Neonatal Specimen Collection Instructions

TEST NAME

TAT*
- STAT
- ROUTINE

CONTAINER TYPE

MINIMUM SAMPLE VOLUME
WHOLE BLOOD

COLLECTION
INSTRUCTIONS

ABG- Arterial Blood Gases

15 mins

Heparin syringe

0.3 mL

1. Mix well.

2. Send on ice

ACTH

(Adrenocorticotrophic hormone)

PLASMA

7 days

Lavender microtainer

1 mL

1. Pre chill tubes

2. Mix gently after drawing

3. Send to lab on ice

ACYL-CARNITINES

Also request free and total carnitine with this order

7 days

Green or Gold microtainer

0.6 mL

1. On ice

2. Send to lab ASAP

ALBUMIN

2 hrs

Green or Gold microtainer

0.4 mL

ALDOSTERONE

10 days

Green or Gold microtainer

2 tubes

0.5 mL

Indicate all drugs administered in last 2 weeks

ALP

(Alkaline Phosphatase)

2 hrs

Green or Gold microtainer

0.4 mL

AFP

(Alpha Fetoprotein)

Same day

Mon-Fri

Gold microtainer

0.5 mL

ALPHA 1 ANTI-

TRYPSIN

7 days

Green or Gold microtainer

0.5 mL

ALPHA 1 ANTI-

TRYPSIN PHENOTYPE

7 days

Gold microtainer

0.5 mL

ALT (Alanine Aminotransferase)

2 hrs

Green or Gold microtainer

0.4 mL

AMIKACIN

- Trough

- Peak

1 day

Green or Gold microtainer

0.5 mL

Trough: 0-30 min

Before next dose

Peak: 30-60 min after IV completed

AMINO ACIDS

- BLOOD

(Quantitative)

5 days

Green microtainer

0.4 mL

Send to lab immediately

AMINO ACIDS

- URINE

Quantitative

(Order urine screen unless diagnosis is known)

7 days

Sterile

Urine container no preservative

5 mL

Keep sample cool

For quantitation, provide tentative diagnosis

AMINO ACIDS

- CSF

4 days

LAP kit. Sterile conical screw top tube.

0.5 mL

Bloody specimen inappropriate for analysis

AMMONIA -BLOOD

1 hr

2 hrs

Lavender

microtainer

0.4 mL

Send on ice immediately and

Indicate time drawn

AMYLASE

4 hrs

Green or Gold microtainer

0.4 mL

ANDROSTENEDIONE

14 days

Gold microtainer

1 mL

ANTI CARDIOLIPIN

7 days

2 Gold microtainers.

1 mL

Anti-Xa

(AXA)

2 hrs

Micro tube. 1 ml with 3.2% Na Citrate.

Attached push cap Blue, transparent label

0.9mL of blood to 0.1-mL 3.2% sodium citrate.

1 Micro tube if AXA ordered only.

2 citrated Micro tubes if ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

1. Dose times: 06:00 and 18:00. Take blood 4 hours after medication is given.

2. Add exactly 0.9 mL blood to liquid in each tube,

3. Invert gently and thoroughly 4-6 times immediately after collecting.

4. Send to lab ASAP.

5. Indicate the type of heparin (Enoxaparin)

APT

2 days

Sterile urine container

10 mL

– Gastric Aspirate

– Stool

– Vomitus

Sample must be pink or red. Colorimetric reaction with brown end-point. Any red-brown or black sample will not be accepted.

AST

(Aspartate

Aminotransferase)

2 hrs

Green or Gold microtainer

0.4 mL

BETA HYDROXY

BUTYRATE

7 days

Gold microtainer preferred

Green microtainer acceptable

0.5 mL

Can be combined with Free Fatty Acids – 0.6 mL both

Send immediately on ice.

BILIRUBIN

-TOTAL

(Microbilirubin or MBR)

- SERUM

2 hrs

Green or Gold microtainer

0.4 mL

BILIRUBIN

DIRECT –

(Bilirubin Conjugated)

2 hrs

Green or Gold microtainer

0.4 mL

Protect from light.

BLOOD CULTURE

Refer to SCI-5.7.15.2.14 (HL)

BACTEC® PEDS PLUS

BOTTLE

(Pink top and label)

1 - 3 mL of blood per bottle.

Do not refrigerate. Deliver A.S.A.P. to the lab.

