5.1 Specimen Labeling & Transport
Key Takeaways
Specimens must be labeled AT THE BEDSIDE immediately after collection — NEVER pre-label tubes before drawing blood
Minimum labeling requirements include: patient full name, date of birth or MRN, date and time of collection, and phlebotomist initials or ID
Mislabeled or unlabeled specimens must be REJECTED — the draw must be repeated; relabeling at a later time is NOT acceptable
Specimens should be transported to the laboratory within 45 minutes to 2 hours of collection, depending on the test
Transport temperature categories include: room temperature (most specimens), chilled/on ice (ABG, ammonia, lactic acid), body temperature (cold agglutinins, cryoglobulins), and protected from light (bilirubin)
Specimens must be transported in a sealed, leak-proof biohazard bag with the requisition form in a separate compartment
Pneumatic tube systems can be used for most routine specimens but are NOT recommended for ABGs, cryoglobulins, or specimens prone to hemolysis
Delay in transport can cause glucose levels to decrease (glycolysis), potassium levels to increase (cell leakage), and coagulation factors to degrade
Specimen labeling and transport are the final critical steps in the phlebotomy process. Errors at this stage can invalidate otherwise perfectly collected specimens and lead to patient harm. The preanalytical phase (everything before the laboratory performs the test) accounts for the majority of all laboratory errors.
Specimen Labeling Requirements
Minimum Required Information
Every specimen label must include:
| Required Field | Details |
|---|---|
| Patient full name | First and last name (must match requisition and wristband) |
| Date of birth or Medical Record Number (MRN) | Second unique identifier |
| Date of collection | Month, day, year |
| Time of collection | Include AM/PM or use 24-hour format |
| Phlebotomist identification | Initials, employee ID, or full name |
| Specimen source (if applicable) | e.g., "left antecubital" or "right hand" |
Labeling Rules
| Rule | Explanation |
|---|---|
| Label at the bedside | Labels must be applied in the patient's presence, after the draw is complete |
| NEVER pre-label tubes | Pre-labeling creates a risk of attaching the wrong label to the wrong specimen |
| Verify with the patient | Confirm the label matches the patient's stated identifiers |
| One patient at a time | Never collect specimens from multiple patients before labeling |
| Handwritten labels | Must be legible; printed labels are preferred |
What Happens with Labeling Errors?
| Error Type | Required Action |
|---|---|
| Unlabeled specimen | REJECT — must redraw; cannot label after the fact |
| Mislabeled specimen | REJECT — must redraw; the risk of patient misidentification is too high |
| Illegible label | REJECT — must redraw |
| Missing required information | May be correctable if the phlebotomist can verify at the bedside; otherwise REJECT |
| Label on the tube (correct) | Acceptable — labels go on the tube, not on the bag |
Key Fact: Specimen labeling errors account for a significant portion of preanalytical errors and are a leading cause of wrong blood in tube (WBIT) events, which can result in fatal transfusion reactions or incorrect treatment decisions.
Specimen Transport
General Transport Guidelines
- Time: Deliver specimens to the laboratory within 45 minutes to 2 hours of collection
- Container: Use a sealed, leak-proof biohazard transport bag
- Requisition form: Place in a separate compartment of the bag (not touching the specimen)
- Upright position: Transport tubes upright (stoppers up) when possible to promote clot formation in serum tubes
Transport Temperature Requirements
| Temperature | Specimens | Method |
|---|---|---|
| Room temperature (20-25C) | Most routine specimens (CBC, BMP, CMP, coagulation, blood bank) | Standard biohazard bag |
| Chilled / On ice (2-8C) | ABG, ammonia, lactic acid, ACTH, gastrin, parathyroid hormone (PTH), catecholamines | Place tube in cup of ice water (NOT directly on ice — direct ice contact can cause hemolysis) |
| Body temperature (37C) | Cold agglutinins, cryoglobulins, cryofibrinogen | Pre-warmed container or heat block |
| Protected from light | Bilirubin, vitamin B12, folate, porphyrins, vitamin A, carotene | Wrap in aluminum foil or use amber tubes |
Effects of Transport Delays
| Analyte | Effect of Delay | Cause |
|---|---|---|
| Glucose | Decreases | Glycolysis (cells continue to consume glucose) |
| Potassium (K+) | Increases | Leakage from red blood cells |
| Lactate | Increases | Continued cellular metabolism |
| Ammonia | Increases | Protein deamination continues |
| Coagulation factors | Degrade | Factor V and Factor VIII are labile (unstable) |
| pH (for ABG) | Decreases | CO2 production continues; metabolism produces acid |
Pneumatic Tube Systems
Most hospitals use pneumatic tube systems to transport specimens quickly:
| Acceptable | NOT Recommended |
|---|---|
| Routine chemistry | ABG specimens |
| CBC and hematology | Cryoglobulins / cold agglutinins |
| Coagulation | Specimens prone to hemolysis |
| Urinalysis | Blood bank crossmatch (some facilities) |
| Blood cultures | Fragile cell studies |
Special Handling Situations
STAT Specimens
- STAT means "immediately" — these specimens have the highest priority
- Transport to the lab immediately by hand (do NOT use the pneumatic tube system if hand delivery is faster)
- Results are typically reported within 1 hour
- Common STAT tests: troponin (heart attack), potassium (critical electrolyte), glucose, hemoglobin
Timed Specimens
- Specimens that must be drawn at a specific time (peak/trough drug levels, cortisol, GTT draws)
- Document the EXACT time of collection on the label and requisition
- Timing errors can render the results clinically meaningless
Specimens Collected During Blood Transfusion
- Blood bank specimens for type and screen must be collected before the transfusion begins
- Post-transfusion specimens should be labeled with the time relative to the transfusion
- Follow facility-specific blood bank identification protocols (some require special armbands)
When should specimen labels be applied to collection tubes?
Before entering the patient's room (pre-labeling)
After leaving the patient's room, at the nurse's station
At the bedside, immediately after collection, in the patient's presence
In the laboratory, after delivery
A specimen arrives at the laboratory without a label. What should happen?
The lab calls the phlebotomist to come label it
The lab applies a label based on the requisition form
The specimen is REJECTED and must be recollected
The specimen is accepted with a note of the labeling error
Which of the following are minimum required elements on a specimen label? (Select all that apply)
Select all that apply
Patient full name
Date and time of collection
Phlebotomist initials or ID
Patient's insurance information
Date of birth or medical record number
Name of the ordering physician
What happens to glucose levels when there is a significant delay in specimen transport to the laboratory?
Glucose levels increase
Glucose levels decrease due to glycolysis
Glucose levels remain stable for up to 24 hours
Glucose levels fluctuate randomly
Match each specimen to its correct transport temperature:
Match each item on the left with the correct item on the right
Arterial blood gas (ABG)
Cold agglutinins
Bilirubin
Complete blood count (CBC)
When transporting a specimen on ice, the tube should be:
Placed directly on dry ice
Placed in a cup of ice water (not directly on ice)
Wrapped in a warm towel then placed on ice
Placed directly on crushed ice without any barrier
Specimens should generally be transported to the laboratory within ___ minutes to 2 hours of collection.
Type your answer below
Which of the following analytes INCREASES when there is a delay in specimen transport?
Glucose
Potassium
Coagulation factors
pH in ABG specimens
A phlebotomist draws a STAT troponin specimen. The correct transport method is:
Place in the pneumatic tube system
Deliver by hand to the laboratory immediately
Place in the next routine transport run
Send with the next available courier
Sections you finish are checked off in the contents.