.67 policy a change of Emergency ID Number to Permanent Medical Record Number form will be forwarded to the laboratory which will be placed in the Blood Bank Department.

All Blood Bank specimens

Patient full name, unit (medical record) number, and Blood Bank ID number label. In

unique situations where a unit (medical record)number has not been assigned, the

patient full name with emergency ID Band number and Blood Bank ID number will

be used as the specimen identifier requirements until a unit (medical record) number

has been assigned.

Preferred Identifiers for Specimens Received From an Outside Source

Patient full name and DOB (or other unique identifier matching requisition data) .

PLACEMENT OF LABELS Because of automated equipment, bar coding, and smaller specimen requirements, correct use and application of labels is important. This is in addition to the rigid identification standards that prevent errors.

STANDARD VACUTAINERS Barcode LIS labels must be placed along the long axis of the tube by placing over the manufacturers label. If emergency specimens must be collected with no LIS labels available – a standard registration label may be used. The LIS label, with the specimen number and test to be done, can be added after order entry.

One label may not completely cover another. Place the LIS label leaving the name, MR #, and date of birth visible on both labels. It is also acceptable, where a specimen has a proper registration label, to simply submit the LIS label along with it. Where neither label is available, the required information must be written clearly on the tube.

MICROTAINERS Microtainers present a challenge because of their size. If using a registration label, apply with the left end at the top as for other tubes. Some of the label projects beyond the tube. Simply pinch it. LIS labels, which do not have bar code in this case, should be wrapped around the tube with the ends matching and pressed together.

1Wilson Memorial Hospital Emergency Department Policy ED.67

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COLLECTING BLOOD SPECIMENS

VENIPUNCTURE PROCEDURE In every possible case, blood will be obtained by venipuncture rather than fingerstick. Venipuncture gives the possibility of repeat or additional testing, and the specimen is usually of better quality because of better volume and less contamination or physical change in handling. Chloro-Sepp (chlorohexidine) may be used for preparing the site for blood culture and aqueous Betadine or other non-alcohol based agent (e.g. soap) may be used for blood ethanol levels where alcohol cleansing is not permissible.

NOTE: GLOVES MUST BE WORN FOR ALL VENIPUNCTURES!

Accepted hand washing procedure must be followed (Infection Control/Employee Health Manual, policy A6 HAND HYGIENE); alcohol-based hand sanitizers may be used.)

1. Make sure patient is accurately identified with 2 unique identifiers and inquire if patient has a latex sensitivity.

2. Prepare equipment: gloves, 70% alcohol-wetted cotton ball, gauze pad, tourniquet, syringe and safety needle with a transfer device or safety butterfly along with a transfer device or vacutainer assembly including safety needle and disposable vacutainer holder. If collecting a blood culture, the bottle must be prepped with antiseptic solution. Needle should ordinarily be 21 ga X 1", 22 ga - 23 ga for very small veins. Inspect supplies for possible defects and applicable expiration dates. When using syringes, the plunger should be moved within the barrel of the syringe to show syringe patency and freedom of plunger movement.

A. Never lay cottonballs on table,etc. Have fresh soaked cottonball ready on dispenser to cleanse site. (Gauze pads are used to apply pressure following venipuncture to prevent dislodging of platelet plug.)

B. Position patient.

C. Wash hands; put gloves on.

Apply the tourniquet several inches above the puncture site. The tourniquet must be released after no more than one minute.2 (If the patient has a skin problem, apply the tourniquet over the patient's sleeve if possible. If there is a known latex allergy, use a non-latex tourniquet.)

4. Have the patient close the hand, but not tightly. The limb should be tilted downward if possible to prevent reflux or “backflow”.

2Stasis may result in erroneously high values for all protein-based analytes, hematocrit, and other cellular elements.

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5. Select the best vein for puncture. (This may be done before gloving, but the tourniquet must be momentarily released while putting gloves on.) When vein selection, cleansing, and access take longer than one minute, the tourniquet must be released and reapplied after 2 minutes to minimize the effects of hemoconcentration. Using the index finger of one hand, palpate the arm until the vein is found. Tapping at the vein site with index and second finger a few times will cause the vein to dilate (do not slap). Also, lowering the extremity will allow the veins to fill to capacity.

Three veins exist in the antecubital area that are acceptable puncture sites for phlebotomy. One of these, however, puts the patient at an inordinately high risk compared with the others. The vein of choice is the median cubital vein. It is usually larger and more stationary, less painfull to puncture, closer to the surface of the skin and more isolated from other underlying structure than the others. Inspect the medial veins of both arms before considering one of the other acceptable veins.

The cephlalic vein is the second choice if the patient's medial vein is inaccessible in either arm.

Due to the proximity of the basilic vein (positioned on the medial or inside aspect of the arm) to the median nerve and brachial artery, this vein should only be considered if no other vein is more prominent.

6. Cleanse the puncture site with an alcohol-soaked cotton ball, or other antiseptic if indicated, working from center outward. Do not touch this area again before puncture (unless re-wipe with alcohol). Exception: the site may be touched with a gloved finger that has also been prepped. Allow site to air dry (don’t fan) to prevent contamination and hemolysis of the specimen as well as to prevent the patient from experiencing a burning sensation during venipuncture. Retie the tourniquet if necessary.

7. Using the thumb (1 to 2 inches below the venipuncture site) to pull the skin taut.

Holding the syringe or vacutainer/needle assembly with the needle bevel up, enter the skin in line with the vein (above the gloved thumb holding the vein), at approximately a 15 degree angle to the arm, leveling out on entry of the vein to keep the needle in the vein’s lumen.

9. A prominent vein may be entered with a quick one-step puncture of skin and vein.

When the veins are deeper or more difficult, a two-step procedure may be followed:

- The puncture is performed, and if the vein has not been entered, the index finger of the other hand may be used to palpate above the venipuncture site to reestablish the exact location of the vein. This should be done visually if possible.

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- Withdraw the needle somewhat and slightly redirect the needle to puncture the vein. Probing is not recommended. Lateral needle relocation should never be attempted in an effort to access the basilic vein since nerves and brachial artery are in close proximity. If no blood returns this time, it will be necessary to start-over selecting a new site, using new equipment. It is not advisable to attempt to draw a patient more than twice before having another person try.

10. Squeeze the vacutainer tube forward into the needle of the vacuatiner holder to puncture the stopper allowing the tube to fill. Once the draw has started, do not change the position of the tube until it is withdrawn from the needle.

After the vacutainer has filled to the correct volume and blood ceases to flow, replace with another vacutainer if required. Correct order of draw must be followed. Always remove the last tube collected from the needle/holder prior to withdrawing the needle from the vein.

Mix immediately after drawing each tube that contains an additive by gently inverting the

tube 5 to 10 times. Do not mix vigorously to avoid hemolysis.

The tourniquet should ordinarily be loosened once the blood flow is established. Release

the tourniquet before removing the needle from the vein.

11. Make sure patient's hand is open; holding a gauze pad over the puncture site with gentle

pressure, remove the needle from the vein (take care to pull the needle straight out) and activate the safety device.

12. The phlebotomist should apply pressure to the point of puncture until the bleeding has

stopped. If the patient assists in applying pressure at the point of puncture, continual

observance is necessary to make sure adequate pressure is applied. (Never bend the

patient’s arm up at the elbow because of hematoma risk.) Inspect the arm. Making

sure bleeding has stopped, bandage the site, telling the patient to leave the bandage on

at least 15 minutes. A flexible Band-Aid (with stretching) may be applied over a dry

gauze pad covering the site to maintain a gentle pressure.

If the patient -

- is known to be on anticoagulants,

- shows other indication bleeding may continue or restart,

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- is known to have a blood dyscrasia or coagulopathy, or

- is not responsive,

Wrap COBAN self-adhesive elastic dressing around the arm. For patients with multiple sticks or sensitive or fragile skin, Coban may be used with a gauze pad only.

13. When using a syringe or butterfly system use the transfer device to transfer blood to

vacutainer tubes. The transfer device punctures the stoppers and allows the vacuum to

pull in the specimen; gently invert tubes several times to mix.

14. Dispose of equipment properly in biohazard/needle disposal(SHARPS) containers.

15. Make sure the tubes / containers are labeled correctly at the time of collection.

Use the large accession label, if possible, to record the collection time and your

initials.

16. Remove gloves and wash hands.

17. Excessive Bleeding

If bleeding persists longer than 5 min, notify the patient's physician or nurse of the problem. Pressure must be continued on the site as long as necessary to stop the bleeding.

When a blood sample cannot be obtained, it may be necessary to:

1. Change the position of the needle. If the needle has penetrated too far into the vein, pull it back a bit. If it has not penetrated far enough, advance it farther into the vein. Rotate the needle half a turn.

2. Try another tube. The tube being used may not have had sufficient vacuum.

3. Loosen the tourniquet. The tourniquet may have been applied too tightly, thereby stopping the blood flow. Reapply the tourniquet loosely.

4. Probing is not recommended. Probing is painful to the patient. In most cases another puncture in a site below the first site, or use of another vein on the other arm, is advisable.

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5. It is advisable not to attempt a venipuncture more than twice. Have another person attempt to draw the specimen or notify the physician.

Notify the patient’s physician if unable to obtain the blood sample at the requested time.

If the patient objects to venipuncture, do not argue or use force; patients have the right to refuse.

To reduce blood collection volume small blood collection containers are available and coordination of blood draws should be attempted for more efficient blood specimen usage.

EXPOSURES The phlebotomist must immediately report an accidental needlestick or contamination of a break in the skin by blood or excreta to a supervisor, and follow institutional guidelines.

FOOT VEINS

Venipuncture on foot / leg veins is not recommended and should not be performed for outpatient venipunctures.

BLOOD SAMPLING FROM INDWELLING CATHETERS

INTERNAL ARTERIOVENOUS FISTULAS OR EXTERNAL ARTERIOVENOUS SHUNTS

One of the vital aspects of hemodialysis is the establishment and maintenance of adequate blood access. The major routes of access are External Arteriovenous Shunts and Internal Arteriovenous Fistulas. These access locations must not

be used for blood collection. Venipuncture at these sites can cause damage to or accidental dislodgement of the fistula. The appearance of an arm with a fistulas is shown in the picture to the left. When touched a fistula has a vibrating sensation. If at all possible, use the other arm.

PEDIATRIC PATIENTS OR SEMI-CONSCIOUS PATIENTS

Take special care to secure the arm to prevent injury caused by movement. Obtain help from others when seen necessary. Use judgment regarding allowing the parent or guardian to help with the child.

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VENIPUNCTURE PROCEDURE WITH NEEDLE/BUTTERFLY AND SYRINGE SYSTEM

PROCEDURE: Perform steps 1-2 of the Venipuncture Procedure prior to continuing below.

1. Insert the appropriate safety needle/butterfly set onto the syringe.

2. Select the puncture site. Cleanse site thoroughly with an alcohol-moistened cotton ball. Allow to air dry. Place the patient's arm in a downward position if possible.

3. Grasp the patient's arm firmly. The phlebotomist's thumb should be used to draw the skin taut. This anchors the vein. The thumb should be one to two inches below the venipuncture site.

4. Line up the needle and syringe with the vein from which the blood will be drawn.

5. Turn the needle so that the bevel side is in an upward position.

6. Push the needle into the vein. A sensation of resistance will be followed by easy penetration as the vein is entered. Remove the tourniquet as soon as blood flow is established.

7. Withdraw the desired amount of blood using the syringe.

8. Holding a gauze pad over the puncture site with gentle pressure, remove the needle

and immediately activate the safety device. The phlebotomist should apply pressure

until the bleeding stops. The site should be inspected to make sure the bleeding has

stopped prior to bandage application.

9. Using a transfer device, transfer blood from syringe to appropriate tubes.

Blood is placed into the tubes following the proper order of draw.

10. Dispose of materials in Biohazard/ needle disposal containers.

11. The specimens are to be properly labeled immediately following collection

and before leaving the patient’s side.

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NOTE: A discard tube must be drawn if the first tube drawn is a coagulation tube (blue top) because the air-space can affect the critical 9:1 ratio of blood to anticoagulant.

CAPILLARY PUNCTURE

PURPOSE: Microcollection by skin puncture involves many of the same steps as venipuncture. Fingersticks are done either because of a specific physician/patient request or because it is not possible to obtain blood by venipuncture.

