CSF Specimen Collection for Analysis

CSF Laboratory Orders

Obtain CSF for gram stain, cell count, protein, glucose and aerobic culture where able. Obtain kit 922257 (20G needle) or 922258 (22G needle) from Hospital Stores (356-1784). The kit should contain 4 pre-numbered tubes to be filled in chronological order. Avoid covering tube numbers with stickers to ensure appropriate routing of samples.

With low volume, one-tube specimens not all testing may be possible and the clinician must determine which tests should be prioritized. If cultures are desired, Microbiology must receive the specimen first to ensure the culturing of a sterile specimen.
Transport time ≤15 minutes. Do not refrigerate CSF for bacterial culture.

If adequate volume is obtained, orders are placed per tube as follows:

Tube #	Orders
#1 – Chemistry/Immunology	Protein (LAB118) and Glucose (LAB611)
#2 – Microbiology	Aerobic culture with gram stain (LAB4801). Select "CSF lumbar puncture", "CSF shunt", or "CSF ventricular trap" as source to ensure appropriate culturing. If cryptococcal meningitis is suspected, fungal cultures (LAB240) and cryptococcal antigen (LAB2233) should be ordered as well. The Meningitis/Encephalitis PCR Panel (LAB8514) should be ordered on all lumbar punctures where infections is being considered and can not be ordered on non-lumbar puncture samples (order individual tests instead).
#3 – Hematology	If a pathologist review is needed, it can be obtained by ordering Cytospin, CSF (LAB1024) in addition to the CSF Cell Count and Differential (LAB1022).
#4 – Specimen Control	Specimen storage (LAB4890). Select "Spinal fluid" as source and request to hold for 30 days at -80°C unless 4°C or -20°C storage is needed for a specific test.