Unit 2: Specimen Transport Methods

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Course Objectives

Assess additives, mediums, broth, and preservatives
Recognize how to choose the right containers for specimens
Prioritize specimen handling and confirm labeling
Arrange transportation, temperature, and packaging

Course Content

Course Creator: Kirsten Hermens, NCMA-P

Total CE Hours: 1 Credit Hour

Pace Course #: 586-2606-26

Key Terms:

Alkaline Peptone Water
Anticoagulant
Aerobic
Anaerobic
Buffers
Cellulose Wadding
Excisional
Hemolysis
Hypothermic
IATA
ICAO
ICD-10 Code
Incisional
ISO 15189
Medium
Oragene
Permeable
Photosensitive
Quantity Not Sufficient (QNS)
Suprapubic Aspiration
Swab Applicator
Transport Vial
Urethral Catheterization
Vitrification

Outline:

Introduction
Key Terms
Specimen Types
- Blood specimens
  - Whole Blood
  - RBC
  - Plasma
  - Platelets
  - Cryoprecipitate
  - Albumin
  - Immunoglobulins
- Microbiological Specimens
  - Surgical Biopsies
  - Tissue
  - Wounds
  - Body Fluids
- Chemical Specimens
  - Hazardous Material
  - Chemical Exposure
  - Blood Collection
  - Urine Collection
- Urine Specimens
  - Random
  - Clean-Catch
  - Culture and Sensitivity
  - Suprapubic Aspiration
  - Urethral Catheterization
  - 24 Hour Collection
- Saliva Specimens
  - Free-flowing
  - FTA Card
  - DNA Kit
    - Oragene
  - Passive Drool
  - Whole Saliva
  - Swab
- Tissue and Biopsy Specimens
  - Renal
  - Liver
  - Bone
  - Bone Marrow
  - Endoscopic
  - Punch
  - Needle
    - FNA
    - Core Needle
    - Vacuum Assisted
  - Brush
  - Lymph Node
  - Ultrasound-Guided
  - Surgical
    - Incisional
    - Excisional
Additives, Mediums, Broth and Preservations
- Blood Additives
  - Anticoagulant
    - Sodium Citrate
    - Lithium Heparin
    - Sodium Heparin
    - EDTA
    - Potassium Oxalate
    - Clot Activator
      - Silica
    - Thixotropic Gel
  - Sodium Fluoride
  - SPS
- Microbiological Transport Mediums
  - Meticulous Preservation
  - Classification of Physical State
    - Semi-solid
    - Liquid
  - Classification of Utility
    - Bacterial
    - Viral
    - Parasites
  - Cary-Blair Medium
  - Amies Medium
    - With Charcoal
    - Without Charcoal
  - Stuart’s Medium
  - Venkatraman Ramakrishnan (VR) Medium
  - Alkaline Peptone Water
  - Sach’s Buffered Glycerol Saline
  - Viral Transport Medium (VTM)
  - Anaerobic Transport Medium (ATM)
  - Chlamydia Transport Medium
  - Mycoplasma Transport Medium
- Chemical Additives
  - Anticoagulants
    - EDTA
    - Sodium Heparin
    - Potassium Oxalate
  - Glucose Preservative
    - Sodium Fluoride
  - Sterile Screw Cap Plastic Container
    - No Additives
  - Aliquoting into Tubes
    - Contain Preservatives
  - Urine Preservatives
    - Certain Buffers
      - Boric Acid
        Most commonly used
      - Hydrochloric Acid
        Used commonly in urine specimens
      - Acetic Acid
        Used in 24-hour urine collection
      - Oxalic Acid
  - Saliva Additives
    - Sodium Dodecyl Sulfate (SDS)
    - Ethylenediaminetetraacetic Acid (EDTA)
    - Tris Buffer
  - Tissue and Biopsy Preservation
    - Fixative, 10% Formal Saline
    - Normothermic
    - Dry State
    - Hypothermic
    - Vitrification
    - Slow Freezing
  - Choosing the Right Containers
    - Blood Collection Containers
      - Blood Specimens
      - Culture Bottles
        Anaerobic
        Aerobic
      - Vacutainer Tubes
      - Microgard Closure
      - Micro capillary Tubes
  - Microbiological Collection Containers
    - Swab
    - Transport Vial
      - Sterile Screw Cap Container
      - Sterile Screw Cap Container with Specified Medium
  - Urine Collection Containers
    - Sterile Screw Cap Container
    - Gray Top Urinalysis Tube with Preservative
    - UA Preservative Plus Plastic Conical Bottom
    - Microscopic slide
      - Cover Slip
  - Saliva Collection Containers
    - Saliva Collection Tubes
    - Funnel Devices
    - Collection Cups
    - Sterilization Kits
    - FTA Cards
      - Elute Cards
      - EasiCollect Devices
      - QIAcard Cards
    - Sterile Collection Swabs
    - Sample Punching Tools
    - Storage Pouches
    - Oragene Saliva Collection Tubes
    - Funnel Device
    - DNA Stabilization Solution
    - Sterile Caps and Packaging
    - SalivaBio Collection Aid
    - Cryovials
    - Cryogenic Tubes
      - Wheaton
      - Nunc
    - Swab
  - Tissue and Biopsy Collection Containers
    - Glass Jar or Bottle with Screw Caps
    - Cryoprotectants
      - Low Molecular Weight Solutes
        Permeable
      - Sugars and High Molecular Weight Polymers
        Non-permeable
Specimen Handling
- Blood Specimen Handling
  - Improper Time of Collection
  - Inadequate Fast
  - Avoid Contamination
  - Use Correct Disinfectants
