Department of Cytology / Page / 1 of 5
Date of Issue / 02.12.2010
Cytology Handbook
VERSION No / 4.3
DATE OF ISSUE
/ 18.05.07REVIEW INTERVAL / Every two years or when there are any changes to the procedures
AUTHORISED BY / R Evans
AUTHOR / R Evans
COPY / Intranet, Extranet and Internet
LOCATION OF COPIES /
- On Great Western Hospital Intranet Website
- Q-Pulse™
Document review history
Review date / Reviewed by / Signature
16.8.10 / R.Evans
29.11.10 / R. Evans
21.11.11 / R.Evans
1.2.12 / R.Evans/J.Scurr/ P.Tidbury
Contents
0General Information
1Contact Details
2Service Availability
3Results
4Specimen Transport
5Request Forms
6Health & Safety
7Quality Management
8SAMPLE REQUIREMENTS FOR CYTOLOGY TESTS
0General Information
The Clinical Pathology Service is provided by the laboratories at the GreatWesternHospital, Swindon. We provide an analytical and interpretative service on a wide-range of clinical specimens. Our efficiency depends to a large extent on your cooperation. Your compliance with a few rules concerning safety, specimen identification and transport will greatly help us to deliver the service you need. We hope that this handbook outlines all the information you require to use our service. However, please feel free to contact us to discuss any problems or issues you may have. Any comments or suggestions about the User Handbook should be addressed to the Quality Manager.
Cytopathology
Cytopathology involves the examination of individual cells:-
- Pre-malignant changes (as in the Cervical Screening Programme involving 25-65 year old women using Liquid Based Cytology techniques)
- Diagnostic features in “non – gynae specimens” eg. Body fluids, fine needle aspirates of lumps.
Cytopathology at The Great Western Hospital also provides a Semen Analysis service for fertility checks and post vasectomy checks.
We aim to be a model of excellence in the delivery of a clinical pathology service. In order to achieve this, we are committed to the following:
- Service user involvement
- Good professional practice & evidence-based practice
- Efficient utilization of resources
- Valuing our staff in order to realize their full potential
- Commitment to the health, safety and welfare of our patients, staff and visitors
- Keeping a safe environment in compliance with current environmental legislation
- Working as teams and partnerships
- Continuous improvement
1Contact Details
Cytology / Office / 01793 604999/5000Cytology / Consultant Cytopathologist / Dr Judy Scurr / 01793 605000
Cytology / Consultant Cytopathologist / Dr Penny Tidbury / 01793 605000
Cytology / Lead BMS3 Cytology / Mrs Rosemary Evans / 01793 604284
2Service Availability
The laboratories are open for receipt of specimens from 0830 to 1700 between Monday and Friday.
Semen analysis samples
The laboratory operates a pre-booked appointment system for Fertility and Post vasectomy samples
A Fertility or Post vasectomy kit must be used. These are available on request from pathology stores and contain
- A patient information sheet for the patient to read and complete
- A pre-checked specimen container
- If e requesting is available please use this method.
Print a copy of the e request form and give to the patient to bring to his appointment with his specimen/kit.
If e requesting is not available please use a blank request form which the clinician/doctor has to complete and sign
3Results
Please note that we need to establish the caller’s identity before giving results over the telephone. We are unable to give results directly to patients or their relatives.
Authorised results are available on the Medway system and the Ward Enquiry system. Results may also be obtained by telephoning extension 5000 (direct dial 01793 605000).
The average turnaround times from specimen received in the laboratory to reported are:-
- Cervical Screening samples 7-10 days
URGENT SAMPLES MUST HAVE URGENT OR FAST TRACK WRITTEN CLEARLY ON THE REQUEST FORM.
Any samples where the request form states ?malignant will also be fast tracked.
- Non – gynae samples 1-2 working days or slightly longer if further tests required.
PLEASE NOTE: IF AN URGENT REPORT IS REQUIRED THE CLINICIAN MUST DISCUSS THE CASE WITH A CONSULTANT CYTOPATHOLOGIST TO ARRANGETHIS.
IF A CONSULTANT IS NOT AVAILABLE A SENIOR MEMBER OF LABORATORY STAFF MUST BE CONTACTED ON ext 4284.
“URGENT SAMPLE” MUST BE CLEARLY WRITTEN ON THE REQUEST FORM WITH NAME ANDCONTACT NUMBER OF REQUESTING CLINICIAN
- Post Vasectomy samples 1-2 working days
- Fertility checks 2 working days
4Specimen Transport
Specimens must be delivered to the laboratory as soon as possible in order to provide the best service and keep turnaround times to a minimum.
