Special Testing Collections and Circumstances

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Course Objectives
  1. Differentiate collection and handling requirements for selected blood and nonblood specimens.
  2.  Identify patient and collection-site factors that require modifying or stopping a collection or seeking assistance.
  3. Recognize common preanalytical errors and determine appropriate corrective actions.

Course Content
Course Creator: Kirsten Hermens NCMA-P
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-3003-24

Key Terms: 
  • Preanalytical factors
  • Specimen integrity
  • Contamination
  • Vasovagal syncope
  • Hematoma
  • Collapsed vein

Outline:
 
I. Introduction and key terms 
II. Course objectives and key terms 
  • The special collection decision process
  • Specimen integrity and safe collection decisions
III. Special blood specimen collections
  • Genetic testing and test-specific requirements
  • Coagulation testing and correct tube fill
  • Common laboratory panels
  • Therapeutic phlebotomy
IV. Nonblood specimen collections
  • Nasal, throat, and buccal swabs
  • Saliva, sputum, and semen specimens
  • Stool collection and patient instructions
  • Urine specimens: random, clean-catch midstream, first-morning, first-catch, and timed collections
    • Indwelling catheter and suprapubic specimens
  • Specimen acceptance and common rejection reasons
  • Timed urine collection scenario and review
V. Preanalytical errors
  • Patient preparation and identification
  • Collection timing, tube selection, tourniquet use, and technique
  • Mixing, clotting, centrifugation, separation, temperature, and light protection
  • Neonatal bilirubin scenario and review
IV. Blood draw challenges and troubleshooting
  • Edema, body habitus, pediatric and older adult needs
  • Tattoos, anxiety, burns, scars, and damaged skin
VI therapy, mastectomy, and lymphatic considerations
  • Absent blood flow, tourniquet assessment, unsuitable sites, and vein movement
  • Controlled needle adjustments, collapsed veins, attempt limits, and escalation
  • Vasovagal syncope, seizures, and nausea
  • Circulation findings, petechiae, thrombosis, and varicose veins
  • Patient assessment scenarios and review
VII. Conclusion
 

References:
 
1. Clinical and Laboratory Standards Institute. (2025). Collection of diagnostic venous blood specimens (8th ed.; CLSI standard PRE02). https://clsi.org/shop/standards/pre02/ 
2. Mayo Clinic Staff. (2026, February 27). Genetic testing. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/genetic-testing/about/pac-20384827 
3. Labcorp. (n.d.). Blood specimens: Coagulation. https://www.labcorp.com/test-menu/resources/blood-specimens-coagulation 
4. National Heart, Lung, and Blood Institute. (2022, March 24). Blood tests. https://www.nhlbi.nih.gov/health/blood-tests 
5. Cleveland Clinic. (2026, May 26). Therapeutic phlebotomy. https://my.clevelandclinic.org/health/treatments/therapeutic-phlebotomy 
6. Centers for Disease Control and Prevention. (2024, October 29). Interim guidelines for collecting and handling of clinical specimens for COVID-19 testing. https://www.cdc.gov/covid/hcp/clinical-care/clinical-specimen-guidelines.html 
7. Centers for Disease Control and Prevention. (2025, December 1). Best practices for use of polymerase chain reaction for diagnosing pertussis. https://www.cdc.gov/pertussis/php/pcr-bestpractices/index.html 
8. Cleveland Clinic. (2022, December 13). Throat culture. https://my.clevelandclinic.org/health/diagnostics/24533-throat-culture 
9. Mayo Clinic Laboratories. (2025). Buccal swab collection instructions [Patient instructions]. https://www.mayocliniclabs.com/~/media/it-mmfiles/special-instructions/BucalSmearInfo.pdf 
10. DNA Genotek. (n.d.). Oragene•Dx OGD-510 and OGD-610 collection instructions. https://dnagenotek.com/us/support/collection-instructions/oragene-dx/OGD-510andOGD-610 
11. Mayo Clinic Laboratories. (n.d.). Cortisol and cortisone, saliva. Retrieved September 29, 2026, from https://www.mayocliniclabs.com/test-catalog/overview/623604 
12. Centers for Disease Control and Prevention. (n.d.). Clinical and laboratory diagnosis for tuberculosis. https://www.cdc.gov/tb/hcp/testing-diagnosis/clinical-and-laboratory-diagnosis.html 
13. World Health Organization. (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). https://www.who.int/publications/i/item/9789240030787 
14. NHS. (2024, June 27). How to collect a sample of poo (stool sample). https://www.nhs.uk/tests-and-treatments/how-to-collect-a-sample-of-poo-stool-sample/ 
15. Mayo Clinic Laboratories. (n.d.). Specimen collection and preparation: Fecal specimens. Retrieved September 29, 2026, from https://www.mayocliniclabs.com/specimen/preparation/index.php?question=3 
16. Clinical and Laboratory Standards Institute. (2024). Processes for the collection of urine specimens (1st ed.; CLSI guideline PRE05). https://clsi.org/shop/standards/pre05/ 
17. Mayo Clinic Laboratories. (n.d.). 24-hour urine collection instructions [Patient instructions]. 
18. Centers for Disease Control and Prevention. (n.d.). Summary of recommendations: Guideline for prevention of catheter- associated urinary tract infections. https://www.cdc.gov/infection-control/hcp/cauti/summary-of-recommendations.html 
19. Merck Manual Professional Edition. (n.d.). How to do suprapubic aspiration of the bladder in a child. https://www.merckmanuals.com/professional/pediatrics/how-to-do-pediatric-urologic-procedures/how-to-do-suprapubic-aspiration-of-the-bladder-in-a-child 
20. National Library of Medicine. (n.d.). Suprapubic catheter care. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000145.htm 
21. Clinical and Laboratory Standards Institute. (2024). Patient and laboratory specimen identification processes (1st ed.; CLSI standard PRE01). https://clsi.org/shop/standards/pre01/ 
22. Labcorp. (n.d.). Introduction to specimen collection. https://www.labcorp.com/test-menu/resources/introduction-to-specimen-collection 
23. Clinical and Laboratory Standards Institute. (2023). Handling, transport, processing, and storage of blood specimens for routine laboratory examinations (1st ed.; CLSI guideline PRE04). https://clsi.org/shop/standards/pre04/ 
24. Mayo Clinic Laboratories. (n.d.). Amikacin, random, serum. Retrieved September 29, 2026, from https://prd1.mayocliniclabs.com/test-catalog/overview/37033 
25. Clinical and Laboratory Standards Institute. (2020). Collection of capillary blood specimens (7th ed.; CLSI standard GP42). https://clsi.org/shop/standards/gp42/ 
26. Diagnostic Laboratory of Oklahoma. (n.d.). Bilirubin, total. Retrieved September 29, 2026, from https://www.dlolab.com/bilirubin-total 
27. Memorial Sloan Kettering Cancer Center. (2026, July 7). Hand and arm guidelines after your axillary lymph node dissection. https://www.mskcc.org/cancer-care/patient-education/hand-and-arm-care-after-removal-axillary-lymph-nodes 
29. Centers for Disease Control and Prevention. (2024, May 15). First aid for seizures. https://www.cdc.gov/epilepsy/first-aid-for-seizures/index.html 
30. Cleveland Clinic. (2021, June 29). Petechiae. https://my.clevelandclinic.org/health/symptoms/21636-petechiae 
31. Centers for Disease Control and Prevention. (2025, March 5). About venous thromboembolism (blood clots). https://www.cdc.gov/blood-clots/about/ 
32. Mayo Clinic Staff. (2024, February 6). Varicose veins: Symptoms and causes. Mayo Clinic. 

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