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Assisting Physicians in the care and treatment of their patients for 40 years.
Cytology Department
SPECIMEN COLLECTION GUIDELINES AND GENERAL INFORMATION
Cytology is the study of cells.
In order to ensure optimal diagnosis of specimens submitted for cytological evaluation, proper handling of the specimen is very important.
Fixation of the specimen is the most critical step in cytology processing to obtain diagnosis. Once the specimen is obtained, it is critical that fixation take place as soon as possible, if not immediately. The various testing ordered, and the type of specimen obtained, dictates what type of fixation or fixative solution is used. Any questions, call Micro Path at 863-681-7171.
PURPOSE:
To establish guidelines for the appropriate method of caring for and handling specimens.
POLICY:
All specimens shall be submitted to the laboratory in the appropriate container, and/or fixative in accordance with the following procedure. Any specimen that does not meet the criteria will be rejected.
Micro Path Laboratory will only accept specimens from health care practitioners licensed to practice medicine by the state in which the specimen was collected.
PROCEDURE:
1. Follow universal precautions when collecting or handling all specimens.
2. Clarify with the physician as to the proper preparation of all specimens.
3. Specimens should be properly fixed as soon as possible.
4. Affix a patient label container the following:
A) Patient’s name.
B) Date
C) Site
D) Physician’s name
If smears are made, label with the patient's name and date.
5. Complete the appropriate requisition form.
6. Specimens will be picked up by a courier and transported to Micro Path Laboratories.
7. Any specimen which is improperly identified as to location or patient ID will be rejected until the discrepancy is corrected by the attending physician.
URINARY TRACT SPECIMEN:
1. Urine should be refrigerated and sent to Micro Path within 12 hours.
2. If urine will not be transported within 12 hours, it needs to placed in 50% alcohol at 1:1 ratio.
3. Refer to Guidelines for Submitting Specimens.
GASTROINTESTINAL TRACT WASHINGS:
1. Esophageal and gastric washing should be placed in PreservCyt solution/50% alcohol. There should be a 1:4 ratio of washing to alcohol.
2. Refer to Guidelines for Submitting Specimens.
BODY CAVITY FLUID:
(Chest, pleural, thoracic, abdominal, peritoneal, paracentesis, ascites, pericardial, synovial, joint fluids).
1. All body cavity fluids should be collected in a heparinized container with at least three units of heparin per milliliter of fluids.
2. It is preferable to have fresh, unfixed fluid which should be refrigerated. If there is a significant delay before pick-up or excess heat, 70% alcohol should be added in equal ratio to the fluid. Never add Saccomanno fixative to body cavity fluids.
3. Refer to Guidelines for Submitting Specimens.
CEREBROSPINAL FLUID:
1. Specimen should be sent to the lab immediately for transporting to Micro Path, or a cytospin done on site. One slide should be spray-fixed and the other slide air-dried.
2. Refer to Guidelines for Submitting Specimens.
GYN SMEARS:
1. Smears should be spray-fixed immediately and placed in an appropriate slide holder.
2. Refer to Guidelines for Submitting Specimens.
RESPIRATORY TRACT:
1. Samples must be deep cough material, well preserved and collected on consecutive days for optimal results. Pertinent history and suspected disease state is very helpful in selecting processing methodology.
2. Specimens should be placed in 70% alcohol or PreservCyt solution. Ratio of specimen to fixative is 1:4.
SPECIMEN COLLECTION
URINE CYTOLOGY
PURPOSE:
To provide guidelines for obtaining urine specimens for cytology testing.
POLICY:
Urine specimens for cytology testing are obtained according to the following procedure:
PROCEDURE:
EQUIPMENT:
Urinal/bedpan or catheter bag
Urine cup and lid
Patient identification label (1)
Plastic specimen bag
Wash cloth
Soap
Antiseptic towelette
SAFETY FACTORS:
Maintain Universal Standard Precautions.
Proper identification of patient and specimen is imperative.
PERFORMED BY:
Caregiver who has demonstrated competency.
STEPS:
1. Verify physician’s order.
2. Obtain urine cup with lid.
3. Identify patient by name and ID bracelet.
* 3.1 Ask patient to state name when possible.
* 3.2 Compare ID bracelet with stated name.
4. Explain procedure to patient.
* 4.1 To alleviate anxiety.
5. Patient should be well hydrated.
* 5.1 Hydration stretches the bladder, dislodging cells and increases volume of cellular material available for evaluation.
6. Provide privacy.
7. Have patient cleanse genitalia with soap and water or antiseptic towelette.
* 7.1 For uncircumcised males, retract the foreskin and remove all secretions around the meatus. For females, cleanse sides and from front to back down the middle to avoid contamination.