LBC samples for cervical screening taken at GP surgeries must be included in the earliest Tilley run after the sample has been taken in order to help comply with the 14 day turnaround time required by the Department of Health from 1st January 2011.
5 Request Forms
- Non gynae and Semenology specimens
All samples must be accompanied by a properly completed request form -ideally an electronically requested CYTOLOGY form or, if not, a Pathology request form (green printing on white), giving full patient demographics, relevant clinical information, patient location and detailing the investigation required.
Please note that inadequately labelled specimens and those not accompanied by adequately completed request forms may not be processed.
Electronic requesting will be available for hospital samples in the near future. Rollout is expected during 2012
Please note: Samples requiring multiple tests in different laboratory departments
e.g. pleural fluids requiring Microbiology, Chemistryand Cytology analysis need separate forms and containers..
The Cytology Department does not perform cell counts
- Cervical cytology (LBC samples)
Please use the electronic request system. If electronic requesting is unavailable, you may use an Open Exeter form (available in HMR101/5 portrait format) from the Open Exeter System.
When using electronic requesting please ensure that all dates are correct and include any past history dates and result codes eg 2A or 2R (available from Open Exeter)This enables us to determine the correct recall for the woman.
Hospital or Community clinic samples
Greenrequest form available from pathology stores(see above for completion of boxes)
Electronic requesting will be available for hospital samples in the near future. Rollout is expected during 2012
6 Health & Safety
All specimens should be regarded as potentially infectious.
Certain specimens from patients who are known or suspected to have the following diseases/conditions constitute a potential higher risk of infection to persons handling the specimens:
- Tuberculosis (specimens from sites where tuberculosis infection is likely)
- Anthrax
- Brucellosis
- Transmissible Spongiform Encephalopathy - including CJD [Creutzfeldt- JakobDisease]
- Viral haemorrhagic fever
- Pandemic Flu
To minimise the risks “Danger of Infection” labels should be attached to the specimen container and request form for all qualifying specimens(available from Phlebotomy Dept, GWH) and the nature of the risk specified on the request form. This is a necessary procedure to protect persons handling the specimens (nursing, portering, transport, reception and laboratory staff). The labels must be used in accordance with the Specimen Transportation Policy available on the Trust intranet.
The Consultant Microbiologist must be contacted before collecting specimens from a patient suspected of having a viral haemorrhagic fever, human avian influenza, SARS (Severe Acute Respiratory Syndrome) or CJD.
Samples thought to constitute a risk to staff because of inadequate packing or warning may be rejected.
7Quality Management
The Pathology Service is committed to maintaining accreditation for its quality management system. Accreditation is undertaken by Clinical Pathology Accreditation (UK) Ltd, an independent external organisation.
Details of our accreditation, together with performance data, are available from the Quality Manager.
In order to help us improve our service, we may ask you to complete a questionnaire. We greatly value the information obtained from these surveys, and we would like to thank you in anticipation of your assistance in completing the questionnaires.
Cytology User Handbook
Great Western Hospitals NHS Foundation TrustPathology Service / DCN: CYT-P-004Department of Cytology / Page / 1 of 14
Date of Issue / 02.12.2010
8SAMPLE REQUIREMENTS FOR CYTOLOGY TESTS
INVESTIGATION/TEST / SAMPLE (CONTAINER/VOLUME) / SPECIAL REQUIREMENTS / AVAILABILITY / TURNAROUND TIME / FACTORS AFFECTING TEST PERFORMANCE/ COMMENTSAscitic Fluid for Cytology / Plain white top universal container. Not >40mls / Not >40mls unless specifically requested by Consultant Cytologist / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / A separate cytology specimen and form is required. Cytology do not perform cell counts on fluids.
