MODULE 10.

HANDLING AND PROCESSING OF *Urine

NON-BLOOD SPECIMENS FOR LABORATORY
TESTING
-Introduction-
Today's technologies allow testing on an impressively wide
variety of samples collected from the human body. Most
often, all that is required is a blood sample. However,
samples of urine, saliva, sputum, feces, semen, and other
bodily fluids and tissues also can be tested.
-objectives-
Upon completion of this module, you should be able to:
1. identify the different non-blood specimens for
laboratory testing;
2. describe the various tests performed on the
different non-blood specimens;
3. discuss the collection and handing procedures for
the different non-blood specimens; and
4. collect and process sample for urinalysis.
Definition of terms
Term Definition (Meriam Webster Dictionary)
Handling - a process by which something is handled
in a commercial transaction
especially: the packaging and shipping of
an object or material (as to a consumer)
Among the non-body fluids in the, body, the urine is the
most analyzed. Moreover, it is inexpensive to test because
collecting the specimen is not tedious and urine is available
most of the time. The procedure for collection should be
explained properly to the patient since the type of urine
collection and the method of collection depend on the type
of test ordered by the physician.
Aside from providing a picture of many metabolic functions
of the body, the urine analysis also helps in m (1) monitoring
wellness, (2) diagnosing and treating urinary tract
infections, (3) detecting and monitoring the progress of
treatment in metabolic diseases, (4) identifying the
effectiveness of an administered therapy, as well as
checking if the patient exhibits any therapy-related
complications.
The accuracy of urine analysis results largely depends on
several factors such as the collection method, container
used, transportation and handling of specimen, and the
timeliness of the testing. The technician handles urine
collection for the outpatient department while urine
collection is part of the
responsibilities of the
nursing department.
The urine collection
procedure should be
explained clearly to
prevent specimen
rejection.

DIFFERENT TYPES OF URINE SPECIMEN

-discussion- 1 Random/Occasion For routine and qualitative UA
al/Single
PART 1. DIFFERENT NON-BLOOD SPECIMENS 2 First Morning Ideal specimen for routine UA and
FOR LABORATORY pregnancy test (hCG)
Phlebotomists may be involved in the collection and Most concentrated; most acidic;
handling of specimens other than blood or non-blood for well preservation of cells and
casts
specimens such as urine, amniotic fluid, saliva, semen,
For evaluation of orthostatic
sputum, etc. They should be familiar with the proper proteinuria
handling procedures to ensure the, integrity of the 3 Second 2nd voided urine after a period of
specimens in order to produce accurate results. Morning/Fasting fasting; for glucose determination
4 2-hour For diabetic screening/monitoring
There are cases when phlebotomists are asked to transport postprandial
these specimens to the laboratory. To avoid delays in 5 Glucose tolerance Optional with blood samples in
testing, they should check and verify information on the glucose tolerance test
label of the specimens before receiving them. A specimen 6 Fractional At least 2 voided collection
should be labeled with the same ID information as that of specimen Series of blood and urine collected
the blood specimen, in which the type or source· of the at specific time intervals to
compare the concentration of a
specimen should be included. The label should be pasted
substance in urine with its
on the container and not on the lid, because the lids are concentration in the blood (used in
removed during testing. Standard precautions in handling the diagnosis of diabetes)
specimens should be followed because all body substances 7 Midstream clean- For routine screening and
are potentially infectious. catch bacterial culture
8 Catheterized For bacterial culture
COLLECTION, HANDLING, AND TESTING 9 Suprapubic Bladder urine for anaerobic
OF NON-BLOOD SAMPLES aspiration bacterial culture and urine
The non-blood samples are substances produced by the cytology
body and can be m either liquid or semi-liquid form. These (picture attached below)
are found within body organs such as the bladder and 10 Pediatric Use of soft, clear, plastic bag with
spaces such as the joints. Specimen adhesive
Sterile specimen obtained by
catheterization or suprapubic
aspiration
11 Three-glass For prostatic infection:
technique 1. First portion of voided *Amniotic Fluid
urine The amniotic fluid is a clear, colorless to pale-yellow liquid
2. Middle portion of voided contained in the amniotic sac that is surrounding and
urine
cushioning the fetus during pregnancy. The specimen is
3. Urine after prostatic
massage collected by the physician using transabdominal
 Examine the 1st and 3rd amniocentesis preferably 15 weeks after gestation. The
specimen microscopically, then procedure is guided by the ultrasound machine and about
compare the number of WBC 10 mL of fluid is aspirated from the amniotic sac through the
and bacteria needle inserted in the is mother's abdominal wall into the
 Prostatic infection = if the uterus. The test is done to detect any genetic disorder;
number of WBC and bacteria in check any problem in fetal development; and verify the
the 3rd specimen is 10x greater gestational age. The specimen collected in a sterile
than that of the 1st ( 3rd > 1st ) container should be protected from light and transported
2nd specimen = CONTROL for
immediately to the clinical laboratory.
bladder and kidney infection. If (+)
for WBCs and bacteria, the results
from the 3rd specimen is
considered INVALID.
12 Timed specimen
A 24-hour Begin and end the collection
Example: 8AM period with an empty bladder
8AM Requires preservative (see table
below for more details)
B 12-hour For ADDIS Count
Example: 8AM
8PM
C 4-hour/First For NITRITE determination
Morning Urine remains in the bladder for at
lease 4 hours before being
collected
D Afternoon (2PM – For UROBILINOGEN
4PM determination