EQUIPMENT:

1. Appropriate micro tubes

2. Sterile lancet (BD Contact Activated Lancet)

3. 70% alcohol

4. Clean cotton balls & gauze pads

5. Gloves

CAUTIONS & LIMITATIONS:

Make sure that the fingertip site is not swollen or edematous, because accumulated fluid in the tissues will contaminate the blood specimen. Do not collect blood from recent incision sites. Do not use providone iodine to disinfect site because of potential for elevated chemistry values. Cold fingers should be pre-warmed prior to collection to ensure good results as warming can increase the blood flow up to seven-fold. It is not advisable to apply adhesive bandages on children less than two years old as they may put it in its mouth, and possibly aspirate it. Bandages may also be ingested by older children.

If a patient is dehydrated or has poor peripheral circulation from other causes (e.g., shock) it may be impossible to obtain a representative blood sample, especially by skin puncture.

PROCEDURE: Perform the prior steps 1-2 in Venipuncture Collection Procedure

1. Choose a finger that is not cold, cyanotic, or swollen. If possible, the stick should be at the tip of the third or fourth finger of the non-dominant hand.

2. Cleanse the site vigorously with an alcohol-moistened cotton ball. Don't use Betadine preps for skin puncture. Blood contaminated with Betadine may have falsely elevated levels of potassium, phosphorus, or uric acid.

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3. Allow to air dry.

4. Open a new sterile skin puncture device within the sight of the patient or guardian and place on a site halfway between the center of the ball of the finger and its side. The puncture should be made across the fingerprints to produce an large, round drop of blood.

5. Hold the patient's finger firmly and press to activate the lancet to make the puncture.

6. Immediately remove the lancet, and discard it in an approved Sharps Container.

7. Wipe away the first drop of blood with a gauze pad.

Apply moderate pressure, encompassing puncture area to obtain a drop of blood. Release this pressure immediately, to allow re-circulation of the blood. The order of collection for microcollection is different than venipuncture: tubes containing EDTA are filled first, followed by tubes containing other additives, then lastly the serum sample tubes.

Work quickly to prevent clotting and repeat until enough blood has been collected in appropriate tubes.

Scooping the blood up from the surface of the skin should be avoided. Drops of blood should be allowed to flow freely into the collector top and down the walls of the tube. If a drop of blood becomes lodged inside the collector top, a gentle tap of the tube on a hard surface is sufficient to move it to the bottom of the tube. When collecting an anticoagulated specimen, the specimen should be mixed well by inverting 8 to 10 times after the lid is placed on the tube.

9. Apply a clean gauze pad to puncture site, using slight pressure and elevation until the bleeding has stopped.

10. Properly label the specimen immediately following collection and before leaving the patient’s side. Note in the specimen comment that the specimen was collected by fingerstick.


NOTES:

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1. Never do more than one puncture at a time. If this is not sufficient, perform another puncture at a different site, using a new lancet. If you cannot obtain enough sample with two capillary punctures request assistance from other laboratory or nursing personnel.

2. Squeezing too tightly will cause tissue juice to mix and dilute the blood.

INFANT HEELSTICK PROCEDURE PURPOSE: Microcollection of blood from an infant's heel involves many of the same steps as venipuncture. It is to be performed with the least amount of trauma. Heel puncture is generally performed on infants less than one year old. However, if the quantity is greater than, or the quality required must be better than what could be obtained by heelstick, then a venipuncture with caution may be performed per institutional policy.

EQUIPMENT:

Appropriate micro tubes

Sterile Lancet (BD Quikheel lancets: Preemie & Infant)

Heel Warmer

Clean gauze or cotton balls

70% alcohol

Gloves

PROCEDURE:

1. Perform the prior steps 1-2 in venipuncture Collection Procedure. Collect proper equipment.

2. Wash hands.

3. Warming the baby’s foot for at least 3 minutes will help increase blood flow. Either a disposable heel warmer or a warm, moist towel at a temperature no higher than 42oC may be used.

4. Put gloves on.

5. Select the site for puncture. It shall be on the plantar surface medial to a line drawn posteriorly from the middle of the great toe to the heel, or lateral to a line drawn posteriorly from between the 4th and 5th toes to the heel. In almost all infants, the heel bone is not under these areas. The puncture shall not be through a previous puncture site, nor shall it be at the curvature of the heel.

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6. Using the appropriate area, clean the site vigorously with alcohol-moistened cotton ball. Don’t use Betadine preps for a skin puncture; blood contaminated with Betadine may have falsely elevated levels of potassium, phosphorus, or uric acid.

7. Allow to air dry.

8. Encompassing, or “milking” the heel to make the skin taught, place the blade slot area of the Quikheel lancet against the heel at the desired incision site. Depress the trigger to puncture. After triggering, immediately remove the lancet and discard in appropriate BioHazard container. Incisions should be made perpendicular to the heelprint.

9. Using a clean gauze pad wipe away the first drop of blood.

10. Apply moderate pressure, encompassing puncture area to obtain a drop of blood. Release this pressure immediately to allow recirculation of the blood. Work quickly to prevent clotting and repeat until enough blood has been collected in appropriate tubes. The order of microcollection is different than veinpuncture; tubes containing EDTA should be filled first, followed by other additive tubes, then serum tubes last.

11. Scooping the blood up from the surface of the skin should be avoided. Drops of blood should be allowed to flow freely into the collector top and down the walls of the tube. When collecting an anticoagulated specimen, the specimen should be mixed well by inverting 8 to 10 times after the closure is placed on the tube.

12. Apply a clean gauze pad to puncture site, using slight pressure and elevation until the bleeding has stopped. Do not apply a bandaid.

13. The specimen must be properly labeled immediately following collection and before leaving the patient’s side.


NOTES:

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1. If enough sample is not obtained, perform another heelstick with a new lancet. If you cannot obtain enough sample after the second attempt request assistance from other laboratory or nursing personnel.

2. Squeezing too tightly will cause tissue juice to mix and dilute the blood.

3. When collecting blood for hematology work, the heel

must be wiped dry after each sampling (platelets will begin to clump immediately

immediately in the blood at the puncture site).

4. Do not puncture a foot if there are bruises, abrasions, or sloughing skin present.

5. Use only a gentle massage when obtaining blood.

6. The lancet used should not risk puncturing the infant’s heel bone.

The Preemie Quikheel has a depth of 0.85 mm and the Infant Quikheel

has a depth of 1.0 mm.

7. Select the least hazardous spot for puncture of the heel; draw an imaginary line from the middle of the great toe postural to the heel. Puncture outside of that line to get an adequate specimen with little chance of bone puncture.

Also puncture only flat surface of the heel and not at the posterior curvature.

VACUTAINERS Check the expiration date on the collection tube; do not use one that has expired. Vacutainer tubes must be filled to the correct level to achieve proper specimen/anticoagulant ratio. Be aware that some fill completely, some do not - the amount of draw is stated on the tube. If a syringe is used to collect blood, a transfer device should be used to fill the vacutainer.

Always strive to fill tubes to the intended volumes. Invert all vacutainers according to manufacturers directions (8-10 times) to mix with anticoagulant or to contact coagulation activators on the inner surfaces.

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MICROCOLLECTION TUBES AND REQUIREMENTS

LAVENDER MICRO:

Fill to between the bottom two lines (250-500 ul). Mix well by inversion 8-10 times. This tube is used for Hematology tests and lead assays.

YELLOW OR AMBER MICRO (SERUM):

Fill volume 400-600 ul. This tube also contains serum separator . The color of the tube protects the specimen from light which is necessary for bilirubin testing. Invert

SST tubes with clot activator 5 times.

GREEN MICRO:

Fill volume 400-600 ul. Mix well by inversion 8-10 times. This tube contains Lithium Heparin and may be used for tests where heparinized plasma is acceptable. It is usually used for chemistry tests on newborns.

NOTE: Always fill EDTA (lavender top) first when more than one microtainer tube is obtained.

NOTE: The blue top tubes commonly used for coagulation studies have no equivalent microcollection tube and must be collected by venipuncture only.

ORDER OF DRAW

Contamination of specimens with tissue fluids or admixture of additives when collecting multiple samples can affect test results. To prevent this, the order of draw is blood cultures, Yellow, Blue, Red, SST, Green, Lavender (pink), Gray whether the phlebotomist is using a straight needle or syringe.

COMMON BLOOD TESTS COLLECTION INFORMATION LIS LABELS When Laboratory Information System labels are used, the labels show the type of standard vacutainers required. When there is extreme difficulty obtaining a satisfactory specimen microtainers may be used. The laboratory can supply information about microtainer or pediatric size vacutainer requirements for a given order.

AMA/CPT PANELS

On the following page is a panel chart listing AMA/CPT test panels that are offered.

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Com

preh

ensi

ve

Met

abol

ic P

anel

-80

053

Ren

al F

unct

ion

Pane

l-800

69

Bas

ic M

etab

olic

Pa

nel-8

0048

Bas

ic M

etab

olic

Pa

nel -

8004

7

Elec

trol

yte

Pane

l-80

051

Hep

atic

Fun

ctio

n Pa

nel-8

0076

Lipi

d Pa

nel-8

0061

Acu

te H

epat

itis

Pane

l-800

74

MNEMONIC MPC RENAL MPB

IONIZED CA

MPB LYTES LIVER LIPID HEPDX

Sodium

Potassium

Chloride

Carbon Dioxide

Glucose

BUN

Creatinine

Calcium TOTAL IONIZED

Albumin

Total Protein

Alk. Phosphatase

AST (SGOT)

ALT (SGPT)

T. Bilirubin

D.Bilirubin

Phosphorus

Cholesterol Total

Triglyceride

HDL Cholesterol

LDL

VLDL

Hepatitis A Antibody, IgM

Hepatitis B Core Antibody, IgM

Hepatitis B Surface Antigen

Hepatitis C Antibody

AMA/CPT test panels that are ordered together will be evaulated according to this chart. The report will be titled with the panel that includes all the tests in each panel. Example: a MPC and Renal are ordered the report will state MPC. The Obstetric panel -80055 is also an orderable test panel.

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VENIPUNCTURE WHEN IV ADMINISTRATION IS IN PROCESS

These type of draws are coordinated with Nursing Staff

IF HEPARIN IS PRESENT OR RUNNING IN AN ARM, DO NOT DRAW FROM THAT ARM. Any heparin at all can significantly affect coagulation test results and many chemistry test results.

1. If an IV is being administered in a patient's arm, take the specimen from the arm opposite the IV if at

all possible.

2. If the above option is not possible and it is necessary to draw distal to the IV site:

a. Select a vein other than the one with the IV, and a site that is distal to the IV site. Place the tourniquet between the IV and puncture sites if possible. Do not release the tourniquet until blood collection is complete.

b. Perform the puncture.

c. Write on the accession label or requisition how the specimen was drawn so that it may be entered in the Accession Comment as contamination may be possible.

3. If there are no other options, it may be possible to draw blood proximal to an IV site depending on what is running and what tests are ordered but can be contaminated with the fluid being administered. (ex. IV's running in both hands)

a. Have the nurse shut off the IV for at least 2 minutes before venipuncture. If the nurse will not shut off the IV, do not perform venipuncture. Notify nursing unit and immediate supervisor.

Do not tamper with an IV; only the nurse or the physician may interrupt the IV.

b. Select a vein other than the one with the IV if at all possible.

c. Perform the puncture. Discard the first 5 ml (one vacutainer) of blood. If several tubes are being collected, draw hematology specimens first, coagulation tests last. Notify nurse to restart IV flow.

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d. Contamination may still be possible. ALWAYS write an Accession Comment to state how the specimen was drawn and what was running in the IV.

Sometimes it may be necessary to notify the physician that venipuncture cannot be performed. There are micro methods which may suffice, especially in hematology and chemistry. In some cases the physician may elect to do a femoral puncture.

Consult a supervisor when in doubt.

If an IV is shut off, there is still a chance there could be IV contamination due to a slow leak of IV fluid in the vein. In the case of Heparin IV therapy, the drug seems to stay in the tissues and be released into the blood even though the IV has been turned off.

MASTECTOMY PATIENTS

Because of improved methods of surgery, complications from a mastectomy are significantly reduced. Therefore, for a patient who has had a mastectomy, a venipuncture on the affected arm may be performed 3 months after the surgery if there are no problems with the patient’s arm such as lymphedema, swelling or abnormal venous return. However, the patient’s decision to refuse venipuncture on the mastectomy-side arm must be respected. For inpatient situations when a patient has arm precautions and an IV or has had a double mastectomy consult with the patient’s nurse as to where the specimen can be obtained.