  - Extended Tourniquet Time
  - Avoid Hemolysis
  - Correct Gauge Needle
  - Use Correct Order of Draw
  - Proper Inversion Amounts
  - Avoid Quantity Not Sufficient (QNS)
  - Avoid Improper Storage Conditions
  - Photosensitive
  - Avoid Processing Delay
  - Failure to Separate Serum From Cells
  - Improper Use of Serum Separator
- Microbiological Specimen Handling
  - Expel Air, Needle Collections
  - Avoid Use of Cotton or Wood Handle Swabs, Ocular Specimens
  - Avoid Toilet Tissue, Stool Specimens
  - Avoid Cross Contamination, Urine Specimens
  - Avoid Lubricants, Genital Specimens
- Chemical Specimen Handling
  - Left Whole
  - Unopened
  - Store at 1˚ - 10˚C
  - Dry Ice, Preferred
- Urine Specimen Handling
  - Unpreserved Specimens, Refrigerated
  - Wash Hands
  - Refrain From Touching the Inside of the Urine Container
  - Avoid Contamination of Feces, Water or Dirt
- Saliva Specimen Handling
  - Choose Correct Tools
  - Patient Preparations
  - Choose Correct Storage Temperature
  - Limit Freeze / Thaw Cycles
  - Long Term Storage, Frozen
  - Long Term Storage, Room Temperature
- Tissue and Biopsy Specimen Handling
  - 10:1, Specimen Immersion
  - Large Specimens, Bucket
  - Amputated Specimens in a Rubber Sheet
  - Bulky Specimens Bisected
  - Stomach / Intestine Opened
  - Cotton Wool, Never Water or Normal Saline
- Confirm Labeling
  - All Specimens
    - Patient’s First and Last Name
    - Date of Birth
    - Sex
    - MRN
    - Physician’s Name
    - Physician Contact Information
    - Confirm Patient Followed Testing Guidelines
    - Identify Floor and Room Number, If Applicable
    - Bed Number, If Applicable
    - Type of Specimen Collected
    - Specimen Identification Barcodes
    - Any Special Handling Instructions
    - Test Codes (ICD-10)
    - Time Collected
    - Date Collected
    - Collector’s Name and Title
    - Any Notable Events During Collection
- Transportation Temperature and Packaging
  - Transportation Temperature
    - Ambient
    - Room Temperature
    - Refrigerated
    - Frozen
  - Transportation Packaging
    - Primary Receptacle
    - Sterile leakproof with Tight Fitting Lid
    - Cushioning Material
    - Secondary Container
    - Documentation
    - Styrofoam Cooler
    - Rigid, Outer Packaging
    - Spill-proof and Absorbent Materials
      - Cellulose Wadding
      - Cotton Balls
      - Super-absorbent Packs
      - Paper Towels
    - Biohazard Envelope
    - Secure, Tamper-Evident
    - Monitoring Devices
    - Insulated Coolers
    - Dry Ice
    - Gel Packs
      - ISO 15189
    - Applicable Identifying Markings
    - Outer Packaging
    - Biohazard
    - Non-Pathogenic
    - Exempt Human Specimen
- Method of Transportation
  - Dangerous Goods Certificate
  - Three Classifications
    - Category A
    - Category B
    - Exempt Specimen
  - Federal Transport Regulations and Standards
  - Biological Specimens
    - IATA
    - ICAO
    - U.S. DOT
    - USPS, Next Day Air
    - FedEx, Priority Overnight
- Tracking and Special Markings
  - Tracking Devices
  - Barcodes
  - Specimen Barcodes
  - QR Codes
  - Laboratory Information Systems (LIS)
  - RDIF Technology
    - Electromagnetic Fields
  - IoT-enabled
    - Reports Any Temperature Fluctuations
- Specific Markings on Shipping Container
  - Shipper and Consignee
  - Responsible Person
  - Emergency Contact
- Documentation
  - Shipper’s Declaration of Dangerous Goods
  - Required information:
    - UN number
    - Proper shipping name, followed by technical name
    - Class or division
    - Quantity of substance and type of container
    - Packing instructions used
    - Authorization code, if applicable
- UN Numbers
  - Proper Shipping Names
    - Common Shipping Names – UN2814
    - Common Shipping Names – UN3245
    - Common Shipping Names – UN3291
    - Common Shipping Names – UN3373
    - Common Shipping Names – UN1845
  - Classes of Clinical Lab Samples
    - Class 6 - Infectious Substances
      - UN2814 – Category A
      - UN3373 – Category B
    - Class 9
      - UN1845 – Dry Ice
      - UN3373 - Biological Substance
  - Examples of Category A Substances
    - Class 6 – UN2814
    - Process of Categorization
  - Examples of Category B Substances
    - UN3373 – Category B
    - Category B - Class 6 UN3373
    - Class 6 UN2814 Packaging Certification
- Specimen Rejection Criteria
  - Rejection Criteria
    - Delayed Delivery
    - Container Leakage
    - Inadequate Volume
    - Inappropriate Transportation Methods
    - Regulatory Non-Compliance
    - Contamination and Improper Collection
    - Incorrect Labeling
    - Hemolysis
    - Clotted Specimens
    - Specimen Age Out
Urgent Response Plan
- Immediate Notification
- Sample Isolation
- Assessment and Action
- Documentation and Review
Conclusion

