HANDLING AND PROCESSING OF

NON-BLOOD SPECIMENS FOR

LABORATORY TESTING
 LEARNING OUTCOMES
At the end of this lesson, the students must be able
to:
1. Identify the different non-blood specimens for
laboratory testing;
2. Describe the various tests performed on the
different non-blood specimens;
3. Discuss the collection and handling procedures
for the different non-blood specimens; and
4. Collect and process sample for urinalysis.
THE DIFFERENT NON-BLOOD SPECIMENS FOR
LABORATORY TESTING
✓ A phlebotomist maybe involved in collection and handling
of specimen other than blood, or non-blood specimen
such as urine, amniotic fluid, saliva, semen, sputum, etc.
✓ He should be familiar with the proper handling procedure
to ensure the integrity of the specimen remains intact,
and ensure that the results are accurate.
THE DIFFERENT NON-BLOOD SPECIMENS FOR
LABORATORY TESTING
✓ To avoid delays in testing, he should check and verify
information on the label of the specimen before receiving
them. The specimen should be labeled with the same ID
information as the blood specimen and the type or source
of the specimen should also be included.
✓ The label should be placed in the container and not the
lid, because are lids are removed during testing. He should
also follow standard precautions in handling specimen
because all body substances are potentially infectious.
TESTS PERFORMED, COLLECTION AND HANDLING
PROCEDURES FOR THE DIFFERENT NON-BLOOD
SPECIMENS
The non blood specimens are substances produced by
the body which can be in liquid or semi liquid form. These
are found within body organs such as the bladder and spaces
such as the joints.
Urine
✓ The procedure for collection should be explained properly to
the patient since the type of urine collection and the method of
collection depends on the type of test ordered by the
physician.
✓ The urine analysis also helps in (1) monitoring wellness,
(2) determination and treatment of urinary tract infections,
(3) detection and monitoring progress of treatment in
metabolic diseases, and (4) determines the effectiveness of an
administered therapy as well as checking if the patients
exhibited any therapy-related complications.
 The accuracy of urine analysis results will largely
depend on several factors such as:
o the collection method,
o container use,
o transportation and handling of specimen and
o the timeliness of the testing.
✓ The phlebotomist handles urine collection for
outpatient department, while inpatient urine collection is
part of the responsibilities of the nursing department.
✓ The urine collection procedure should be explained clearly
to prevent specimen rejection.
Common Urine Tests
Routine urinalysis (UA)
✓ This frequently ordered urine test screens the patient for any
urinary or systematic disorders.
✓ The analysis is not limited to physical analysis (color, clarity
and odor) but also covers the chemical (ph, specific gravity,
detection of bacteria, etc.) and microscopic analysis (urine
components such as cells, crystals and microorganisms) of the
specimen.
✓ Although random specimen is acceptable, midstream collection
is recommended and ideal to ensure that there is no
contamination caused by genital secretions, pubic hair or
bacteria surrounding the urinary opening.
✓ The specimen container used for collection should be clear and
dry with tight-fitting lids and they should be chemically
cleaned.
✓ After collection, the specimen should be transported to the
laboratory immediately but it could be held at room
temperature for 2 hours or it could be refrigerated if transport
will take longer than prescribed.
✓ Make sure that the specimen is protected from light.
Urine Culture & sensitivity (C&S)
✓ The Culture & sensitivity (C&S) urine test is requested if the
patient has symptoms of a urinary tract infection (UTI).
✓ The urine specimen used should be midstream clean-catch
collection which is placed in a sterile container.
✓ A measured portion of urine is cultured on a special nutrient
medium for 18 to 24 hours.
✓ If a microorganism is present and identified, a sensitivity or
antibiotic susceptibility test is performed to determine the
most effective antibiotic that should be prescribed for
treatment.
Urine cytology studies
✓ The urine cytology study on urine is requested by the
physician to detect cancer, cytomegalovirus, & other viral and
inflammatory diseases in the urinary system.
✓ A fresh clean-catch specimen is required.
✓ A smear from the cells of the lining of the urinary tract is
stained using the Papanicolaou (PAP) method and examined
under the microscope for abnormal cells.
✓ The collected specimen should be examined immediately but if
delays could not be avoided, the specimen is preserved by
adding an equal volume of 50% alcohol.
