Preparation for tests

Two weeks  prior to blood draw:

• eat normally 
• avoid bodymass fluctuations.

48 hours prior to blood draw:

• avoid strenous physical activity and exercise 
• do not consume alcohol.

24 hours prior to blood draw:

• u eat normally, but avoid meals rich in fats.

12 hours prior to blood draw:

•  do not eat, drink alcohol and coffe nor smoke (water is allowed).

Cholesterol determination should not be conducted unless at least 8 weeks have passed after:

• acute myocardial infarct akutnog infarkta miokarda
• surgical operation kirurške operacije
• trauma
• secondary comorbidities altering lipid metabolism 
• acute bacterial or viral infections.

Blood draw is performed in the morning. 

Preparation and test instructions: 

• 3 days prior to performing the test eat normally, avoid changing quantity and type of food and drink consumed
• 24 hours prior the test, strenous physical activity (swimming, strength training, cycling) is stricty prohibited 
• the night before performing the test, from 11 p.m. onward 23, food and drink consumation is strictly prohibited (plain water consumption is still allowed) 
• in the morning of the day the test is performed, you are not allowed to consume food or drinks (besides plain water) and smoke 
• arrive fasted at the laboratory, in the morning 
• urine sample must be provided prior performing OGTT to rule out too high fasting blood gluose values
• blood specimen is collected in fasting state 
• you ought to consume the glucose drink slowly, in small sips 
• exactly 60 and/or 120 minutes from drinking glucose, come in for your second (and third) blood draw 
• during the duration of OGTT, do not move excessively, exercise, eat drink and smoke 
• sit still in the waiting room and keep track of exact time for blood draw 
• it is more than recommended to consume food and drink after the last blood draw (120th minute).

Collecting the appropriate saple  for the test: Pravilno uzimanje uzoraka za pretragu:

• testing should be delayed by 10-12 days after the final round of antibiotics, proton pump inhibitors or bismuth preparations, if used  
• random stool sample is acceptable for this test 
• unscrew the cap with the applicator stick — be careful not to spill the liquid (transport medium)
• insert the applicator (stick attached to the cap) into the stool at several randomly chosen spots
• a small amount of stool is sufficient for analysis - the amount remaining on the applicator after insertion is enough
• replace the cap with the applicator and close the bottle tightly - be careful not to break off the tip of the cap
• label the sample (name and date)
• bring to the laboratory as soon as possible - if necessary, the sample can be stored in a sealed bag in the refrigerator (2–8°C) for up to 2 days

When bacterial gastrointestinal disease is suspected, you need to put a walnut-sized stool sample into a screw-top container (which you can get from the lab or buy at a pharmacy), close it tightly, and deliver it to the lab within 2 hours. Use a bedpan or a similar method for defecation and collection because the stool must not be contaminated with toilet water or urine. If there’s mucus or blood in the stool, be sure to include that in the sample.

For virus tests, the sample can be kept in the fridge and delivered for processing within 24 hours.

To test for parasites, you should follow the sample collection procedure mentioned above, but the sample should be kept refrigerated and delivered to the lab within 24 hours. If the test comes back negative, it’s recommended to repeat it up to three times at irregular intervals, meaning sampling on randomly chosen days. Stool that is of normal consistency is a sign that the digestive system is functioning normally and finding parasites in such a sample is unlikely.

Perianal smear: for the test, you need to prepare a slide with adhesive tape beforehand (it can be picked up at the reception of the Breyer Polyclinic). In the morning, right after waking up and before getting out of bed, get into a position where the adhesive tape can be applied over the anal opening. Then peel the tape from the slide and press it firmly on the anal opening to take the 'smear.' The adhesive tape should then, carefully kept flat and not crumpled, be reapplied along the slide in the same manner as it was received from the lab. Wrap the prepared slide in paper and bring it to the lab the same day. It is advisable to repeat the test 2–3 times over several days since the female E. vermicularis parasite lays eggs on the edge of the anal opening at irregular intervals.

Sputum sample should consist of material obtained by a deep cough first thing in the morning. Before collecting the sample, rinse your mouth thoroughly with only water. Do not brush your teeth or use any mouthwash or oral disinfectants. Expectorate (cough) the sample into a sterile container available at the pharmacy or at the reception of Breyer Polyclinic and deliver it to the laboratory within 2 hours.