BUN (UREA)

2 hrs

Green or Gold microtainer

0.4 mL

Capillary Blood Gases (CBG)

20 mins

Heparin coated capillary

(0.14 mL) Or full cap tube

1. Mix well.

2. Insert metal mixing flea and cap ends.

3. Send immediately on ice

CALCIUM (Total)

2 hrs

Green or Gold microtainer

0.4 mL

Can be ordered as Ca/Alb/Phos/Mg panel

CARBOXY HEMOGLOBIN (COHB)

- BLOOD

20 mins

Heparin syringe

0.25 mL

Send on ice.

CARNITINE

Free and total

7 days

Gold microtainer preferred.

Green acceptable.

Also, performed on urine.

0.5mL serum or plasma

Send on ice

CSF CELL COUNT

1 hr

CSF collection tube

0.05 mL

Send to lab ASAP.

If delay anticipated, keep specimen at room temperature.

If multiple tubes of CSF are collected, the first tube shall not be used for microbiological examination.

Indicate the order collected on the tube. Send tube 3 for cell count.

CSF DIFFERENTIAL

2 hrs

CSF collection tube

0.10 mL (cell count also performed)

See CSF Cell Count

CSF GLUCOSE

1 hr

CSF collection tube

0.4 mL (Glucose and Protein)

See CSF Cell Count

Send tube 1 for glucose.

CSF PROTEIN

1 hr

CSF collection tube

0.4 mL (Glucose and Protein)

See CSF Glucose

CHOLESTEROL

4 hrs

Green or Gold microtainer

0.4 mL

CHROMOSOMES

(KARYOTYPE)

7-12 days

Sodium Heparin vacutainer or Sodium Heparin syringe

1-3 mL

A HSC or Mt. Sinai chromosome requisition must be filled out.

Send to the lab at room temp.

Do not take sample on the weekend or late Friday.

COCAINE-URINE

24 hrs

Sterile urine container

2 mL

A HSC toxicology form must be filled out. See Biochemistry section of SCI.

COCAINE – HAIR

10 days

Sterile urine container

5 mg

A HSC toxicology form must be filled out. Done only if urine screen is negative

See Biochemistry Section of SCI

CBC (Complete Blood Count) and DIFFERENTIAL (DIFF)

CBC =30mins

DIFF = 1 hour

Lavender microtainer

0.3 mL whole blood

Gently invert 10 times immediately after collecting to prevent formation of clots

CORD BLOOD

-Blood Bank

(Routine)

Same day

Pink top vacutainer 6 mL draw

3 mL

SIGNED, completely filled-in pink requisition MUST accompany

FULLY labelled sample

CORD BLOOD

-HEMOGLOBIN

30 minutes

Lavender microtainer

0.30 mL

Gently invert 10 times immediately after collecting to prevent formation of clots

CORD GASES

- Arterial

- Venous

15 mins

Balanced Heparin syringe

0.3 mL syringe

1. Indicate if arterial or venus cord

2. Mix well.

3. Send on ice immediately

CORTISOL

Same Day

Gold microtainer

0.5 mL

150 uL

CREATININE

1 hr

Green or Gold microtainer

0.4 mL

CK

(Creatine Kinase)

2 hrs

Green or Gold microtainer

0.4 mL

CRP

2 hrs

Green or Gold microtainer

0.4 mL

Dehydroepiandroster-one sulphate (DHEAS)

7 days

Green microtainer

0.5 mL

DIMER

1 hr

Micro tube. 1 ml with 3.2% Na Citrate.

Attached push cap Blue, transparent label

1 Micro tube for

D-Dimer only.

2 citrated Micro tube tubes if ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

Add exactly 0.9 mL blood to liquid in each tube

- Invert gently and thoroughly 4-6 times immediately after collecting

- Send to lab ASAP.

7 – DEHYDRO

CHOLESTEROL

20 days

Green or Gold microtainer

0.7 mL

Send to the lab protected from light

DIHYDRO-

TESTOSTERONE

(DHT)

20 days

Gold microtainer

2.0 mL

DIGOXIN

4 hrs

Green or Gold microtainer

0.3 mL

DILANTIN

(Phenytoin)

4 hrs

Green or Gold microtainer

0.5 mL

DIRECT ANTIGLOBULIN TEST (DAT)

Same Day

Lavender microtainer

≥ 0.5 mL

SIGNED, completely filled-in pink requisition MUST accompany FULLY labelled sample

ELECTROLYTES

(NA, K+, CL)

1 hr

Green or Gold microtainer

0.4 mL

ELECTROLYTES

(URINE)

1 hr

Sterile urine container

0.4 mL

FACTOR ASSAYS – COAG

Micro tube. 1 ml with 3.2% Na Citrate.

