Laboratory test contribute crucial information around a patient"s health. Correct diagnostic and also therapeutic decision rely, in part, top top the accuracy of test results. Sufficient patient preparation, specimen collection, and also specimen handling are essential prerequisites for exact test results. The accuracy the test outcomes is dependency on the verity of specimens.

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Safety and also Disposal Considerations in Specimen Collection

In all settings in i beg your pardon specimens are gathered and prepared for testing, laboratory and health treatment personnel need to follow current recommended sterile techniques, including precautions about the usage of needles and also other sterile equipment. Act all organic material as product that is perhaps hazardous and contaminated specimen repertoire supplies. For every those who are connected in specimen collection and also preparation, the duty to adhere to existing recommendations design to preserve the safety of both patients and also health treatment workers walk not end when the patient is dismissed.

There are four steps involved in obtaining a an excellent quality specimen for testing: (1) ready of the patient, (2) collection of the specimen, (3) handling the specimen, and (4) save and/or delivering the specimen. Due to the fact that information connected to any kind of of these locations may change as clinical laboratory an innovation changes, please refer to the recent edition of the Directory of Services and also Interpretive Guide for existing instructions.


Prior to every collection, testimonial the ideal test description, consisting of the specimen kind indicated, the volume, the procedure, the collection materials, patience preparation, and also storage and handling instructions.

Preparing the Patient. Administer the patient, in advance, with proper collection instructions and also information top top fasting, diet, and also medication limitations when suggested for the details test.

Preparing the Specimen. Verify the patient"s identification. Ideal identification of specimens is very important. All main specimen containers have to be labeled v at the very least two identifiers at the moment of collection. It is registered slides may be labeled with a solitary identifier, yet two identifiers are preferred. Instances of acceptable identifiers include (but are not minimal to): patient"s surname (patient"s an initial and critical name exactly as they appear on the test inquiry form), day of birth, hospital number, test request type number, accession number, or unique random number. A place such together a hospital room number is no an appropriate patient identifier. If chain of custody documentation is necessary for the procedure, monitor the ideal protocol. All specimens must be labeled in the visibility of the patient. Procedure and save the specimen(s) as required. Suitable storage and handling are important to preserve the integrity of the specimen and, consequently, the test results.

Avoiding common Problems

Careful attention to routine measures can get rid of most the the potential troubles related come specimen collection. Materials noted by the activities for specimen collection can maintain the top quality of the specimen only once they are used in strict accordance through the accuse provided. To collection a sufficient quantity the each form of specimen suggested for the measures to be performed, you re welcome consult the volume demands published in this Directory.

General Specimen Collection. Some that the common considerations affect all species of specimens:

Submit a amount of specimen sufficient to perform the test and avoid a QNS (quantity no sufficient), as shown in the test requirements. (See amount Not Sufficient.)Use the container/tube shown in the test requirements for appropriate specimen preservation.Follow patient instructions before specimen collection.Carefully tighten specimen container sheathe to protect against leakage and/or potential pollution of specimens.Maintain the specimen at the temperature suggested in the check requirements.

Serum Preparation. The most typical serum preparation considerations:

Separate serum indigenous red cell within two hours of venipuncture.Mix specimen v additive immediately after collection.Avoid hemolysis: red blood cells damaged down and components spilled right into serum. Causes and prevention are debated under the section on hemolysis.Avoid lipemia: cloudy or milky serum sometimes because of the patient"s diet (discussed under the ar on lipemia).

Plasma Preparation. The most usual considerations in the preparation of plasma:

Collect specimen in additive suggested in the test requirements.Mix specimen v additive immediately after collection by inverting 5-10 times.Avoid hemolysis or red blood cabinet breakdown.Fill the tube completely, thereby staying clear of a dilution factor extreme for complete specimen volume (QNS).Separate plasma from cell within two hours of venipuncture when indicated in the test requirements.Label transport tubes together “plasma.”Indicate type of anticoagulant (eg, “EDTA,” “citrate,” etc).

