Texas Health Steps: Specimen Collection and Handling

Contents

Getting Started

• Contact Information
• Acceptable Identifiers

Illustrations of Purple Top Tubes 

• Venous blood collections
• Fingerstick or heel stick blood collections

THSteps Unsatisfactory Specimens and How to Avoid Them 

• Required information on G-THSTEPS/G-1B form
• Miscellaneous situations related to G-THSTEPS/G-1B form

Unsatisfactory Codes Related to Collection Tube or Specimen 

• Unsatisfactory codes that will affect an entire mailing container.
• Identification issues for blood collection tube/specimen
• Incorrect tube type or specimen submitted.
• Age of specimen
• Specimen volume requirements
• Shipping errors
• Miscellaneous rejections

Getting Started

Obtain supplies to collect and ship or mail specimens to the DSHS Laboratory from the Container Preparation Department. DSHS offers THSteps supplies, including postage paid mailing labels and cold shipping boxes with air bills, at no cost to the medical provider. Enrolled THSteps providers may request supplies by telephone at 1 (888) 963-7111 ext. 7661 or (512) 776-7661, or by fax at (512) 776-7672.

Review the specimen requirements for the desired test.

Collect the appropriate blood specimens in the correct blood collection tubes. For specimens other than blood (e.g., GC/CT), collect the sample with the appropriate specimen collection device.

All information recorded on the submission form and specimen collection tubes or other specimen collection devices must be clear and legible.  If a label is used, ensure that it is firmly attached to the specimen to ensure accurate identification.

All specimens must be labeled with at least two patient identifiers that MUST match the identification on the submission form, see the list of acceptable identifiers below.  

Complete the required fields of the appropriate submission forms accurately, completely, and legibly. Ensure that the patient's name matches exactly on the specimen and the submission form.

Clearly mark the type of specimen being submitted, the test(s) desired, and the payor source on the appropriate submission form. Submit a separate submission form for each specimen type. 

If necessary, complete any required information on the submission form that indicates how the specimen was stored before shipping (e.g., date/time specimen removed from freezer/refrigerator for glucose, or cholesterol).

For whole blood specimens shipped at ambient temperature through the U.S. Postal Service, mail specimens the day of collection or the following day to ensure that specimens are received in the laboratory within the required timeframe for each test. Specimens may be refrigerated overnight before being mailed the following day. NEVER freeze whole blood specimens.

Acceptable specimen identifiers include but are not limited to: 

• Patient Name
• CDC Number
• Unique Random Number
• Medical Record Number
• Medicaid Number
• Newborn Screening Kit Number Date of Birth

Note: Location based identifiers are NOT acceptable (e.g., hospital room number or street address).

Illustrations of Purple Top Tubes

Venous Blood Collections

Becton Dickinson (BD) 2 mL Vacutainer® K2 EDTA 3.6 mg tube
 
This is the DSHS Laboratory-specified blood collection tube for hemoglobin and lead testing when collecting by venipuncture. It is provided by the DSHS Laboratory to enroll Texas health Steps providers. The Laboratory will also accept 3 mL and 4 mL tubes from the same manufacturer. The fill volume for each tube is stated at the bottom of the label. 

Note the indicator mark on the edge of the label.  Some tubes may have different color labels and markings. The mark on the edge of the label indicates the approximate volume that the tube is designed to collect. Tubes that are designed to draw 3 mLs or 4 mLs will have this mark closer to the top of the tube.

The 2 mL blood collection tubes have a low vacuum as they are designed to draw only 2 mL of blood. This means that blood will flow more slowly into the tube and the draw may take longer to obtain the desired volume of blood.

There are three options for obtaining sufficient volume for the vacuum blood collection tubes.

1. Typical venipuncture technique using a Vacutainer® tube and a multi-draw needle. The tube is designed to draw ~2 mL of blood. Do not remove the needle from the vein too soon or the vacuum of the tube will not have sufficient time to draw the correct volume. Once the draw is complete, mix by inversion at least 10 times to ensure adequate mixing of blood and anticoagulant to avoid clotting.
    
2. Venipuncture using a “butterfly” collection device with a vacuum blood collection tube. Once the “butterfly” device is attached to the tube, the “dead space” in the “butterfly” tubing will evacuate enough of the vacuum in the tube that it can no longer pull the desired volume. Avoid this problem by using a “waste” or “discard” tube – attach the “butterfly” to the tube and perform the venipuncture; once a small amount of blood is drawn into the vacuum tube, remove this “waste” or “discard” tube and replace it with a second vacuum tube that has not had its vacuum compromised. At this point, the second vacuum tube should pull the correct volume. Again, do not remove the needle from the vein too soon or the vacuum of the tube will not have sufficient time to draw the correct volume.  
   
   Another way to perform this action without use of a “waste” or “discard” tube is to attach the blood collection tube to the “butterfly” collection device once blood is flowing into the tubing.
    
3. Venipuncture using a syringe and “butterfly” collection device. This option allows the phlebotomist to use the “butterfly” device but uses a syringe of appropriate size to draw sufficient blood in order to meet the fill volume requirement for the blood collection tube to be used.  

Fingerstick or Heelstick Blood Collections

Becton Dickinson (BD) Microtainer® MAP 250 µL – 500 µL tube

• This is the DSHS Laboratory-specified blood collection tube for hemoglobin and lead testing when collecting by finger stick. It is provided by the DSHS Laboratory to enroll Texas Health Steps providers.
• The minimum and maximum acceptable volumes are indicated on the tube by the 250 and 500 µL lines. The blood level must be anywhere between these two lines to be acceptable for fill volume. The target volume is indicated by the 375µL line.

Unsatisfactory Specimens and How to Avoid Them

The following table is specifically for Clinical Chemistry THSteps tests. Information regarding HIV, RPR, or Gonorrhea/Chlamydia unsatisfactory specimens may be references in the Laboratory Testing Services Manual (LTSM)

Required information on G-THSTEPS/ G-1B form.

Miscellaneous situations related to G-THSTEPS/G-1B form.

Unsatisfactory code related to collection tube or specimen:

Unsatisfactory codes that will affect an entire mailing container.

Identification issues for blood collection tube/specimen

Incorrect tube type or specimen submitted.

Age of Specimen

Specimen volume requirements

Shipping Errors

Miscellaneous Rejections