Test Code Non-Gynecologic Request Form Cytology, Body Cavity Fluid
Methodology
Includes routine cytologic evaluation on microscopic slides and a cell block, whenever possible.
Performing Laboratory
Peninsula Regional Medical Center - Pathology
Specimen Requirements
Acceptable Specimens:
Abdominal fluid, abdominal washing, ascites fluid, cul-de-sac fluid, culdocentesis fluid, hydrocele fluid, paracentesis fluid, pelvic washing, pericardial fluid, peritoneal fluid, peritoneal washing, pleural fluid, synovial fluid, or thoracentesis fluid
Submit fresh, unfixed, heparinized specimen as follows:
Collect specimen.
1. Attach completed patient identification label to specimen container.
2. Collect 50-200 mL (or more) of fluid into a collection bag, bottle or sterile container.
3. Deliver to Histology Department immediately. If there is a delay in transport, send specimen refrigerated.
4. Specimen rejection criteria is based on improper specimen labeling, collection, handling, or submission:
A. Clotted or frozen specimen
B. Specimen that is contaminated on outside of collection container
C. Specimen that has leaked into plastic biohazard bag
D. No non-gynecologic cytology requisition form
E. Name on requisition does not match name on specimen container
F. Unlabeled specimen container. Two patient identifiers are required on specimen container
G. No physician’s name
H. If rejection compromises patient care (one-time specimen such as cerebrospinal fluid or STAT request) laboratory personnel will contact a pathologist to determine if specimen will be tested.
5. Label specimen container with patient’s full first and last name, date of birth, date of collection, specimen source, and submitting physician’s name.
6. Complete a non-gynecologic cytology requisition form. Include the following information:
A. Patient’s full first and last name
B. Date of birth
C. Medical record or Social Security number
D. Date of collection
E. Submitting physician’s name. Include names of physicians to receive cytology report copies.
F. Specimen source
G. Pertinent clinical information
7. Place specimen in a plastic biohazard bag and insert non-gynecologic cytology requisition form into separate paper pouch.