BCH NHS Trust

Version 3. March 2009

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For more detailed departmental specific information including reference ranges, contacts and service information follow the left hand links. For blood collection information follow the links below. General laboratory information is contained below.

Specimen Requirements by Test ( A - Z )

 

Z

General Information

 

LABORATORY LOCATION

 

Pathology is located in a single block located on Whittal Street next to the main multi-storey car park. Access can be obtained directly from Whittle Street or internally via the coloured walk way off the hospital ground floor main corridor (MAPS). The main laboratory reception is situated on the ground floor with the various disciplines being spread over three floors.

 

NON ACCIDENTAL INJURY

 

Where a non accidental injury is suspected, specimens sent to the laboratories may subsequently be required as evidence by the police or coroner. In order to establish a chain of custody and ensure that material is not discarded, in all cases of suspected non accidental injury the NAI FORM A  must be completed and delivered in person to the laboratory with each patient sample. THE AIR TUBE SYSTEM MUST NOT BE USED. Specimens will not be released to the police until the requesting consultant agrees. Where specimens are required by the coroner, the requesting consultant will be informed.

 

CONSENT FOR USE OF TISSUE

 

Occasionally, where there is material left over after laboratory testing, it may be used for other purposes such as quality control or audit. Specific research is regulated by the ethics committee. Consent for the use of tissue requires that patients must be given the option to refuse permission for spare material to be used. When this occurs, each request to the laboratory must be clearly marked so that specimens are not used for other purposes. A statement regarding this is being included in patient information leaflets and will be displayed in phlebotomy areas.

 

Sending a specimen: what to do

 

Transport of specimens to the laboratory

 

The laboratories operate a joint specimen transport service. Specimens are collected at 09.00 and 14.00, Monday to Friday (excluding Bank Holidays). Specimens should be left at the designated collection point on the Ward/Department.

 

At other times specimens may be delivered to the laboratories in person (there is a common Reception Area on the ground floor of the laboratory block), or via the air tube transport system. The air tube system is managed by Clinical Chemistry. See the appropriate section for guidance on using the air tube system. To report problems please telephone ext 9912.

 

Please do not send microbiology specimens via the air tube system out of hours unless arranged with the on-call Biomedical Scientist. Out of hours blood cultures should be placed in the incubators in the satellite laboratory in the ICU or A&E. Other microbiology samples should be refrigerated either in the small laboratory refrigerator in ICU, or retained in departmental refrigerators.

 

Request Forms - Combined Chemistry and Haematology Request Forms

 

There are some limited instructions on the back of the request form (see below).

 

Key points for their use:

 

· If hand writing information on the request form(s) it is ESSENTIAL to use a biro and press firmly.

 

· If patient stickers are used they should be attached to BOTH forms if specimens are to be sent to both laboratories (or just to the relevant form for samples coming to a single laboratory).  Unlabelled forms will be returned to the requesting clinician/ward for completion.

 

· Please ensure patient information/consultant/location etc is up to date.

· Please ensure the requestor’s name and contact details are clearly recorded on the request form. 

· Please include clinical details and relevant clinical status on request forms.

· Please send separate samples to the relevant laboratory in the colour-coded bags.

· If serum is required for a Chemistry test and a Haematology test, two clotted samples should be sent – one in each bag.

Clinical Chemistry     =           Green

Haematology              =           Red

 

· Please do not separate the two parts of the form from one another – simply send the whole ’package’ to the laboratory where most urgent processing and/or analysis is required.

 

These forms may be used for all specimen types (blood, CSF, urine, other) and should be used to accompany all specimens sent to the laboratory. They should also be used where specimens are to be collected by the laboratory phlebotomy services.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Request Forms - Non Chemistry / Haematology Requests

 

Request forms are printed in different colours for each laboratory discipline.

 

Histopathology           =           Black

Microbiology                =           Blue

Virology                        =           Orange

 

These forms may be used for all specimen types (blood, CSF, urine, other) and should be used to accompany all specimens sent to the laboratory. They should also be used where specimens are to be collected by the laboratory phlebotomy services.

 

A separate request form is required for each laboratory discipline. However the same form can be used for more than one specimen of the same type e.g. blood, urine collected from the same patient at the same time. In this case all the samples must accompany the form to the laboratory at the same time.

 

All request forms must be completed in full and legibly. Please take particular care to ensure that the Consultant and Speciality are given (this information is essential for activity data purposes), and that the correct ward is given.

 

Please note that patient information stickers may relate to a previous admission, and may be incorrect.