NOTE: Sample quality is assessed prior to microbiological analysis by microscopic examination and evaluation of epithelial cell count. A high percentage of epithelial cells indicates an inadequate sample (meaning it is predominantly oral cavity content and/or saliva) and a report describing the findings will be issued accordingly.

• Prepare clean bottles that can hold at least 2 litres of fluid (e.g. two empty and clean water bottles) and a funnel if needed, which can be discarded afterwards
• On the first day of collection, discard the first morning urine completely by urinating into the toilet
• After discarding the initial morning urination, collect every next urine into the prepared bottle/bottles
• The last urine sample to collect is from the first morning urination on the second day
• It is important to collect all urine throughout the collection period, as incomplete collection will result in inaccurate results
• Bring the bottles (i.e. the 24-hour urine sample) to the laboratory in the morning.

Performing this test requires a special container with transport medium you can pick up at the reception of Breyer Polyclinic.

No dietary restrictions are needed beforehand.

Procedure with the container containing the transport medium:

• Unscrew the lid (be careful not to spill the liquid from the container)  
• Stick the applicator (swab attached to the lid) into the stool, in three randomly chosen spots  
• Important: gently wipe the applicator with toilet paper to removes excess sample  
• Close the bottle tightly and shake: this mixes the sample with the transport medium  
• Label the sample (name and date)

The sample is stable for up to a week in the refrigerator in this medium. Make sure to bring it to the lab whenever you can during that time frame.

Collecting a urine sample properly for a urine culture is crucial for the proper interpretation of the test and timely prescription of any necessary specific treatment. That’s why it’s important and in your interest to carefully read and follow these instructions.

The sample should be a midstream of the first morning urine or a midstream urine sample taken 3–4 hours after the last urination. The urine sample should be delivered in a sterile container, which can be purchased at a pharmacy or picked up at the Breyer Polyclinic reception.

Procedure with a sterile container from the pharmacy:

Prepare the bathroom and plan so that you can comfortably carry out all the necessary steps listed below:  

• open the sterile container
• set the lid aside in a safe place with the inside facing up (do not touch the inside with your fingers to avoid contamination) and get the container ready for collecting urine  
• thoroughly wash the urogenital area with soap and rinse well under running water, without wiping  
• use one hand to spread and/or remove skin folds so that the urine stream can flow freely (without rinsing the surrounding skin/mucosa) into the container  
• first, start urinating outside the container with a strong stream (the first flush of the urine will flush out bacteria from the urethra)  
• without stopping, continue urinating into the prepared container to collect the “midstream urine” which will be the sample for testing  
• carefully close the urine container and deliver it to the lab as soon as possible (within 2 hours).

Procedure for patients with a urinary catheter

For patients who have a urinary catheter, it’s important to keep in mind that their  urine sample may contain potential bacteria from the bladder in addition to bacteria that coat the inner surface of the catheter. The culture of such a sample more often than not grows a large number of different bacteria (colonies), which makes the result difficult to properly interpret and to tell which bacteria might be pathogenic and truly from the bladder. Therefore, a urine sample for a culture should be taken on the day the catheter is replaced. After insertion and brief bladder emptying, the new catheter should be closed and the bladder should not be emptied for another 3–4 hours. Then, when releasing urine, the midstream should be collected in a sterile container and delivered to the Breyer Polyclinic within 2 hours.

Alternatively, the midstream urine can be poured directly over both sides of the Uricult plate (available at Breyer Polyclinic). The plate should be briefly drained of excess urine, placed back in its container, and closed tightly. The inoculated plate should then be delivered to Breyer Polyclinic during the day. 
**In both cases, please make sure to mention that it is catheter urine. If needed, the questionnaire available at the Polyclinic reception can also be filled out.

Urine Bag Procedure (for children wearing diapers)

The urine sample for urine culture in children wearing diapers can be collected using a urine collection bag (available at the pharmacy). The child's urogenital area should be thoroughly washed with soap (in boys, retract the foreskin upwards), then rinsed thoroughly under running water and dried with a clean cloth. Once the urine bag is secured and the child is dressed, it is advisable to check frequently whether the bag has filled, so that the sample is kept in the bag for as short as possible (as it will be warmed by the child's body) and delivered to the laboratory for processing as soon as possible. This reduces the risk of bacterial overgrowth in the sample as a result of prolonged retention of urine in the bag, which could lead to a false diagnosis of urinary tract infection in an otherwise healthy child.

