NON BLOOD

• A phlebotomist maybe involved in collection and handling of specimen other than blood, or non-blood specimen such as urine, amniotic fluid, saliva, semen, sputum, etc.
• To avoid delays in testing, he should check and verify information on the label of the specimen before receiving them
• Non body-fluid specimens


  Substances produced by the body which can be in liquid or semi liquid form, found within body organs such as the bladder and spaces such as the joints
• Urine collection procedure


  1. Explain properly to the patient

  2. Depends on the type of test ordered by the physician

  3. Midstream collection recommended to avoid contamination

  4. Specimen container should be clear, dry, with tight-fitting lids and chemically cleaned

  5. Transport to lab immediately or refrigerate if longer than 2 hours

  6. Protect from light
• Urine analysis


  • Monitors wellness
  • Determines and treats urinary tract infections
  • Detects and monitors progress of metabolic diseases
  • Determines effectiveness of administered therapy and checks for therapy-related complications
• Factors affecting accuracy of urine analysis

  • Collection method
  • Container use
  • Transportation and handling of specimen
  • Timeliness of testing
• Common urine tests


  • Routine urinalysis (UA)
  • Culture & sensitivity (C&S)
  • Urine cytology studies
  • Urine drug testing
  • Urine glucose and ketone testing
  • Urine pregnancy testing
• Routine urinalysis (UA)


  1. Screens for urinary or systematic disorders

  2. Includes physical, chemical and microscopic analysis

  3. Random specimen acceptable but midstream collection recommended to avoid contamination

  4. Specimen container should be clear, dry, with tight-fitting lids and chemically cleaned

  5. Transport to lab immediately or refrigerate if longer than 2 hours

  6. Protect from light
• Culture & sensitivity (C&S) urine test

  1. Requested if patient has symptoms of urinary tract infection (UTI)

  2. Midstream clean-catch collection in sterile container

  3. Cultured on special nutrient medium for 18-24 hours

  4. If microorganism present, sensitivity test performed to determine most effective antibiotic
• Urine cytology studies


  1. Requested to detect cancer, cytomegalovirus, and other viral and inflammatory diseases in urinary system

  2. Fresh clean-catch specimen required

  3. Smear from cells of urinary tract lining stained and examined under microscope

  4. If delays, specimen preserved by adding equal volume of 50% alcohol
• Urine drug testing


  1. Performed to detect illicit use of recreational drugs, use of anabolic steroids, and unwarranted use of prescription drugs

  2. Also monitors therapeutic drug use and confirms drug overdose
• Urine glucose and ketone testing

  1. Performed to screen diabetes and determine glucose level for diabetic patients

  2. Urine ketone level test used to determine diabetic ketoacidosis

  3. Color changes in test strip compared to color chart to interpret results
• Urine pregnancy testing


  1. Used to confirm pregnancy, can be detected 8-10 days from conception

  2. First morning urine specimen preferred as it has highest concentration of HCG
• Types of urine specimens

  • Random
  • First morning/8-hour
  • Fasting
  • Timed (tolerance test, 2-hour postprandial, 24-hour, double-voided)
• 24-hour urine collection procedure


  1. Empty bladder upon waking up

  2. Affix label and write down time and date

  3. Collect all urine passed for next 24 hours

  4. Refrigerate if instructed

  5. Collect urine prior to bowel movement

  6. Drink fluids to avoid dehydration

  7. Take last void at end of 24 hour period

  8. Seal container and transport to lab as soon as possible
• Urine collection methods


  • Regular voided
  • Midstream
  • Midstream clean-catch
  • Catheterized
  • Suprapubic aspiration
  • Pediatric
• Amniotic fluid


  Clear and slightly yellowish liquid contained in the amniotic sac surrounding and cushioning the fetus during pregnancy
• Amniotic fluid collection


  1. Collected by physician using transabdominal amniocentesis, guided by ultrasound

  2. About 10 mL of fluid aspirated from amniotic sac through needle inserted in mother's abdominal wall into uterus

  3. Test done to detect genetic disorders, check fetal development, and verify gestational age
• Cerebrospinal fluid (CSF)


