Laboratory Procedures Clinical

1. Laboratory ProceduresClinical Vanderbilt University Medical Center Nashville, TN Department of Pathology

2. Who to Contact? • The Main Lab: 343-9155 (3-9155) • Client Services (Reference Tests): 322-4844 (2-4844) • Reference test are tests that are sent to an outside facility. These numbers are resources which you can access at any time for any questions you may have about how a test is drawn, what color tube, etc.

3. Labels • Labels should be legible. • ALL test tubes and urine cups must be labeled. • Pt’s Name, MR# • Required on all specimens DIRECTION NAME MR # DATE TIME INTL http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/F575E10C0648EB8686256A6B00502EA9

4. Requisitions • All requisitions require: • Pt’s Full name • Pt’s MR number • Current date • Current Billing Number • Doctor’s code • Clinic code • Doctor’s signature • ICD-9 Code(s) • Tests ordered clearly marked

5. Patient Verification is MANDITORY • Two identifiers should be used • Name • DOB • ID Bracelet (if available) • SSN • Government Issue • Driver’s License, ID Card with Picture • Photograph: VPH • Medical Record (chart) http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/29B5F84E98DB814986256CB5007E4E6D

6. Causes of Common Labeling Errors • Failure to verify patient properly • Not labeling specimens immediately after drawing specimens • Failure to label specimens before leaving patient’s side.

7. Effect of Labeling Errors • Incorrect laboratory results will be reported. • Delays laboratory results. • If detected, specimen may be discarded. • Incorrect results may hinder proper patient care, or even death.

8. 5 Steps to Effective Labeling • Verify Patient Identification by 2 identifiers. • Match Patient ID to requisition. • Match Patient ID to Specimen Label(s) • Label specimen before you leave the Patient. • Match the label to Requisition as the specimen is bagged for transport.

9. Specimen Packaging • Requisition should be folded so the patient’s name and priority shows through the plastic bag. • Blood tubes and urine specimens should be packed in separate bags. • Blood Cultures should be packed separate from blood tubes. • Requisitions should be inserted in pocket provided separating blood from paperwork. Name, Mr#, Billing Code, DR's Code, Clinic Code Priority (STAT, Routine) Pt. Info Priority TUBE TUBE TUBE

10. Safety • Universal Precautionsatall times • PPE’s (Gloves, lab coats, etc.) • Discard sharps properly ASAP • Keep your work area clean and organized

11. Tube Order • Red or Gold top, (aka SST or Tiger top) Light Green, (Lithium Heparin) • Blue top • Green Heparinized (dark Green) • Lavender EDTA (always last) • If a Blood Culture is ordered, draw the blood culture first and collect the rest in the original order. • All tubes should be gently inverted to avoid hemolysis and clotting.

12. Blue Sodium Citrate Tube • If a PT or PTT is ordered by itself always draw 3 to 5 ml. in a discard tube. (RED or Gold) • These specimens should be sent ASAP. • This tube must always be full.

13. Tips For Good Customer Service • Always let patient see you change gloves. • Always let the patient see you taking out new equipment. • Always be courteous • Always maintain a clean appearance both personally and professionally. • Always be confident. * Remember you are in control.

14. Tips to Avoid Hemolysis • Use the largest bore needle available whenever possible. • Avoid using syringes to draw blood. • Avoid using Butterfly needle sets. • Do not push blood into tubes with syringes and butterfly needle sets. • Make sure the blood is being draw under the tubes own evacuated system. • Make sure the blood flow into tube is quick and constant. • Always invert tubes (especially tubes with additives).

15. Who to Contact? • The Main Lab: 343-9155 (3-9155) • Client Services (Reference Tests): 322-4844 (2-4844) • Reference test are tests that are sent to an outside facility. These numbers are resources which you can access at any time for any questions you may have about how a test is drawn, what color tube, etc.

16. Serum No Anti-coagulant Red Top or SST (Gold Top) Tube. Plasma Anti-coagulated Lavender Dark Green Top Light Blue Serum Vs. Plasma(Fluid Part of The Blood)

17. Latex Alternatives • Nitrile Gloves • Vinyl Gloves • Nitrile Tourniquets • Cartoon Band aids • If all else fails use regular tourniquets over cloth (Sleeves, Gauze)

18. Questions and Answers

19. Star Panel • To Access Non- Vanderbilt Patient Accounts, security needs to be obtained for VPLS. • Contact Security Manager, request SAMS (Security Access and Maintenance Team) access form for VPLS Security.