Urine drug testing
✓ Drug screening is performed using urine since many
drugs are detected in the urine but not in the blood. This
test is performed to detect:
(1) illicit use of recreational drugs,
(2) use of anabolic steroids to enhance performance in
sports, and
(3) unwarranted use of prescription drugs. It also monitors
therapeutic drug use to minimize the symptoms
associated with the withdrawal and also confirm drug
overdose.
✓ A random sample is placed in a chemically clean
container with lid and submitted for testing which is
performed in groups depending on the drug
classification.
Urine glucose and ketone testing
✓ The urine glucose and ketone testing is performed to
screen diabetes and determine the glucose level for
patients who are already diabetic.
✓ The urine ketone level test is used to determine if the
patient is suffering from diabetic ketoacidosis.
✓ The color changes in the test strip are compared to a
color chart to interpret the result of the test.
Urine pregnancy testing
✓ The urine pregnancy test is used to confirm pregnancy
which can be detected 8 to 10 days from conception.
✓ The first morning urine specimen is preferred because it
has the highest concentration of human gonadotropin
(HCG).
Types of Urine Specimens
1. Random: collected at any time
2. First morning/8-hour urine specimen: collected immediately upon
waking up from an 8 hours of sleep
3. Fasting: second specimen voided after fasting (glucose monitoring)
4. Timed: collected at specific times or pooled throughout a specific
time period.
a. Tolerance test (glucose) - fasting, 1/2 hour, 1 hour, etc.
b. 2-hour postprandial - 2 hours after a meal
c. 24-hour - collection & pooling of all urine which is voided in 24
hours
d. Double-voided - wait time of approximately30 minutes after
emptying the bladder
24-Hour Urine Collection Procedure
1. Empty the bladder upon waking up.
2. Affix the label in the container and write down the time and date
of the specimen collection. Start timing.
3. Collect all the urine that has been passed for the next 24 hours
4. If instructed, refrigerate the specimen collected all throughout
the collection period.
5. The urine is collected prior to bowel movement.
6. Drink fluid as needed to avoid dehydration.
7. Take one last void at the end of the 24 hour collection period.
8. Make sure to seal the container before placing in the cooler.
Arrange to transport the specimen to the laboratory at the
soonest possible time.
Urine Collection Methods

1. Regular voided: patient voids or urinates into clean container

2. Midstream: patient voids or urinates into toilet first, interrupted and
then restarted into the container with the last urine flow voided in the
toilet.
3. Midstream clean-catch: requires special cleaning of genital area
before collection
4. Catheterized: collected from sterile catheter inserted through urethra
into the bladder
5. Suprapubic aspiration: collected by inserting needle directly into
bladder & aspirating the urine by the use of a sterile syringe.
6. Pediatric: collected in a plastic bag for children not potty trained and
checked every 15 minutes until the required volume is collected.
Amniotic Fluid
✓ The amniotic fluid is a clear and slightly yellowish liquid contained in
the amniotic sac that is surrounding and cushioning the fetus during
pregnancy.
✓ The specimen is collected by the physician using transabdominal
amniocentesis preferably 15 weeks after gestation.
✓ The procedure is guided by the ultrasound machine and about 10 mL
of fluid is aspirated from the amniotic sac thru the needle inserted in
the mother's abdominal wall into the uterus.
✓ The test is done to detect any genetic disorder, check any problem in
fetal development and verify the gestational age.
✓ The specimen collected in a sterile container should be protected
from light and transported immediately to the clinical laboratory.
Cerebrospinal Fluid
✓ The cerebrospinal fluid (CSF) refers the liquid that
surrounds brain & spinal cord.
✓ This specimen is clear and colorless and is obtained by
the physician using lumbar puncture or spinal tap.
✓ The testing is used to diagnose meningitis and other
disorders such as brain abscess, CNS cancer and multiple
sclerosis.
✓ The routine tests performed are cell counts, chloride,
glucose and total protein.
✓ The CSF is collected in 3 special sterile tubes: first tube -
chemistry and immunology test, second tube -
microbiology studies, and the third tube for cell counts.
✓ These should be kept at room temperature and sent to
the laboratory for immediate analysis.
Gastric Fluid/Gastric Analysis

✓ The gastric analysis is performed to check the contents of

the stomach for abnormal substances and evaluate the
production of acid by evaluating the gastric acid
concentration.
