All laboratory testing requires the creation and completion of a visit.  If laboratory testing is to be completed on the day of the visit, the submitting department is responsible for creating a visit for the in- or out-patient and checking-in the patient in a timely manner.

1.) Complete requisition for appropriate laboratory - Form: A-1a General Lab (Pathology Doctor's Orders), Form: A-1a Therapeutic Drug Monitoring (TDA) (Pathology Doctor's Orders), Form: A-1a Clinical Microbiology Laboratory (Pathology Doctor's Orders), Form: A-1a Immunopathology Laboratory (Pathology Doctor's Orders), Form: A-1a Critical Care/Special Care Nurseries Laboratory (Pathology Doctor's Orders), Form: A-1a Molecular Pathology/Diagnostics Laboratory (Pathology Doctor's Orders), or A-1a Miscellaneous Request (Pathology Doctor's Order). (Please refer to the tables for complete forms listing). Information required:

A. Complete and readable addressograph or a minimum of complete hospital number, name (last, first, middle initial), and birthdate.

B. Nursing station or clinic.

C. Time sample was collected/drawn.

D. Ordering physician's name, code and signature. Clinic codes are unacceptable.

E. Some Pathology Doctor's Orders Forms have a location for narrative or ICD-9-CM coding to be written. At the present time, this data field is not required. When required, use the number adjacent to the ICD-9-CM code (1-9), enter the appropriate number (1-9) in the parentheses next to the test name. If the tests are not available on the laboratory form, write complete test name on A-1a Miscellaneous Request form.

Form: A-1a Clinical Microbiology Laboratory (Pathology Doctor's Orders) requires list of antibiotics patient is receiving.

Form: A-1a Immunopathology Laboratory (Pathology Doctor's Orders) and Form: A-1a Clinical Microbiology Laboratory (Pathology Doctor's Orders) require diagnosis because testing procedures often vary according to clinical diagnosis suspected.

2.) Determine correct tube type and blood volume for tests ordered (e.g. anti-coagulant, additive, phlebotomy tubes and order of draw). The correct sequence to draw blood specimens or to transfer from a syringe is:

>>>Blood cultures, light blue top, red top, light green (PST) green top, lavender top and/or pink, white top, gray top, yellow top, and Fibrin Degradation Products (FDP) top.

 

NOTE:

A. If a blue top tube is the only tube required, it is not necessary to draw a red top prior to drawing a blue top.

B. Specimens for type and crossmatch require a specific patient identification and collection process. Refer to "Blood Center Services" appendix.

3.) Properly identify the patient. On in-patients compare the name and hospital number from the arm band to that on the requisition. If patient is an outpatient, ask them to state their full name and date of birth. If patient is an infant or confused adult, check arm band or ask person accompanying the patient for identification. See Patient Identifiers (UIHC Policy V.35)

4.) After drawing, but before leaving the patient, label the tube(s) with two patient identifiers. Transport to the appropriate laboratory. Consult Pathology Laboratory Services Handbook for appropriate transportation requirements, e.g., "on ice".

5.) Intravenous Fluids: When an intravenous fluid is being administered in a hand or arm, do not draw blood from that arm, if at all possible.  Tests results may be altered by dilution and/or content of the intravenous fluid, resulting in misleading laboratory values.  If I.V. fluids are running in both arms or the second arm is not a viable option, consider performing a skin puncture.

For samples that MUST be collected from an arm with an active I.V., the best option is to collect the sample distal (below) the intravenous site.  The infusion must be turned off for a MINIMUM of 2 minutes, before drawing the sample.  If the only available site is proximal (above) to the I.V. site, turn off the I.V. for at least 2 minutes and draw from a vein other than the vein with the I.V. line.  Always write “drawn distal/proximal to I.V.” on the requisition.  Follow the same procedure if a sample must be drawn during blood products transfusion.