BLOOD COLLECTION FROM INDWELLING LINES OR VAD’S

Per CLSI standards, obtaining blood specimens from indwelling lines or VADs may be a problem and a potential source of test error because of incomplete flushing of collection site resulting in contamination and/or dilution of the specimen contributing to inaccurate results. If the blood must be drawn through an indwelling line or VAD, possible heparin contamination and specimen dilution should be considered. The line should be flushed with 5 ml saline, and the first 5 ml of blood or six dead space volumes of the indwelling line or VAD discarded.

Line draws for coagulation specimens should not be considered. It is recommended that blood specimens for coagulation testing be collected by venipuncture using a blood collection system that collects the specimen directly into a tube containing the anticoagulant.

URINE SPECIMEN COLLECTION

ROUTINE URINALYSIS For routine urinalysis, the first morning specimen is generally recommended because of uniform concentration and volume at that time. Urine should be collected in a clean, leakproof container. Urinalysis should be performed within 2 hours of collection. If testing is delayed, the specimen must be refrigerated. Refer to nursing procedures for various collection methods.

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Urine specimens cannot be left standing at room temperature because of bacterial growth and a rise in pH that will break down formed elements and alter chemicals. All specimens for routine urinalysis should be brought directly to the laboratory, or refrigerated for no longer than 8 hours. Specimens for culture should be brought directly into the laboratory, or refrigerated no longer than 12 hours.

Mark the method and time of collection on labels and in LIS (or on specimen or outpatient requisition)! These affect interpretation of results. Clean voided specimens are preferable for routine urinalysis over "voided" specimens. Always label the container with proper patient name and number.

URINE FOR CULTURE- SEE MICROBIOLOGY SECTION

TIMED SPECIMENS For quantitative analyses, urine must be collected completely and accurately within a given time interval, usually 24 hours.

To do this, have patient void in the morning, discarding the urine and noting the exact time. After this, the patient voids as he wishes, pooling all urine in a proper container. Exactly 24 hours after the start time that was recorded, have the patient once again void completely and add that specimen to the container.

On occasion, a 24-hour collection may require more than one container. If this happens, be sure to mark both containers to that effect, e.g., "#1 of 2" and #2 of 2." The two containers should be brought to the laboratory together upon completion of collection.

If the 24-hour specimen is being collected by Foley catheter, the catheter bag should be emptied into the collection container at 2-hour intervals.

24-hour collections should always start in the morning; always at the same time on the same patient. People whose life schedules are different, e.g., third shift workers, should have collection times likewise altered.

The laboratory will supply the proper container, with the proper additive for any given test. Label all containers with name, ID#, Date of Birth and start and finish times. Warn patients to handle containers containing concentrated acid preservative with extreme care, especially when removing the cap after being transported in hot weather! Storage of specimen during collection should be checked prior to starting. Consult the laboratory or the LabCorp Directory of Services guide for preservation requirements.

There is often a need for more than one type of assay to be done that requires 24-hour urine collection. In some cases, the type of specimen preservation required for one conflicts with that of another. A portioning device (P-Splitter”) is available from the laboratory for this.

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BODY FLUIDS

AMNIOTIC FLUID - (COMPUNET #73514R/LAMB (MEDITECH)

A lamellar body count (LBC) will be tested first. If the LBC is <=15,000, the sample is reported as “immature” and no further testing is performed. If the LBC is >=50,000, the sample is reported as “mature” and no further testing is performed. If the LBC is between 16,000 and 49,000, a FLM(Fetal Lung Maturity) test will be performed. IF the results are less than or equal to 39 the sample is reported as “immature” and no further testing is done. If the results are greater than or equal to 45, the sample is considered “mature” and no further testing is performed. If the results are borderline (40-44) L/S, PG testing is performed.

L/S testing is performed once per day Monday-Friday and only performed based on the results as stated above. If a physician insists on an L/S ratio, the physician will need to contact the Medical Director/Pathologist at Compunet to have this test approved. Any specimen requiring this test based on the lamellar body count result or approved physician request needs to be received by 12:30 pm or L/S results will not be received until the next day(as long as the next day is Monday-Friday).

Compunet’s Pathology Dept. may be reached at 937-208-3588.

If an L/S,PG test needs to be ordered in Meditech it must be ordered as a Miscellaneous Reference Test.

Stat PG testing is no longer offered. It is offered only as a routine part of the L/S ratio test.

Specimen: A minimum of 4 mls (8 is preferred) of amniotic fluid which is free from red cell or meconium contamination is the preferred sample type. Vaginal pool will be accepted if the volume is at least 4 mls and is free of mucous contamination. Protect specimen from light and maintain on ice.

CEREBROSPINAL FLUID - CSF specimens must be handled aseptically by using screw-cap tubes provided with the collection tray that is available from the Materiels department. See that fractions of the specimen are placed in the tubes in proper order according to the pre-printed numbers on the tubes. Each must be labeled with the patient's ID. Bring to laboratory immediately.

GASTRIC FLUID - Submit in clean container. pH is measured to the nearest whole pH unit by indicator dye.

PARACENTESIS, THORACENTESIS FLUIDS - Large volumes of body cavity fluids should be collected aseptically in evacuated bottles available in the storeroom. Inject approximately 5U/mL, 2500U/500ml or 5000U/1000ml of heparin aseptically into the evacutainer bottle to prevent clotting.

If cell counts, crystal identification, bacteriology, or cytology tests are required, collect specimens aseptically in lavender (EDTA) vacutainer and mix well. If chemistry tests are required, also submit a specimen in a green (PST) vacutainer. Fluids should be brought to the laboratory immediately after collection.

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SEMEN ANALYSIS - Weekday appointments before 12:00 PM are encouraged to ensure that testing personnel are available. The physician must instruct the patient in the method and timing of collection. Collection materials may be obtained from the laboratory. The specimen must be delivered to the laboratory immediately, kept warm during transport by carrying it in an inner pocket.

Note on the order whether the specimen is for FERTILITY STUDY OR POST-VASECTOMY examination.

SYNOVIAL FLUID- If cell counts or crystal identification are required, collect specimens aseptically in a lavender (EDTA) vacutainer and mix well. If chemistry tests are required, also submit a specimen in a green (PST) vacutainer. If microbiology tests are required see BODY FLUID CULTURES in the MICROBIOLOGY SECTION of this guide. The specimen must be attended to immediately as clotting begins as soon as the fluid is aspirated. All remaining fluid along with vacutainer tubes should be brought to the laboratory immediately after collection. If remaining fluid is submitted in a syringe, remove the needle and replace it with a Luer cap.

FECES

FECAL SPECIMEN COLLECTION

On the following page are standard instructions for stool specimen collection, as provided to outpatients.

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INSTRUCTIONS FOR STOOL SPECIMEN COLLECTION IMPORTANT: PLEASE READ AND FOLLOW ALL DIRECTIONS. CAUTION: ALL SOLUTIONS ARE POISONOUS, DO NOT DRINK

This kit consists of 1, 2, or 3 tubes. The tubes may have liquid in them.

PLEASE! DO NOT URINATE ON THE SPECIMEN, IN THE COLLECTION CONTAINER, OR IN THE SPECIMEN TUBE.

DON’T PASS THE SPECIMEN DIRECTLY INTO THE TUBE.

DON’T PASS THE SPECIMEN INTO A TOILET.

WAIT A WEEK FOLLOWING BARIUM BEFORE COLLECTING SPECIMENS FOR OVA & PARASITES, CULTURES, SMEARS, CLOSTRIDIUM DIFFICILE, ROTAVIRUS, AND TWO WEEKS FOR FECAL FAT.

The stool should be passed into a clean, DRY, container. Place a large plastic bag into a wastebasket or other suitable container to catch the specimen.

Open the tube. Using the collection spoon built into the lid of the tube, place small scoops of stool from areas that appear bloody, slimy, or watery into the tube until the contents rise to the red line. If the stool is formed (hard), try to sample small amounts from each end and the middle.

Mix the contents of the tube with the spoon, and twist the cap tightly closed and shake the tube vigorously until the contents are well mixed. Repeat for each tube provided. CHECK ALL CAPS TO BE CERTAIN THEY ARE TIGHTLY CLOSED.

MARK THE LABELS on the tubes with the identification information requested. Also CHECK THE BOX ON THE LABEL that looks most like the specimen when collected.

Wash your hands thoroughly. If any liquid from the tubes gets on your skin or in your eyes, flush with plenty running water. If irritation develops, consult a physician. THE FOLLOWING INSTRUCTIONS ARE FOR STORAGE OF THE SPECIMEN. THE TESTS YOUR DOCTOR ORDERED ARE CHECKED.

Ova & Parasites PINK ANDGREY CONTAINERS Room Temp Return to lab within 24 hours frommultiple sample orders collect one spe

Culture & Sensitivity ORANGE CONTAINER Refrigerate Return to lab within 24 hours frommultiple sample orders collect one spe

Clostridium difficile PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours frommultiple sample orders collect one spe

Rotavirus PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours from tim

Reducing substance PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours from tim

Stool pH PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours from tim

Fecal fats PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours from tim

Stool for WBC’s PLAIN / NO PRESERV CONTAINER Refrigerate Return to lab within 24 hours from tim

Crypto/Giardia Ag, EIA ORANGE CONTAINER Refrigerate Return to lab within 24 hours frommultiple sample orders collect one spe

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Pinworm preparation Plain Tube/ No Preservative

Contains paddle attached to lid.

Room Temp Collect specimen as soon as possible after patient arises and prior to defacation or bathing. Pat the perianal area with the sticky side of the paddle(sticky side labeled on paddle that is attached to tube lid) and replace specimen back in tube.

Return to the lab within 24 hours of collection.

PHONE THE LABORATORY WITH ANY QUESTIONS: 937-498-5312

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Occult Blood - Where the stool is formed there may be areas with and without blood. Sample any red or tarry areas. "Hemoccult" or other sampling slides may be obtained from the laboratory and kept at the nursing unit for collecting samples. Some have provisions for sampling more than one spot on the specimen. Follow instructions on the covers of the cards. Be sure specimen card is not expired or discolored. Do not send specimens for fecal occult blood in any other manner. Watery excreta collected after enema, or specimens taken after barium enema, are usually too dilute to give reliable results.

In outpatient testing, order “Occult Blood Screen 1-3 specimens” when performing allowable screening under Medicare. Outpatients will be given specimen collection cards with instructions to return to the laboratory only when all ordered specimens have been collected.

Fecal occult blood collection cards cannot be used for emesis or other types of specimens.

SPUTUM –SEE ALSO MICROBIOLOGY AND PATHOLOGY/HISTOLOGY/CYTOLOGY SECTIONS

GENERAL CONSIDERATIONS If more than one sputum culture or cytology is ordered, collect one per day. First morning specimens are preferred. Saliva is not acceptable. The purpose of spacing is to increase the chances of finding tumor cells, mycobacteria, or other evidence of pulmonary disease.

Specimens for Diagnostic Cytology and Microbiology must be handled differently. Therefore a separate specimen must be collected for each, or a single specimen of ample volume must be delivered to the laboratory during open hours for culture followed by fixation for cytology.

SPECIMEN PRODUCTION AND COLLECTION - Sputum specimen may be expectorated or induced. First morning specimen is recommended. Expectorated guidelines: have patient rinse mouth with water to remove excess oral flora. Instruct patient to cough deeply to produce a lower respiratory specimen (NOT POST NASAL DRIP OR SALIVA). If patient cannot cough up sputum, call cardiopulmonary to have the sputum specimen induced with a nebulizer. Collect in sterile container. May be refrigerated up to 24 hrs before delivery to lab. Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

ROUTINE CULTURE -SEE MICROBIOLOGY SECTION

FUNGUS SMEAR AND/OR CULTURE -SEE MICROBIOLOGY SECTION

SPUTUM CYTOLOGY - SEE PATHOLOGY/HISTOLOGY/CYTOLOGY

Original – 12/96

Revised – 12/98, 07/03, 04/05,04/06,07/06,04/07,11/07,05/09,08/09,12/11

Reviewed-04/11

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SPECIMEN REJECTION POLICY Laboratory personnel must judge the suitability of a specimen for testing and reject specimens unsuitable for analysis or contact appropriate personnel for clarification.

