Laboratory General

The value of clinical laboratory results is directly related to the quality of the specimen submitted for analysis. Specimens can be collected in clinic by the medical staff, in-office phlebotomist (IOP), or at a Quest Diagnostics Patient Service Center (PSC). 

The patient must be properly prepared prior to specimen collection. After collection, the specimen must be properly processed, packaged, and transported to the laboratory at an appropriate temperature in a timely manner. The specimen will be assessed for quality upon arrival into the laboratory.

It is critical that an adequate specimen volume is submitted for analysis. The preferred volume requested in the Test Directory is sufficient for the initial analysis of the specimen and any confirmatory tests that may be needed. If initial, repeat, or confirmatory tests cannot be performed, the laboratory report will indicate that the specimen quantity submitted was not sufficient for testing (QNS).

If an inappropriate specimen or unclear test request was submitted, notification with instructions for resolution will be sent. 

The Test Directory provides information on specimen requirements such as preferred and alternative specimens, patient preparation, minimum volume required to perform testing, storage/transport temperature, stability at all temperatures, collection, or special handling instructions, and rejection criteria.

When serum or plasma is to be submitted for analysis, it is good practice to collect a volume of blood that is 2 to 2.5 times the volume of serum or plasma needed for the test. As an example, if 4 mL of serum or plasma is needed for a test, collect 8 to 10 mL of blood.

Storage temperatures are specified as follows:

• Room Temperature (15 °C to 30 °C)
• Refrigerated (2 °C to 8 °C)
• Frozen (-20 °C or colder)

If needed, please contact client services at 1.866.MYQUEST (1.866.697.8378) for clarification about specimen requirements or patient preparation prior to collection. 

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Specimens containing blood or other potentially infectious material should be handled in a safe manner using universal precautions and according to applicable legal requirements or guidance. Information on safe specimen handling may be obtained from the U.S. Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). In handling human specimens, the goal is to protect healthcare workers and the general public from exposure to blood and to other potentially infectious body fluids.

Work areas contaminated with potentially infectious material must be disinfected immediately with an appropriate disinfectant such as a 10% bleach solution.

In the event of an exposure to blood or other potentially infectious material, administer first aid immediately. Needlesticks and cuts should be washed with soap and water. Exposures to the nose and mouth should be flushed with water, while exposures to the eyes should be irrigated for at least 15 minutes with water or saline.

Once first aid has been rendered, notify a manager or supervisor, and seek prompt medical attention.

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Patient preparation is important to ensure accurate laboratory testing results.  Some specimens may require collection at a specific time because of medications, fasting requirements and/or biological variations (circadian rhythm).  It is important that timed tests are collected at the precisely specified intervals (such as tolerance tests, cortisol, and therapy monitoring).   No food, liquid, chewing gum or other objects should be in the patient's mouth at the time the specimen is collected.  Patients with a history of syncope must be recumbent.*

Please refer to the Test Directory or call 1.866.MYQUEST for specific patient preparation instructions.

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For many tests, a fasting specimen will be requested for testing to yield the most accurate results. Fasting is defined as the abstention from eating or drinking anything other than water for 9-12 hours prior to specimen collection. 

If fasting is required, the patient should also be advised to refrain from strenuous activity or exercise during the fasting period and to avoid becoming dehydrated.

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Because reference ranges are often applied by patient age and/or gender, it is helpful to indicate both data on the test requisition or electronic order. 

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Pediatric color-coded Vacuette^® tubes are provided to facilitate special handling. These tubes will hold up to 1.5 mL of specimen. When collecting for multiple tests, please use the minimum volume listed in the Test Directory for each specific test in order to determine how many tubes are required. For larger volume samples, standard specimen transfer tubes should be used.

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Some tests require a substance to be administered to the patient. Specimens are collected before the substance is administered and at specific times afterwards.

Please refer to the Test Directory for specific provocation tests requirements. Call 1.866.MYQUEST (1.866.697.8378) to schedule at a PSC capable of administration and collection.

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All specimens should be labeled at the time of collection with at least two (2) patient identifiers that must also appear on the requisition.