 

Information about  the specimen together with the date and time (please use the 24 hour clock)  is important for both correct specimen identification and interpretation. The type of specimen, fasting or dietary status, site of infection, clinical details and duration of symptoms (for microbiology the date of onset of symptoms or date of contact are often vital in selecting and interpreting serological tests), details of antibiotic therapy (microbiology) and drug therapy (toxicology) may all be relevant.

 

It is important that both the form and container are correctly labelled.  When unlabelled or mislabelled specimens are received medical staff will, where possible, be given the opportunity to amend the label.

 

If the patient is private, the appropriate box must be ticked on the request form.  If no box is ticked it will be assumed that the patient is NHS.

 

 

The requesting individual must also sign the form.

 

Text Box: Laboratory departments are not obliged to accept incorrectly or inadequately labelled specimens or request forms. The completion of the request form is the responsibility of the medical officer.

Specimen containers

 

Specimens should only be sent to the laboratory in appropriate containers issued by the relevant department. The laboratory will replenish stocks of routine containers if ward staff leave a written order at the designated specimen collection point on their ward. Please give 24 hours notice.

 

High risk specimens

 

All  staff  are  required  by the Health and Safety  at  Work  Act  to  take reasonable  care  for their own safety and that of other people who  may  be affected by their actions.   Laboratory work is hazardous and clinical staff are often in a position to warn laboratory staff when extra precautions are necessary for certain specimens.

 

All specimens are potentially an infection risk and must be handled carefully. However, additional precautions are necessary for certain specimens from patients known, or suspected to have, infections that may be transmitted to laboratory and other health care workers. These MUST be labelled as biohazard and MUST not be sent in the air tube system. Specimens from patients with haemophilia, infective liver disease, Hepatitis C or who are HBsAg or HIV Ab positive, are particularly hazardous to laboratory personnel.

 

Appropriate Biohazard (Danger of Infection) labels must be attached to request forms and specimen containers. Lids of specimen containers must be securely tightened and the containers securely sealed within the specimen pouch attached to the request form.

 

Samples requiring labelling and handling as Biohazard -  (Danger of Infection)

(Capillary blood must NOT be taken)

 

All specimens from patients suspected or proven to have the following infections:

 

 - Acute Hepatitis of viral aetiology

 - Hepatitis B or C (acute or chronic)

 - Patients with liver disease in whom Hepatitis has not  been excluded

 - Acquired Immunodeficiency Deficiency Syndrome (AIDS) or HIV positive

 - All patients who have fever and have recently returned from an area where viral haemorrhagic fevers are endemic

 - Sputum and other material that may contain tubercle bacilli from patients with suspected or proven tuberculosis.

 - CSF, brain tissue and spinal cord material from patients at risk of or suspected of having a proven transmissible spongiform 

   encephalopathy (CJD, vCJD etc.)

 - Stools from patients with suspected typhoid, paratyphoid or dysentery (e.g. recently returned from an endemic region such as the 

   Indian sub-continent)

 - Blood and urine cultures from patients with suspected typhoid or paratyphoid. or recently returned from an endemic region such as 

   the Indian sub-continent.

 - Stool specimens from patients with suspected E. coli 0157 infection (haemolytic-uraemic syndrome (HUS)).

 - Other specimens such as those from patients with suspected SARS as directed by the Infection Control Team.

 

Specimens  should NOT be collected from patients in whom a diagnosis of viral  haemorrhagic  fever is strongly suspected before consulting a Medical  Microbiologist.

 

Text Box: If you suspect a patient may be Hepatitis B surface antigen positive, Hepatitis C, or HIV positive UNTIL PROVEN OTHERWISE They must be treated as "HIGH RISK".

Rejection by the laboratory of specimens submitted for testing

 

Occasionally the laboratory has to reject specimens for testing for the following reasons.

 

The request made is inappropriate.

 

The names on the specimen and the request form do not match.

 

Inadequate information on the specimen or request form to unequivocally identify the patient.        

 

Insufficient information is provided on the request form to determine the test required.

 

The specimen submitted is unsuitable for the investigation required.

 

The specimen fails to comply with safety protocols.

 

Damage to the specimen container at some stage has resulted in leakage or total loss of the specimen.

 

The quality of the specimen is inadequate, e.g. age of the specimen, haemolysis of blood specimen, insufficient specimen etc.

 

Where possible the laboratory will contact the ward/clinician in order to resolve the problem. A written report giving the reason why a specimen has been rejected will be issued within one working day wherever possible.

 

Sometimes, when serological investigations are requested, serum will be stored in the laboratory rather than being tested immediately. This may be because the clinical details provided are insufficient to determine the appropriate investigation, or because useful information will only be obtained by testing a convalescent serum specimen in parallel. In all such instances a written report indicating that the specimen has been stored will be issued within one working day of receipt.