Breast Cyst Fluid for Cytology / Plain white top universal container. As available / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please send separate forms/samples for Cytology/Microbiology and Chemistry
Bronchial Brushings for Cytology / Slides must be labelled in PENCIL with name, DOB/Hosp no. Place fixed and dry slides in separate containers & specify on slide F for fixed, U for unfixed. Snip off brush into Cytolyte solution. & agitate vigorously / Slides & Cytoloyt bottle avaiable from Cytology Dept / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required)
Bronchial Washings / Lavages for Cytology / Plain white top universal container or dedicated endoscopy kit / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required)
INVESTIGATION/TEST / SAMPLE (CONTAINER/VOLUME) / SPECIAL REQUIREMENTS / AVAILABILITY / TURNAROUND TIME / FACTORS AFFECTING TEST PERFORMANCE/ COMMENTS
Cervical Samples / LBC Vial / Ensure all sections of the request form are completed / Vials must reach the lab on the next available courier/tilley run in order to comply with TAT requirements / Result issued from laboratory within 10 days of sample being received into the laboratory
Cerebrospinal Fluid (CSF) for Cytology / Plain white top universal container. / NB. Please send all CSF sample pots to Microbiology first. / average 1-2 working days (may be longer if immunocytochemistry is required) / Cell counts are performed by Microbiology. Cytology analysis is for the detection of malignant cells only
Fine needle aspirate PLEASE SPECIFY SITE OF FNA ON REQUEST FORM / Minimum 1 fixed slide, 1 dry slide + 1 bottle of needle washings / Slides and needle washing bottles kits available on request from cytology dept / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Slides must be labelled in PENCIL with name, DOB/Hosp no. Immediately fix 1 slide with fixative & label fixed slide F and place in "fixed" slide container. Place thoroughly dry slide in "air dried" slide container. FNA instructions available on request (CYT-F-003)
INVESTIGATION/TEST / SAMPLE (CONTAINER/VOLUME) / SPECIAL REQUIREMENTS / AVAILABILITY / TURNAROUND TIME / FACTORS AFFECTING TEST PERFORMANCE/ COMMENTS
Joint Fluids for Cytology / Plain white top universal container. As available / NB. Crystals analysis performed by microbiology / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please send separate forms/samples for Cytology/Microbiology and Chemistry
Nipple Discharge for Cytology / Minimum 1 fixed slide, and if sufficient material, 1 dry slide / Slides available on request from cytology dept / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Slides must be labelled in PENCIL with name, DOB/Hosp no. Immediately fix 1 slide with fixative & label fixed slide F and place in "fixed" slide container. Place thoroughly dry slide in "air dried" slide container
Oesophageal Brushings for Cytology / As for Bronchial Brushings, place fixed and dry slides in separate containers / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required)
Ovarian Cyst Fluid for Cytology / Plain white top universal container. Not >20mls / Not >20mls unless specifically requested by Consultant Cytologist / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please send separate forms/samples for Cytology/Microbiology and Chemistry
INVESTIGATION/TEST / SAMPLE (CONTAINER/VOLUME) / SPECIAL REQUIREMENTS / AVAILABILITY / TURNAROUND TIME / FACTORS AFFECTING TEST PERFORMANCE/ COMMENTS
Peritoneal Fluid for Cytology / Plain white top universal container. Not >40mls / Not >40mls unless specifically requested by Consultant Cytologist / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please specify whether fluid or washings. Cytology do not perform cell counts on fluids.
Peritoneal Washing for Cytology / Plain white top universal container. Not >40mls / Not >40mls unless specifically requested by Consultant Cytologist / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please specify whether fluid or washings. Cytology do not perform cell counts on fluids.
Pleural Fluid for Cytology / Plain white top universal container. Not >40mls / Not >40mls unless specifically requested by Consultant Cytologist / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / A separate cytology specimen and form is required. Cytology do not perform cell counts on fluids.
Semen Sample for Fertility Studies or Post Vasectomy Reversal / Fertility Study Kits available from Pathology Stores. Complete ejaculate required / Samples should be produced within a hour of appointment time and delivery to Pathology reception / Appointments must be pre booked by patient. See patient info sheet in kit for details / average 2 working days
INVESTIGATION/TEST / SAMPLE (CONTAINER/VOLUME) / SPECIAL REQUIREMENTS / AVAILABILITY / TURNAROUND TIME / FACTORS AFFECTING TEST PERFORMANCE/ COMMENTS
Semen Sample for Post Vasectomy Checks / Post Vasectomy Kits available from Pathology Stores. Complete ejaculate required / Samples should be produced within 2 hours of appointment time and delivery to Pathology reception / Appointments must be pre booked by patient. See patient info sheet in kit for details / average 1-2 working days
Skin Scrapings for Cytology / Slides must be labelled in PENCIL with name, DOB/Hosp no. & fixed immediately / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required)
Sputum for Cytology / 1 expectorate after deep cough into a plain silver lidded sputum container / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Patient information sheet CYT-F-013
Thyroid Cyst Fluid for Cytology / Plain white top universal container. As available / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required)
Urine for Cytology / Whole voided urine (not early morning urine or mid stream sample) in a 500ml cytology urine container available from Pathology Reception / Whole voided urine required not early morning urine / Specimens accepted to department 8.30am - 5pm / average 1-2 working days (may be longer if immunocytochemistry is required) / Please do NOT use Boric acid containers. See Patient Information Leaflet CYT-F-015
Cytology User Handbook