Gamma-Dynacare supplies colour-coded sterile evacuated glass tubes for blood collection. To determine the correct tube for each test, consult the Test Information section of this web site or your Gamma-Dynacare Specimen Requirement Chart.

All specimen containers must be clearly labeled with two unique patient identifiers (the patient's full name and one other identifier) and the date of collection. Also include other specifics such as:

• Second patient identifier such as Date of Birth, Health Card Number or Chart Number;
• Time of day for those requiring timed specimens;
• Proper identification of specimens involved in serial sampling (i.e. Glucose Tolerance Test).

Follow proper phlebotomy procedures when using evacuated glass tubes to prevent back-flow of blood from tube to the patient:

• Correctly position patient's arm and collection tube;
• Avoid excessive thumb pressure on end of tube;
• Avoid thumb or finger pressure around venipuncture site during the phlebotomy.

Also avoid prolonged tourniquet application. It may cause false increases in serum constituents such as potassium, various proteins or constituents bound to protein such as calcium. It may also cause hemolysis of the specimen, which may also interfere with some test procedures, and cause increases in results for tests such as potassium, creatine kinase, magnesium, etc. For further details regarding the recommended phlebotomy procedure, please refer to our Directory of Client Services in the Downloadable Forms section of this web site.

1. Physicians are required to order Hepatitis testing by clinical condition, namely: (a) Acute; (b) Chronic or (c) for determination of Immune Status (specify Hepatitis A or B). 
2. Only one of the above three categories of hepatitis testing may be ordered on the same requisition. It is therefore suggested that physicians decide which clinical condition needs to be investigated before requesting the appropriate category of Hepatitis testing.
3. It is still possible, however, to order any required Hepatitis marker by writing the name of the marker(s) in the “Other Tests” area of the OHIP Laboratory requisition. All test/markers ordered in this manner will be performed and reported.
4. When ordering Hepatitis testing by category, there is no need to specify Hepatitis A, B or C, except for “Immune Status” testing, in which case Hepatitis A, B or both A and B must be indicated. For example, if a request for “Chronic Hepatitis” is received, the markers for B and C will be run automatically and reported (Hepatitis A does not have a “chronic” state). Please note that for Acute Hepatitis, an ALT is performed prior to hepatitis testing and if not elevated, the Hepatitis markers will not be performed.
5. If only one of the markers from the Chronic or the Acute category is required, order the appropriate marker, not the condition. Refer to example below:

If all 3 acute markers are negative, repeat Hep C again in 4-6 weeks.

      6.    Please do not order screens of any type, for example, “Hepatitis B Screen”. These types of requests can no longer be  accommodated since they are not clinically specific.

Gamma-Dynacare Medical Laboratories recommends several precautions be taken in the storage and transportation of culture specimens to assure the reliability of the results:

• Refrigerate all urine, sputum and stool cultures while waiting for transportation to the laboratory;
• Hold swabs at room temperature (22°-25°C);
• Refrigerate swabs if a delay in transportation of longer than 10 hours is expected.

Blood cultures and fluid aspirates (synovial fluid and CSF for example) must be kept at room temperature.

It is equally important to:

• State if the patient is taking antibiotics;
• Provide clinical information;
• Write the patient’s full name and the time and date of the collection on each sample including second identifier.

Transport all specimens promptly to Gamma-Dynacare. Delays of more than 24 hours from collection to receipt at the laboratory will compromise some culture results.

SWABS

Swabs should be collected by the physician and the specimens transported to the laboratory in the transport medium provided by Gamma-Dynacare. All swabs have expiry dates, so rotation of stock is important. The site must be specified on the requisition AND the swabs to assist in the evaluation of any bacteria isolated.

Specimens requiring investigation (i.e., deep wounds) can be collected with the universal M40 swabs, routinely provided by Gamma-Dynacare.

If applicable, an aspirate is the specimen of choice in an anaerobic infection. Note: Aspirates can be collected and submitted to the laboratory using the M40 swabs collection kit. If aspirate is collected in a syringe, transfer sample to a sterile container or a blood culture bottle. DO NOT SEND SYRINGE.

THROAT SWABS

Rub the swab firmly over the back of the throat to touch areas of inflammation. Avoid contamination by saliva or contact with other areas of the mouth, especially the tongue. Insert the swab into the transport medium and submit to the laboratory. G.C. culture on throat swabs is performed on request only and is not part of the routine procedure. This request should be indicated on both the swab and the requisition. 