Attached push cap Blue, transparent label

NOTE: Not to be combined with full coagulation panel

May need 2^nd tube if more than 4 factors ordered

1. Add exactly 0.9 mL blood to liquid in each tube.

2. Invert gently and thoroughly 4-6 times immediately after collecting

3. Send to lab ASAP.

FECAL OCCULT BLOOD

2 hrs

Sterile bottle

0.5 mL

1. Send in sterile bottle.

2. Label as “STAT” and notify lab that a sample is being sent

FERRITIN

4 hrs

(M-F)

Green or

Gold Microtainer

0.5 mL

FIBRINOGEN

1 hr

Micro tube. 1 ml with 3.2% Na Citrate.

Attached push cap Blue, transparent label

repeat fibrinogen only.

ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

1. Add exactly 0.9 mL blood to liquid in each tube.

2. Invert gently and thoroughly 4-6 times immediately after collecting

3. Send to lab ASAP.

FREE T3

4 hrs

(M-F)

Green or Gold microtainer

0.8 mL with TSH for full thyroid panel

FREE T4

4 hrs

(M-F)

Green or Gold microtainer

0.8 mL with TSH for full thyroid panel

FREE FATTY ACIDS

Weekly

Gold microtainer preferred.

Green microtainer acceptable

0.6 mL –

Can be combined with Beta Hydroxy-butyrate (0.6 mL for both).

FASTING Sample preferred

FOLLICLE STIMULATING HORMONE (FSH)

4 hrs

(M-F)

Green or Gold microtainer

0.4 mL

G-6-P-D SCREEN

(Glucose-6-phosphate dehydrogenase)

Batch test. Performed Tues and Thurs

Lavender microtainer

0.5 mL

Gently invert 10 times immediately after collecting to prevent clot formation

CBC & Retic must be ordered with each G6PD Screen request.

Send separate tube for CBC and Retic.

G-6-P-D ASSAY

(Glucose-6-phosphate dehydrogenase)

5 days

Lavender microtainer

0.25 mL

G-6-P-D screen results must be indeterminate or deficient.

GALACTOSEMIA

SCREEN

Done on Fridays

Heparin syringe

0.4 mL use a 3 mL syringe

Send on ice immediately to lab.

Test invalid if baby has been transfused.

GAMMA GT (gGT)

(Gamma-glutamyl transpeptidase)

4 hrs

Green or Gold microtainer

0.4 mL

GENTAMICIN

– Trough
– Peak
– Random

2 hrs

4 hrs

Gold microtainer

0.5 mL

Trough: 0-30 min before next dose

Peak: 30- 60 min after IV completed

Indicate time on label

GLUCOSE - BLOOD

1 hr

Green or Gold microtainer

0.4 mL

GLUCOSE - CSF

1 hr

CSF collection tube

0.4 mL (Glucose and Protein)

Send to lab ASAP.

If delay anticipated, keep specimen at room temperature.

If multiple tubes of CSF are collected, the first tube shall not be used for microbiological examination. Indicate the order collected on the tube.

Send tube 1 for glucose.

GROUP & SCREEN

- Blood Bank

STAT= 45 mins

Routine = Same Day

Lavender microtainer

≥ 0.5 mL

SIGNED, completely filled-in pink requisition MUST accompany

FULLY labelled sample

GROWTH HORMONE (GH)

7 days

Gold microtainer

1.0 mL

HAPTOGLOBIN

4 hrs

(M-F)

Gold microtainer

0.5 mL

HEMOGLOBIN ELECTROPHORESIS

3 working days

Lavender microtainer

0.5 mL

Gently invert 10 times immediately after collecting to prevent clot formation

17 – HYDROXY PROGESTERONE

2 weeks

Gold microtainer

0.8 mL

HOMOCYSTEINE

(TOTAL) - PLASMA

7 days

Lavender microtainer

0.5 mL

Send on ice

Human Herpes Virus Type 6 by PCR

(HHV 6A, 6B, 7)

2 days

Lavender microtainer

Need 1 mL

Sent to Hospital for Sick Children

Same as Roseola infantum, Exanthem subitum

Human Immunodeficiency Virus (HIV 1 and 2)

6 days

Lavender microtainer

Need 2 mL of plasma

Sent to Hospital for Sick Children. Refer to infant sample sheet

Human Immunodeficiency Virus by DNA PCR

1-2 weeks

Lavender microtainer

Need 2 mL of plasma

Sent to Hospital for Sick Children. Refer to infant sample sheet

INSULIN

4 hrs

(M-F)