Rejection Criteria May Include:

ANY SPECIMEN:

• No order or requisition, or proper label.

• Improper or no identification on the primary container;

• labels submitted with but none attached to primary container;

• primary container label not matching transport container label.

• Exterior of primary container contaminated; leaking container.

• Improper container, including rubber glove for transport.

• Necessary information not documented, e.g., 24 hr. urine collection.

• Improper preservative, storage temperature or time.

• Improper collection method or materials.

• Insufficient quantity.

• Specimen in syringes WITH NEEDLES ATTACHED

BLOOD

• Specimen collected in improper container or anticoagulant.

• Specimen/anticoagulant volume ratio not correct (short sampled or overfilled vacutainer).

• Hemolyzed specimens.

• Insufficient quantity.

• Serum/plasma sitting on cells too long for certain tests.

• Clot in non-coagulated specimens

URINE

• Specimen contaminated with feces.

• Specimen obviously improperly collected or stored, including short collection of timed specimens.

• Wrong preservative added

FECES

• Specimen in improper container (specimens in bedpans, diapers, etc., are not accepted).

• For occult blood test, specimen not collected using folders supplied for the purpose.

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• For ova & parasites, specimen not fixed (see procedure).

When a specimen is deemed rejectable, the responsible party or unit is contacted.

When specimens are found to have been delivered without proper labeling, the collector will not be allowed to return and label them or complete identification after the fact - the specimens will be rejected.

The affected tests are cancelled and a note is added explaining what tests were affected, with the reason. A new order must be placed with new labels and accession numbers being generated and specimens labeled correctly.

Original – 12/96

Revised – 12/98, 07/03, 04/05, 12/06, 08/09

Reviewed-04/11

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TRANSFUSION SERVICE Blood and Blood Products are supplied to Wilson Memorial Laboratory by Community Blood Center of Dayton, Ohio.

Modern techniques of antibody detection and crossmatching reduce the possibility of administering incompatible blood to a minimum. These techniques still take time, which may vary considerably for individual patients.

WHILE EVERY TRANSFUSION IS POTENTIALLY DANGEROUS.

THE MOST FREQUENT AND SEVERE REACTIONS OCCUR FROM CLERICAL ERRORS - WRONG PATIENT, WRONG UNIT, WRONG NAME. CLOSE AND CAREFUL ADHERENCE TO LABELING AND VERIFICATION POLICIES IS CRITICAL.

ROUTINE PROCEDURES

To prevent error in blood transfusion, the following procedures are used:

Inform the laboratory of the request for blood well in advance of the need. No matter how far in advance, notify the laboratory immediately when a crossmatch order is written.

The following two pages include the requisition for Physician’s Orders for Blood or Blood Products.

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WILSON MEMORIAL HOSPITAL PATIENT NAME:

Sidney, Ohio Date of Birth:

9/10 PHYSICIAN’S ORDERS FOR BLOOD OR BLOOD PRODUCTS FOR TRANSFUSION

DATE/TIME ____________________ PATIENT’S DIAGNOSIS: _________________________________________________

Obtain signed consent.

Pre-medication orders for: Benadryl 25 mg po

Acetaminophen 650 mg po Lasix 40 mg po between units

Ibuprofen 600 mg po Other:________________________________________________

ALL CELLULAR BLOOD PRODUCTS WILL BE LEUKOREDUCED - Either a Type & Crossmatch or a Type & Rh will be performed on each specimen collected to provide the products as ordered below. 3

Order platelets for sure use only

_____ Units of Packed Red Cells 1 unit Apheresed Platelets (equivalent to 5 Random Donor Platelets)

(One unit of prbcs in an adult will increase the 2 units Apheresed Platelets (equivalent to 10 Random Donor Platelets)

Hgb by approximately 1 g/dL & Hct by 3%) ( 1 unit of apheresed platelets should increase the platelet count by 25,000-35,000/ul )

________ Units of Fresh Frozen Plasma 10 units Cryoprecipitate

(A dose of 10-15 mL/kg is usually adequate 20 units Cryoprecipitate

to correct a coagulopathy) (One unit per 10 kg is usually adequate) Patient weight __________kg

CHECK TRANSFUSION CRITERIA BELOW. If none apply, please justify in “Other” section.

Use progress notes to document efficacy of transfusion. Note: Blood Product usage is tracked and may be peer reviewed.

PACKED RED CELLS Most recent hemoglobin __________ g/dL or hematocrit__________%

NON-BLEEDING PATIENT: Hemoglobin < 8g/dL or Hematocrit < 25% and/or signs of hypoxia (document below)

BLEEDING PATIENT: Rapid blood loss 20% - 50% of blood volume

Other ______________________________________________________________________________________________

*Follow-up with a Hgb/Hct within 24 hours after transfusion and/or note diminished signs of hypoxia.

PLATELETS Most recent platelet count _____________/ ul

NON-BLEEDING PATIENT: Platelet count <20,000 OR Platelet count <50,000 and planned invasive OR Surgical procedure within 12 hours AND bleeding time greater than 10 min.

BLEEDING PATIENT: Massive blood loss greater than 100% OR Uncontrolled diffuse oozing OR Platelet count <50,000

Other_______________________________________________________________________________________________

*Follow-up with a platelet count 1 hour after transfusion.

FRESH FROZEN PLASMA Most recent coag. Studies: PT_______ INR________ PTT________

NON-BLEEDING PATIENT: PT >16 sec or PTT > 55 sec within 24 hours of planned invasive or surgical procedure OR Documented Factor deficiency

BLEEDING PATIENT: Massive blood loss greater than 50%-100% OR Uncontrolled diffuse oozing0

Other_______________________________________________________________________________________________

*Follow-up with a PT/PTT or a specific coagulation assay within 4 hours after transfusion.

CRYOPRECIPITATE Most recent coag. Studies: PT______ INR______ PTT______ Fibrinogen______

3 Reference: Lab Service Guide: Transfusion Section, current edition

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NON-BLEEDING PATIENT: Planned invasive or surgical procedure AND documented deficiency of fibrinogen <80 mg/dl . OR Documented Von Willebrand disease OR documented deficiency of Factor VIII.

BLEEDING PATIENT: Uncontrolled diffuse oozing in a bleeding patient

Other_______________________________________________________________________________________________

*Follow-up with a Factor VIII or fibrinogen assay within 12 hours of transfusion

Transcribed / faxed by: ___________ PHYSICIAN SIGNATURE: __________________________________________

RN Signature: _______________________ Time Noted: ______________ 24 hour check: ______________

1Reference : Lab Service Guide: Transfusion Section, current edition

FAX TO PHARMACY

FORM CAN BE PRINTED FROM WILSON WEB SITE UNDER PHYSICIAN ORDERS, GENERAL

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Blood bank specimens for patients who may receive blood products (i.e. T&C, T&S, PRBC’s, Platelets, FFP, Cryoprecipitate), requires an approved collector, special labeling guidelines & unique patient identifiers. See the Blood Bank Training & Reference Guideline found on all nursing units. A list of approved collectors is kept in blood bank.

When a crossmatch order is completed, blood bank will call the patient’s nurse to notify her/him that the patient’s blood is ready. The nurse is to bring a paper with the patient’s name & medical record number on it for each unit of blood to be signed out. (A registration label will suffice.)

If an RN is unable to sign out the blood, she may send someone with a signed slip. If the lab slip is not signed, the lab tech must obtain and document a verbal consent. Blood will be delivered by laboratory personnel only in case of extreme necessity where no one else is available.

To reduce the chance of error, only one unit of blood will ordinarily be signed out at one time to one nurse. In the case of massive bleeding more than one unit may be given out for one patient.

Have a saline IV started before signing out blood! If for any reason blood cannot be administered after it has been taken from the laboratory, return it immediately. The unit must not have been entered, warmed or refrigerated while out of the blood bank. Because of strict regulations regarding storage temperature, it is not permissible to keep blood at room temperature or in ordinary refrigerators even for short periods. The maximum time an unopened 250 cc. unit can remain out of refrigeration and yet be returned and put back into the inventory is 20 minutes. If it has been >20 minutes but < 30, returning the unit may be possible in certain situations.

When a blood product is to be issued, the blood bank tech and nursing person are to verbally recheck the patient’s demographics label brought for sign out against the blood bank work book and unit hangtag to verify the patient’s name & MR#. Additionally, the tech will verbally verify the hangtag against the blood bank workbook and the unit to verify all information agrees. If there are any discrepancies, the donor unit is not to leave the blood bank until it has been resolved. The tech must verify the appearance of the unit is acceptable and initial the log, remove donor segments, and place the unit in a transport bag before the blood product leaves the Blood Bank. The nursing personnel will sign the blood bank workbook. The date & time issued must also be documented. At bedside, data must be rechecked with the patient's identification bands. Verification is recorded on the Transfusion Report hangtag that accompanies the blood product. If question of error exists, notify transfusion service immediately. Do no transfuse until problem is resolved.

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Do not warm blood before or during administration, except where indicated for massive transfusion or where potent cold antibodies are present. This may be done only through instructions of the physician or transfusion service, using a blood warmer designed for the purpose. A blood warmer may be signed out of the blood bank at the time of issue. Additional blood warmers are found in the surgery department.

Do not add medication to blood. While it has been acceptable to add sterile isotonic (0.9%) saline to packed red blood cells to reduce viscosity, this is not usually necessary.

All blood and blood components are to be infused through a standard blood administration set with a filter. An additional leuko-reduction filter may be needed for non-leukoreduced PRBC’s.

Blood should be infused within 4 hours.

Record on the Transfusion Report Tag the patient's pulse, temperature, and blood pressure before giving blood and after.

Preadministration of antipyretics is recommended for every transfusion if clinically acceptable to reduce non-hemolytic transfusion reactions.

Administer blood slowly at first, observing patient closely for first 15 min. or per nursing manual for possible adverse reaction. Any sign, symptom or complaint on the part of the patient that was not present when the transfusion of blood or blood component was began may be a sign of a transfusion reaction. Discard the blood bag with the bag tag still attached, 4 hours after an uncomplicated transfusion. Chart the Original Copy of the Transfusion Report, and return Blood Bank Copy to lab.

If patient develops mild urticaria or fever not exceeding 1 degree C., consult with physician before stopping blood. Note this on chart. For mild urticarial reactions only, the reaction needs to be reported but no testing is required. Complete the “Investigation of Possible Transfusion Reaction” form and send it to blood bank.

If patient develops chills, fever exceeding 1 degree C. (1.8oF), dyspnea, nausea, etc., stop the transfusion and obtain a form, kept in the nursing unit, for "Investigation of Possible Transfusion Reaction". Follow the instructions listed on it. Keep IV open with saline. Call patient's physician and blood bank. Collect 1 EDTA (purple or pink top) & 1 plain (red top) vacutainer according to instructions on the Investigation of Possible Transfusion Reaction form. If the patient’s temperature increase is >4oF (2oC), a blood culture is to be done.

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It is important to determine whether intravascular hemolysis has occurred. Notify the laboratory immediately in all instances to begin methods of proof or disproof. The unused portion of blood or the empty bag must be handled aseptically and returned to the laboratory. Urine must be collected and observed for evidence of hemolysis (pink or red color of urine). The urine must be sent immediately to lab if hemolysis is suspected. Also consult nursing care manual for other steps to take in suspected reaction.

When successful compatibility testing has not been completed, blood may be issued only after an Emergency Release of Blood form is signed by a physician, or nurse delegated by the physician. If signed by RN, the physician must also sign at a later time.

For release of incompatible x-matches due to warm autoagglutinins, high-titer, low-avidity (HTLA) antibodies or high frequency antibodies, a “Transfusion of Crossmatch Incompatible RBC’s” form must be signed by the responsible physician or nurse per V.O. from the physician. If signed by RN, the physician must also sign at a later time.

PEDIATRIC TRANSFUSIONS

If small volumes of components are to be given, the nurse will have to monitor the amount infused.

EMERGENCY TRANSFUSION

It takes approximately one hour for a routine crossmatch to be completed after a blood specimen is received in the laboratory; an "emergency" crossmatch takes at least 40 minutes. In order to help the clinician in making decisions as to whether to wait for the crossmatch procedure in emergencies or to request uncrossmatched blood, the following information is provided:

(ID CARDS, DOG TAGS, ETC., WILL NOT BE ACCEPTED AS PROOF OF A PERSON'S BLOOD GROUP.)

