Procedure Guidelines

General Considerations

All specimens delivered to the laboratory must adhere to the following requirements.

Requisition forms must include:
- Patient's legal name -- legibly printed or typed
- Patient's date of birth
- Type of specimen submitted
- Office or hospital submitting specimen
- Date of service
The specimen container must indicate:
- Patient's name, either written on container or on label firmly affixed to the container
- Type of specimen submitted
All non-gyn specimens must be submitted in a leak-proof container that is placed in a sealed biohazard specimen bag
All bagged specimens shall have an accurately completed requisition accompanying them
Allow all spray fixed and air dried slides to dry completely before placing in cardboard slide carriers for transport
When sending slides fixed in 95% alcohol filled bottles, be certain the caps are tightened before transport

Unacceptable Specimens

A specimen may be considered unacceptable if certain of the above criteria are not fulfilled. Unlabeled specimens may be returned for proper identification (This is an accreditation requirement)

Note: if surgical specimens are co-submitted--they must be placed in a separate bag from the cytology specimen to avoid formalin fume contamination.

Cytology At-A-Glance Submission Requirements

Gynecological Specimens
Chlamydia smears	One air dried slide
Smear for detection of viral changes (Tzank smear)	Spray fixed slide(s)
Pap smear, liquid based-See instructions below	SurePath vial Note: HPV, Chlamydia GC, and HSV tests may be run from the same vial.
Pap smear, conventional	Spray fixed slide(s)
Smear for maturation index	Spray fixed slide(s)
Non-Gynecological Specimens
Prepared slides
Buccal smear	Spray fixed slide(s)
Nipple secretion	Spray fixed slide(s)
Smear for detection of viral changes	Spray fixed slide(s)
Urinary Tract
Urethral wash	Add equal amount of cytology fixative, refrigerate
Uretal wash	Add equal amount of cytology fixative, refrigerate
Bladder wash	Add equal amount of cytology fixative, refrigerate
Urine; voided	Add equal amount of cytology fixative, refrigerate
Urine; catheterized	Add equal amount of cytology fixative, refrigerate
Bronchoscopy Specimens
Bronchial wash	Refrigerate until pickup/delivery; fresh specimen
Bronchial brush	Prepared slides; spray fix OR drop into bottle of 95% alcohol
Used brush	Place brushes into a container of cytology fixative
Sputum	Collect in cytology fixative
Cytology and/or Special Stains	Collect in cytology fixative, refrigerate
FNA (Fine Needle Aspiration)
Prepared smears	Spray fix; air dried slides may be made on some samples
Fluids	Express material into a container of cytology fixative
Esophageal wash/brush	Refer to bronchial wash/brush instructions above
Body Cavity Fluids	Refrigerate until pickup/delivery
Cyst Fluids	Refer to body cavity fluids
Peritoneal washing	Refer to body cavity fluids

SurePath Submission Instructions

Observe universal precautions for collecting and handling specimens.
Insert the broom into the endocervical canal. Apply gentle pressure until the bristles form against the cervix. Maintaining gentle pressure, hold the stem between the thumb and forefinger. Rotate the brush five times (360 degrees) in a clockwise direction.
Preserve the entire sample by placing your thumb against the back of the broom pad, and disconnecting the broom head from the stem directly into the SurePath preservative vial.
Place the cap on the labeled vial.
Mark the lab requisition with the tests to be performed on the specimen:

a. Pap: Pap smear results

b. HPV: HPV testing performed whether or not the Pap result is abnormal

c. HPV Reflex: HPV testing performed if the Pap result is atypical

d. CT: Chlamydia testing

e. Gonorrhea: Gonorrhea testing
Quad screen: Pap, Reflex HPV, Chlamydia, and Gonorrhea testing
Quad screen plus: Includes the Quad screen and HSV testing.

Note: All of the above tests may be performed on one specimen
Place the vial and requisition into specimen bag and submit to the laboratory.