8. Collect urine. If patient has a catheter, clamp catheter tubing off below the urine sample port and place urine sample in urine cup.
* 8.1 From 60 cc to 100 cc is desirable, but smaller amounts may contain sufficient cellularity for evaluation.
* 8.2 Never leave the tubing clamped for more than ten minutes at a time without checking it.
* 8.3 Random urine collection after first morning void is preferred. Do not use timed collections, these tend to be degenerated and clog the processors filter with debris.
9. Secure specimen container lid.
10. Apply patient identification label to outside of container.
*10.1 Label should include specimen source, test requested, date and time collected, and initials of the collector.
*10.2 For accurate specimen evaluation and reporting, be sure to note on the label if the specimen is a catheterized sample or if the patient was recently catheterized.
11. Place specimen container in a plastic bag. Tie bag securely with a knot.
12. Transport urine specimen to laboratory promptly or refrigerate until transport is possible.
13. Document procedure.
SPECIMEN COLLECTION
BODY CAVITY FLUIDS FOR CYTOLOGY
PURPOSE:
To establish guidelines for obtaining body cavity fluids for cytology testing.
POLICY:
Body cavity fluids for cytology testing are obtained according to the following procedure.
PROCEDURE:
EQUIPMENT:
Specimen collection bag or bottle
Heparin
Patient identification labels
Gloves
SAFETY FACTORS:
Maintain universal standard precautions.
Proper identification of patient and specimen is imperative.
PERFORMED BY:
Physician assisted by caregivers who have demonstrated competency.
STEPS:1. Heparinize container with 3 units of heparin per mls volume of container or 3 units of heparin per mls of specimen collected.
* 1.1 Specimen container should be heparinized prior to specimen collection when possible. If specimen container is not heparinized prior to specimen collection, heparinize after collection, gently moving container to mix heparin with specimen.
2. Identify patient by name and ID bracelet.
* 2.1 Ask patient to state name when possible.
* 2.2 Compare ID bracelet with stated name.
3. Explain procedure and purpose to patient.
* 3.1 To alleviate anxiety.
4. When physician has completed specimen collection, label specimen container with identification label.
* 4.1 Label should include specimen source, test requested, date and time of collection, physician collecting specimen, and caregiver’s initials.
5. Place specimen container in a plastic bag and tie securely with a knot.
6. Transport specimen to laboratory promptly within 15 – 30 minutes.
7. Document procedure.
* Key points
SPECIMEN COLLECTION
BRONCHOSCOPY SPECIMENS FOR CYTOLOGY
PURPOSE:
To provide guidelines for obtaining bronchial and bronchoalveolar specimens for cytology testing.
POLICY:
Bronchial and bronchoalveolar specimens for cytology are obtained according to the following procedure.
PROCEDURE:
EQUIPMENT:
Specimen collection container
Patient identification labels
Frosted end microslides
Pencil
Cytology spray fixative
Slide folders for transport
CytoLyt
Gloves
Mask
Gown
SAFETY FACTORS:
Maintain universal standard precautions.
Proper identification of both the patient and the specimen is imperative.
PERFORMED BY:
Physician assisted caregiver who has demonstrated competency.
STEPS:1. Assemble equipment.
2. Identify the patient by name and identification bracelet.
* 2.1 Address the patient by name.
* 2.2 Ask the patient to state name when possible
* 2.3 Compare identification bracelet name and number with the label.
3. Explain the procedure to the patient.
* 3.1 To alleviate anxiety.
4. When the patient has completed the specimen collection, place washing material in specimen container. Cap and label container.
* 4.1 Label should include specimen source, test requested, time and date collected, physician name and caregiver’s initials.
5. When brushings are done, using circular motion to dislodge cells, smear contents of brush onto slide labeled with patient’s last name. Immediately spray fixative evenly on the slide. Let slides dry before placing in labeled slide folder. Slides may alternatively be fixed by placing in a slide container of 95% ethyl alcohol.
* 5.1 Care must be taken to ensure that the cells do not dry by immediately fixing with spray or 96% ethyl alcohol.
* 5.2 Label on the slide folder should include specimen source, test requested, date and time collected, physician name and caregiver’s initials.
6. Place specimens in plastic bag. Tie securely with a knot.
7. Transportation specimen promptly to the laboratory.
8. Document procedure.
* Key points
SPECIMEN COLLECTION
BRONCHOSCOPY SPECIMENS FOR CYTOLOGY
PURPOSE:
To provide guidelines for obtaining bronchial and bronchoalveolar specimens for cytology testing.
