UPMC Presbyterian-Shadyside

Pittsburgh, Pennsylvania

DEPARTMENT OF PATHOLOGY

POLICIES AND PROCEDURES

Policy: CYTO 2.1

Subject: Specimen Collection
Effective Date: February 2011

POLICY/PRINCIPLE

It is the policy of the PUH/SHY cytology lab to assure that specimens submitted for cytologic evaluation be collected and submitted in the appropriate manner to ensure optimal quality of patient care. Properly collected specimens yield the optimal quality and volume of cells to enable the most accurate diagnoses.

SCOPE

Instructions for collection of cytology specimens are included on SharePoint and are available to nursing units and physician offices, entitled Laboratory Test Information and Specimen Collection Manual.

Instructions for collection of cytology specimens outside of the UPMC system can be accessed on the UPMC Department of Pathology Non Gynecologic Cytology Webpage (link to word document half way down the page).

RESPONSIBILITY
This policy is the responsibility of all individuals involved in the collection, labeling and handling of Cytopathology specimens.

PROCESS

Patient Identification

According to UPMC PUH-SHY policy # CP-17 Patient Identification, “It is the policy of UPMC Presbyterian Shadyside (UPMCPS) that all patients receiving care shall be properly identified by hospital personnel. It is further the policy of the hospital that each department will define and implement an intradepartmental procedure in support of this policy which will assure proper patient identification at all times.”

Type of container and amount of specimen to be collected/collection requirements.

All collection containers submitted to the Cytopathology Lab for processing must be labeled with the patients full name,a second patient identifiers (i.e., Date of Birth or, Medical Record Number or, Social Security Number) and the source from where the sample was collected (ie, Pleural Fluid, Bile Duct Brushing, etc...). A paper requisition or electric order with matching information must also accompany the patient sample for testing. Any missing items will delay specimen processing or result in specimen rejection. *95% EtOH slide jars, formalin, and CytoLyt available from the Cytology Lab (PUH: 412-647-0375 or SHY: 412-623-2331).

Cytology Specimen Type / Container/Media / Special Handling Instructions
FineNeedle Aspirations (US-guided, CT-guided, EBUS, EUS, and Superficial FNA's) excluding Thyroid FNA's (see below). / PUH: Smears fixed in 95% EtOH jars. Additional needle rinses must be submitted in formalin or CytoLyt.
SHY: It is preferred that no slides be made and all needles just be rinsed in CytoLyt. / Smears made on-site at the time of procedure should be fixed immediately in a container of 95% EtOH to prevent air-drying artifact. Smears should be labeled using an approved STAT pen or a No 2 pencil with the patients name and second identifier (DOB, SS# or MR#). DO NOT USE A REGULAR PEN OR SHARPIE MARKER.
Thyroid FNA's / Air dried smears and smears fixed in 95% EtOH are required for thyroid evaluation. Additional needle rinses may be collected in a CytoLyt container for Thin Prep processing.MolecularTestingNote: Samples being collected for potential MAP studies should be collected in RNA/DNA Stabilization Reagent. / Two smears should be made for each FNA pass on-site at the time of procedure. One should be air dried and sent in a clean container and the other should be fixed immediately in 95% EtOH to prevent air-drying artifact. Smears should be labeled using only an approved STAT pen or a No 2 pencil with the patients name and second identifier (DOB, SS# or MR#). DO NOT USE A REGULAR PEN OR SHARPIE MARKER.
CSF / Fresh and in a clean container with at least 1 cc of fluid is preferred. / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#). Note: All CSF's delivered to Specimen Processing between 4:30 PM and 4:00 AM Monday through Friday, as well as weekends are sent to Hematology Lab for preliminary processing.
Core Needle Biopsies without on-site evalutaion / Cores should be submitted in formalin / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#). Core needle biopsies should be placed directly into a formalin container and submitted to Surgical Pathology.
BAL/Bronchial Washing / Minimum 5 ml. Fresh and in a sterile container. / Submit with requisition (Cytology order written) to the Microbiology Lab at the Clinical Lab Building (PH: 412-647-3727). If Microbiology is not requested please send sample directly to Cytology Lab.
All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#).
Bronchial Brushing / Brush submitted in CytoLyt Vial or
Clean container with saline / All specimen containers must be labeled with patient name and second identifier (DOB, SS#, MRN#). CytoLyt vial should also contain the brush.
Bile Duct Brushing / Brush submitted in CytoLyt Vial or
Clean container with saline / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#). CytoLyt vial should also contain the brush.
Brain Cyst Fluids / Fresh and in a clean container. / Submit all brain cyst fluid originating at PUH directly to PUH Gross Room for processing. Those originating from SHY remain at SHY unless there is a correlating surgical.
Bladder Washing/Urine / Fresh in clean specimen container. Add CytoLyt if it will be sitting over night or over the weekend. / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#).
Esophageal Brushing / CytoLyt Vial or
Clean container with saline / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#). CytoLyt vial should also contain the brush.
Misc. Fluid Collections / Fresh and in a clean container. / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#).
Pleural, Ascites, & Pericardial Fluids / Fresh and in a clean container. A minimum of 5 ml, not to exceed 1000 ml. / DO NOT SEND IV COLLECTION BAGS OR PLEURAVACS. All specimen containers must be labeled with patient name and second identifier(DOB, SS# or MRN#).
Pancreas Cyst Fluid / Fresh and in a clean container or in CytoLyt container / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#).
Sputum / Fresh and in a clean container. / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#).
Lymphoma Work-up
PUH ONLY / Preferably in RPMI media, fresh fluid is also acceptable. / All specimen containers must be labeled with patient name and second identifier (DOB, SS# or MRN#). Send to Cytology with written request for FLOW Cytometry.
Tzank Smear / Gently scrape the area of abnormality. If the abnormality is a vesicle, remove the covering and scrape. Smear the material on glass slides and fix in 95% EtOH immediately. / Smears should be labeled using only an approved STAT pen or a No 2 pencil with the patients name and second identifier (DOB, SS# or MR#). DO NOT USE A REGULAR PEN OR SHARPIE MARKER.

5.0REFERENCES

Gill GW. Cytopreparation. Principles and Practice. Springer 2013.

6.0ATTACHMENTS

Attachment 2.1 A: Cytopathology Requisition

TS Reviewed:

NPO 11/23/12 (SP)

WK 11/14/12 (SP)

NPO 11/23/11 (SP)

WK 11/14/11 (SP)

WK 3/21/11

NPO 2/14/2011

NPO/WK 1/2010

MD Reviewed:

SY 1/17/12 (SP)

RD 1/17/12 (SP)

Date of Initial Issue: March 2009