What information must be included if the phlebotomist must manually label a blood collection tube from an outpatient?

Requisition Completion, Specimen Labeling and Phlebotomy Guidelines

All laboratory testing requires the creation and completion of a visit for the date of the sample collection. If laboratory testing is to be completed on the day of the visit, the submitting department is responsible for creating a visit for the checking-in the patient prior to the collection of the laboratory sample. If a sample for laboratory testing is received after a patient visit and sent to the laboratory for testing, the submitting department is responsible for creating a visit for the date that the sample was collected.

1. All requisitions (both Epic generated and non-electronic) require the date and time of collection and the collector's initials be recorded. Microbiology also requires the collector's title and the collection site of the blood draw.

   Please refer to the tables below for complete forms listing of manual requisitions which might be used during an Epic down time or absence of computer generated EPIC order.



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, gray top, and yellow top.


NOTE:

1. If a light blue top tube is drawn with a holder and butterfly needle, prime the tubing with a discard tube before filling the sodium citrate tube (light blue topped).
2. Specimens for Blood Bank require a specific patient identification and collection process. Refer to "Blood Center Services" additional information.


3. Identify the patient using two identifiers.
• On in-patients compare the name and hospital number from the arm band to that on the requisition and labels and ask the patient to state their full name and date of birth.
• 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 (University of Iowa Hospitals and Clinics Policy V.35).


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


5. Intravenous Fluids: If possible, draw blood from the arm/hand that does NOT have intravenous fluid being administered. Tests results may be altered by dilution and/or content of the intravenous fluid, resulting in misleading laboratory values.
• 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. Record "drawn distal/proximal to I.V." in the patient's chart.
• Follow the same procedure if a sample must be drawn during blood products transfusion. Best practice is to wait one hour after the transfusion is completed before drawing the sample.



STORES#	TUBE, BLOOD COLLECTION	SIZE	BD#	TUBE TOP COLOR
Contact Specimen Control	ARU & PRU TUBES	2 ML	Greiner 454322	LIGHT BLUE
TRACE ELEMENT FREE SERUM	6.0 ML	368380	ROYAL BLUE
TRACE ELEMENT FREE PLASMA (EDTA)	6.0 ML	368381	ROYAL BLUE
SERUM SEPARATOR TUBE	5.0 ML	367986	GOLD
922749	ACD SOLUTION A	8.5 ML	364606	YELLOW
907693	NA HEPARIN	10 ML		GREEN
924085	NA HEPARIN	4 ML	367871	GREEN
907695	LITHIUM HEPARIN (PST)	4.5 ML	367963	LIGHT GREEN
923258	LITHIUM HEPARIN (PST)	0.6 ML	365958	LIGHT GREEN
907692	K2 EDTA	6 ML	367899	PINK
907688	K2 EDTA	3 ML	367856	LAVENDER
924265	K2 EDTA	0.6 ML	Sarstedt 15.1671	LAVENDER
109201	K2 EDTA MAP TUBE	0.5 ML	363706	PINK
907690	SODIUM CITRATE	2.7 ML	363083	LIGHT BLUE
907689	SODIUM CITRATE	1.8 ML	363080	LIGHT BLUE
907752	CLOT ACTIVATOR	5 ML	367814	RED
922705	CLOT ACTIVATOR	0.6 ML	365963	RED
907694	NA FLUORIDE	6 ML	367925	GRAY
75971	URINE CHEMISTRY TUBE	6 ML	366408	CLEAR (RED STOPPER)
922857				24-HOUR URINE CONTAINER
924373				DELI STOOL CONTAINER

The following forms are only used if Epic is unavailable or in select areas where Epic is not live.

Form/Requisition	Name	Processed Stores Order #
Form A-1a	Blood Center Request	922339
Form 0-9	Bone Marrow Examination Request	922993
Form A-1a	Clinical Microbiology Doctor's Order Form	923618
Form A-1a	Critical Care/Special Care Nurseries Laboratory	923779
Form H-2	Cytology Consult Report	922380
Form A-1a TDA	Doctor's Order Therapeutic Drug Assay	Not Available through Processed Stores
Form A-1a	Immunopathology Laboratory	922943
Form A-1a	Miscellaneous Request	922348
Form A-1a Lab	Pathology Doctor's Order-Lab Test	923533
Form A-1a Lab	Pathology Doctor's Order-Inpatient Service	923766
Form A-1a	Molecular Pathology/Diagnostics Laboratory	Not Available through Processed Stores
Form H-1	Surgical Pathology Consultation Request	922379



6. For areas not live on Epic Orders and during Epic down-time: Complete requisition for appropriate laboratory:
• Form: A-1a General Lab (Pathology Doctor's Orders)
• Form: A-1a Therapeutic Drug Assay (TDA) (Pathology Doctor's Orders)
• Form: A-1a Clinical Microbiology Laboratory (Pathology Doctor's Orders)
     Requires list of antibiotics patient is receiving.
     Requires diagnosis, testing varies according to suspected clinical diagnosis.
• 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)
• Form: Blood Center Request (Pathology Doctor's Orders)
• (Please refer to the tables for complete forms listing).
• Information required on A-1a forms:
1. Label the form/requisition with an Epic label or print the full name (last, first, middle initial), medical record number, birthdate, and current date on the requisition.
   
2. Nursing station or clinic.
   
3. Ordering physician's name, code and signature. Clinic codes are unacceptable.

What should be mentioned on the label of the sample tube?

What information needs to be on the specimen label after collection?

When labeling a lab tube you should?

Which of the following information is essential for labeling a patient's specimen?