Respiratory Virus Cascading Panel
Label Mnemonic: RVPCR
Epic Lab Code: LAB8563
Downtime Form: A-1a Clinical Microbiology Laboratory Requisition
BT 6004
Bacteriology/Virology Section
Collection Medium:
Swab Kit Flexible Nasopharyngeal--Viral 3.0 mL
Delivery Instructions:
Transport the specimen to the Microbiology laboratory (6004 BT) immediately on ice or refrigerate. If the tube system is used, ensure specimens are in leak-proof containers that are securely closed and double bagged. Do not send traps through the tube system.
Testing Schedule:
24 hrs/day, 7 days a week, including holidays.
Turn Around Time:
24 hours (upon receipt in laboratory)
This order replaces the Influenza Panel for inpatient and ED encounters, and is orderable for outpatient encounters. If positive for Influenza A, Influenza B or Influenza H1N1, only the results of these 3 tests will be reported. If Influenza negative, the remaining viruses on the Respiratory Virus Panel will be reported (parainfluenza 1, 2 and 3; RSV A and B; metapneumovirus; and adenovirus). To order the remaining tests on the Respiratory virus Panel when only the Influenza tests have been reported, order LAB8564, "Respiratory virus Panel Cascading Add on".

This PCR assay tests for eight respiratory viruses: Influenza A (including H1N1), influenza B, parainfluenza viruses 1, 2, 3, adenovirus, respiratory syncytial virus (RSV), and human metapneumovirus. Human metapneumovirus is a recently identified (2001) respiratory virus related to RSV. Its clinical manifestations are also similar to that of RSV and ranges from mild upper respiratory infections to bronchiolitis and severe pneumonia. The performance characteristics of this test were determined by the University of Iowa Microbiology and Molecular Pathology Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration (FDA). The FDA has determined that such clearance or approval is not necessary. This test is for clinical purposes. It should not be regarded as investigational or for research. The laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform high complexity clinical laboratory testing.

Processing Instructions:
Specimen Collection:
* Droplet Precautions (surgical mask) should be used by healthcare
  workers obtaining clinical specimens. Since sneezes, coughing or
  splashes may occur during sample collection, eye protection also
  should be worn.
* A nasopharyngeal swab OR nasopharyngeal wash/aspirate specimen
  should be collected. For patients who are intubated, an endotracheal
  aspirate should also be collected.
* Nasopharyngeal swab: Collect specimen using the flexible minitip
  flocked swab (Hospital Stores #33595). Measure the distance from the
  patient's nostril (half the distance from nostril to base of the
  ear) and hold the swab at that location. Do not advance the swab
  beyond that point. Gently insert the swab along the base of one
  nostril (straight back, not upwards) and continue along the floor of
  the nasal passage until reaching the nasopharynx. Rotate swab 2-3
  times and hold in place for 5 seconds. Place swab in tube containing
  viral transport medium. Break off the excess length of swab at the
  score mark to permit capping of the tube.
* Nasopharyngeal wash/aspirate:
  A. Assemble equipment:
     - Sterile specimen trap
     - Personal Protective Equipment (gloves, surgical mask, eye
     - Appropriate size suction catheter (8 fr for infants/children,
       10/12 fr adults)
     - Normal saline vial
     - Wall suction
     - Bag or cup of ice for specimen transport to laboratory
  B. Place patient with head tilted slightly back.
  C. With sterile gloved hand, insert suction catheter into the
     patient's nose to the depth of the nasopharyngeal area (beyond
     the turbinates). Do not remove catheter until end of procedure.
  D. With the non-sterile gloved hand, instill approximately 1-2 mL
     normal saline outside the catheter.
  E. Apply suction to aspirate nasopharyngeal secretions.
  F. Above steps may need to be repeated to obtain 1 mL sample in
     specimen trap.
  G. Remove catheter from patient. With specimen trap still in-line,
     rinse catheter with remaining saline to clear secretions.
  H. Specimens transported by tube system must be transferred from
     trap to leak-proof sterile container (be sure the lid is tightly