POLICY:
Bronchial and bronchoalveolar specimens for cytology are obtained according to the following procedure.
PROCEDURE:
EQUIPMENT:
Specimen collection container
Patient identification labels
Frosted end microslides
Pencil
Cytology spray fixative
Slide folders for transport
CytoLyt
Gloves
Mask
Gown
SAFETY FACTORS:
Maintain universal standard precautions.
Proper identification of both the patient and the specimen is imperative.
PERFORMED BY:
Physician assisted caregiver who has demonstrated competency.
STEPS:
1. Assemble equipment.
2. Identify the patient by name and identification bracelet.
* 2.1 Address the patient by name.
* 2.2 Ask the patient to state name when possible
* 2.3 Compare identification bracelet name and number with the label.
3. Explain the procedure to the patient.
* 3.1 To alleviate anxiety.
4. When the patient has completed the specimen collection, place washing material in specimen container. Cap and label container.
* 4.1 Label should include specimen source, test requested, time and date collected, physician name and caregiver’s initials.
5. When brushings are done, using circular motion to dislodge cells, smear contents of brush onto slide labeled with patient’s last name. Immediately spray fixative evenly on the slide. Let slides dry before placing in labeled slide folder. Slides may alternatively be fixed by placing in a slide container of 95% ethyl alcohol.
* 5.1 Care must be taken to ensure that the cells do not dry by immediately fixing with spray or 96% ethyl alcohol.
* 5.2 Label on the slide folder should include specimen source, test requested, date and time collected, physician name and caregiver’s initials.
6. Place specimens in plastic bag. Tie securely with a knot.
7. Transportation specimen promptly to the laboratory.
8. Document procedure.
* Key points
SPECIMEN COLLECTION
FINE NEEDLE ASPIRATION FOR CYTOLOGY
NAME: FINE NEEDLE ASPIRATION (THIN PREP)
PRINCIPLE:
Palpable subcutaneous material can be aspirated using a needle and syringe and displayed in smears, cell blocks, filter preparations and cytocentrifuge preparations sufficient to render a diagnosis.
SPECIMEN:
Any palpable mass in head, neck, thyroid, salivary glands, lymph nodes and subcutaneous sites.
PROCEDURE:
1. Fill out requisition form with patient’s name, date of birth/age, physician, site being aspirated, and pertinent clinical information.
2. Label slides with patient’s last name and specimen source.
3. Place 1-2 drops of aspirated material on slide, placing a second slide on top face down and pulling apart in one smooth motion.
Place one slide in 95% alcohol or fix with spray fixative and let one slide
air dry.
4. Place remaining fluid in vial containing PreservCyt Solution.
5. Place a patient label with name and source of specimen on the PreservCyt vial.
6. Place in designated area for transport to Micro Path Lab for processing and diagnosing.
SPECIMEN COLLECTION
GASTROINTESTINAL TRACT CYTOLOGY
PURPOSE:
To establish guidelines for obtaining gastrointestinal tract specimens for cytology testing.
POLICY:
Gastrointestinal tract specimens for cytology are obtained according to the following procedure.
PROCEDURE:
EQUIPMENT:
Coulter cup filled to 15 cc level with CytoLyt or slides, pencil, and slide container with 95% Ethyl Alcohol.
Patient identification labels
Gloves
SAFETY FACTORS:
Maintain Universal Standard Precautions.
Proper identified of patient and specimen is imperative.
PERFORMED BY:
Physician assisted by caregivers who have demonstrated competency.
STEPS:
1. Identify patient by name and ID bracelet.
* 1.1 Ask patient to state name when possible.
* 1.2 Compare ID bracelet with stated name.
2. Explain procedure and purpose to patient.
* 2.1 To alleviate anxiety.
3. When physician has completed specimen collection, either place the brush in the coulter cup with CytoLyt or if physician prefers, wipe brush across a slide labeled with the patient's last name in circular motion to dislodge material on the slide. Drop it immediately into the slide container filled with 95% Ethyl Alcohol. When all the material has been placed on the slides, place the brush into a coulter cup with CytoLyt.
* 3.1 The brush must be cut to place into the cup of CytoLyt. When the physician prefers to make slides, care must be taken to
A) Work quickly, not letting the material on the brush to dry.
B) Placing the slides into alcohol as they are made.
C) Not to make the slides too thick for optimal evaluation.
Placing the brush into CytoLyt even after wiping on the slides ensures that all material is available for evaluation.
4. Label the specimen container with a patient identification label.
* 4.1 Label should include specimen source, test requested, date and time of collection, physician collecting specimen and caregiver’s initials.