GENITAL SWABS

Selection of genital swab collection site is determined by symptoms.

Vaginal Swab: Required for laboratory diagnosis of Trichomonas vaginalis infection, Bacterial Vaginosis and Candidosis.

Cervical Swabs: Required for isolation of Neisseria gonorrhoeae (vulva swab is acceptable for children).

GBS Swab: Vag/rectal swabs. Recommended at 35 to 37 weeks gestational for detection of Group B streptococci in pregnant females. The specialized procedure used in the laboratory for the detection of GBS prevents using these swabs for other investigations. All types of genital swabs must be submitted in transport media. Dry swabs are not acceptable.

BLOOD CULTURES

Gamma-Dynacare provides special bottles for the collection of blood for culture. Aerobic, Anaerobic, Pediatric and “FAN” bottles. FAN are for collection of blood on patients already receiving antibiotic treatment. The volume of blood cultured is different for children and adults, since, it is not safe to take large samples of blood from young children, particularly newborns. In infants and children 1 to 5 mL of blood for culture should be sufficient. Please note the vacuum in the blood culture bottles will draw greater than 10 mL of blood. Guidelines on the bottles may be used to indicate when the correct amount of blood has been drawn.

For adults, 10 mL of blood appears to be a reasonable lower limit per bottle. Two blood cultures should be collected within a 24 hour period unless clinical circumstances (i.e., endocarditis, pediatric patients, suspected brucellosis) dictate otherwise. Include one anaerobic bottle in the two blood cultures.

Blood cultures may be collected serially (within 30 minutes) or simultaneously (separate site, separate venipuncture). There is no clear evidence to indicate that either one is superior.

Any anti-microbial therapy initiated should be indicated on the laboratory requisition and blood should be collected in bottles marked “FAN”.

Blood cultures MUST NOT be refrigerated.

STERILE FLUIDS

Aseptic collection technique is required in the sampling of sterile body sites. Fluids for culture should be submitted in sterile containers. Sterile fluids should be held at room temperature until they can be transported to the laboratory. DO NOT SUBMIT SYRINGES TO THE LABORATORY for testing. Fluids must be transferred into a sterile container or a blood culture bottle. The use of “Red Top” vacutainer tubes is not permitted as they contain a silica coating.

Although most parasites recovered are microscopic, from time to time an adult worm or worm section (proglottid) are recovered. Identification requires the parasite be in its most natural state.

• Submit all worms and worm sections in saline.
• If transport is delayed, the specimen should be submitted in 10% formalin or SAF.

The exoskeleton of most arthropods prevents dehydration. However, if dehydration should occur, the deformation of the arthropod may prevent accurate identification of the organism. ENSURE the container is labeled with full patient name, date/time of collection and test required.

• Arthropods should be submitted to the lab in a tightly sealed leak-proof container containing alcohol to reduce dehydration deformation.
• In the case of myasis, the larva or maggot should be submitted live.

The APTIMA Transcription Mediated Assay (TMA) from Gen-Probe Inc. is a Nucleic Acid amplification and detection based system.

Swabs provided for the APTIMA Combo 2 system are unisex. Cervical swabs and urethral swabs (for male) are collected with unisex swab kits. The collection kit contains 2 swabs. Use the white swab for cleaning the cervix and then use blue swab for sampling. Submit only the blue swab for testing. Swabs are stored at room temperature and are suitable for testing for 60 days.

Urine specimens must be a 30 mL first void collected any time. The patient should not have urinated for at least one hour before collection. Urine samples must reach the lab and be transferred to the special Gen-Probe urine transport tube within 24 hours. After transfer, the urine specimen is suitable for testing for 30 days.

Detection of Chlamydia on rectal, throat or eye swabs can be done by Chlamydia culture only. This test is performed by PHL and the use of PHL culture transport media is mandatory.

Culture:

• Culture for Chlamydia is recommended for medical-legal purposes, prepubertal patients and for specimens from non-genital sites (i.e., rectum or throat). Since culture only detects viable organisms, specimens must be held and transported under refrigeration. PHL Culture kits and ice packs are available from Gamma-Dynacare.

The Digene Hybrid Capture II DNA HPV test is used for the detection of oncogenic High Risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68.

Test ordering:

Indicate on the Diagnostic Cytology requisition one of the following choices:

• PAP and HPV
• HPV only
• PHV if ASC-US

Ordering the HPV test as an add-on (verbally or by fax-back to the cytology department) must be requested within a 21-day window from collection of the Surepath liquid-based sample.