1. The patient’s name (full last name, then full first name as it appears on the requisition), or a unique ID code is always required.
2. The second patient identifier may be one (1) of the following:
   
   • Date of birth (month/day/year)
   • Other unique patient identifier, eg, hospital or office ID code or file number
   • Quest Diagnostics requisition number or specimen barcode label provided on our requisition
   • Other barcode labels can be used if barcode matches the unique identifiers on the printed requisition
3. Date and time of collection

NOTE: Location-based identifiers are NOT acceptable, eg, hospital room number or street address.

If the label is handwritten, print information using a ballpoint pen. Do not use a felt tip pen.

If glass slides are submitted, use a pencil for labeling the frosted/painted end.

When using an electronically generated patient label, place the label lengthwise on the tube. When submitting a specimen in a container other than the tube used to draw the sample (eg, transfer vials), also indicate specimen type on the label (eg, serum, plasma, urine).

When submitting specimens for microbiological testing (eg, cultures, bacterial antigen, microscopic examination), the nature and anatomic source of the sample and the specific organism(s) to be detected, if any, should be specified on the vial and requisition.

Specimens that are improperly labeled will be rejected.

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Specimens must be accompanied by a paper requisition/manifest, prepared either by hand or printed from an electronic ordering system. Package manual requisitions individually (one (1) patient per specimen bag). There is a link to a customizable requisition at the end of this section. At a minimum, the requisition should contain the following information:

• Quest client account and name of provider 
• Adequate patient identification (eg, name, address, telephone number, medical record number)
• Patient sex
• Patient date of birth, or age
• Name and address of physician ordering the test
• Test(s) requested (with Quest Test Code)
• Date of specimen collection
• Time of collection, when appropriate
• Source and type of specimen when appropriate
• Clinical information, when appropriate 

Complete the “Patient Information” and “Insurance Information” sections legibly on the requisition. Indicate with a check mark which party will be responsible for payment in the “Bill To” section of the requisition. Enter the ICD diagnosis code that reflects the patient’s symptoms, condition, or diagnosis and provide medical justification for the tests ordered. Select the tests to be performed. 

When ordering tests in a series (eg, growth- hormone stimulation, glucose tolerance):

1. Use one (1) test requisition
2. Label each specimen with the patient’s name, date and time of collection, or site (if applicable)
3. Submit all specimens within a series together in one (1) specimen bag

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C. Customizable Requisition

(Under Construction)

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An irreplaceable specimen is defined as one for which recollection is difficult or impossible. This could be due to the nature or availability of the specimen or the exceptionally distressful means of their collection. Irreplaceable specimens include the following:

• Cultures, any source (note: CT/GC, BV, and other DNA probe tests are not considered irreplaceable)
• Timed specimens (eg, pre/post TDM. Excludes easily recollected samples such as post-prandial glucose)
• Pediatric venipunctures (defined as <12 years of age)
• Microtainer venipunctures (as used in patients very difficult to draw)
• Tissue biopsies or bone marrow submitted for testing (other than routine histopathology)
• Fine needle biopsies/aspirations
• Body cavity fluids (amniotic, pleural, synovial, ascites)
• Products of conception
• Lavages, washings, or brushings
• Cerebrospinal fluid
• Cord blood
• Kidney stones
• Meconium for drug screening

1. Place the collected specimen into the front pocket of the purple bag labeled “Irreplaceable Specimen.”
2. Fold the requisition and place it into the rear pocket of the bag so the barcode label is viewed in the envelope window; this is critical to enable tracking.
3. When ordering through Quanum^®, please use the purple bag as well as the “Irreplaceable Specimen” labels.
4. For direct clients of Quest Chantilly and Quest San Juan Capistrano, place the purple bag containing the irreplaceable specimen inside a routine specimen bag with that site.

Ensure that the proper temperature bag is selected. 

Reordering Irreplaceable Specimen bags can be done 2 ways:

• Order through Quanum (supplies section)
• Call Client Services at 1.866.MYQUEST (1.866.697.8378); select Option #1, followed by Option #4, and ask for the purple irreplaceable bag

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^{*See CLSI GP41-ED7:2017, Clinical & Laboratory Standards Institute: CLSI Guidelines}