Texas Health Steps specimen collection and handling

• Tips to Prevent "Specimen Clotted":
  Venipuncture
  Capillary (Finger Stick)
  
  

• Tips to Prevent "Quantity not sufficient":
  Venipuncture
  Capillary (Finger Stick)
  
  

• Illustrations of Purple Top Tubes

See the illustrations below for the correct fill volume of the purple top tubes.

Label the specimen clearly and legibly with the patient’s full name exactly as it is printed on their Medicaid card. (Suggestion for finger stick collection tubes: write the patient’s name on adhesive tape, small address label, medical or masking tape, and attach it to the blood collection tube. Ensure that the label will not fall off easily.)

Fill out test request forms completely and legibly. Laboratory tests may be performed only if the specimen tube is labeled with the patient’s full name on the tube and the patient's name on the tube exactly matches the patient's name on the test request form. Make sure that you have clearly indicated which tests are requested by marking the appropriate tests on the G-1B form. Your Texas Health Steps (EPSDT) Provider/TPI number must be written in the top box to receive results in a timely manner.

If requesting an RPR (syphilis screen) and HIV screen, please collect specimen in a red top tube and submit a separate specimen for each test.

Routinely mail specimens the same day they are collected. If this is not possible, you may refrigerate specimens overnight, but do not freeze them.

When collecting finger stick blood specimens for lead testing, ensure that the person collecting the specimen and the patient wash their hands with soap and water prior to collection of specimen.

Supplies to collect and ship specimens to TDSHS, including postage paid mailing labels, are provided as part of the routine Texas Health Steps (EPSDT) testing services at TDSHS. Request supplies by telephone at 1 (888) 963-7111 ext. 7661 or (512) 458-7661 with a valid Texas Health Steps (EPSDT) provider/TPI number.

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Tips to Prevent "Specimen Clotted"

Capillary (Finger Stick)

To increase blood flow, ensure that the collection site is warm, obtain a good puncture, and position the collection site below patient’s heart.

Always wipe away the first drop of blood. This first drop contains tissue fluid and clotting factors that can cause a specimen to clot quickly.

Avoid scraping the site when collecting blood as this can stimulate clotting.

Tips to Prevent "Quantity not sufficient"

Venipuncture 

Purple top collection tubes containing powdered EDTA (K₂EDTA may be on label) must be filled to the manufacturer specified volume. "Butterfly" collection systems are not recommended because the blood collection tubes may lose vacuum due to dead space in the tubing and may affect fill volume.

Capillary (Finger Stick)

To increase blood flow, ensure that the collection site is warm, obtain a good puncture, and position the collection site below patient’s heart.

Avoid overfilling or underfilling the collection tube. Fill the tube no less or more than the manufacturer stated fill volume. Collection tubes contain only enough anticoagulant for the stated fill volume.

Mix all EDTA (purple top) specimens thoroughly immediately after collection. 

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Illustrations of Purple Top Tubes

To assist in determining the correct fill volume of the purple top tubes, it was decided to provide an illustration for the acceptable levels for each type of tube. Each tube must be filled to the manufacturer stated fill volume, or the specimen will be rejected. 

For example: If you need to collect 4 mL of blood for a test and you only put 4 mL of blood in a 6 mL tube, the specimen will be rejected because the fill volume on the tube is 6 mL. Also, no glass tubes will be accepted.
 
Becton Dickinson (BD) Microtainer® 250 uL – 500 uL Tube: 

We will accept this tube.

The tube is used for finger/heel sticks. The manufacturer stated fill volume for this tube is in the range of 250 uL minimum to 500 uL maximum. (The arrows point to the 250 uL and 500 uL lines.)

Becton Dickinson (BD) 2mL Vacutainer® K2 EDTA 3.6mg Tube:

The tube is used for venipuncture draws. The manufacturer stated fill volume for this tube is 2 mL. The Vacutainer should draw the tube’s fill volume automatically. The black mark on the label of the tube (indicated by the arrow) is an estimated volume mark, not an actual volume mark. The position of the label varies from tube to tube. The 2 ml Vacutainer will draw blood from the vein at a much slower rate than the higher volume Vacutainer tubes which is appropriate when collecting blood specimens from pediatric patients.

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