Urine Collection. The most common urine collection considerations:

Obtain a clean-catch, midstream specimen.Store unpreserved specimens refrigerated or in a cool location until all set for transport.Provide patients through instructions for 24-hour urine collection.Add the preservative (as specified in the test requirements) come the urine repertoire container before collection of the specimen.Provide sufficient quantity that sample to meet the minimum fill line on preservative deliver container.Provide the proper mixing of specimen through urine preventive as specified in the check requirements.Use the collection container as specified in the check requirements, and refrigerate the specimen when bacteriological examination of the specimen is required.Carefully tighten specimen container lids to protect against leakage the specimen.Divide specimen right into separate containers for tests through such requirements.Provide a complete 24-hour collection/aliquot or various other timed specimen.Provide a 24-hour to pee volume as soon as an aliquot from the 24-hour collection is submitted.Preservatives differ for every test; describe test details for the forced preservative.


In general, grossly or also moderately hemolyzed blood specimens might not be acceptable for testing. Hemolysis occurs once the red cells rupture and also hemoglobin and other intracellular contents spill right into the serum. Hemolyzed serum or plasma is pink or red, rather than the typical clear straw or pale yellow color.

Most situations of hemolysis can be avoided through observing the measures listed.

For regimen collections, use a 21- to 22-gauge needle. (On occasion, however, it might be essential to usage a 23-gauge needle for patients from elderly and also pediatric populaces with small or an overwhelming veins.)If over there is air leakage about the needle or ns of vacuum in the tube, change the vacuum tube.If you room using your own collection devices instead the the vacuum pipe technique, use only clean, dry, sterile needles, syringes, and also tubes.Collect blood in room temperature containers unless the specimen necessity specifies otherwise.When there is an obstacle accessing a vein or when a vacuum pipe fills as well slowly because of a challenging venipuncture, damage to the red blood cells might result. Address this difficulty by collecting a fresh tube once blood circulation is established or select an additional puncture site and, making use of sterile/unused equipment, collect a 2nd specimen. Also, use of a blood press cuff, in lieu the a tourniquet, will mitigate trauma to fragile red blood cells.Do not remove the needle native the vein v the vacuum pipe engaged. This uses to both the critical tube gathered during a regime venipuncture and to tubes accumulated during a difficult procedure.Premature remove of the tube causes a rush of waiting to get in the tube, i beg your pardon may an outcome in damage to the red cells.Be together gentle as possible, illustration the blood evenly. Too lot pressure in drawing blood into a syringe or forcefully ejecting blood right into a collection tube native a syringe may damages red cells.Allow collection site to dry after cleaning with the alcohol pad. Alcohol provided to clean the puncture site may cause contamination in a tube.Do not collect a specimen native or with a hematoma.Allow specimen come clot totally (for 30 come 60 minutes) prior to centrifuging.Do not centrifuge the specimen for an ext than 10 minutes unless otherwise specified by the collection instructions.

Vacuum pipe Containing Additives (eg, anticoagulants, preservatives, clot activators, gel-barrier). Once using vacuum pipe containing an additive:

Tap the pipe gently in ~ a allude just below the height to release any type of additive adhering to the tube or top.Permit the pipe to fill fully to for sure the appropriate ratio that blood come additive. There will be part dead room at the height of the tube.To allow for sufficient mixing of blood with the anticoagulant or preservative, usage a slow-moving rolling wrist movement to invert the pipe gently 4 to eight times. Failure to invert pipe may result in the development of microscope clots.Rapid wrist motion or vigorous shiver may contribute to hemolysis.Check to watch that all the preventive or anticoagulant is dissolved. If any kind of preservative powder is visible, proceed inverting the tube progressively until the flour is dissolved.If many samples are being drawn, invert every specimen as soon as that is drawn. Do not delay. Location the pipe upright in a rack as quickly as feasible after collection.The gel-barrier pipe is one additive tube and should be inverted five to 6 times after collection. Enable the tube to was standing for 30 to 60 minutes for finish clotting to take place prior to centrifugation.

Vacuum Tubes without Anticoagulants. When utilizing vacuum tubes containing no additives:

Permit the pipe to to fill completely.Let the specimen stand for 30 come 60 minutes and also (preferably) not much longer than 60 minutes prior to centrifugation.Centrifuge the specimen in ~ the end of the waiting period in accordance through the manufacturer"s instructions for speed.

