Central Processing cp

CENTRAL PROCESSING

GENERAL SHIPPING INSTRUCTIONS FOR LABORATORY SPECIMENS

Central Processing Branch (486-7494) - General Shipping Instructions for Clinical and HIV Specimens

The efficiency and accuracy of our processing section is related to many factors. First, and probably most important, is the condition of your shipment upon arrival. A properly packed shipment facilitates rapid and accurate unpacking and processing on this end. If you follow the guidelines published elsewhere in this manual, we should be able to process your shipment in a minimum of time and without error.

A. The Department of Pathology and Area Laboratory Services (DPALS) receives an average of 700 to a peak of 1000 specimens per day from over 20 medical units of various sizes. Specimen identification is a critical item.

B. All serum or plasma specimens should be prepared according to the specific instructions given in this manual and elsewhere. In general, the specimen should be spun, and the serum or plasma separated as soon as possible. The specimen should then be transferred to a 5 mL plastic tube (FSN: 6650-01-C33-0372; Tube, serum, 5 mL, 500 each) with a tightly fitting cap (FSN: 6640-01-C33-0373; Cap, plastic tube, 1000 each). Double and triple check the caps to be sure they are tight. Specimen leakage in transit is a very common problem. If these tubes cannot be obtained by your activity, use a similar 5 mL plastic tube that will fit in a standard, metal, 90-hole test tube rack. Screw-top tubes should not be used because they invariably leak in transit.

C. Each container must be labeled in such a way that it can be positively matched with the laboratory slip. We require that you use the patient's first and last name, FMP and complete SSN and the test code. Identify the type of specimen in the container if it is any other than serum.

D. When a health care provider requests more than one test on a single laboratory slip, the submitting laboratory must split that specimen and generate a new laboratory slip for the additional tests. Exceptions to this are LRMC Department of Pathology and Area Laboratory Services test groups:

Hemoglobin electrophoresis
Lipid profile
Hepatitis panel
Thyroid profile
B12 and Folate
LH and FSH
AFB and fungal culture

This is required because specimens for various analyses are routinely processed at the different laboratory sections where the specific analytical procedures are performed.

E. Additional important data required for certain lab requests:

For PKUs: Date of Birth dd/mm/yy and Date of Feeding dd/mm/yy
For Microbial specimens state source: Wound, lesion, stool, gastric, urine, cervix, urethra etc.
For Cortisols: State AM or PM or mark specimen time in 24 hour clock.
For timed specimens: Baseline, 30 min, 60 min etc
For 24 hour Urines: TV in format N,NNN mL/24 Hours
Paired sera for viral titer: Acute or Convalescent (best to arrive together but not a requirement)

F. Pack your shipment to avoid leakage and breakage in transit. Be especially careful with the hard plastic reusable ice packs. These tend to break specimen containers as well as the shipping box. We find the flexible gel-filled ice packs better. However, even these can cause problems. They often arrive thawed and punctured, with the gel all over the shipment. If you use the gel packs, please seal them in plastic bags. The bottom line is to be sure the ice packs, whatever kind you use, do not come in direct contact with the specimens. Styrofoam boxes should be further enclosed in cardboard boxes for protection. Following are listed some of the more common shipment problems we encounter that cost valuable time and perhaps, more importantly, accuracy:

Improper box size for shipment: A large box with few specimens and no padding. During transit the specimens (and usually an ice pack) collide so that the shipment usually arrives with multiple broken tubes.
Tubes packed in ziplock bags, usually 20-40/bag: Assuming none of the tubes break during shipping, we have to stop and match every tube with its corresponding laboratory slip in more or less random order. We strongly suggest the use of test tube racks or sealing tubes in individual plastic pouches in the same order the laboratory slips are arranged.
Ice cubes in a ziplock bag for refrigeration: These leak and usually soak the entire shipment. Most of the time, the ink smears and the slips are no longer readable. Please use gel ice packs. If you have to use ice cubes, HEAT SEAL the bag.

The ideal shipment would have laboratory slips and shipping log packed separately in their own bag. Once this was opened, we would find that the laboratory slips are in the same order as the sealed specimen tubes in a test tube rack. We could then go across the rack, down the shipping log, and sequentially through the laboratory slips and everything would match. Organize your shipment so it can be unpacked and processed quickly and accurately. When leaking specimens and melting ice soak the laboratory slips, they are totally unreadable, and your shipment will be rejected. We recommend putting all laboratory slips and the shipping log in their own sealed plastic bag. We further ask that you put the specimens and laboratory slips in the same order.

Place specimens in racks in the same order as the slips are placed. Do not use ziplock type plastic bags for specimens. We notice breakage when only this packing technique is used.

G. Referring facilities within Germany should ship by either UPS or their own couriers. They are quick and generally very good with the shipments. Outside Germany, try to get your shipment on a MAC or MEDEVAC flight. The Air Force does bang things up, but not too badly. As a last resort, ship via MPS. These shipments generally come to us nearly destroyed. The APO system is so slow that any frozen or refrigerated specimens will not be that way upon arrival.

Ship all clinical and HIV specimens directly to:

    Landstuhl Regional Medical Center
    Department of Pathology and Area Laboratory Services
    ATTN: MCEUL-P/CP
    Geb. 3711, 2 OG
    Kirchberg-Marceau Kaserne
    66849 Landstuhl/Kirchberg

SHIPPING CONTAINERS - We will return (by MPS or your courier) all serviceable and acceptable shipping containers that have not been destroyed by the various carriers. We will also return racks, ice packs, slide boxes, etc., if they are all clearly marked. All unsuitable containers will be discarded by the Department of Pathology and Area Laboratory Services. Boxes into which shipments have leaked are considered contaminated and will be destroyed.

H. All tissue and cytology specimens (anatomic pathology, cytology, toxicology, or veterinary medicine) should be packed separately.

I. Toxicology specimens requiring legal chain of custody must come in their own secured containers with the chain of custody form ON THE OUTSIDE. If other, non-custody specimens are included, the specimens under the chain of custody must be clearly marked so they may be unpacked by the lab personnel. Chain of custody requirements are very specific and must be followed to the letter. Any questions and uncertainties should be resolved prior to shipping by calling 486-7494.

LOCATION: Central Processing Section is located in the Department of Pathology, Building 3711, 2nd floor.

DUTY HOURS: Regular duty hours, with full staff, are 0730-1630 hrs, Monday through Friday. On weekends, holidays, and after regular duty hours, the section operates with a reduced staff. Phlebotomy and the Patient Reception area are open only until 1600 hrs and are closed all day on holidays and training holidays.