  Liquid that surrounds brain and spinal cord
• CSF collection


  1. Collected via lumbar puncture between 3rd and 4th lumbar vertebrae

  2. Testing used to diagnose meningitis and other disorders like brain abscess, CNS cancer, and multiple sclerosis

  3. Collected in 3 special sterile tubes: first for chemistry/immunology, second for microbiology, third for cell counts
• Gastric fluid/Gastric analysis


  Performed to check stomach contents for abnormal substances and evaluate acid production
• Gastric fluid collection


  1. Aspirated to determine acidity before stimulation

  2. Gastric stimulant administered intravenously after specimen collection

  3. Series of timed collections follow using Levin or Rehfuss method to insert tube
• Nasopharyngeal (NP) secretions


  Collected and cultured to determine presence of bacteria that causes diphtheria, meningitis, pertussis, and pneumonia
• NP secretions collection


  1. Gently insert dacron or sterile cotton-tipped flexible wire swab into nose into nasopharynx

  2. Rotate and gently remove swab, place in properly labeled sterile container with transport medium, transport immediately to lab
• Saliva


  Fluid secreted by glands inside mouth, used to check hormone levels and determine alcohol/drug/substance abuse
• Saliva collection


  1. Easy and non-invasive using testing kits, many are point-of-care tests

  2. Specimen needs to be frozen to ensure stability before delivery to lab
• Semen


  Thick yellowish-white fluid containing sperm released during male ejaculation
• Semen analysis


  Performed to evaluate fertility and assess effectiveness of treatment
• Types of specimens


  • Saliva
  • Semen
  • Serous fluid
  • Sputum
  • Sweat
  • Synovial fluid
  • Buccal (cheek) swabs
  • Bone marrow
  • Breath samples
  • Feces (stool)
  • Hair
  • Throat swabs
  • Tissue specimen
• Saliva collection


  1. Easy and non-invasive

  2. Testing kits available

  3. Many are point-of-care test (POCT)

  4. Specimen needs to be frozen to ensure stability prior to delivery to clinical laboratory
• Semen collection


  1. Preferred method is masturbation

  2. Other methods like coitus interruptus, withdrawal method, spermicide-free condom are also used but not as accurate as masturbation

  3. Collected specimen is placed in sterile container, kept warm and protected from light
• Serous fluid collection


  1. Collected by physician by aspiration

  2. Placed in tubes depending on type of test

  3. EDTA tubes for cell counts and smears

  4. Heparin or sodium fluoride tubes for chemistry tests

  5. Non-anticoagulant tubes for biochemical tests

  6. Heparinized tubes for cultures
• Sputum collection


  1. Recommended to be done first thing in the morning

  2. At least 1 hour after meal to avoid gagging

  3. Patient should gargle with water and remove dentures

  4. Patient should take 3 or 4 deep breaths, inhale and exhale, cough forcefully on last breath, and expectorate and expel sputum into sterile container

  5. Procedure repeated until adequate amount collected (about 3 to 5 mL)
• Sweat collection


  1. Electrical stimulation in forearm or thigh (iontophoresis) used to transport pilocarpine (sweat-stimulating drug) into skin

  2. Sweat collected, weight recorded, and chloride content analyzed
• Synovial fluid collection


  1. Collected via arthrocentesis

  2. Collected in 3 tubes: EDTA/heparin for cell counts, ID of crystals, smear preparation; sterile for culture & sensitivity; non-additive for macroscopic appearance, chemistry, immunology tests and observing clot formation
• Buccal (cheek) swab collection

  1. Phlebotomist collects sample by placing swab inside cheek and gently massaging area

  2. Swab sent to lab where DNA is extracted from cells
• Bone marrow collection


  1. Physician inserts large-gauge needle into sternum (breastbone) or iliac crest (hip bone) and aspirates 1.0 to 1.5 mL of specimen

  2. Hematology technologist makes special slides from first marrow aspiration
• Breath sample collection


  1. urea breath test (C-UBT): Baseline breath sample taken, patient drinks special substance with synthetic urea, then asked to breathe into Mylar balloon at specified intervals

  Hydrogen breath test: Baseline breath sample taken, patient drinks special drink, additional breath samples taken every 30 minutes for 3 hours
• Feces (stool) collection


  Collected in clean and wide-mouth container that is sealed and sent to lab after collection
• Hair sample


  Used for trace & heavy metal analysis and to detect chronic drug abuse