Lipemic Serum or Plasma (Turbidity)

Normal serum or plasma is a clear and light yellow to straw in color. Turbid serum or plasma shows up cloudy or milky.

Serum or plasma may be cloudy because of bacterial pollution or chronic or transient high lipid levels in the patient"s blood.

The major dietary sources of lipids (fatty substances) space meats, butter, cream, and cheese. Patients that consume these foods items within the 24-hour period immediately preceding collection the a blood specimen may have actually temporarily elevated lipid levels, which might be manifested by cloudy or lipemic serum. Lipemic serum or plasma may not it is in a true indicator of the patient"s physiologic state. (See number 1.) regardless of diet and also length of fast, part patients may develop cloudy specimens.


To stop dietary-induced high lipid levels before testing, countless physicians need patients come exclude the high-fat foods items from their diets or to quick for 12 come 14 hours prior to specimen collection. For morning specimen collection, the laboratory recommends the the patient be compelled to rapid from 6 pm on the ahead evening.

Quantity not Sufficient

One the the most typical problems in specimen repertoire is the submission of an inadequate volume the specimen for testing. The laboratory sends out out a report significant QNS (quantity not sufficient), and the patient has to be called ago for a repeat arsenal at one inconvenience to the patient and to the physician. Come ensure an enough specimen volume:

Always draw whole blood in an quantity 2½ times the required volume the serum compelled for a specific test.For example, if 2 mL serum space required, attract at least 5 mL entirety blood. If there is challenge in performing venipuncture, minimum volume may be it is registered if it is suggested in the check description. For most profile testing, draw at the very least two 8.5-mL gel-barrier tubes.If pediatric tubes space used, be sure to collection an sufficient volume that specimen to carry out the test.Provide patients with sufficient containers and instructions because that 24-hour urine and also stool collections.It is critical, especially for any type of specimen collection tube include an additive, to permit the pipe to fill to the "fill line" marked on the tube. This requirement is important in bespeak to attain the proper blood-to-additive ratio; otherwise, the specimen might be discovered to it is in QNS.

Outdoor Specimen Lockboxes

For clients who specimen lockboxes have to be placed outdoors, including a frozen gel load to the lockbox during warmer weather will certainly help administer a center temperature within the lockbox till specimens are built up by your company representative.

Gel packs need to be prepared for use by placing them in a freezer for four hours or longer. They must be frozen solid before being placed in the lockbox, and also they should be frozen solid prior to each use, even though they might be supplied with specimens that room not frozen.

Number the Frozen gelatin Packs Recommended

Approximate out Temperature

Frozen gelatin Packs Recommended

Below 80°F


80°F − 100°F

One frozen gelatin pack

105°F − 120°F

Two frozen gel packs

If the is not feasible to prevent placing the specimen lockbox in direct sunlight, include 20°F come the temperatures detailed above to identify how plenty of frozen gelatin packs to use. For lockbox instructions and also Q&A, select Instructions for Use.

Preparing the Patient

Patient Instructions

It is crucial to acquire the patient"s understanding and also cooperation in obtaining an agree specimen.

Patient States

Basal State. In general, specimens because that determining the concentration of human body constituents must be gathered when the patience is in a basal state (ie, in the beforehand morning after ~ awakening and about 12 come 14 hrs after the last ingestion the food). Referral intervals are many frequently based upon specimens indigenous this arsenal period.

The ingredient of blood is altered after meals by nutrient being took in into the bloodstream. Consequently, postprandial blood (blood drawn after a meal) is not an ideal for part chemistry tests. One overnight quick is preferable (from 6 pm of the evening previous to collection) come ensure the the patience is in the basal state. This minimizes the impacts of ingested building material on the check results. Before you collection the specimen, questioning the patient when he/she last ate or drank anything. If the patience has eaten recently and the physician wants the check to be performed anyway, friend should show “nonfasting” ~ above the test inquiry form. In the clinical information/comments section of the test inquiry form, indicate the time the patient ate. Fasting does encompass abstaining native coffee, tea, or sugar-free products.

