1 Foundations of Special Specimen Collection

Core requirements

Special specimen collection involves more than selecting a tube. Reliable collection requires verifying the order and patient, following the test-specific procedure, preserving specimen quality, labeling at the bedside, and transporting under the required conditions.

Exact requirements may differ by test, collection device, laboratory, and facility. Follow current laboratory instructions and approved procedures whenever they differ from general guidance.

Prepare and verify

Before collecting, review the order and test requirements. Confirm the requested test, specimen type, collection site or method, required volume, timing, container, patient preparation, and handling instructions. Check whether the order calls for a timed series, special documentation, or a specific collector.

Explain the procedure and provide any required preparation instructions, such as fasting when specifically ordered. Gather the correct, in-date supplies and personal protective equipment before starting.

Use Positive patient identification by matching at least two patient-specific identifiers to the order and the patient’s identification band. If identity, order, preparation, or collection requirements cannot be verified, pause and resolve the discrepancy before collecting. Also confirm that the planned site and method are appropriate for both the specimen and the patient.

Use aseptic technique and the correct tube sequence

Use Aseptic technique: perform hand hygiene and wear gloves and other protective equipment as indicated. For venipuncture, clean the site with the appropriate antiseptic and allow it to dry. Do not touch the prepared site unless using a sterile technique, and avoid touching a sterile bottle septum or other critical surface after disinfection. Use a new sterile, single-use device for each patient.

When collecting multiple venous tubes, the usual Order of draw is:

1. Blood culture bottles or tubes

2. Sodium citrate (light-blue)

3. Serum tubes

4. Heparin tubes

5. EDTA tubes

6. Fluoride/oxalate tubes, commonly gray

This sequence helps prevent carryover of tube additives that could affect test results. Tube colors and products can vary, so follow the laboratory’s current policy for unfamiliar or special tubes. Capillary collections use the capillary order specified by the laboratory; it is not simply the venous sequence.

Collect blood cultures carefully

Blood cultures are collected to detect microorganisms in the bloodstream. Skin organisms introduced during collection can produce a false-positive result, so contamination control and careful documentation matter.

Collect before antimicrobial therapy when feasible, but do not delay urgent treatment. Disinfect the skin with the approved antiseptic and allow it to dry; disinfect the bottle septum as directed. Avoid repalpating the cleaned site unless using a sterile glove or following the approved sterile procedure.

Collect the ordered number of sets and the volume specified for the patient and culture system. Adequate blood volume is especially important for adults; do not apply adult volumes to infants or children. Follow pediatric, neonatal, and local laboratory instructions. A Blood culture set commonly includes aerobic and anaerobic bottles, but the precise plan and volumes depend on the order and patient.

Document the collection time, site, method, volume, and other required details. Transport cultures promptly according to laboratory policy. Adult guidance emphasizes adequate volume, documentation, and immediate transport; pediatric and neonatal collections require age- and weight-appropriate directions.

Handle glucose specimens by method

Point-of-care (POC) glucose uses a meter and a fresh capillary or other approved specimen. Confirm the patient, follow the meter and test-strip instructions, and record the result and collection time as required. For a fingerstick, clean and dry the site as directed by the device instructions. Do not share single-use lancets, and clean and disinfect meters between patients according to the manufacturer’s instructions.

Laboratory glucose requires the correct tube and timely processing. Blood cells continue to consume glucose after collection, so glucose may fall while the specimen remains in contact with cells. Use the laboratory-specified tube and promptly separate serum or plasma when required; some procedures accept a glycolysis-inhibiting tube. Do not assume one tube or handling method suits every glucose test.

For glucose-tolerance or other timed testing, record the required interval, such as fasting, one-hour, or two-hour, on each specimen and collect at the ordered times.

Collect neonatal specimens

Use a trained collector and a collection method appropriate to the infant, test, and required volume. Venipuncture may be preferred when a test needs more blood or a particular specimen type; heel puncture is appropriate for selected capillary tests. Follow neonatal policies for comfort, positioning, and assistance.

For a Neonatal heel puncture, use an appropriate single-use neonatal lancet and an approved heel puncture area. Avoid excessive squeezing or “milking,” which can damage cells or dilute the specimen with tissue fluid. Collect only the amount needed, apply pressure afterward, and check that bleeding has stopped. Capillary specimens are not interchangeable with venous specimens for every test, so confirm acceptability first.

Newborn dried-blood-spot screening uses a specific filter-paper card and collection method. Apply blood as instructed by the screening program and submit the card with the required infant, collection, and clinical information. Allow the spots to dry completely, protect the card from contamination, and follow the program’s directions for drying and dispatch. Do not stack or package a wet card. Timing matters because screening supports early detection and follow-up.

Plan for special procedures

For a Timed or serial collection, confirm the start point and scheduled collection times. Label each specimen with its actual collection time or interval rather than relying on the order sequence alone.

Collections from a vascular access device require an approved procedure. Document the collection source and follow requirements for pausing infusions, discard volume, and line clearing when applicable.

Identify special temperature, light-protection, or rapid-delivery requirements before collection, and arrange the correct container and transport plan in advance. For Chain of custody specimens, use the designated forms, seals, and documentation steps, and maintain custody as required by the receiving laboratory or program.

These are examples of special requirements, not universal instructions. The specific test directory and facility procedure determine the acceptable method, specimen, and transport conditions.

Label and transport specimens

Use Bedside labeling: label every primary container at the collection site immediately after collection, in the patient’s presence when possible. Use the identifiers required by policy and include the collection date and time. Add the specimen source, collector, timed interval, or other required details. Match the label to the order before the specimen leaves the patient.

Never label an uncollected tube in advance or leave an unlabeled specimen for later identification. Resolve label mismatches according to policy. Secure the cap, check for leakage, and use the required transport packaging and appropriate secondary containment. Separate specimens from paperwork as required.

Send specimens promptly and follow test-specific conditions for temperature, light protection, separation, drying, and transport deadlines. If a specimen is mislabeled, compromised, delayed, or collected in the wrong container, notify the laboratory and follow the facility’s rejection or recollection process rather than guessing at acceptability.