Green or Gold microtainer

1.0 mL

Send on ICE

INSULIN LIKE GROWTH FACTOR

7 days

Serum

1 mL

Send to lab on ice IMMEDIATELY

IONIZED CALCIUM

20 mins

Heparin syringe

0.3 mL

Send IMMEDIATELY to LAB (Preferred sample type)

KARYOTYPE

See Chromosome studies

KETONES

Green or Gold microtainer

0.4 mL

LACTATE

20 Mins

Heparin syringe

0.3 mL

Send to lab on ice IMMEDIATELY

2 hrs

Green microtainer

LEUITINIZING HORMONE - LH

4 hrs

(M-F)

Green or Gold microtainer

0.4 mL

LIVER PANEL

(Includes ALP, AST, ALT, and TBIL)

4 hrs

Green or Gold microtainer

0.6 mL

MAGNESIUM

2 hrs

4 hrs

Green or Gold microtainer

0.4 mL

0.6 mL for panel with Ca/Phos/Mg/Alb

METABOLIC SCREEN

- URINE

(Includes Amino Acid screen, DNPH, NITROPRUSSIDE)

10 days

Random urine

Sterile Urine container

3-5 mL

MET-HAEMOGLOBIN

20 mins

Heparin syringe ,CBG tube, or heparinized microtainer

Send to lab on ice

Immediately.

MUCOPOLY-

SACCHARIDES

(SCREEN)

7-10 days

Random urine

10 mL

Refrigerate if sample not completed in one collection

NEONATAL ETT (Endotracheal Tube)

C&S: Positive- 1 to 2 days unless otherwise indicated

Negative:

2-4 days

Sterile screw cap container

If the specimen is large enough to get into the container (ie a large amount of secretions), use that. If there is a smaller amount that is stuck in the suction catheter, suction up just enough sterile saline to get the specimen into the container

NEONATAL MECONIUM TOXICOLOGY

Consider consulting with team before using them on full-term infants

Meconium can identify drugs taken within the last 20 wks of pregnancy

Varies

White plastic container (provided)

The kits provide popsicle sticks and plastic sheets to line the diapers with so the stool does not become absorbed into the diaper and is easier to collect. It is not advised to use the plastic sheets in the preterm population as it may lead to diaper dermatitis

3g (1 teaspoon)

can be collected over a period of 5-7 days until 3g (~ 1 teaspoon) of volume has been reached.

Stop collecting once stool becomes transitional. Send what has been collected as they may be able to test, but for fewer substances.

Can be kept at room temperature (if collecting specimen over several days)

IF also testing alcohol specimen MUST be refrigerated if collecting over several days. Send specimen to the lab on ice.

Stability limitations: 2 weeks room temp, 3 months refrigerated, 1 year frozen

NEONATAL HAIR TOXICOLOGY

Hair can identify drugs taken within last 90 days of pregnancy

Varies

White paper envelope (provided)

100mg of hair is needed to run a panel test

(The diameter of a #2 pencil)

USDTL is a forensic lab and can accurately test hair, but the amount required is significant.

Discuss the feasibility of sending hair for testing with the team before attempting to collect a sample.

USDTL can run 1 test on 50 mg of hair (MUST indicate on form which drug you are looking for)

Stability limitations: no stability limitations available

NEONATAL SCREEN

Varies

Newborn Screening Card

Follow SCI-5.7.16.0 Neonatal Screening-Blood Collection on Filter Paper

(HL)

NEUROTRANSMITTER METABOLITES

14 days from receipt of sample

Call lab for special collection containers (total of 5 special containers)

3.5 mL of CSF

Call lab for special collection containers. Each set consists of 5 numbered tubes in a small plastic bag. Tube #3 contains antioxidants necessary to protect the sample from oxidation. One set of tubes is required per patient. CSF should be collected directly from the tap needle: Collect from the first drop into the containers in the order indicated. Fill each tube to the marked line (0.5 ml in tubes 1, 2, & 5 – 1.0 ml in tubes 3 & 4). Label each tube without covering up the tube number. Place the tubes into a biohazard plastic bag, place on ice, and send to lab immediately.

OLIGOSACCHARIDES

(SCREEN)

7-10 days

Random urine

1 mL

Refrigerate if sample not completed in one collection

ORGANIC ACIDS

(qualitative)

5 days

Random urine

2 mL

Refrigerate if sample not completed in one collection

OSMOLALITY

- Blood

1 hr

2 hrs

Green or Gold microtainer

0.4 mL

OSMOLALITY

- Urine

1 hr

2 hrs

Sterile Urine container

0.3 mL

PCR – CSF for Streptococcus pneumoniae and Neisseria meningitidis

Mon – Friday same day

CSF sterile container

CSF collected by LP in sterile screw cap container. Minimum volume is 0.2 mL.

