CSF and Body Fluid Collection Guidelines

• All body fluids, especially cerebrospinal fluid (CSF), must be taken to the laboratory immediately after collection as cell lysis can begin within one hour of collection. Hand directly to the laboratory personnel (do not leave on counter). Lab personnel deliver all CSF specimens to Hematology.
• Serous fluid (pleural, peritoneal, pericardial) may contain debris from the collection of the specimen. It is essential to put Hematology samples into EDTA immediately. For  Chemistry samples, please see specific requirements in the chart below.
• Fluid for Crystals must follow chart requirements as indicated below.
• CSF collections - use the standard pre-packaged sterile collection tubes numbered 1 to 4 for CSF collections (available through CHR). Collect the CSF from lumbar puncture into these tubes in sequence. For adults, typically 1.5-2 mL is collected into each tube.   This will provide testing for routine chemistry, cell counts, culture and other investigations. Three tubes are sufficient for pediatric collections. Ensure each tube is labelled correctly with patient identification and order of collection (1, 2, 3, 4).
• CLS staff: if "CJD" is indicated on requisition, follow BCERP procedures. 
• If unable to collect optimum volume of fluid refer to the Alphabetical Test Directory for specific test volumes. Samples may be shared for certain tests; contact the laboratory for assistance.ALWAYS indicate priority of test orders.
• State source of fluid on requisition. If samples are collected from more than one site, each specimen and requisition must be labeled with source.
• Clotting of sample will occur when fibrinogen is introduced with a traumatic puncture.
• DO NOT SEND FLUIDS IN SYRINGES (WITH OR WITHOUT NEEDLES ATTACHED). 
• DO NOT SEND FLUIDS IN TRANSFUSION BAGS, OR I.V. BOTTLES FOR HEMATOLOGY OR CHEMISTY ANALYSIS.
• DO NOT SEND LARGE VOLUMES OF FLUID. POUR INTO APPROPRIATE CONTAINERS OR CONTACT LABORATORY FOR DIRECTION.
• See Specimen Requirements Identification - Spinal Fluid and Body Fluid for specimen labeling requirements.
• Do not refrigerate fluids.
• The chart below summaries the most frequently ordered tests on the most common fluids. Refer to the Alphabetical Test Directory for additional tests and other fluids.

Fluid	Test	Requisi-tion	Volume / Container	Notes	Additional Information
CSF	Cell Count, Differential	CLS Acute Care	1 mL in pre-packaged sterile tube or  5 mL  red top tube	Deliver to lab immediately. Hand directly to lab personnel	Alphabetical Test Directory  or contact lab (Hematology)
Dialysate fluid	Cell Count	CLS Acute Care	3-5 mL in lavender top EDTA tube	Do not send large volumes. Must not be clotted.	Alphabetical Test Directory or contact lab (Hematology)
Pleural Peritoneal Pericardial Synovial	Cell Count, Differential	CLS Acute Care	3-5 mL in lavender top EDTA tube or dark green top sodium heparin tube	Place immediately into tubes after collection, mix well	Alphabetical Test Directory or contact lab (Hematology)
Peritoneal Pericardial	Hgb, HCT	CLS Acute Care	3–5 mL in lavender top EDTA tube		Contact lab (Hematology)
CSF	Albumin, Glucose, Protein pH Lactate	CLS Acute Care	0.5-1.0 mL in pre-packaged sterile tube or 5 mL  red top tube	0.2 mL for each test.	Alphabetical Test Directory or contact lab  (albumin only: Chemistry-DSC protein,glucose: Chemistry-DSC, ACH, FMC, PLC, RGH lactate: Chemistry-ACH, FMC, PLC & RGH)
Synovial	Glucose, Protein	CLS Acute Care	0.5 mL in gold top SST or light green (mint) top PST tube		Alphabetical Test Directory or contact lab (Chemistry-DSC only)
All	Culture (bacterial, Candida/yeast, fungus, AFB)	CLS Microbiology	Volumes vary for each fluid type	Do not send swabs. Large volume fluids can be sent in sterile screw cap containers (up to 80 mL) Dialysate fluids can be collected using FAN bottles.	Alphabetical Test Directory or Microbiology Tests/Bacterial, Candida/Yeast, Fungal, or AFB Culture or Microbiology Helpdesk 770-3646
All	Anaerobic culture	CLS Microbiology	Anaerobic transport media (PRAS) or sterile container	Do not use swab. Inject fluid via rubber septum into anaerobic media.	Alphabetical Test Directory or Microbiology Test/Anaerobic Culture or Microbiology Helpdesk 770-3646
All, FNA		CLS Cytopathology	Cytolyte container	CSF: Minimum of 1.0 mL	Cytopathology or CLS Lab Information Centre
CSF, Body Fluids, FNA		CLS Flow Cytometry	2 mL CSF (10 mL preferred), 10-20 mL body fluid	Do NOT put in cytology fixative. FNA must be in RPMI/TTM solution.	Flow Cytometry or CLS Lab Information Centre or Flow Cytometry 944-4765
Amniotic Fluid		CLS Acute Care			Alphabetical Test Directory for collection guidelines
Pleural Peritoneal	pH	CLS Acute Care	0.5 – 1.0 mL in red top tube or dark green sodium heparin tube(lithium heparin syringe is acceptable if collected by nursing unit). Unspun light green (mint) top PST tube is acceptable.		Alphabetical Test Directory or contact lab (pleural: Respiratory-ACH, FMC, PLC, RGH; peritoneal: Chemistry-ACH, FMC, PLC, RGH)
Pleural Peritoneal	Glucose LD Total Protein	CLS Acute Care	0.5 – 1.0 mL in gold top SST or light green (mint) top PST tube.		Alphabetical Test Directory or contact lab (Chemistry-DSC)
CSF	CJD Protein 14-3-3 Mad Cow Disease Creutzfeld Jakob		2-3 mL CSF	Send to lab by TDG. CLS staff: Follow BCERP procedures.	See Protein 14-3-3