O NEGATIVE vs. GROUP SPECIFIC

There is ordinarily no need to order O Negative blood transfusion for an emergency, since it takes but a few minutes to determine the patient's correct group. It is much better to order group specific uncrossmatched blood. O negative will usually be in much shorter supply than most other types.

When group O must be given to a patient of group A or B however, the present-day use of Adsol suspended red cells minimizes the concentration of anti-A or anti-B that is transfused.

HAZARDS OF TRANSFUSING UNCROSSMATCHED BLOOD

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Although transfused blood may be group specific, there may still be incompatibility due to an unexpected antibody, either immune or naturally occurring, in the patient's blood. While uncommon, this could cause serious reaction. The procedure for screening for unexpected antibodies is concurrent with the crossmatch. If an antibody is detected, its identification and location of compatible units may take from 1 to 24 hours.

Uncrossmatched blood will not be issued without a signed "Emergency Release of Blood" form.

EMERGENCY RECORD-KEEPING

Transfusion records must be maintained as completely and accurately as possible, but in cases when many units are being given in a very short time, it becomes acceptable to simply write "EMERGENCY" over the area where patient pre- and post-transfusion vital signs are recorded. Proper identification procedures and accounting for each unit must still be accomplished.

OP TRANSFUSION

Outpatient transfusions are generally scheduled by Surgery Scheduling to be performed in the Same Day Surgery Department. During off hours, these are to be arranged through the Nursing Supervisor (pager 2222). If at all possible the patient should come to the laboratory the day before the scheduled transfusion to have testing done, since it often occurs that other urgent work must take priority, and there are times antibody workups are required, or special logistical problems, that take hours or even a full day.

AUTOLOGOUS TRANSFUSION

Autologous donation scheduling for preoperative patients is arranged by the physician and patient directly with the Community Blood Center in Dayton. These are done only at the Community Blood Center or one of its Satellite locations.

Contact CBC (800-388-4483 or 937-461-3450) for details. Information packets are available in the blood bank.

Standard testing still applies for the unit and the patient when autologous blood has been collected and sent to our hospital for use. Autologous units will be transfused before volunteer donor blood.

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AVAILABILITY OF BLOOD

Blood components used by WMH transfusion service are processed and distributed by the Community Blood Center (CBC) in Dayton. All units have been tested and found negative for anti-HIV-1/2 and anti-HTLV-I&II, HIV-1 antigen, hepatitis B core and surface antigens, hepatitis-C antibodies and syphilis antibody.

It is impractical to keep more than a few units of less common types on hand because of outdating and waste, and filling requisitions on short notice is sometimes difficult. Type B Negative and AB are not routinely kept in stock; compatible packed cells will ordinarily be substituted. Notify the laboratory as far in advance as possible for expected blood needs.

Only packed leuko-reduced red cells and fresh frozen plasma are stocked. All other blood products (platelets and cryoprecipitate) must be special ordered.

RELEASE POLICY

Since low levels of blood inventory are kept on hand, it is necessary to have blood crossmatched only when there is a clinical need for probable transfusion. Therefore, efforts to release crossmatched units may be made for medical patients in order to increase the available inventory. The communication will be between the blood bank tech and the patient’s nurse or physician.

COMPONENTS

Blood products cannot be modified here at our facility due to FDA labeling rules. Therefore aliquotting of blood can no longer be done. Cryoprecipitate can be obtained from CBC as a pre-pooled pack of 10 units and then be thawed here at Wilson Memorial as needed.

LEUKO-REDUCED (LEUKOCYTE POOR) RED BLOOD CELLS Any order for rbc’s will include a Type & Crossmatch (T&C) if a Type & Screen or T&C were not previously done on the current valid specimen.

The policy at WMH is to use all leukoreduced products which will reduce transfusion reaction workups and alloimmunization. Packed RBC’s that are received as non-leukoreduced must be leukoreduced at the bedside by use of a leukoreduction filter that will be issued at the time of signout. The units should be well-mixed before hanging and then mixed periodically during the transfusion to improve flow.

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PLATELETS Platelets are not stocked in the blood bank and must be special ordered from the Community Blood Center (CBC) in Dayton. They are to be ordered only for sure use as they are not returnable and wastage is not an acceptable practice.

Apheresis platelet unit is the only available platelet product. It is collected from a single donor and contains platelets equal to at least 5 units of random donor platelets and will raise the platelet count 30-60,000/uL.

In order for a patient to receive platelets, standard blood bank specimen collection , labeling and unique patient identifiers must be followed as described in the “Blood Bank Training & Guidelines” reference located on each nursing unit. For any platelet order, a blood type will be performed on a blood bank specimen where the patient has the corresponding blood bank armband. For returning outpatients, the patient may be instructed to keep the blood bank band to bring back in with him/her for additional platelet transfusions for 1 month without repeat testing necessary.

Platelets must be transfused through a standard blood administration set and filter at a rate as rapidly as tolerated by the patient but most take less than 4 hours

Platelet counts should be measured 1-2 hours post infusion. Failure to show an increase may be due to DIC, sepsis, splenomegaly, platelet antibodies, or chemotherapy. For prophylaxis this dose may need to be repeated in 1-3 days because of the short lifespan of transfused platelets (3-4 days).

Platelet refractoriness may be a problem for some patients. In order to select the platelets most likely to cause an increase in the post-transfusion increment, a systematic strategy follows:

1 a. Transfuse with unselected Apheresis products.

b. Assess the effectiveness of transfusion (by one-hour post-transfusion increment).

2 a. If poor post-transfusion increment, request crossmatched and/or HLA selected Apheresis Platelets.

b. The product to transfuse will be decided upon after testing has been performed by the Community Blood Center (CBC).

c. Medical decisions concerning platelet transfusion therapy will be made by a CBC physician in consultation with the ordering physician.

d. All platelet products that are HLA-selected or crossmatch compatible MUST be irradiated prior to shipment. This is automatically done by CBC.

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HLA typing, antibody screening and platelet crossmatching must be done by the blood center (not routinely done on weekends or holidays as large call-in fees are incurred). Consultation should be made by the physician with the laboratory medical director where these procedures are considered.

FRESH FROZEN PLASMA Fresh frozen plasma is separated from whole blood within 6 hours of collection. Loss of labile Factors V and VIII is minimal, and each mL of the product contains about 1 unit of coagulation factor activity. The volume of a unit is about 200-250 mL.

2-4 units of group AB are kept on hand for emergency use. Crossmatching is not required, but ABO compatibility should be maintained. For any FFP order, a blood type will be performed on a blood bank specimen where the patient has the corresponding blood bank armband. Once the patient’s type has been determined, he/she will be given other ABO compatible units if possible to conserve the group AB.

The product must be thawed before use, and this requires 20-30 minutes. It must be transfused as soon as possible, no later than 24 hours after thawing (kept at 1-6 degrees C. between thawing and administration). It must be transfused through standard filter.

Post-transfusion monitoring should be done by PT or PTT.

CRYOPRECIPITATE Cryoprecipitate is used as a source of fibrinogen (130-250 mg/bag) and Factor VIII (about 100 units/bag). It must be special-ordered from CBC. There is no longer a commercial source of fibrinogen concentrate due to hepatitis risk. The units are ordered in sets of 10 units as the units are pre-pooled, 10 per pool, before being frozen.

For any CRYO order, a blood type will be performed on a blood bank specimen where the patient has the corresponding blood bank armband.

ABO-compatible units of the product must be thawed before use, cannot be kept more than 4 hours after thawing, and are kept at room temperature between thawing and administration. They must be transfused through a standard blood filter.

GRANULOCYTES

Prophylactic use of granulocytes is of doubtful value, and is inappropriate for cases treated at this hospital.

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UNEXPECTED ANTIBODIES

All Type and Screen and Type and Crossmatch patients are screened for unexpected antibodies, and identification is made after positive findings. Data from patients with unexpected antibodies is kept on file for future reference. It must be noted that with most antibody problems, it may take a much longer than usual amount of time to make compatible blood available. Some can be identified locally, but others require specialized procedures at the blood center.

In cases of autoantibodies or high-titer, low-avaidity (HTLA) antibodies where they interfere with finding a compatible crossmatch, or antibodies to a high frequency antigen where no compatible units may be found, the patient's physician must be notified before transfusion and a “Transfusion of Crossmatch Incompatible RBCs” form must be signed by the responsible physician.

TYPE AND SCREEN PROCEDURE (T&S)

Typing and screening of a patient is performed when there is a very low probability of need for actual transfusion. Instead of crossmatching specific units of blood, the ABO group and Rh is determined, and the patient is screened for irregular antibodies. The chances of any type-specific unit of blood being incompatible for a patient with a negative antibody screen have been calculated to be a very small fraction of one percent. This saves crossmatching costs for the patient, and improves the logistical handling of blood.

If an unexpected antibody is found in a patient’s type & screen, crossmatching may be done as necessary to assure availability of compatible blood in case need arises.

In the event transfusion should become necessary, "immediate spin" crossmatches are performed, which usually take less than 15 minutes if ordered "stat".

Neither T&S nor crossmatching can be done more than three days before surgery, unless it can be accurately stated that the patient has had no pregnancy or transfusion of blood products within the preceding three months. In scheduling a patient for typing & screening or crossmatching, such as in Pre-Admission Testing, time desired for validity of the crossmatch in the period after surgery must be taken into consideration.

CORD BLOOD

Cord blood specimens must be labeled with the baby's name and MR number. In the event emergency testing is needed and the baby's MR# is not yet available, the mother's name and MR# may be used with the specimen specifically identified with the words "CORD BLOOD".

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Specimens of cord bloods should be collected and submitted for each delivery, in case of later complications where they may be valuable in diagnosis. Submit one clot and one EDTA sample. Also, immediately submit a heparinized (plain green top) (not a plasma separator tube) tube to Cardiopulmonary, on ice, if a cord blood pH is requested. The routine cord blood workup (CORDW) presently includes ABO, Rh and Direct Coombs. A reflex ABO, Rh, and Antibody Screen may be performed on the baby's mother if the cord blood has a positive DAT for aid in the interpretation of the positive DAT. For samples with no tests ordered, a CORHO is to be ordered. This will document that the specimen is in the blood bank and is being stored for at least 1 week in case future testing in required.

RH IMMUNE GLOBULIN

The Rh type of all women who are admitted for delivery, abortion, or amniocentesis must be determined during the admission lab tests unless it is documented on the patient’s chart.

Rh Immune Globulin (RhoGAM) is to be administered to Rh (D) negative women as soon as possible (preferably within 72 hours) of exposure to Rh (D) positive red cells to prevent future maternal sensitization and future possibilities of hemolytic disease of the newborn or transfusion-related problems or reactions. A standard 300ug dose will cover 15ml of red cells (30ml whole blood).

For all inpatient/ED/OP Surgery patients, following appropriate testing RhoGam will be provided by the blood bank for administration by the patient’s hospital care provider. Outpatient RhoGam injection orders must be scheduled through Same Day Surgery.

Indications for Rh Immune Globulin (RhIG) :

• Postpartum mother (if the newborn is Rh(D)-positive, Weak D positive or type unknown)

o Mother must be negative for Rh(D) and its weak form (Du).

o Mother must not be already sensitized to Rh. Anti-Rh (D) in the mother must be due only to antenatal administration of RhIG; an additional dose is give postpartum.

• Routine antepartum prophylaxis at 26 to 28 weeks gestation

• Antepartum amniocentesis, chorionic villus sampling & percutaneous umbilical blood sampling

• Antepartum abdominal trauma or obstetrical manipulation

• Ectopic pregnancy

• Abortion or threatened abortion at any stage of gestation with continuation of pregnancy

• Transfusion of Rh(D) positive blood or blood components containing rbc’s into an Rh negative patient (especially for women of childbearing age).

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NOTE: RhoGAM is not effective for and should not be administered to previously sensitized women. However, if blood test is inconclusive, RhoGAM should be given as it will cause no harm.

To order RhoGAM workup in Meditech,

• “RHIGWP for postpartum RhoGAM workup

• “RHIGWA for antepartum RhoGAM workup

The specimen to collect for a post-partum RhoGAM workup is an EDTA (purple or pink top) tube drawn after delivery. It is preferable to collect this maternal sample within one hour after delivery. Since this is a quantitative test, the amount of fetal cells in circulation is best measured in a sample collected immediately after possible transplacental hemorrhage. The sample collection within one hour after delivery is a recommendation made to improve prevention of immunization by determining an adequate dose of RhIG.