Fasting or diet restrictions, such as low-fat diets, have to be explained in detail, specifically to age or overanxious patients or your caregivers. Notify patients the fasting walk not incorporate abstaining from water. Dehydration resulting from water abstinence can change test results.

When specimens are not collected in the basal state, the following additional effects need to be taken into consideration when interpreting check results.

Exercise. Moderate exercise deserve to cause boost in blood glucose, lactic acid, serum proteins, and creatine kinase (CK).Emotional or physical Stress. The clinical standing of the patient can cause variations in check results.Time of job of Collection. Diurnal variations and variations in circadian rhythm have the right to also influence test results. For example, growth hormone peaks in the morning before waking and decreases throughout the day. Serum iron level may adjust as lot as 30% to 50%, depending upon individual variation, from morning till evening.

Note: For chemistry profiles, 12- to 14-hour fasting specimens room recommended.

Timed Specimens

There space two types of timed blood specimens: One is because that a single blood specimen ordered come be attracted at a specific time. The various other is because that a test that may require multiple blood specimens to be gathered at several details times.

Single Specimens. Here space some instances in i m sorry timed single specimens might be required.

Fasting plasma glucose alone or in conjunction through a arbitrarily glucose determination, as recommended by the American Diabetes Association, to diagnose diabetes. Fasting below is defined as no caloric intake for at the very least eight hours.Postprandial glucose might be perform two hrs after a enjoy the meal for a timed test that is advantageous in diabetes detection.Blood glucose determinations might be ordered in ~ a particular time to inspect the result of insulin treatment.Blood societies may be ordered because that a specific time if a bloodstream bacterial epidemic is suspected.Therapeutic security of patients on medication.

Multiple Specimens. Here room some instances in which time multiple specimen tests might be ordered.


Sequential Sampling

Diagnosis of numerous endocrine diseases requires sequential sampling that blood and/or urine. periodically offers reduced fees for serial tests when the following conditions are met:

All sequential specimens are from the same patient and are sent to the laboratory at the exact same time.The specimens are clearly labeled through their chronological succession (1 that 6, 2 that 6, or time drawn) and also with the patient"s name, other distinctive identifier, and also date that collection.Only one test request kind accompanies the serial samples, and also it is completed with all patience information, including any medications administered and also the variety of samples sent.The test request form and every specimens are sent out in one container (box or plastic specimen deliver bag).

Serial Monitoring

Monitoring a patient gradually for a particular condition is a sports of sequential sampling. Numerous tumor mite (tests offered to monitor the patient"s response to treatment for cancer) might be monitored end the course of several years. Certain instructions because that serial monitoring are found in the test summary for the applicable check being monitored.

Interference that Medications and Other Substances

Many common prescription and also nonprescription (over-the-counter) medications have the right to interfere v chemical determinations or transform levels of building material measured. Drug interference is facility and often method-dependent such the only general recommendations deserve to be stated here. Precautions to be observed should be determined by the physician, and also the patient have to then it is in told to stop specified drugs for the essential periods that time prior to specimen collection.

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If the patient can not be taken off the medication in question, that presence should be listed on the test request form.

Summary: Interference that Medications and Other SubstancesDrugs or their metabolites are frequently concentrated in the urine in sufficient amounts to interfere substantially with pee assays. (See appendices or separation, personal, instance tests for certain information.)Drug interference of significant clinical significance has been well-documented in the following instances.Thiazide diuretic therapy. The pharmacologic or toxic effect is hyperuricemia and also hyperglycemia.Catecholamine assay. If a “24-hour medicine abstinence period” because that a patient is no possible, bespeak VMA or metanephrines.Oral contraceptives reason a to decrease in serum vitamin B12 levels the is often indistinguishable native vitamin B12 deficiency of any type of cause. They additionally cause rise in full serum thyroxine-binding globulin. This outcomes in increase in both total serum thyroxine and unsaturated thyroxine-binding globulin, yet with no far-reaching change in unbound (free) thyroxine.Many medications have actually been presented to have actually long-term residual results that interfere v testing.Refer to individual test descriptions for details information.