References:

(2024). Transportation Guidelines. Mayo Clinic. https://www.mayocliniclabs.com/-/media/it-mmfiles/Special-Instructions/6/5/2/united-states-shipping-guide
(2024, September 27). Guidelines Safe and Effective. Ship Science. https://www.shipscience.com/guidelines-for-safe-and-effective-laboratory-specimen-transport-7/
(n.d.). Specimen Packing and Shipping. CDC. https://www.cdc.gov/laboratory/specimen-submission/pdf/Specimen-Packing-and-Shipping-Guidance-Infectious-Diseases-Laboratories.pdf
(n.d.). Exempt Human Specimen. National Institute of Health Environmental Services. https://www.bing.com/search?q=exempt+human+specimen+shipping+protocol&FORM=QSRE7
(2024, May 11). Blood Products. Darwyn Health. https://darwynhealth.com/blood-disorders/managing-blood-disorders/blood-transfusion/blood-products/understanding-different-types-of-blood-products-and-their-uses/?lang=en
(2024, May 17). Transport Media. BNO. https://biologynotesonline.com/transport-media/
(2024, October 16). Chemical Specimen Collection. CDC. https://www.cdc.gov/laboratory-response-network/php/chemical/specimen-collection.html
(2024, October 29). Saliva Collection. Trume Labs. https://trumelabs.com/blog/saliva-sample-collection-methods/
(2023, January 1). Biopsy Types. Medical Lab Scientist. https://medicallabscientist.org/biopsy-specimens-collection-and-types/#google_vignette
(2024, June 1). Urine Preservatives and Collection. Mayo Clinic. https://www.mayocliniclabs.com/-/media/it-mmfiles/Special-Instructions/9/6/7/Urine_Preservatives-Collection_and_Transportation_for_24-Hour_Urine_Specimens
(2012, August 1). Saliva Preservatives. Tech Briefs. https://www.techbriefs.com/component/content/article/14237-msc-25144-1
(2022, September 28). Tissue Preservation Strategies. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9802477/
(2020, July 22). Microbiology. Pathology Lab. https://www.pathologylab.org/filesimages/Microbiology
(2024, January 1). Storing Saliva Samples. Salimetrics. https://salimetrics.com/saliva-collection-handbook/#storing-saliva-samples
(2018, January 1). DOT Transportation Guidelines. Department of Transportation. https://www.transportation.gov/sites/dot.gov/files/docs/resources/partners/drug-and-alcohol-testing/2567/urine-specimen-collection-guidelines-january-2018.pdf
American Society for Microbiology (2021, April 20). Packing and Shipping Infectious Substances. ASM. Retrieved July 25, 2024, from https://asm.org/guideline/packing-and-shipping-infectious-substances
(2018, January 1). UN3373 Medical Packages. UN3373. Retrieved July 25, 2024, from https://www.un3373.com/category-biological-substances/category-b/
Mayo Clinic Laboratories Global Logistics (2023). Transporting Dangerous Goods. Mayo Clinic Laboratories. Retrieved July 25, 2024, from https://news.mayocliniclabs.com/n1/96e99366cea7b0de/uploads/2023/06/Handout-English.pdf
(n.d.). Frequently Shipped Biological Material and Proper Classification. University of Iowa. https://ehs.research.uiowa.edu/frequently-shipped-biological-material-and-proper-classification
(2022). Record of Training Certificate [Photograph]. Cbk. https://cbk.wroc.pl/wp-content/uploads/2022/05/SSZ-22.04.2022-2024.pdf
(2023, March 24). Specimen Handling and Transportation. Lab Test Guide. https://www.labtestsguide.com/sops-for-specimen-handling-and-transportation

Special Photo Credits:

P1. Selvaraj, Y., & Malaisamy, K. (2021). Rejuvenation of Ovary and Thin Endometrium by Autologous PRP Injection in POR and Recurrent Implantation Failure. Advances in Sexual Medicine, 11(01), 1–15. https://doi.org/10.4236/asm.2021.111001

P2. (2016). Packaging and Transporting Infectious Substances [Photograph]. Centers for Disease Control and Prevention. https://www.cdc.gov/smallpox/lab-personnel/specimen-collection/pack-transport.html

P3. (n.d.). Packing Category A and B and Exempt Human and Exempt Animal Specimens Job Aid [Photograph]. CDC. https://www.cdc.gov/mmwr/preview/mmwrhtml/su6101a1.htm