Testing will be determined in the blood bank based on the reason for the workup and the patient’s gestational age. It may include an ABO and/or Rh type, antibody screen, antibody ID, and fetal bleed determination on the mother’s specimen. A test for fetal red blood cells must be performed on all women after 20 weeks gestation when there is reason to suspect that a large fetal-maternal hemorrhage may have occurred. The antibody screen, if tested during the antenatal period, is acceptable and may not need to be repeated.

A fetal bleed test will be done on the mother's post delivery blood to determine if there has been an excessive fetomaternal bleed involving the Rh-positive fetus and an increased dosage of RhIG may be indicated. Additional doses of Rhogam will be provided by the blood bank based on the reported results of the Kleihauer-Betke test. If multiple doses of RhoGAM are indicated, the patient’s physician is to be notified and Pharmacy contacted for pooling directions if desired. Multiple doses may be administered at the same time or at spaced intervals, preferably within the three days of exposure.

RhIG should be given as soon as possible following delivery, but is not a stat procedure.

RhIG must be obtained and signed out from in the blood bank at the time of administration. Nursing personnel must bring the patients demographics information (Name & MR#) with them. Patient information pamphlets are available from the blood bank if needed.

If a patient refuses the RhoGAM, the physician must be notified and the patient’s refusal must be documented in the patient’s chart

When RhIG is administered, make sure that:

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o All instructions on the RhIG container are carried out;

o RhIG is injected IM, not IV, and that all the contents of the vial are injected;

o Copy 1 of the administration record is completed and charted;

o Copy 3 is sent to the laboratory.

o Patient received the Patient Identification Card completed with injection information and told to carry it with her. Explain that after each subsequent Rh positive pregnancy or miscarriage, she should again be injected with RhoGAM to protect future children.

For outpatients needing a RhoGAM injection, arrangements must be made with the OP Surgery department.

THERAPEUTIC PHLEBOTOMY

Therapeutic phlebotomy is performed by authorized Nursing personnel only on patients who meet the criteria listed in the Nursing Procedure. In outpatient cases, phlebotomy is performed in the OP Surgery department.

Original – 12/96

Revised – 12/98, 07/03, 04/05, 4/07,07/08,06/09,11/09,04/11,12/11

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POINT OF CARE TESTING Point of Care lab testing may only be used in specified units for specifically approved tests. Currently those tests include: glucose meter testing, PT/INR meter testing, urinalysis reagent strips, fecal occult blood, physician performed microscopy, nitrazine paper for body fluid pH and AmniSure Rupture of Fetal Membranes (ROM) testing. Only certified testing personnel may perform these tests. Point of care testing is done under lab supervision and quality control is monitored by the point of care testing coordinator

Original – 12/96

Revised – 12/98, 07/03, 04/05,07/08,04/11

Reviewed – 10/06,06/09

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PATHOLOGY/HISTOLOGY/CYTOLOGY

NOTE REGARDING CHARGES FOR PATHOLOGY: The patient should be advised that there are two charges, billed separately, associated with any pathology/cytology work: the hospital charge for the processing and technical time required, and the professional fee for the pathologist's examination.

REQUISITIONS AND LABELING Specimen containers for cytology or pathology must be labeled with the patient name, date of birth, date of service, specimen type and if available current account number and unit number (medical record number). See CYTOPATHOLOGY or TISSUE PATHOLOGY below for proper fixatives, containers, and handling. Multiple specimens submitted must be numbered and must correspond to numbers appearing on the requisition. Specimen site must be identified, e.g., right, left, body location.

Cytology and surgical specimens may not be submitted with the same requisition; each must have its own.

INPATIENTS: Use Pathology Form #36, with a printed label.

OUTPATIENTS/NONPATIENTS: The Pathology #36 or WMH OP Requisition form must show 1) Date, 2) Patient name, date of birth, and address, 3) Physician. Guarantor information must also be submitted.

The Clinical Diagnosis must be written on the requisition. Pertinent clinical history should be included - some specimens may require special handling by the laboratory.

Add any specific orders, e.g., frozen section or special stains, or flow cytometry.

Improperly labeled specimens from inpatients will be returned to the submitting department. Physicians' offices will be notified of improperly labeled specimens and the specimens may be returned.

CYTOPATHOLOGY

CYTOPATHOLOGY BRUSHINGS: BRONCHOSCOPY, EGD., ETC. - Specimens to be submitted for cytology taken by "brushing" procedure should be submitted to the laboratory in labeled containers with 15-20 cc of Saccomanno fixative, which may be obtained from the laboratory. After the surgeon collects the specimen, simply cut the brush and place immediately in the fixative. Do not place the brush back into the plastic tubing. No smear preparations are necessary at the time of surgery, as the smears may be done upon arrival in the laboratory. Smears will be prepared and cytocentrifugation will be done on each specimen submitted. Do not submit surgical specimens and specimens for cytologic examination on the same requisition.

Needed stains for AFB, fungi or pneumocystis should be indicated.

FINE NEEDLE ASPIRATES - Fine needle aspirations requiring technical assistance, should be scheduled with the histology section. Technical assistance is available upon request (WMH campus only), weekdays only, 7:00 AM to 3:30 PM.

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Fine needle specimens collected after 3:30 PM should be collected and submitted in the following manner:

When the physician collects the specimen, one drop is placed on a glass slide, only if ample material is available, and a smear is prepared by placing a second slide flatly on top and gently pulling the two apart. The slides, pre-labeled with the patient's last name, are immediately placed in 95% ethanol.

The needle and syringe are flushed several times using Saccomanno fixative, retaining all the washings. This specimen is for cytocentrifugation and is preferred over slide smears. (Saccomanno fixative and 95% ethanol are available from the laboratory.)

All prepared material is sent to the laboratory as soon as possible. A completed pathology requisition (#36) must accompany the specimen. Copies of any previous X-ray, CT scan, or clinical history should be submitted.

CT SCAN - Fine needle aspirations done under CT scan must be scheduled with the histology section. The pathologist, as well as a technician, will prepare and stain slides from the material collected. The pathologist will give a verbal report regarding cell content of the specimen.

PLEURAL OR OTHER FLUID CYTOLOGY - Pleural or paracentesis fluids generally maintain cells well. Any clots may be removed and placed in formalin for histologic sections. The fluid is otherwise mixed with Saccomanno's as soon as possible for cytocentrifugation. Because of the varying volumes and conditions of such fluids, it is best simply to submit them to the laboratory as soon as possible.

If a cell count is desired, body fluids must be kept from clotting by addition of ½ to 1 mL of Heparin, 100 units/cc, to the collection container, or an aliquot may be placed in an EDTA (lavender) vacutainer and mixed.

SPUTUM CYTOLOGY - The prerequisite for a good cytology analysis, besides good collection technique, is good preservation. Saccomanno fixative is used for this purpose. A pre-measured vial with 30 mL of fixative (available in the laboratory) is added to no more than 10-15 mL of sputum in a sputum collector. The mixture should be shaken with each addition of specimen. Remove and cap the inner container from the specimen collector, label it, and submit to the laboratory. With proper use of this fixative, the specimen can be kept at bedside several hours, or held overnight when collected at home.

URINE CYTOLOGY - For malignant cells, a random urine specimen must be mixed with equal parts of Saccomanno fixative or taken to the laboratory immediately, as urine destroys cells rapidly.

A minimum of 10 mL of randomly collected urine must be submitted; a complete voiding is preferable.

TISSUE PATHOLOGY

SPECIMEN HANDLING - With the exception of lymph nodes and tissues requiring culture, all surgical specimens, biopsies, fetuses, placentae, etc., for pathology (gross and microscopic)

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must be placed in a leakproof container and covered with 10% formalin, unless instructed otherwise by the pathologist. It is important that the volume of formalin be adequate - about ten times the volume of the specimen. Specimen should not be allowed to dry before placing in formalin. Rough handling of any small specimens with hemostats, etc., should be avoided. Any cultures of tissues must be made before placing in formalin, and lymph nodes or other tissues suspicious for lymphoma should be sent in the fresh state, immediately after collection. Questions regarding handling of specimens with multiple or special testing ordered should be directed promptly to histology (498-5539) or microbiology (498-5347).

The requisition should include as much clinical information as possible. See p. 79. Normal processing of tissue for microscopic analysis ordinarily requires 24 weekday hours. More time is required for special procedures such as decalcification or special staining procedures.

SURGICAL PATHOLOGY - Tissues submitted for surgical pathology will ordinarily have gross and microscopic studies performed. The following are exceptions:

SPECIMENS THAT DO NOT REQUIRE EXAMINATION BY THE PATHOLOGIST:

IF THESE SPECIMENS ARE SUBMITTED, A GROSS EXAMINATION ONLY WILL BE PERFORMED FOR DOCUMENTATION PURPOSES. *ORTHOPEDIC APPLIANCES

*RIBS FOR EXPOSURE

*SKIN FROM ECTROPION AND BLEPHAROPLASTY

*TEETH

*FOREIGN BODIES

*IUD'S

*CATARACTS

*INGROWN TOENAILS

SPECIMENS EXAMINED AS "GROSS ONLY"UNLESS INDICATED BY SURGEON: *TONSILS AND ADENOIDS (under age 21)

*BUNIONS

*HEEL SPURS

*TRAUMATIC AMPUTATIONS (FINGERS, ETC.)

*LOOSE BODIES

*HAMMER TOES

*PREPUCE IN CHILDREN(under age 21)

It is understood that the surgeon may request that any of the above be examined microscopically; microscopic examination may also be performed at the discretion of the pathologist.

FROZEN SECTIONS -These must be scheduled with the histology section. Provide the date, time and type of surgery well in advance of actual surgery date and be sure to call histology with any schedule changes.

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PLACENTAL EXAMINATION - Any placenta received in pathology will receive a gross and microscopic examination. Each placenta should be accompanied by pertinent clinical information specifically: fetal weight; Apgar scores; delivery abnormalities; (e.g. meconium staining, cord knots, abruptions, pre delivery clinical problems –( e.g. preelcampsia/eclampsia, diabetes, smoking, alcohol or drug use, etc.)) The following are recommended indications for placental examination.

* All perinatal deaths

* All multiple gestations

* Neonatal diagnostic enigmas

* Unexplained premature births

* Unusual disorders of the gravida or fetus/infant

* All high-risk pregnancies

*When invasive, therapeutic or diagnostic procedures have been performed during pregnancies.

A partial list of gestational abnormalities that should lead to a placental examination includes maternal diabetes mellitus or gestational glucose intolerance, any type of maternal hypertension, delivery before 38 weeks or after 42 weeks of gestation, oligohydramnios or, polyhydramnios, fever or other indication of maternal infection, history or suspicion of maternal substance abuse, placenta previa, abruptio placenta and any maternal bleeding during pregnancy.

A partial list of fetal and neonatal conditions that should lead to a microscopic examination of the placenta includes congenital malformations, stillbirths, neonatal death, fetal growth retardation, hydrops, meconium in the amniotic fluid, apgar scores of 0 to 3 in one minute.

Other conditions include neurologic abnormalities or seizures in the newborn, any evidence of fetal distress during labor and delivery, fetal tachycardia, neonatal respiratory distress, any evidence of infection in the neonate, multiple births, admission to the neonatal intensive care unit, or any clinical abnormalities that keep the neonate in the hospital longer than is usual for normal newborns.

CYTOGENETIC STUDIES - Fetal tissue or placenta is required. Consult with pathology immediately when this work is contemplated. This is not recommended unless gross fetal deficiency suggests chromosomal abnormalities.

STEROID RECEPTOR ASSAY - Steroid receptor assays must be requested by the physician, and are performed by immunoperoxidase methods and may be done on formalin-fixed paraffin embedded tumor. A DNA-ploidy study may be done at the same time if requested. DNA-ploidy and HER 2 neu studies are performed at a reference laboratory.

BONE MARROW EXAMINATION - Appointment must be made with the laboratory the day before or at least by early morning of the same day when a bone marrow biopsy is to be performed. Since this is a complex procedure, requiring special equipment and solutions, advance notice is needed for preparation and processing of the specimens obtained. A technical assistant from histology can be assigned to help the physician and make the films, during weekday duty hours only on the WMH campus only.

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Nursing unit personnel must order and have available from the storeroom the disposable bone marrow biopsy tray and Jamshidi needle required. A consent form must be signed.