SUPRAPUBIC ASPIRATION

*Cerebrospinal Fluid
The cerebrospinal fluid (CSF) refers to the liquid that
surrounds brain and spinal cord. This specimen is clear and
colorless and is obtained by the physician using a lumbar
puncture or spinal tap. The testing is used to diagnose
meningitis and other disorders such as brain abscess, CNS
cancer, and multiple sclerosis. The routine tests performed
Are cell counts, chloride, glucose and total protein, The
CSF is collected in three special sterile tubes.
Order of collection
 1st tube: CHEMISTRY & SEROLOGY
 2nd tube: MICROBIOLOGY
 3rd tube: HEMATOLOGY/CELL COUNT
(because it is least
likely to contain cells
introduced by the spinal
tap procedure)
 4th tube: may be drawn
for microbiology to
provide better exclusion
of skin contamination
 LOW-VOLUME
SPECIMENS collected
on one tube, order of
testing should be MICROBIOLOGY first,

MODULE 10 – HANDLING AND PROCESSING OF NON-BLOOD SPECIMENS FOR LABORATORY TESTING 2

 then HEMATOLOGY and
CHEMISTRY/SEROLOGY
 Test are performed on a STAT basis (within
30 MINUTES ~Alba’s)
Preservation:
 1st tube: FROZEN (-15 to -30°C)
 2nd tube: ROOM TEMPERATURE (19 to
26°C)
 3RD tube: REFRIGERATED (2 to 8°C)
SUMMARY:
1st tube Chemistry & Frozen
Serology
2nd tube Microbiology Room temperature
3rd tube Hematology Refrigerated
*Gastric Fluid/Gastric Analysis
The gastric analysis is performed to check the contents of
the stomach for abnormal substances and evaluate the
production of acid by evaluating the gastric acid
concentration. In basal gastric analysis, a tube is passed
through the mouth and throat (oropharynx), or nose and
throat (nasopharynx) into the stomach after the patient has
done fasting for a specified period of time. The sample is
aspirated to determine acidity before the stimulation. A
gastric stimulant is administered
intravenously after the specimen
collection. A series of collection will
follow with timed intervals. The
collected specimens are placed in
sterile containers. The phlebotomist
labels the specimens properly and
assists by drawing blood for serum
gastrin determination.
*Nasopharyngeal Secretions
The nasopharyngeal (NP) secretions specimens are
collected and cultured to determine the presence of
bacteria that can cause (1) diphtheria (2) meningitis (3)
pertussis (whooping cough), and (4) pneumonia. Collection
is performed by gently inserting a dacron or sterile cotton-
MODULE 10 – HANDLING AND PROCESSING OF NON-BLOOD SPECIMENS FOR LABORATORY TESTING
tipped flexible wire swab through the nose and into the
nasopharynx (nasal cavity and pharynx). The swab is
rotated and gently removed, then placed in a properly
labeled sterile container containing the transport medium
for immediate delivery to the laboratory.
*Saliva
The saliva, the fluid secreted by the glands inside the
mouth, is used to check the hormone levels and to
determine alcohol and drug or
substance abuse. The collection
of saliva is easy and non-invasive
because testing kits are available
and many are point-of-care testing
(POCT). The specimen needs to
be frozen to ensure stability prior
to delivery to the clinical
laboratory.
*Semen
The seminal fluid is a thick yellowish-white fluid that
contains sperm released during the male ejaculation.
Analysis is done to evaluate the fertility and assess the
effectiveness of the sterilization after a vasectomy
procedure, but it is also ordered
for forensic or legal reasons
such as criminal investigations
involving sexual assault. The
collected specimen is placed in
a sterile container, kept warm,
and protected from light.
*Serous Fluid
The serous fluid is found between the membrane that
encloses the pleural, pericardial; and peritoneal cavities.
This serum-like fluid is pale-yellow in color and watery and
its main function is to allow the membranes to pass through
each other with minimal friction. An effusion or increase in
volume indicates inflammation, infection, or decrease in the
serum protein level. The-fluid is collected by the physician
by aspiration and placed in tubes depending on the type of
test. EDTA tubes are used for cell counts and smears;
heparin or sodium fluoride tubes for chemistry tests, non-
anticoagulant tubes for biochemical tests, and heparinized