Collection:

• A Liquid-based PAP Collection Kit can be used for both PAP and HPV test; or
• The HPV Collection Kit (the Digene Cervical Sampler) can be used. These samplers can be ordered with your regular lab supplies.
• If you choose to collect separate samples, collect the HPV sample after the Pap smear sample has been taken.

1. Remove excess mucus from the cervical os and surrounding ectocervix using a cotton or Dacron swab. Discard the swab.
2. Insert the brush 1-1.5 cm into the os of the cervix until the largest outer bristles of the brush touch the ectocervix. Rotate it 3 full turns in a counter-clockwise direction (see figure printed on the back of pouch). Do not insert brush completely into the cervical canal. Refer to diagram provided with each Digene Cervical sampler.
3. Remove the brush/broom from the canal. Avoid touching the bristles to the outside of the tube or to any other object.
4. Insert brush/broom to bottom of the Transport Tube. Snap off shaft at score line and cap tube securely, or place device into the PAP liquid preservative fluid.

Cervical biopsy (for HPV testing):

Fresh cervical biopsies up to 5 mm in cross-section must be placed immediately into the Digene Specimen Transport Medium and stored frozen at -20ºC. Cervical biopsies processed with histological fixatives (10% formalin) cannot be tested for HPV with the Digene procedures.

Storage and transport instructions:

• Store Digene collection kits at 15-30ºC until the expiration date printed on pouch label.
• Cervical samples/specimens may be held for up to 2 weeks at room temperature and shipped without refrigeration at 2-30ºC.

Skin scrapings:

1. Clean infected site with alcohol. If inflamed, cleanse with sterile water. Allow to air dry.
2. Scrape the affected periphery with scalpel and deposit specimen onto unfolded black paper in kit.
3. Fold black paper carefully to envelop all scrapings inside.
4. Place the folded paper in a sterile screw-cap container or transport envelope and label with patient’s name and a second identifier, and specimen site and diagnosis.

Nail clippings:

1. Clean collection site with 70% alcohol. Allow to air dry.
2. Clip affected nails with nail clipper or small scissors onto unfolded black paper provided in kit. Any debris under nails should also be collected.
3. Fold black paper carefully to envelop specimen and place into sterile screw-cap container or transport envelope and label with patient’s name and a second identifier, and specimen site and diagnosis.

Hair samples:

1. Epilate lustreless or broken hairs from infected areas of scalp. Include skin scrapings from scalp.
2. Collect hairs and scrapings onto unfolded black paper provided and fold paper carefully into envelope.
3. Complete the container label with patient’s full name and second identifier. Record time and date of collection on the container.

NOTE: Specimens for diagnosis of “Systemic Mycoses”, (i.e., fluids, sputum, etc.) are referred to PHL Mycology Laboratory.

All biopsies, both external and internal (cervical, rectal, vas deferens, liver, products of conception, etc.) must be sent in containers of 10% buffered formalin. These are provided by our laboratory upon request. It is important to ensure that an appropriate ratio of formalin to specimen is maintained. Ten to 20 times the volume of the specimen is recommended. Gamma-Dynacare routinely supplies 5, 15, 30, 90 and 2,000 mL containers of 10% buffered formalin. Upon special request, 1,000 mL containers may also be obtained by contacting the Histology Department. Use the Gamma-Dynacare Histopathology or OHIP requisition and indicate clinical data, tissue site and the patient’s clinical history.

The specimen container must be identified with first and last name of the patient (please ensure this is legible), the anatomical site of the biopsy and a second positive patient identifier such as a health card number or birthdate. Inadequately labeled specimens will be returned for proper identification causing a delay in results.

Skin biopsy specimens to be examined by immunoflourescence staining require a special transport medium that we supply. Record all pertinent clinical information on the accompanying requisition.

GYNECOLOGICAL CYTOLOGY SPECIMENS (PAP Smears)

Physicians are reminded that the PAP smear is a screening test with an inherent false negative rate.

PAP smears are usually taken from the vaginal fornix and the endocervix, making certain the transformation zone has been sampled. Instruct the patient to abstain from douching or using any vaginal medicines for 48 hours before the examination. The examination should be carried out during the mid-part of the patient’s menstrual cycle.

Gamma-Dynacare currently offers 2 methods of collection for gynecological cytology specimens: Liquid-based and Conventional.

