Specimen Processing and Chain of Custody
Key Takeaways
- Correct patient identification, labeling, timing, and handling protect lab accuracy and patient safety.
- Specimens are labeled at the point of collection using facility-approved identifiers.
- Chain of custody means the specimen path is traceable from collection through transfer.
- When a specimen error occurs, the safe response is to report and document, not to hide or relabel.
Processing Specimens Safely
A lab result is only useful if the specimen belongs to the correct patient, was drawn at the correct time, and was handled as required. In dialysis, common specimens include monthly labs, adequacy samples, cultures, medication levels when ordered, and other tests by facility policy.
Use the required patient identifiers before collection. Label tubes at the chairside or point of collection. A label should not be placed later from memory, because interruptions and similar names can cause serious errors.
Specimen timing matters. Pre-dialysis samples are usually drawn before treatment affects the result. Post-dialysis samples may require a specific technique or timing so access recirculation or rebound does not distort the result.
Processing steps can include correct tube order, mixing by gentle inversion when required, placing specimens in the correct bag, adding requisitions, chilling or protecting from light when ordered, and transporting within the required time. Follow the lab manual and facility procedure.
Chain of custody means the specimen can be tracked from collection to handoff. It may include collector identity, date, time, patient identifiers, seal checks, and documented transfer. For any chain-of-custody specimen, gaps or broken seals must be reported.
Infection control still applies. Wear required PPE, avoid contaminating the outside of containers, clean blood spills promptly, and place sharps directly into approved sharps containers. Never recap needles unless a specific safety device and procedure requires it.
When something goes wrong, report it. A wrong tube, missing label, clotted sample, delayed transport, broken container, or uncertain patient identity can make the result unsafe to use. The technician documents the facts and follows policy for recollection or incident reporting.
Two patients with similar names are being dialyzed near each other. What is the best action before drawing monthly labs?
A specimen requiring chain of custody is received with a broken seal. What should the technician do?
A technician notices that a blood tube was not labeled at the chairside and cannot be linked with certainty to one patient. What is the safest action?