AUTOPSY

Autopsies are not performed on site. Medical-legal cases are handled by the county coroner’s office and are sent to Montgomery County. Arrangements can be made through the pathology department for autopsies at a referral site; probably Ohio State University Medical Center. All charges will be billed to the family by the referral service and not by Wilson Memorial hospital. These charges are usually borne by the family, as Medicare and insurance companies do not pay for autopsies.

Original – 12/96

Revised – 12/98, 07/03, 04/05,10/05, 10/06,04/07,10/07,08/09,04/11

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MICROBIOLOGY

All microbiological specimens should be properly labeled with the patient’s name and MR number (or date of birth for outpatients). Specimens should have the collection date/time/collector’s initials and specimen source on the container’s label. Refer to nursing manual for proper collection procedures. Specimens should routinely be sent to the lab within an hour. See below or call lab for proper storage instructions if specimen delivery is delayed. Tests are ordered in Meditech under Microbiology except for some of the rapid antigen tests which are ordered under General Lab.

ABSCESS/WOUND CULTURE – Order ABSC in Meditech for aerobic abscess culture or WNDC for aerobic wound culture. Order GS for gram stain.

Specimens In Order of Preference: Aspirate: Abscess, Burns, Cellulitis, Decubitus, Deep Wound, Superficial Wound

Tissue: Abscess, Burn, Decubitus, Deep Wound

Swab: Abscess, Burn, Deep Wound, Superficial Wound

Preliminary reports are made daily. Final report at 2 days or upon completion. Antibiotic susceptibility testing is based on the findings of the culture , the patient’s clinical condition or physician request.

Anaerobic culture is ordered separately (ANC). Anaerobic cultures should be brought to the lab immediately or collected in an ACT I gel tube.

ACID FAST (TB, MYCOBACTERIA) CULTURE - All acid fast cultures and smears are sent to LabCorp, our reference lab. Order AFBC under General Lab in Meditech. Smears are automatically included with the AFBC order. See the LabCorp Directory for specimen requirements.

ANAEROBIC CULTURE (“AN”) – Order ANC. Often ordered with aerobic culture on wounds, abscesses, body fluid,tissue etc. Bring to lab immediately. If specimen cannot be brought to lab immediately, put swab or body fluid in ACT I transport tube. Preliminary reports are issued daily. Final report is are issued at 5 days or upon completion.

ANTIBIOTIC SUSCEPTIBILITY TESTING - Not an orderable test in Meditech. Susceptibility testing is done based on culture interpretation or physician request. A Vitek automated analyzer is used for organism identification and antibiotic Mean Inhibitory Concentration (MIC) susceptibility testing. Results may be available late afternoon of organism isolation or the following morning.

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BLOOD CULTURES MEDITECH ORDERS:

BC2 for routine blood cultures (this will generate 2 blood culture orders)

BC1 for infants (<2 yrs) where 1.0 – 1.5 ml is adequate.

FCBLD2 for fungus blood cultures (will generate X2)

SPECIMEN COLLECTION:

Routine blood cultures for acute septicemia should automatically be collected X2 from two different sites. Timing is not important unless the physician designates a specific time interval. In cases of suspected endocarditis, several samples should be obtained at spaced intervals.

For cath lines: a venipuncture specimen should be drawn along with the cath line specimen using standard technique for withdrawing specimens from the particular line. When drawing from an INT, cleanse the end with alcohol before removing blood for culture.

Cath tips: it is recommended that removed catheter tips only be cultured for skin infection or epidemiology purposes, not to determine septicemia. If a removed cath tip is cultured, concurrent blood cultures (X2) should also be obtained.

PATIENT AND TUBE PREPARATION:

Remove bottle cap and disinfect top with alcohol.

Disinfect the venipuncture site with ChloraPrep Frepp sponge. Cleanse up & down and side to side for 30 seconds. Allow to air dry for 30 seconds before making the venipuncture. Do not blot, wipe or fan the area. ChloraPrep is not used on patients under 2 months of age- for these patients an alcohol followed by iodine scrub is required). Collect the blood bottles using a needle and syringe or an adapter with butterfly. For adults collect a standard aerobic (SA/blue) bottle AND a Standard Anaerobic bottle (SN/purple). For short draws and young children use one Pediatric bottle (PF/yellow). Label tubes with patient name, MR#, date and time of draw.

Write on the collection tube the time and site of draw or if drawn from a cath line.

VOLUME OF DRAW:

SA/SN bottles: 5-10 ml per bottle; 10 ml preferred; do not overfill

PF bottles: 1-4 ml per bottle; 4 ml preferred; use for peds and short draws; do not overfill

Pediatric guidelines: 1.0-1.5 ml per year of age until age 8 yrs.

A short draw will decrease the detection of a positive blood culture. State in the comment area if a less than optimum amount was collected.

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Use FA/FN tubes if patient is on antibiotics.

Initial positive blood culture gram stains are called to the RN charge nurse or physician.

Preliminary reports are issued daily. Final reports are issued at 5 days or upon completion.

BODY FLUID CULTURES - Order BFC in Meditech and choose appropriate source. Order GS for gram stain. Specimens may include abdominal (peritoneal), amniotic, ascites, bile, joint (synovial), pericardial,and pleural (throacentesis) fluids. Synovial fluids should IMMEDIATELY be placed in a sterile lavender(EDTA) tubes. Large volumes of pleural or peritoneal fluid are collected in sterile evacuation containers. Inject approximately 5U/ml, 2500U/500ml or 5000U/1000ml heparin aseptically into the evacutainer bottle to prevent clotting. All fluid should be sent to the laboratory. Preliminary reports are issued daily. Final reports are issued at 3 days or upon completion.

CHLAMYDIA ANTIGEN – Order CHLAMR in Meditech under General Lab.. This rapid immunoassay test can only be done on females. Acceptable specimens include endocerivical swab or cytology brush. Testing is done on the same day of specimen receipt or within 1 hr if ordered stat.

CLOSTRIDIUM DIFFICLE (C.DIFF) ANTIGEN ANDTOXINS A & B – Order CDTAG in Meditech under LAB category for this rapid enzyme immunoassay test. Collect stool in an orange cap container. Bring to lab immediately or refrigerate until delivery (up to 4 days). Stools should no longer be ordered X3. If the antigen is positive, but the toxins are negative, repeat the test in 24 hours. If both the antigen and toxin are negative, wait 3-7 days to retest. Testing is done on the same day of specimen receipt or within 1 hr if ordered stat.

EYE CULTURE - Order EYEC for culture and GS for gram stain in Meditech. Specimens may include swabs from conjunctiva, cornea or periocular areas, as well as corneal scrapings or vitreous fluid aspirates. Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

EAR CULTURE – Order EARC for culture and GS for gram stain in Meditech. Swab from external ear or middle ear fluid may be submitted. . Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

FECAL WBC SMEAR- Order FECAL WBC in Meditech. Collect stool in an orange cap or clean, dry container. Avoid urine contamination. Bring to lab within 30 minutes or refrigerate (up to 24 hrs). Results are usually reported within 24 hrs of specimen receipt.

FUNGUS CULTURE - Meditech orders:

FCBF for body fluids

FCCSF for spinal fluids

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FCUR for urines

FCBLD2 or FCBLD1 for blood

FCOTHER for all sources

Specimens should be sent to the lab within one hour of collection. Preliminary reports are issued weekly. Final reports are issued at 30 days.

GRAM STAIN – Order GS in Meditech. May be ordered alone or with a culture.

A gram stain will automatically be added to certain cultures per American Society of Microbiology recommendations. These culture include: Wound/Abscess, Sputum, Bronch wash/brush & BAL, genital, body fluid/CSF, tissue, eye and ear.

Results are reported within 24 hrs or within 1 hr if ordered stat.

GROUP A STREP ANTIGEN SCREEN - Order SS under General Lab in Meditech for this rapid immunoassay. Use a Dacron, polyester or nylon tipped swab to swab the back of the throat. Do not use cotton or calcium alginate swabs, or wooden shafts. Do not use a transport medium that contains gelatin, agar, or charcoal. These tests are done the same day they are received. If ordered stat, results will be available within one hour.

GROUP B STREPTOCOCCUS CULTURE - Order GBSC in Meditech. These cultures are usually done on pregnant women. Use a culturette to collect a vaginal swab. Preliminary results are issued daily. Final reports are issued at 3 days or upon completion.

HELICOBACTER PYLORI - RAPID UREA - Order HPYL in Meditech. Gastric tissue collected in surgery from the pyloric antrum or other suspicious area is submerged in urea agar (CLOtest) which has been warmed to room temperature. The agar must not be outdated, dry, shrunken or other than a straw color. If urea agar is unavailable, sterile normal saline without preservatives may be used to transport the tissue sample to the laboratory - keep at room temperature and deliver within 1 hour. If the specimen needs to be pushed into the agar, the end of a sterile stick may be used. It is best to moisten the end used by first touching the agar or else the tissue sample may adhere to the end of the stick. Be sure to check this before discarding the stick to prevent losing the tissue. Keep inoculated urea at room temperature. Deliver to lab within 72 hrs. Results are usually reported at 24 hrs.

INFLUENZA A&B – Order INFLA&B under General Lab in Meditech for this rapid immunoassay test. Acceptable specimens are np swab, nasal swab or nasal washing/aspirates. Specimens should be obtained early in the course of the disease. If specimen cannot be brought to the lab immediately it may be stored at 2-25C for 8 hrs. Testing is done on the same day of specimen receipt or within 1 hr if ordered stat.

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KOH - In Meditech order KOH for vaginal or swab specimens or KOHHSN for hair, skin, or nails. The latter should be placed in a sterile container. DO NOT submit skin, hair or nails on slides. KOH on vaginal swabs are done on same day of receipt or within1 hr if ordered stat. Skin, hair or nails are reported within 48 hrs.

NASOPHARYNGEAL CULTURE - Order NPC in Meditech.. Nasopharyngeal (np) cultures are different from throat cultures. They are recommended for pneumococci, meningococci, Hemophilus influenzae, or Bordetella pertussis since these organisms are more commonly found in the nasopharynx than the throat. NP swabs may be collected by nursing or cardiopulmonary. Use a sterile polyester tipped flexible wire swab. Insert flexible swab in nose until it reaches the posterior nares. Leave swab in place for 5-15 seconds, rotate and remove. Place swab in BBL Culture Swab Transport tube (discard regular swabs) and send to lab. Routine culture results are reported daily with the final report at 2 days.

The recommended test for Bordeltella pertusis is the DNA Real-time PCR. This is sent to a reference lab and usually has a 4 day turn around time. An np swab should be collected and put in viral transport media. B. pertusis culture is also sent to a reference lab and has about an 8 day turn around time. The laboratory should be notified immediately if a B. pertussis culture is desired since special media is required. Collect an np swab and place in a BBL culture tube. Deliver to lab immediately.

SKIN SCRAPINGS FOR SCABIES, MITES, LICE, VISIBLE LARVAE- Order MACRO EXAM in Meditech. Find areas that are infected such as papules, vesicle or burrows. Using a sterile scalpel scrape 6 or 7 times into the skin. A drop of mineral oil may be put onto the scalpel and/or the skin to contain the scrapings. The collected material can then be gently scraped onto a slide or into the container. Place in a closed container and transport to the laboratory. Results are usually available within 24 hrs.

SPINAL FLUID CULTURE - Order CSFC for culture and GS for gram stain in Meditech. Spinal fluid is collected by the physician. Label all tubes and number them in the order taken. Tube #2 is usually used for culture. Bring fluid to lab immediately. Preliminary reports are issued daily. Final reports are issued at 3 days or upon completion.

SPUTUM CULTURE - Order SPUC for culture and GS for gram stain in Meditech. Sputum specimen may be expectorated or induced. First morning specimen is recommended. Expectorated guidelines: have patient rinse mouth with water to remove excess oral flora. Instruct patient to cough deeply to produce a lower respiratory specimen (NOT POST NASAL DRIP OR SALIVA). If patient cannot cough up sputum, call cardiopulmonary to have the sputum specimen induced with a nebulizer. Collect in sterile container. May be refrigerated up to 24 hrs before delivery to lab. Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

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STOOL - Order STC in Meditech. Collect stool sample(preferred) or rectal swab for culture. Cultures should be submitted only once per 24 hours. Use orange Para Pack for Stool Culture for collection. Store in refrigerator at 2-8C. Rectal swabs may be stored up to 24 hrs; Para-Pak up to 96 hrs if holding fluid color remains red. Cultures are screened for Salmonella, Shigella, Campylobacter, Yersinia, Aeromonas, Plesiomonas, Vibrio, Shiga toxin producing E. coli (includes E. coli 0157) and possible opportunistic pathogens. Preliminary results are issued daily. Final reports are issued at 2 days or upon completion. Note: Campylobacter antigen testing cannot be done on a rectal swab.

