Note: All meconium specimens are to be handled with "chain of custody" documentation intact.
1. Specimen Collection Kits:
The Nursery and Neonatal Intensive Care Units have been supplied with specimen collection kits. Each kit contains:
A. 6 diaper liners
B. 6 wooden tongue depressors
C. 60 ml plastic specimen vial with snap-lock lid
D. red adhesive security seal (not used)
E. box seal
F. plastic Biohazard bag
Obtain additional specimen collection kits and “Chain of Custody” forms by calling MecStat Labs at 1-800-235-2367.
2. Specimen Requirement:
Maximum window of exposure is achieved by collecting and pooling all meconium passed during the postnatal period. Because meconium is heterogeneous and drug does not appear to diffuse throughout the entire meconium mass, the pooling of multiple passing of meconium is highly encouraged until milk stool appears. Three (3) grams of meconium are necessary for maximum sensitivity. United States Drug Testing Laboratories (USDTL) will analyze smaller amounts, but with a resulting reduction in sensitivity and/or reduction in the window of drug exposure.
3. Specimen Collection:
A. Strategically place a liner in the diaper so that as meconium is passed, it collects on the liner instead of the diaper. Transfer the meconium from the liner to the collection vial using wooden tongue depressors provided. Continue collecting meconium specimens into the same collection vial until first milk stool appears (a minimum volume of 3 gm of meconium is recommended). Greater sensitivity and longer window of exposure can be achieved by collecting all available meconium.
B. Meconium specimens must be stored at room temperature in a locked drawer, designated for this purpose, from the time of collection until they are ready to be shipped.
C. Affix an identification label (including infant’s name and identification number) to the collection vial.
D. Peel off one of the tamper proof, bar coded labels from the lower left corner of the form and place it over the top and down the sides of the specimen container.
E. Place the specimen vial in the plastic bag provided. Place the entire bag with its contents into the collection kit.
F. Complete the “Requisition” form.
a. Step 1: Newborn name and ID number.
b. Step 2: Select the MecStat-5 Panel (unless the physician specifies otherwise).
c. Step 3: Each collection of meconium is documented.
d. Step 4: The final collector/person sealing the collection vial in 3.D. must sign and complete the date/time that the specimen was sealed in the appropriate spaces on the MecStat Requisition form.
Note: This begins the "chain of custody" documentation.
e. Make sure that the appropriate UCL site return address is stamped or written on all copies of the Requisition form.
G. The nurse who seals the collection vial and signs the "Chain of Custody". Bring the sealed specimen box along with the yellow and pink copies of the Requisition form to the laboratory.
Note: DO NOT SEND THE SPECIMEN WITH THE IN-HOUSE MESSENGER OR WITH ANOTHER NURSERY STAFF MEMBER.
1. Accept the sealed box containing the specimen and the yellow and pink copies of the Requisition form.
Note: Do not sign the “Chain-of-Custody” form. Only nursing staff are to sign and seal these specimens.
2. Staple the yellow copy of the Requisition form to the UCL requisition and file in the Pending File.
3. File the pink copy of the Requisition form in the laboratory legal consent file.
A. The sealed specimen collection box is placed in a Fed-Ex lab pak.
B. Specimens received Monday through Friday are picked up by Fed-Ex; the driver stops routinely and checks for pick-ups on weekdays..
C. Specimens received on weekends (Saturday or Sunday) do not ship; hold and ship the specimen on Monday.
9. If there are any questions or if additional specimen collection supplies and pre-printed air bills are needed call MecStat Laboratories at 1-800-235-2367.
10. Results are returned by MecStat Lab via fax within 24 hours after they receive the specimen. When the faxed report is received:
A. Results are entered and released in the UCL CLICS.
B. A copy of the faxed report is sent to the physician.
C. A copy of the faxed report is sent to the Nursery in an envelope labeled “Newborn Nursery Confidential Lab Results”.
i. 3-16-92 L. Kelley
ii. 9-23-98 R. Maiers, J. Mueller & S. Hosch (Revised: II.3.)
iii. 10-13-98 R. Maiers, M. English (Revised: II.3., Added II.6., format)
iv. September 1999 L. Kelley (Revised: I.1-3., II.1-8.)
v. May 2002 L. Kelley (Revised: I.3.F.e. added, II.1.B., 3-6.)
vi. May 2002 L. McGovern (Revised: I.2.,3.A,B,F&G.)
vii. October 2003 L. Kelley (Revised: I.1.D., 3.C-D., F.a-e.; II.1. & 1.B.; new form)
viii. June 2006 L. Kelley (Revised: courier and report handling changes)
ix. April 2008 L. Kelley (Revised: II.8. shipment)
x. March 2009 L. Kelley (Revised: II.8. shipment)
xi. March 2010 L. Dolphin (Revised: I.3.G.; II.4.)
Interim Review: June 2011 A. Cartmill (Revised: II.1.note; form)