Additional notes!
Urine
Methods of Urine Collection Types of Urine Specimen
1. Midstream 1. Occasional/Single/Random
2. Catheterized 2. Timed
3. Suprapubic Aspiration 3. First Morning
4. Glass technique 4. Fasting/Second Morning
5. Pediatric Specimen
6. Drug Specimen Collection
Preservation
Physical Preservation of Urine Chemical Preservation of Urine
1. Refrigeration 1. Formalin
2. Freezing/Ice 2. Thymol
3. Boric Acid
4. Toluene/toluol
5. Sodium fluoride/benzoic acid
6. Phenol
7. HCl
8. H2SO4
9. Saccamano’s Fixative
Changes in Urine with delayed testing
Result Reason
Changes in color Breakdown or alteration of chromogen or other urine constituent (e.g.,
hemoglobin, melanin, homogentisic acid, porphyrins)
Changes in odor Bacterial growth, decomposition
Increased turbidity Increased bacteria, crystal formation, precipitation of amorphous
material
Falsely low pH Glucose converted to acids and alcohols by bacteria producing
ammonia; carbon dioxide (CO2) lost
Falsely elevated pH Breakdown of urea by bacteria, forming ammonia
False-negative glucose Utilization by bacteria (glycolysis)
False-negative ketone Volatilization of acetone; breakdown of acetoacetate by bacteria
False-negative bilirubin Destroyed by light; oxidation to biliverdin
False-negative Destroyed by light
urobilinogen
False-positive nitrite Nitrite produced by bacteria after specimen is voided
False-negative nitrite Nitrite converts to nitrogen and evaporates.
Increased bacteriuria Bacteria multiply in specimen before analysis.
Disintegration of Unstable environment, especially in alkaline urine, hypotonic urine, or
cells/casts both
CSF Additional notes: (Please refer to this)
Ideally, tests are performed on a STAT basis. If not possible, specimens are maintained in the following
manner:
• Hematology tubes are refrigerated
• Microbiology tubes remain at room temperature
• Chemistry and serology tubes are frozen
Tube 1 Chemical and Serologic tests Frozen
Tube 2 Microbiology Room temperature
Tube 3 Cell count Refrigerated
Pleural Fluid
• Aspirated from the pleural space (cavity) surrounding the lungs by a procedure called
pleurocentesis/thoracentesis. Inflammation of the pleural membranes (pleura) is called pleuritis,
and chest pain caused by the inflammation is called pleurisy
• Except for an EDTA tube for total and differential cell counts, the specimen should be collected in
heparinized tubes to avoid clotting.
• Aliquots for aerobic and anaerobic bacterial cultures are best inoculated into blood culture media
at the bedside. If malignancy, fungal infection, or mycobacterial infection is suspected, all
remaining fluid (≥100 mL) should be submitted to maximize the yield of stains and culture.
Pericardial Fluid
• Aspirated from the pericardial cavity surrounding the heart in a procedure called
pericardiocentesis (or pericardial tap). Inflammation of the pericardium or pericardial space is
called pericarditis.
• Pericardial effusions are most often caused by viral infection, and enterovirus is the most common
etiologic agent. They may also develop as a result of bacterial, tuberculous, or fungal infection, or
in association with autoimmune disorders, renal failure, myocardial infarction, mediastinal injury,
or the effects of various drugs, or they may be idiopathic
• Normal pericardial fluid is pale yellow and clear. Large effusions (>350 mL) are most often caused
by malignancy or uremia, or they may be idiopathic
Peritoneal Fluid
• Aspirated from the abdominal cavity by a procedure called paracentesis. Inflammation of the
peritoneum, the lining of the abdominal cavity, is called peritonitis.
• Ascites is the pathologic accumulation of excess fluid in the peritoneal cavity. Up to 50 mL of fluid
is normally present in this mesothelial-lined space. As with pleural and pericardial fluids, it is
produced as an ultrafiltrate of plasma dependent on vascular permeability and on hydrostatic and
oncotic Starling forces
Category A Category B
• Classification of an infectious substance • Classification of an infectious
in a form capable of causing permanent substance not in a form generally
disability or life-threatening or fatal capable of causing permanent
disease in otherwise healthy humans or disability or life-threatening or
animals when exposure to it occurs. fatal disease in otherwise healthy
• An exposure occurs when an infectious humans or animals when exposure
substance is released outside of its to it occurs.
protective packaging, resulting in • This includes Category B infectious
physical contact with humans or substances transported for
animals. diagnostic or investigational
• Classification must be based on the purposes.
known medical history or symptoms of
the source patient or animal, endemic
local conditions, or professional
judgment concerning the individual
circumstances of the source human or
animal.
• Category A poses a higher degree of risk
than Category B.