tubes for blood cultures.
o PERICARDIAL FLUID is contained in the
PERICARDIUM which encloses the heart
o PLEURAL FLUID is contained in the PLEURAL
CAVITY which encloses the lungs
3
 o PERITONEAL FLUID is contained in the
PERITONEUM which encloses abdominal organs
*Sputum
Sputum (mucous or phlegm) specimens are used to
diagnose and/or monitor lower respiratory tract infections
like tuberculosis. It is recommended that the collection be
done first thing in the morning since a larger volume has
accumulated overnight, and at least 1 hour after meal to
avoid gagging. The patient should gargle with water and
remove dentures (if any). He/she should: (1) take 3 or 4
deep breaths, (2) inhale and exhale, (3) cough forcefully on
the last breath and (4) expectorate and expel sputum into
the sterile container. The procedure is repeated until an
adequate amount is collected, which is about 3 to 5 mL. The
collected specimen is transported and should be processed
immediately upon arrival at the laboratory.
*Sweat
Sweat is used to analyze the chloride content of patients
under the age 20 with symptoms of cystic fibrosis (exocrine
gland disorder). During the sweat chlorides test, electrical
stimulation in the forearm or thigh
(iontophoresis) is used to transport
the pilocarpine (sweat-simulating
drug) in the skin. The sweat is then
collected; the weight is recorded; and
the chloride content is analyzed.
The sweat specimen can also be used
to determine illegal use of drug by
placing patches on the skin for an
extended period of time which is further confirmed by
subsequent drug testing.
*Synovial Fluid
The synovial fluid (viscous
fluid that lubricates
movable joints) is tested to
determine conditions such
as arthritis, gout, and other
inflammatory conditions.
The fluid is collected in
three tubes:
• EDTA/heparin: for cell counts, ID of crystals, smear
preparation
• Sterile: culture and sensitivity
• Non-additive: macroscopic appearance, chemistry,
immunology tests, and observing the clot formation
MODULE 10 – HANDLING AND PROCESSING OF NON-BLOOD SPECIMENS FOR LABORATORY TESTING
*Buccal (Cheek) Swabs
A buccal swab is used to obtain loose cells inside the cheek
for purposes of DNA analysis. It is a less invasive and
painless alternative to blood collection. The phlebotomist
collects sample by placing
the swab inside the cheek
and gently massages the
area. After the collection,
the swab is sent to the
laboratory where the DNA
is extracted from the cells in
the swab.
*Bone Marrow
The bone marrow is examined to identify blood diseases.
The physician inserts a large-gauge needle into the
sternum (breastbone) or iliac crest (hip bone) and aspirates
1.0 to 1.5 mL of specimen. A hematology technologist
makes special slides from the first marrow aspiration.
*Breath Samples
There are two types of testing for breath: C-urea breath test
(C-UBT) and hydrogen breath test. The C-urea test checks
for the presence of Helicobacter pylori which is a type of
bacteria that damages the stomach lining. After the
collection of the baseline breath
sample, the patient is asked to drink
a special substance has synthetic
urea, then asked to breath into a
Mylar balloon at specified intervals.
The breath specimens are analyzed
or carbon-13, which confirms the
presence of H. pylori.
The hydrogen breath test, on the other hand helps in the
detection of carbohydrate digestion problems such as
lactose (milk sugar) and fructose (fruit sugar). This test can
also detect bacterial overgrowth in the small intestine and
is thought as the most accurate tolerance test. In
preparation for the test, the patient must not take antibiotics
two weeks prior to the scheduled test. The patient should
not eat certain food for 24 hours before the test and should
be fasting on the day of the test. Smoking and exercise are
also restricted 30 minutes before the test. The baseline
breath sample is taken by breathing into a special bag
before the introduction of a special drink. Additional breath
4
 Student assessment question 1:
samples are taken every 30 minutes for three hours and all Fill up the table below: Choose five (5) body fluid (non-
are sent to the laboratory for analysis. blood specimens) ONLY. (50 pts)