Consult with lab before requesting test. Approval by the microbiologist is required. Store in 4ºC refrigerator for up to 48 hours; if >48 hrs, store at -20ºC

PCR-VIROLOGY Testing-CSF

Varies

CSF sterile container

0.25 mL of CSF

For Neonates and children ≤ 12 yrs only with a diagnosis of HSV encephalitis. Request Herpes Simplex Group (CMV, EBV, HHV8). Requires approval by a Medical Microbiologist.

Indicate virus test required

PHENOBARBITAL

1- 2 days

Green or Gold microtainer

0.4 mL

Indicate pre, post dose or random. Biochemist approval required.

HSC send out

PHENYTOIN

(Dilantin)

4 hrs

Green or Gold microtainer

0.5 mL

Indicate pre, post dose or random

PHOSPHATE

(Inorganic)

4 hrs

Green or Gold microtainer

0.4 mL 0.6mL for panel with Ca/ Phos/Mg/Alb

PTH, (Intact)

(PARATHYROID HORMONE)

4 hrs

Lavender microtainer

1.5 mL

Note time of draw

PT/PTT

1 hr

Micro tube. 1 ml with 3.2% Na Citrate.

Attached push cap Blue, transparent label

NOTE:

for full Coag panel – PT/PTT,

D-Dimer, and Fibrinogen

1. Add exactly 0.9 mL blood to liquid in tube.

2. Invert gently and thoroughly 4-6 times

3. Send to lab ASAP.

PYRUVATE

3 days

Lithium heparin syringe

0.4 mL –

-Lactate and pyruvate done on same sample

On ice to lab immediately

(Must reach lab within 30 min of collection)

PYRUVATE KINASE

3 days

EDTA (lavender tube)

2 ml Lavendar top tube

(Must reach lab within 30 min of collection)

Sample must not be clotted.

PROTEIN - CSF

1 hr

CSF collection tube

0.4 mL (Glucose and Protein)

See CSF Glucose

RENIN

3 weeks

Lavender microtainer

3 mL – 3 tubes

Send to lab on ice.

RETICULOCYTE COUNT

30 mins

Lavender microtainer

0.30 mL whole blood

Invert gently and thoroughly 4-6 times immediately after collecting

CBC must be ordered with each request for Retic

SIROLIMUS

3 days

Mon. to Thur.

Lavender microtainer

0.5 mL

Trough sample

0-30 min before next dose

TAY-SACHS

(Hexosaminidase)

7-12 days

Heparin syringe

1-3 mL

A HSC Molecular Genetics requisition must be filled out.

Monday to Friday (8-4)

Send to the lab at room temp.

TESTOSTERONE

-Total

4 hrs

(M-F)

Gold microtainer

1 mL

Thyroid function

(FT3, FT4 and TSH

4 hrs

(M-F)

Green or Gold Microtainer

0.8 mL

TOBRAMYCIN

– Trough

– Peak

– Random

4 hrs

Green or Gold microtainer

0.4 mL

Indicate

– Trough

– Peak

– Random on label

TORCH SCREEN –serology for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex

7-10 days

Gold microtainer

1-2 mL

Follow PHL requisition instructions.

Parvovirus not part of TORCH panel.

TRANSFERRIN

7 days

Gold microtainer

0.6 mL

TRANSFERRIN ISOELECTRIC FOCUSING FOR CDG

Varies

3 Gold microtainers

2 mL (1.2 mL minimum).

TRIGLYCERIDES

4 hrs

Green or Gold microtainer

0.4 mL

TROPONIN

1 hr

Green microtainer

0.8 mL

UREA (BUN)

1 hr

Green or Gold microtainer

0.4 mL.

URINALYSIS

2 hrs

Sterile Urine container

2 mL urine

URINE DRUG SCREEN

Same Day

Sterile Urine container

5 mL urine

A HSC Toxicology form must be filled out

URINE SUCCINYL ACETONE

Same Day (sent by lab M to F)

Sterile Urine container

3 mL urine

VANCOMYCIN

- Trough

– Peak

– Random

4 hrs

Green or Gold microtainer

0.5 mL

Indicate pre, post dose or random on label

VIRUS ISOLATION

Varies according to specimen type. Refer to SCI-5.7.15.2.10.

VITAMIN D;25 OH

7 days

Gold microtainer

0.5 mL