5. Place specimen container in a plastic bag and tie securely with a knot.
6. Transport specimen to Micro Path Laboratories.
7. Document procedure.
SPECIMEN COLLECTION
MONOLAYER PREP FEMALE GENITAL TRACT
Materials Needed:
Endocervical brush or broom/plastic spatula collection devices
Speculum
PreservCyt thin prep pap test vial and collection devices
Patient label
Request form or label with test request information
Patient Preparation:
Advise the patient not to douche within 24 hours prior to examination. If the patient is bleeding or has douched, it is not a contraindication for taking a pap smear; however, the need for a possible repeat smear would be increased.
Collection Technique:
Label the PreservCyt vial with patient’s name, specimen source, and collection.
Cervical Smear: Endocervical Brush/Spatula Protocol
The small end of the plastic cervical scraper should be placed into the external os and rotated 360°, thoroughly scraping the squamocolumnar junction and obtaining a good endocervical component. Rinse the spatula into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
Endocervical Smear:
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervical os until only the bottom-most fibers are exposed. Slowly rotate ¼ to ½ turn in one direction. DO NOT OVER ROTATE. Rinse the brush in PreservCyt solution by rotating the device in the solution 10 times while pushing against the vial wall. Then swirl the brush between your fingers vigorously to further release material. Discard the brush.
Vaginal Smear:
Scrape the upper 1/3rd of the lateral vaginal wall for hormonal evaluation. Rinse the plastic scraper vigorously in the vial 10 times and discard.
Cervical/Endocervical Smear: Broom-like Device Protocol
Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently, and rotate the broom in a clockwise direction five times. Rinse the broom into the bottom of the vial either breaking end off into the vial or pushing the broom into the bottom 10 times and swirling vigorously, then discarding broom.
Tighten the cap so that the torque line on the cap passes the torque line on the PreservCyt vial.
Record the patient’s name, I.D. number, requesting physician’s name, specimen source, collection date, clinical history, including the last menstrual period, use of birth control pills, pregnancy, post partum status, post op status, previous cytodiagnosis on the request form. Note: Medicare requires the date of the last pap test for routine testing (screening) and the previous diagnosis if testing is not routine (diagnostic).
Place the vial and requisition in a specimen bag for transport to the laboratory.
SPECIMEN COLLECTION
SPUTUM FOR CYTOLOGY
PURPOSE:
To provide guidelines for obtaining expectorated sputum specimens for cytology testing.
POLICY:
Expectorated sputum specimens are obtained according to the following procedure.
PROCEDURE:
EQUIPMENT:
Sputum specimen collection container.
Patient identification labels
Gloves
Mask
Material for patient to brush teeth or mouth wash
SAFETY FACTORS:
Maintain universal standard precautions.
Proper identification of both the patient and the specimen is imperative.
PERFORMED BY:
Caregiver who has demonstrated competency.
STEPS:
1. Verify the physician’s order.
* 1.1 Multiple specimens are collected at least eight hours apart.
2. Assemble equipment.
3. Identify the patient by name and identification bracelet.
* 3.1 Address the patient by name.
* 3.2 Ask the patient to state name when possible.
* 3.3 Compare identification bracelet name and number with the label.
4. Explain the procedure and the purpose to the patient.
* 4.1 To alleviate anxiety.
* 4.2 Patient should understand that only secretions representative of lower respiratory tract are acceptable. Salvia is unacceptable.
5. Have patient brush teeth and tongue and rinse mouth well with tap water several times or rinse with disinfectant mouthwash.
* 5.1 Minimizes oropharyngeal contamination of sputum.
* 5.2 If specimen has not been collected within three hours, repeat mouth cleansing procedure.
6. Instruct patient to take several deep breaths and to cough deeply. Have patient expectorate thick exudative material into sputum cup.
* 6.1 Early or first morning specimens are best. Sputum volume should not exceed 15 most likely; 1 – 3 most likely is usually sufficient.
* 6.2 The sputum cup may be left at the bedside.
* 6.3 If the caregiver is within three free of the patient when a sputum specimen is collected, a mask must be worn regardless of isolation status of the patient.
7. Match patient identification bracelet with the label and attach the patient identification label to the outside of the specimen container. Do not take the sputum collection container apart.
* 8.1 Identify the test to be done and the specific source of the specimen on the label with date and time of collection and the initials of the collector.
8. Place labeled specimen container in a plastic specimen bag. Tie bag securely with a knot.
9. Wash hands.
10. Immediately after collection, add 20 cc of CytoLyt and transport specimen to the laboratory.
* 10.1 Cells begin to degenerate and mouth flora grows rapidly.
11. Document procedure.
* Key Points