9.3 Other Specimens and Time/Temperature Requirements

CMLA II.4.A.3 asks you to instruct patients in collection of other specimens, with semen, feces, and sputum as the outline examples. II.4.A.4 is time/temperature requirements. II.4.A.5.b is handle and process all body fluids for chemical analysis. Blood handling, plasma-on-cells limits, and send-outs were Chapter 8. This section is everything that is not venous or capillary blood, plus the remaining fluids an assistant may receive (including cerebrospinal fluid (CSF) if it arrives at your bench).

Quick Answer: Semen stays near body temperature and is delivered promptly. Stool: match O&P, C. difficile, occult blood, and culture to different containers. Sputum is a deep cough, not spit. CSF is never discarded and is STAT. Read the clock and the temperature for each fluid; do not store them all like leftover UA.

Semen

Semen analysis (fertility or post-vasectomy, per the order) is extremely time- and temperature-sensitive. Motility dies in the cold and in excessive heat. Typical assistant-level instruction (overridden by the laboratory sheet):

• Provide the laboratory's clean, wide-mouth container. Ordinary condoms (lubricated or spermicidal) are not acceptable unless the SOP issues a special non-spermicidal collection condom.
• Collect by masturbation after the abstinence interval the SOP states (commonly a few days; follow the printed range). Do not collect by withdrawal during intercourse unless the laboratory explicitly allows a specified device.
• Collect the entire ejaculate. The first portion is often sperm-rich; losing it falsely lowers the count.
• Cap, label with two identifiers and the collection time, and keep the container near body temperature during transport—often against the torso under clothing. Do not refrigerate. Do not leave it on a sunny dashboard or a heating vent.
• Deliver promptly. Many laboratories require arrival within about 30–60 minutes so liquefaction and motility can be read on time. Call ahead; this is not a drop-box specimen.

If the specimen is cold, overheated, incomplete, collected in a lubricant condom, or hours late, it is unsuitable. Recollect. You do not "warm it in the microwave" to salvage motility.

Feces (stool): one order, many kits

"Stool" is not a single specimen type. The test requested picks the container. Instruct the patient with the kit in hand, not with a leftover urine cup.

Teach the mechanical collection: pass stool into a clean collection hat or onto plastic wrap stretched over the toilet (not into toilet water), transfer the requested amount, and avoid urine and toilet-bowl water. For C. diff, formed pellets are often rejected because the clinical definition needs unformed stool. For O&P, three separately timed specimens may be ordered; one leftover bit in the refrigerator is not three collections.

Sputum versus saliva

Sputum is material from the lower airways, produced by a deep cough. Saliva is oral spit. A saliva-filled cup labeled "sputum" wastes a stain and a culture; you will grow mouth flora and miss the pneumonia organism.

Assistant-level script:

• First-morning specimen is often preferred (secretions pooled overnight).
• Rinse the mouth with water. Do not use antiseptic mouthwash immediately before collection.
• Take several deep breaths and cough from the chest, not a throat-clear into the cup.
• Collect into a sterile leakproof sputum cup. A few milliliters of true sputum beat a cup of spit.
• Label, bag, and deliver promptly. Many respiratory cultures travel at room temperature or per the microbiology SOP; do not freeze, and do not leave the cup on a radiator.

If the cup looks like watery saliva with bubbles and no mucoid or purulent material, flag it before the bench pretends it is sputum. Induced sputum (nebulized saline) is a respiratory-therapy procedure; CMLA instructs and receives, and does not independently perform induction unless competency and SOP say otherwise.

Other body fluids for chemical analysis

Assistants may receive pleural, peritoneal (ascites), synovial, amniotic, or drain fluids that a provider collected. Your job is identity, container, clock, temperature, and not discarding leftovers.

• Use the laboratory's numbered tubes or sterile cups as the directory lists. A chemistry fluid often goes in a specified chemistry tube; a culture of the same fluid needs a sterile container without a conflicting additive. Do not assume a gold-top serum tube is validated for every fluid.
• Label on the container, not on the bag, with two identifiers, fluid type, and collection time. "Left knee" versus "right knee" matters.
• Deliver promptly. Cell counts and some chemistries (glucose, lactate) change as cells metabolize. If the SOP says STAT, it is STAT even if the courier run is in an hour—call.
• Do not pour fluids down the sink because "we already have enough in tube 1." Extra volume may be needed for add-on chemistry, culture, or crystal exam.

CSF: if the assistant receives it

CSF is obtained by lumbar puncture, a provider procedure. If tubes arrive at the CMLA bench:

• Never discard CSF. Volume is precious and recollection is a lumbar puncture, not a clean-catch.
• Treat as STAT. Walk it to the testing section or call the courier. Do not park CSF in the routine urine refrigerator "until someone has time."
• Keep tubes in numbered order if the collector labeled tube 1, 2, 3. Chemistry, microbiology, and cell count often use different tubes; do not pool them to "make one full tube."
• Follow the SOP for temperature. Bacterial culture on CSF is commonly kept at room temperature and processed immediately; refrigeration can harm some organisms (classic teaching includes Neisseria). Viral PCR or other send-outs may have different holds—read the directory instead of defaulting to "everything cold."
• An unlabeled CSF tube is a crisis, not a casual reject-and-recollect like a UA cup. Stop, notify the collector and supervisor immediately, and do not guess a name.

Time and temperature: non-blood remaining work

Chapter 8 already covered blood transport, ice slurries versus frozen, and plasma-on-cells. Reuse the habit, not the blood table:

• Near body temperature, fast: semen.
• Prompt or refrigerate: unpreserved urine (Section 9.2), many stools for C. diff, many fluids for chemistry.
• Room temperature, STAT: many CSF cultures; many sputa per micro SOP.
• Fixative or transport medium: O&P vials, Cary-Blair, boric-acid urine tubes—once in the correct medium, follow that label, not the urine-cup rule.
• Never the household freezer, dashboard, or windowsill unless the SOP names that storage.

In practice

A clinic drop-off includes a condom-collected semen specimen on an ice pack, a formed stool in an O&P formalin vial labeled "C. diff," a saliva cup labeled sputum, and three CSF tubes with only a bag sticker. You do not run any of them "to be helpful." Semen on ice is the wrong temperature. C. diff in formalin is the wrong container and the stool is formed. Saliva is not sputum. CSF without container identifiers is an immediate call to the collector—never a trash-can decision.

Exam traps

• Refrigerating semen or heating it to "keep it warm."
• One stool cup for O&P, C. diff, occult blood, and culture.
• Accepting spit as sputum.
• Discarding leftover CSF or refrigerating it with the UA cups by habit.
• Applying Chapter 8 blood ice-slurry rules to every non-blood fluid.

When CMLA names semen, stool, sputum, or CSF, answer with the container, the clock, and the temperature—and name the look-alike fluid it is not.