Specimen Collection

Principle

While most donors will cooperate fully if treated with dignity and courtesy, there may be instances when unusual events may occur. For this reason, it is imperative for the collector to have a thorough understanding of the collection process and to have the ability to explain the process clearly to the donor so they will fully understand the directions. During collection of the specimen and completing the forms, it is vital that the collector devote his/her full attention to the procedure without interruptions. Any unusual appearance or behavior is to be noted on the urine chain of custody form.

Procedure

While it is not possible to anticipate every type of unusual event, some of the more frequent are:

1. Specimen Temperature Outside Limits: If the specimen temperature is outside normal parameters, i.e., less than 90°F or greater than 100°F then:

• Inform the donor that the temperature of the specimen is outside normal limits (too low or too high) and that the specimen needs to be recollected. If the specimen cannot be recollected or the donor refuses, inform the donor that specimen temperature will be noted on the final report. NOTE: This is important because if the donor has drug in his/her system at the time of collection, collection at a later time may allow the drug to clear. Therefore, if at all possible, make every effort to resolve the situation at the time of the incident.

2. Specimen Contains Visible Blood: Urine specimens may not contain visible blood for drug testing because:

• Blood may interfere with the testing process (which could result in false negative tests).
• Urines containing visible blood are considered biohazardous and require special packing procedures in order to be shipped (Federal Bloodborne Pathogens standard) .

Instructions to client to obtain a clean catch urine specimen:

• Wipe area until free of blood.
• Start urinating into the toilet. After a few seconds, place the urine container under the stream of urine until the cup is at least half-full.

3. Uncooperative or Belligerent Donor: Presumably, the donor has agreed to the drug test prior to appearing at the collection site. However, attitudes may change just before, or during the collection process. Remain courteous and do not argue with a donor. It remains the right of the donor to refuse collection at any time, of course at his/her own risk. Remind the donor that you will call the requesting agency with a recount of the pertinent facts .

   If physical violence seems imminent, call for assistance and ask the donor to leave the premises. Use the same procedure you would use for any other circumstance in which you fear bodily harm or property damage, including calling 911.

4. Suspicion Donor is Adulterating Sample (Adding water or other substance): Remain courteous and do not argue with the donor. The following statement may be appropriate:

   "We are instructed to tell everyone that the lab tests for water and other materials that may have been added. It will show up on the test report."

   Grounds for these type of suspicions may include out of range specimen temperature, abnormal urine smell or appearance, or unusual sediments.

5. Donor Cannot Urinate or Produces Insufficient Volume: Upon receipt of the specimen, the collector must first determine if there is sufficient urine for testing. Minimum sample volume is twenty (20) mL and is sufficient for retest and confirmatory procedures if required. If there is not sufficient urine volume, then follow the procedures below:

   1. Ask a supervisor to determine if there is adequate urine volume to perform the requested testing.

   2. If there is not a sufficient urine volume, the collector shall take possession of the partial specimen and instruct the donor to drink fluids (no more than 8 oz.) and try again in a reasonable amount of time. If possible, the donor should remain on the premises and preferably within visual contact of the collection site person until a complete specimen is provided.

   3. In the event a donor cannot provide a specimen of adequate volume, the requesting agency should be notified for further instruction. In some cases, it may be acceptable to reschedule the collection. However, it may be necessary to determine whether a valid medical reason exists for the donor's scarce urine output or if the donor is refusing to provide a specimen.

6. Donor Accuses Collector of Carelessness, Personal Misconduct, or Deliberate Mishandling of Specimen: This is unlikely; however it does occur.

   Remain calm and professional. Listen carefully. If there is another person at the site, ask that individual to join you and the participant. If you are alone, call your supervisor while in the presence of the participant. It is important to document what took place and what was said. The matter should be treated with the utmost seriousness. It could result in the loss of a client, a civil lawsuit, or even a criminal suit. State fully to the participant and, if possible, to a witness what you did or did not do. Make every reasonable effort to persuade the participant of your good intentions and lack of negligence; however, do not attempt to deny actual error on your part. If it is obvious that a participant is attacking you to perhaps cover the presence of drug use, treat it as a legal matter with documentation and immediate notification to your supervisor.