✓ In basal gastric analysis, a tube is passed through the
mouth and throat (oropharynx), or nose and throat
(nasopharynx) into the stomach after the patient had
done fasting for a specified period of time.
✓ The sample is aspirated to determine acidity before the
stimulation. A gastric stimulant is administered
intravenously after the specimen collection.
✓ A series of collection will follow with timed intervals.
✓ The collected specimens are placed in sterile containers.
The phlebotomist labels the specimens properly and
assists by drawing blood for serum gastrin determination.
Nasopharyngeal Secretions
The Nasopharyngeal (NP) secretions specimen are
collected and cultured to determine the presence of bacteria
that causes:
(1) diphtheria,
(2) meningitis,
(3) pertussis (whooping cough), and
(4) pneumonia.
✓ Collection is performed by gently inserting a dacron or
sterile cotton-tipped flexible wire swab into the nose into
the nasopharynx (nasal cavity & pharynx).
✓ The swab is rotated and gently removed then placed in a
properly labeled sterile container containing transport
medium for immediate transport to the laboratory.
Saliva
✓ The saliva which is the fluid secreted by the glands inside
the mouth is used to check the hormone levels and also
determine alcohol and drug or substance abuse.
✓ The collection of saliva is easy and non-invasive because
testing kits are available and many are point-of-care test
(POCT).
✓ The specimen needs to be frozen to ensure stability prior
to the delivery to the clinical laboratory.
Semen
✓ The seminal fluid is a thick yellowish-white fluid that
contains sperm release during the male ejaculation.
✓ Analysis is done to evaluate the fertility and assess the
effectiveness of sterilization after a vasectomy procedure
but it is also ordered for forensic or legal reasons such as
criminal investigations involving sexual assault.
✓ The collected specimen is placed in sterile container, kept
warm and protected from light.
Serous Fluid
✓ The serous fluid is found between the membrane that
encloses that pleural, pericardial, & peritoneal cavities.
✓ This serum-like fluid is pale-yellow in color and watery
and its main function is to allow the membranes to pass
each other with minimal friction.
✓ An effusion or increase in volume indicates inflammation,
infection or decrease in the serum protein level.
Serous Fluid
✓ The fluid is collected by the physician by aspiration and
placed in tubes depending on the type of test.
✓ EDTA tubes are used for cell counts and smears, heparin
or sodium fluoride tubes for chemistry tests, non-
anticoagulant tubes for biochemical tests, and for cultures
the heparinized should be used.
✓ The type of fluid which is based on the body cavity origin
should be indicated in the label as follows: pleural fluid
(lungs), peritoneal fluid (abdominal cavity), and
pericardial fluid (heart).
Sputum
✓ Sputum (mucous or phlegm) specimen are used to
diagnose and/or monitor lower respiratory tract infections
like tuberculosis.
✓ It is recommended that the collection be done first thing
in the morning since larger volume have accumulated
overnight and at least 1 hour after meal to avoid gagging.
✓ The patient should gargle with water and remove dentures (if
any). The patient should:
(1) take 3 or 4 deep breaths,
(2) inhale and exhale,
(3) cough forcefully on the last breath, and
(4) expectorate and expel sputum into the sterile container.
The procedure is repeated until adequate amount is collected
which is about 3 to 5 mL.
The collected specimen is transported and should be processed
immediately upon arrival at the laboratory.
Sweat
✓ The sweat is used to analyze the chloride content of
patients under the age of 20 with symptoms of cystic
fibrosis (exocrine gland disorder).
✓ During the sweat chlorides test, electrical stimulation in
the forearm or thigh (iontoporesis) is used to transport
the pilocarpine (sweat-stimulating drug) into the skin.
The sweat is then collected, the weight is recorded and
the chloride content is analyzed.
✓ The sweat specimen can also be used to determine illegal
use of drug by placing patches on the skin for an
extended period of time and which is further confirmed
by subsequent drug testing.
Synovial Fluid
The synovial fluid (viscous fluid that lubricates movable
joints) are tested to determine conditions such as arthritis, gout
and other inflammatory conditions since increase in volume is
attributed to inflammation. These are collected in 3 tubes:
• EDTA/heparin: for cell counts, ID of crystals, smear
preparation
• Sterile: culture & sensitivity
• Non-additive: macroscopic appearance, chemistry,
immunology tests and observing the clot formation
Buccal (Cheek) Swabs
✓ Buccal swabs are used to obtain loose cells inside the
cheek for purposes of DNA analysis.