The slide or specimen container MUST be clearly labeled with 2 unique identifiers (full name, plus health card number or birthdate) or the specimen will be rejected.

LIQUID-BASED

1. Cervical Sample Collection: Insert the Rovers Cervex-Broom into the endo-cervical canal. Apply gentle pressure until the bristles form against the cervix. Maintaining gentle pressure, hold the stem between the thumb and forefinger and rotate the brush/broom five times in a clockwise direction. Remove the sampling device from the endo-cervical canal.
2. The entire sample is placed into the transport vial. Place your thumb against the back of the brush/broom pad, and disconnect the entire brush/broom from the stem into the CytoRich preservative vial.
3. Place the cap on the vial and tighten to ensure specimen will not leak. Label the vial and lab requisition form with patient name and second identifier, and physician's name. Store at room temperature until picked up by the laboratory.
4. Complete the requested information to include the patient’s age, date of last menstrual cycle, use of IUD, use of hormonal therapy. Please also be sure to record other related clinical information such as any history of abnormal cytology, systemic chemotherapy, gynecological surgery, cryosurgery and electrocautery diagnosis if applicable. Failure to provide adequate clinical information may result in a misleading report.
5. Place the vial and requisition into a specimen bag and send to the laboratory.

 CONVENTIONAL:

1. Print the patient’s full name and second unique identifier, on the frosted end of the slide using a lead pencil. Do not use ink, as it may be erased during processing. Collect specimen as above.
2. If using the spatula for sample collection, insert the spatula into the cervical Os and rotate the spatula clockwise for one full rotation (360°). When using the broom/brush to collect the sample insert the broom/brush into the cervical Os and rotate the broom/brush in a clockwise direction one quarter turn (90°).
3. Spread the sample on the labeled side without encroaching on the frosted area.
4. Spray the smear immediately with cytology fixative to prevent drying and degeneration of the material.
5. Allow the fixed smear to dry before placing into the plastic transport container. Do not write on the plastic container.

SPUTUM FOR CYTOLOGY

Sputum is material collected from the lower respiratory tract. Saliva by contrast accumulates in the mouth and does not constitute a “sputum” sample. Sputum specimens should be collected on three consecutive mornings before eating. Instruct the patient to inhale and exhale deeply several times and to cough deeply from the chest to obtain secretions from the bronchial tree.

Have the patient follow these directions carefully to provide an appropriate sample:

1. Before breakfast or brushing teeth, assume an elbow-knee position on the bed for five minutes so lungs are higher than windpipe.
2. Inhale and exhale deeply several times. Cough deeply from the chest/diaphragm to obtain the secretion from the bronchial tree.
3. Collect the specimen directly into a Gamma-Dynacare sterile container containing no preservatives.
4. Deliver sputum sample to Gamma-Dynacare. If there is a delay, keep the specimen refrigerated or fix in 50% alcohol. Fresh specimens are preferred.

Complete the specific cytology requisition and submit it with the sample to the laboratory as soon as possible. PLEASE SUPPLY ANY PERTINENT CLINICAL HISTORY.

FLUIDS

(Breast, Cyst, Body Cavity, etc.)

Fluid samples may need to be collected from a variety of body sites. Fresh, unfixed samples are preferred. If fresh specimens cannot be brought directly to the laboratory, it is advisable to collect specimens into sterile containers and add cytology fixative (50% alcohol) to the specimen after collecting.

The volume of the fixative should be the same or slightly greater than the volume of the fluid. Secure the lid and clearly label the bottle with the patient’s name and a second unique patient identifier (OHIP # or birthdate). Submit the specimen to the laboratory with a completed cytology requisition.

DIRECT SMEAR

(Oral, Pharyngeal, Nipple Discharge, etc.)

Apply specimens to the slides directly from the collection instrument. Gently smear the material to prepare a uniformly thin sample. Fix immediately with cytology fixative to avoid degeneration. Label the slides with pencil on the frosted end and submit with a completed cytology requisition to Gamma-Dynacare.

Fine needle aspiration of material from subcutaneous and more deeply placed lesions for cytological or histological examinations has become an increasingly important diagnostic aid.

Many superficial lesions may be sampled quite readily, especially when they can be targeted by manual palpation.

Deep lesions may require the assistance of radiological or ultrasonic imaging techniques for targeting.

A needle guide is available for sampling the prostate gland. For further information, please inquire at Gamma-Dynacare Medical Laboratories.