Specimen Collection

Phlebotomy Order of Draw

As per the Clinical and Laboratory Standards Institute (CLSI) standard H3-A6 (Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard – Sixth Edition; October 2007), the following order of draw is recommended for both glass and plastic venous collection tubes when drawing multiple specimens for clinical laboratory testing during a single venipuncture. Its purpose is to avoid test result error due to additive carryover. All additive tubes should be filled to their stated volumes.

1. Blood culture tube
2. Coagulation tube (e.g. light blue top tubes)
3. Serum tube with or without clot activator, with or without gel (e.g. red, gold, or speckle-top tubes)
4. Heparin tube with or without gel plasma separator (e.g. green top tubes)
5. EDTA tube with or without gel separator (e.g. lavender top tubes)
6. Glycolytic inhibitor tube (e.g. gray top tubes)

Note: When using a winged (e.g. butterfly) blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube. The discard tube must be used to prime the tubing of the collection set, which will assure maintenance of the proper anticoagulant/blood ratio in the first tube filled. The discard tube should be a non-additive or a coagulation tube, and need not be completely filled.

It is extremely important to draw a waste tube when drawing blood for coagulation studies other than prothrombin time (PT), and activated partial thromboplastin time (aPTT) testing.

Microtainer Order of Draw

The order of collection for microcollection differs from that of venipuncture. As per the CLSI standard H4-A6 (Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard – Sixth Edition; September 2008), collect multiple specimens in the following order:

1. Arterial blood gases (ABG)
2. EDTA specimens (e.g. lavender)
3. Other additive specimens
4. Specimens requiring serum (e.g. gold, red)

Order Priorities

Laboratory test turnaround time is dependent on the priority assigned to the requested procedure. The test turnaround time priority definition is as follows:

STAT 60 minutes from the receipt of the specimen into the laboratory site performing the test.

Urgent 4 hours from the receipt of the specimen into the laboratory site that is performing the test.

Routine 24 hours from the receipt of the specimen into the laboratory site performing the test, except for tests only performed certain days of the week. See individual tests in the Alphabetized Test Listing (Section III).

Note: Only certain tests will be performed STAT. Please refer to the STAT list located at the end of this section.

Specimen Labeling - Regulatory Standards

Laboratory Alliance is committed to following the highest ethical standards to provide quality laboratory services to our customers and to complying with all federal, state, and local laws and regulations.

Laboratory Alliance of Central New York is licensed to operate by the New York State Department of Health. The four laboratory locations, which comprise Laboratory Alliance, undergo biannual inspections by the New York State Department of Health.

In accordance with the New York State Department of Health Rules and Regulations, all specimens submitted to the laboratory must be adequately labeled so that there is no ambiguity as to the patient's identity, specimen source, and time and date of collection.

Part 58-1.10 (e) of the New York Code of Rules and Regulations for Clinical Laboratories states: A specimen received by a laboratory shall not be tested if:

1. the apparent condition of the specimen indicates that it is unsatisfactory for testing or that it is inappropriate for the test requested;
2. it has been collected, labeled, preserved or otherwise handled in such a manner that it has become unsatisfactory or unreliable as a test specimen;
3. it is perishable and the time lapse between the collection of the specimen and its receipt by the laboratory is of such duration that the test finding may no longer be reliable; or
4. the date and, in the case of tests specified by the department, the hour when the specimen was taken by the physician or other authorized person is not furnished with the specimen.

We cannot proceed with your test because...

We strive to provide a timely return of your patient test results but are often delayed because of errors in the submission process. Teamwork and attention to detail will help us serve you better!

Top 5 Reasons We Have to Call Our Clients

1. Patient name is misspelled
   Confirm spellings of patient name on the specimen with the patient name on the enclosed paperwork.
2. Specimen(s) are mislabeled or unlabeled
3. Test order clarification or unknown specimen source
   Every specimen and every test must have a clearly written test order or check off the appropriate box on the requisition. If submitting a culture, please indicate specimen source.
4. Missing or incomplete insurance information
   Insurance information must be included on the electronic requisition or the Lab Alliance requisition.
5. Missing diagnosis codes or diagnoses that do not support medical necessity
   LCD and NCD code information can be found on our website under the “Healthcare Providers” tab. Use this reference to assign the proper ICD-10 code for those tests that require a medically necessary diagnosis code.

Questions? Call our Customer Service Department at 315-461-3008

Revised 9/22/17