✓ This is less invasive and painless alternative to blood
collection.
✓ The phlebotomist collects sample by placing the swab
inside the cheek and gently massages the area.
✓ After the collection the swab is sent to the laboratory
where the DNA is extracted from the cells in the swab.
Bone Marrow
✓ The bone marrow is examined to identify blood diseases.
✓ The physician inserts a large-gauge needle into the
sternum (breastbone) or iliac crest (hip bone) and
aspirates 1.0 to 1.5 mL of specimen.
✓ A hematology technologist makes special slides from the
first marrow aspiration.
Breath Samples
✓ There are two types of testing for breath: C-urea breath
test (C-UBT) and Hydrogen breath test.
✓ The C-urea test checks for the presence of Helicobacter
pylori (H. pylori) which is a type of bacteria that damages
the stomach lining.
✓ After the collection of the baseline breath sample, the
patient is asked to drink a special substance that has
synthetic urea.
Breath Samples
✓ He is then asked to breath into a Mylar balloon at
specified intervals. The breath specimens are analyzed for
carbon-13 which confirms the presence of the H. pylori.
✓ The Hydrogen breath test, on the other hand, helps in
the detection of carbohydrate digestion problems such as
lactose (milk sugar) and fructose (fruit sugar).
✓ This test can also detect bacterial overgrowth in the small
intestine and is thought as the most accurate tolerance
test.
✓ In preparation for the test, the patient must not take
antibiotics 2 weeks prior to the scheduled test.
✓ He should not eat certain food for 24 hours before the
test and should be on fasting on the day of the test.
Smoking and exercise is also restricted 30 minutes before
the test.
✓ The baseline breath sample is taken by breathing into a
special bag before the introduction of a special drink.
✓ Additional breath samples are taken every 30 minutes for
3 hours and all are sent to the laboratory for analysis.
Feces (Stool)
The fecal specimen (feces or stool) is collected to
(1) determine gastrointestinal disorder,
(2) analyze for presence of intestinal ova & parasites (O&P),
(3) cultured for the presence of pathogenic bacteria and
viruses,
(4) check fat and urobilinogen content,
(5) test for presence of occult blood. They are collected in a
clean and wide-mouth container that are sealed and sent
to the laboratory after collection.
Hair
Aside from using the hair sample for trace & heavy
metal analysis, it is also used to detect chronic drug abuse
where hair is the preferred specimen because not only is it
easy to obtain, but it is also not easy to alter or tamper.
Throat swabs
✓ Throat swabs are mostly collected to aid in streptococcal
(strep) infection detection.
✓ A special kit contains a sterile polyester-tipped swab and
a covered transport tube.
✓ The tube contains transport medium.
The throat culture specimen collection procedures are as follows:
1. Follow hand hygiene and PPE procedures
2. Open the container to remove the swab in an aseptic manner.
3. Stand to the side of the patient or stand back to avoid droplet
contact when the patient coughs.
4. Ask the patient to tilt his head back and open his mouth wide.
5. Examine the throat by directing a flashlight to the back of the
throat.
6. Use a tongue depressor to depress the tongue and ask the
patient to say "Ah" to raise the uvula and get it out of the way.
7. Swab the tonsils, tonsilar crypts, back of the throat and
any area that has ulceration and inflammation but avoid
touching the lips, tongue and uvula.
8. Discard the tongue depressor only after the swab has
been taken out of the mouth.
9. The swab is placed in the transport tube (dipped in the
medium) and the covered carefully.
10. Follow proper labeling procedure for the specimen.
11. Remove the gloves properly & apply proper hand
decontamination technique.
12. The collection tube is sent to the laboratory for
immediate processing.
Tissue Specimen
✓ The tissue specimen is usually collected using biopsy where
the tissue sample is removed for examination.
✓ The phlebotomist should check the proper handling procedure
if the specimen arrived not immersed in solution.
✓ In the case of genetic analysis, the tissue samples are not to
be placed in formalin.
✓ Improper handling is costly, inconvenient and cannot be easily
repeated.