Body Fluid Purpose of the Special

Test Consideration/
Things to
remember in this
fluid
1.
2.
3.
4.
*Feces 5.
The fecal specimen (feces
or stool) is collected (1) to
determine gastrointestinal
disorder, (2) to analyze for
-SUMMARY-
the presence of intestinal
ova and parasites (O&P), Useful information regarding a patient’s disease process
(3) to be cultured then can be determined from body fluids such as urine, feces,
examined for the semen, pleural, synovial, cerebrospinal fluid, and many
presence of pathogenic more. A wide range of variables can affect the reliability and
bacteria and viruses (4) to clinical significance of the final result. Carefully following the
check fat ah urobilinogen guidelines for body fluid sample collections will help to
content, or (5) to test for maintain the quality of the sample.
the presence of occult
blood. This specimen is -reference-
collected in a clean and • Learning Guide for Principles of Medical
wide-mouth container that Laboratory Sciences 2
is sealed and sent to the Copyright 2020 by C&E Publishing Inc.,
laboratory after collection. Bernard U. Ebuen, Nini F. Lim, Edliberto P.
Manahan, Jose Jurel M. Nuevo, Maria Luisa R.
*Hair Olano, and Aileen C. Patron
Hair samples can be used to analyze for trace and heavy
metals. They can also be used to detect chronic drug abuse
where hair is the preferred specimen not only can also
because it is easy to obtain, but also because it is not easily
tampered or altered.

*Throat Swabs
Throat swabs are mostly
collected to aid in streptococcal
(strep) infection detection, A
special kit contains a sterile
polyester-tipped swab and a
covered transport tube. The
tube contains the transport
medium.

*Tissue Specimen
The tissue specimen is usually collected using biopsy
through which the samle is removed for examination. The
phlebotomist should check the proper handling procedure Prepared by:
particularly if the specimen delivered is not immersed in a
solution. In case of genetic analysis, the tissue samples Ruth Abigail S. Contante, RMT, LPT
should not be placed in formalin. Improper handling is costly Instructor
and inconvenient, and the test cannot be easily repeated.

MODULE 10 – HANDLING AND PROCESSING OF NON-BLOOD SPECIMENS FOR LABORATORY TESTING 5