THROAT CULTURE - Order THC in Meditech. With patient's tongue depressed and the throat well exposed, rub a sterile Culture Swab firmly over the back of the throat, both tonsils or tonsillar fossae, and any areas of inflammation or exudation. Avoid touching the tongue or lips with the swab. Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

TISSUE CULTURE - Order TISSC for aerobic culture and GS for gram stain in Meditech. List source. Send tissue to laboratory immediately in a plain sterile container or with a small amount of sterile saline to keep the specimen moist. Order ANC if anaerobic culture is also requested. Preliminary results are issued daily. Final reports are issued at 3 days or upon completion Anaerobic cultures are held for 5 days.

URINE CULTURE - Order UC in Meditech. Enter type of specimen: clean catch/midstream, catheterized, suprapublic aspiration or cystoscopy. Foley cath tips should not be submitted for culture. Urine specimens should be cultured within 2 hrs after collection, or may be held up to 24 hrs if refrigerated. Antibiotic susceptibility testing is performed based on the findings of the culture, urinalysis and clinical condition of the patient. A culture will be initiated when an order of “culture if indicated” is received and if the urinalysis results are positive for nitrite and/or leukocyte esterase.8 Preliminary results are issued daily. Final reports are issued at 2 days or upon completion.

WET PREP – Order WETP in Meditech. Submit swab or swab in 0.5 ml sterile saline. Exam done same day of receipt or within an hour if ordered stat.

GENITAL CULTURE - Order GENC for culture and GS for gram stain in Meditech. If gonorrhea is suspected, culture must be set up within 1 hr. If GC culture only is ordered, order GC in Meditech. Enter specimen source: vaginal, cervical, urethral, rectal throat, etc. For direct plating for GC, Thayer-Martin medium plates are available in the laboratory, and are stored refrigerated in high-use areas such as the emergency room. Plates MUST be brought to room

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temperature before inoculation. For direct inoculation, the swab is gently rolled in a large "Z" on the surface of the medium. Bring to lab immediately.

Special Gen- Probe collection swabs are required for DNA probes for Chlamydia and N. gonorrheae which are sent to a reference lab. Only urogenital specimens can be used. For males, patient should not urinate for one hour before specimen collection. Gen-Probe transport swabs are kept in the Laboratory and Emergency Department. Follow instructions on kit.

VIROLOGY - Sent to reference lab. Consult LabCorp Directory of Services Manual for available virology and viral serology tests.

RESPIRATORY SYNCYTIAL VIRUS ANTIGEN (RSV) - Order RSVAG under General Lab in Meditech. Preferred specimens for the rapid enzyme immunoassay (EIA) method is nasopharyngeal washings or aspirates. Washings may be collected by nursing personnel or cardio pulmonary. Results are available on the same day of specimen receipt or within an hour if ordered stat.

Original – 12/96

Revised – 12/98, 07/03, 04/05, 04/06, 12/06, 02/07,04/07,08/07,03/08,02/09,05/10,01/11,02/12

Reviewed-06/09

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TOXICOLOGY

GENERAL CONSIDERATIONS All toxicology work is expensive, and there is a great variety of substances that may or may not be detected or measured. To have the work done in the best manner and at the least expense, there must be close communication between doctor, nurse, and laboratory. Most toxicology must be referred to a laboratory specializing in such work. Where screening for unknown substances is done, orders must state whether detected drugs are to be quantitated, which amounts to additional work and cost.

RAPID URINE DRUG SCREEN We can perform a urine drugs of abuse screen. The procedure is qualitative and screens for the presence of Amphetamines/Methamphetamines, Barbituates, Benzodiazepines, Cocaine metabolites, Ecstacy, Opiates, Phencyclidine (PCP) and Cannabinoids(marijuana, THC). It is meant primarily for emergency use. Order UDS in LIS. A more specific test such as gas chromatography/mass spectrometry is preferred for confirmatory tests.

COMPREHENSIVE DRUG SCREENS Used for diagnosis in coma/overdose; both blood and urine or gastric contents are required. Screening is done on urine or gastric contents; quantitation on blood. Use no tinctures or alcohol for venipuncture prep. It is helpful for the toxicology laboratory to know what substances may be suspected. Testing is not available on a STAT basis.

The typical test order would be

DAUG (DRUG ANALYSIS, URINE OR GASTRIC) (Routine, Referred)

ETHANOL TESTING Diagnostic, but not legal, ethanol testing is done at Wilson Memorial. Order ALC for diagnostic test

When an ethanol specimen is to be collected, no alcohol or tinctures may be used for venipuncture prep.

CORONER'S CASES Any toxicology work involved with a death must be considered medicolegal in nature. All specimens taken for this purpose must be handled with a chain of custody procedure.

Samples should be sent through our laboratory to LabCorp Biomedical Laboratories. The container must be sealed and initialed by the person collecting the specimen, and it is forwarded for testing through Wilson Memorial Laboratory, not given to a law enforcement officer. Indicate on the requisition that results are to be returned to the laboratory director of Wilson Memorial. Results will be given only to the coroner and the medical records department. Fees are charged to the coroner's office.

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SPECIAL REQUEST TOXICOLOGY

Ethanol or drug testing requests made by parent or guardian, or a person who feels he is unjustly accused of DWI, are medicolegal. A written doctor's order is required in any case. Usual tests ordered are:

-ETCOC (BLOOD ETHANOL WITH CHAIN OF CUSTODY)

-DACOC (URINE DRUG ABUSE SCREEN WITH CHAIN OF CUSTODY)

Law Enforcement And Common Pleas Court Testing

**PLEASE NOTE: Without a Court Order a patient has the right in the State of Ohio to refuse to have blood drawn or any other testing done.**

COMMON PLEAS COURT

Ohio law and local government requires the Shelby County Common Pleas Court Administrator to see that immediate and follow-up HIV testing are done on individuals charged with certain crimes. Orders for this work will be in the form of a court order for HIV testing (only HIV testing is done). The patient may or may not be in the custody of an officer.

An HIV Testing Acknowledgement Form from the court will accompany the order.

SHELBY COUNTY JAIL

Testing may be required on individuals incarcerated at the jail for requirements of Ohio Revised Code 2907.29 or for other medical care. Patient or submitted specimen testing will be initiated upon receiving the written order from the jail physician.

LAW ENFORCEMENT DRAWS (Shelby County Sheriff's Dept., Sidney Police Dept., or State Highway Patrol)

During normal laboratory outpatient hours:

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Law Enforcement requests for collection on an outpatient basis may be processed with a court order/search warrant. A copy of the court order/search warrant will need to be scanned into Chart One. If a court order/search warrant is not available, the law enforcement officer will need to complete the WMH Law Enforcement Collections Request Form. This form will be taken to registration to enable the patient to be registered into the computer system. The WMH Law Enforcement Collections Request Form will be returned with the patient for collection. The collector will fill out the Collector section of the WMH Law Enforcement Collections Request Form. The completed form is scanned into Chart One.

The officers should bring a kit to be used; if not, they will need to make arrangements to obtain one (we do not stock them). Our culturette swabs if used are not returned to the culturette tube; hand the specimen to the officer who will allow it to air dry and will package the specimens. If a urine drug screen is required, utilize the officer’s COC procedure.

A venipuncture charge is ordered if a blood specimen is to be collected.

After normal laboratory outpatient hours: Law Enforcement requests for collection on an outpatient basis may be processed with a court order/search warrant. A copy of the court order/search warrant will need to be scanned into Chart One. If a court order/search warrant is not available, the law enforcement officer will need to complete the WMH Law Enforcement Collections Request Form. This form will be used to register the patient into the computer system by the Emergency Department. The WMH Law Enforcement Collections Request Form will be returned with the patient for collection. The collector will fill out the Collector section of the WMH Law Enforcement Collections Request Form. The completed form is scanned into Chart One.

For after-hour Law Enforcement draws, the Emergency Department will register the patient as an outpatient; a PCT and an officer will accompany the patient to the lab where the PCT will use one of the phlebotomy drawing rooms to obtain the desired specimen(s). The collector will fill out the Collector section of the WMH Law Enforcement Collections Request Form. The laboratory may order the venipuncture. The paper-work is scanned into ChartOne.

A venipuncture charge is ordered for a blood specimen collection.

Request for specimens from Law Enforcement Agencies The officer requesting specimens from WMH will be instructed to see the Laboratory Administrative Director, the House Supervisor, or the Quality Management Director. The agency will be required to have search warrant and affidavit signed by the judge. A Law Enforcement Specimen Request Form will be filled out for documentation and this form will be sent to Medical Records for scanning into Chart One.

The WMH Law Enforcement Collections Request Form and the WMH Law Enforcement Specimen Request Form can be found on the WMH intranet.

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If the specimen is a Chain of Custody alcohol, Betadine or alcohol-free skin cleaner should be used for skin cleansing.

Original – 12/96

Revised – 12/98, 07/03, 04/05, 02/06,05/08,06/08, 08/09,04/11

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REFERENCE RANGES AND CRITICAL VALUES

REFERENCE RANGES for tests performed at Wilson Memorial Hospital Laboratory are found on all patient reports. Reference ranges are established by utilizing medical reference material, specific manufacturer data and normal patient population under the direction of the Medical Director and can be provided upon request.

CRITICAL VALUES are assessed by the laboratory utilizing the medical staff approved critical values. Appropriate results falling in these ranges will be relayed within 30 minutes to the physician or his office staff in case of outpatients, to the RN on a nursing unit for inpatients, or the nursing staff/office staff for nursing home or agency patients. Documentation of calling, receiving, and read-back is documented in LIS for reports.

Original – 12/96

Revised – 12/98, 07/03, 04/05, 06/06, 04/07 Reviewed-06/09,04/11

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WILSON MEMORIAL LABORATORY CRITICAL LIST

Approved by Medical Staff 01/19/10

CHEMISTRY WHEN REPORTED CALCIUM <6.0 mg/dL >13.0 mg/dL ALWAYS

GLUCOSE <40 mg/dL >600 mg/dL FIRST REPORT ONLY EVERY 30 DAYS

GLUCOSE, NEWBORN <30 mg/dL >200 mg/dL ALWAYS

POTASSIUM <3.0 mmol/L >6.2 mmol/L ALWAYS

SODIUM <110 mmol/L >160 mmol/L ALWAYS

NEONATAL TBIL >18.0 mg/dL ALWAYS

TROPONIN >1.5 ng/mL FIRST REPORT ONLY PER ADMISSION

THERAPEUTIC DRUGS

ACETAMINOPHIN >150 ug/mL ALWAYS

CARBAMAZEPINE >20 ug/mL ALWAYS

DIGOXIN >2.5 ng/mL ALWAYS

PHENOBARBITOL >60 ug/mL ALWAYS

THEOPHYLINE >40 ug/mL ALWAYS

VALPROIC ACID >200 ug/mL ALWAYS

HEMATOLOGY

HEMATOCRIT <18 % FIRST REPORT ONLY EVERY 30 DAYS

HEMOGLOBIN <6 gm/dL FIRST REPORT ONLY EVERY 30 DAYS

WBC <1.0 x103 uL FIRST REPORT ONLY EVERY 30 DAYS

PLATELET <20 x103 uL FIRST REPORT ONLY EVERY 30 DAYS

INR >5.0 ALWAYS

PTT >100 seconds ALWAYS

MICROBIOLOGY

BLOOD CULTURE POSITIVE ALWAYS

CSF CULTURE POSITIVE ALWAYS

CSF SMEAR POSITIVE ALWAYS Revised 03/06

INDEX

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Revised 05/06 Protime removed from list due to new coagulation reagent/instrument-INR is used

Revised-04/08

Reviewed-06/09,04/11

Revised 01/10

Documents

LABORATORY SERVICE GUIDE - Wilson Health · Bilirubin Scan, Amniotic Fluid À LAB BILAF H Bilirubin, Direct LAB BILD G Bilirubin, Total (Reflexes to Direct) LAB BILT G Bilirubin,