When submitting the sample for processing, it is important to indicate that the sample was collected using a urine bag. If required, a questionnaire with additional information about the child's illness, allergies and other relevant details should also be filled. Furthermore, it is advisable to request a urine sediment examination from the same sample, so that the clinician can more reliably assess whether a urinary tract infection is present.

If iron suplementation therapy and/or iron enriched multivitamin supplements are being administered, serum iron should be checked at least:

• a week to 10 days after taking oral supplements  
• three days after giving intravenous supplements  
• a month after intramuscular iron administration  

Also, completely avoid taking vitamin C (ascorbic acid, L-ascorbate), drinking juices that can affect iron (blueberry, black currant, blackberry, beetroot) or blackberry wine 24–48 hours before taking a blood sample.

Blood should be drawn in the morning on an empty stomach.

Measuring ferritin levels in serum shows the body's iron saturation better than measuring iron itself. No special preparation is needed to determine ferritin.

Urine cytology analysis – how to prepare?  
For a urine cytology test, 3 urine samples are needed, given over 3 consecutive working days (at our laboratory) between 7 – 9 a.m. You need to provide a midstream of the second morning urine, directly from the urethral opening (separating the outer parts of the genitals) into a container with a lid that you get at our reception desk. Women should not give urine during menstruation, nor one day before or after menstruation. For immobile or hard-to-move patients, someone else can bring the urine within 30 minutes (no later than 60 minutes) after collection.

Nasal swab for eosinophils
If you are using corticosteroid preparations in your nose, either as drops or sprays, it is recommended to pause the medication at least 4 days before the cytology test for eosinophils. Saline solution won’t affect the test results, so you can use it up until the day of the test.

Cytological Analysis of Sputum
For a cytological analysis of sputum, 3 sputum samples are needed, brought to our laboratory over 3 consecutive working days (at our laboratory). For a quality cytological analysis of sputum, whether looking for assessment of inflammation, allergies, or screening for malignant cells, a deep morning sputum 'from the lungs' is required. Before providing the sputum, it is recommended to rinse your mouth with just warm water, without antiseptic agents.

Cytological Analysis of Peripheral Blood Smear – Do You Need to Come Fasting?
No, for the cytological analysis of a peripheral blood smear, no special preparation or prior appointment is needed. A small drop of blood is taken from the fingertip using a small lancet, and smears are made on slides.

Cytological analysis of breast discharge  
For a cytological analysis of breast discharge, 3 samples are needed, which are taken over 3 consecutive working days at the cytology clinic. An appointment is necessary and can be arranged by calling +385 1 3775 092 or emailing lab@breyer.hr.  

No special preparation is required for the test itself, just come on the days when there is discharge and bring any medical documentation related to the requested test (breast ultrasound report, mammogram, breast MRI, previous cytology results, etc.).  

Cytological analysis of a swab/scarification of skin or mucosal changes – is any preparation needed?  
Before taking a cytological swab of blistering or other changes on the skin and mucosa, it is recommended not to apply any creams to the area, especially thick creams, to ensure a quality sample for microscopic analysis.

The time required to produce the results varies from test to test (check for each individual test) and also depends on the time the sample is received (check the article that describes this), and in the event that the test is not listed or there is some specificity, check by phone or email.

You can send samples for STD testing by mail from anywhere in Croatia.  
The first stream of the first morning urine is collected using a specially designed device that allows automatic stabilization of the sample during transport, ensuring the accuracy of diagnostic results.  
Self-sampling of a rectal (anal) swab is done according to the instructions.  
Men can also get tested for HPV by taking a swab from the urogenital area according to the instructions.  

For samples you send by mail, check the price for each service and add the amount for transport and sample tracking, which is €26.00.  

• Chlamydia  
• HPV  
• STD 4 panel  
• STD 7 panel

If you are sending samples by mail, please carefully follow these instructions:

• choose the desired test and pay the appropriate amount to the email address lab@breyer.hr
• send us the following information: type of desired test full name (optional - we also accept samples under a code), gender (optional - we also accept samples under a code), date of birth (optional - we also accept samples under a code), email where you want to receive the results contact phone/mobile number mailing address where you want to receive the testing kit proof of payment the day before sampling (by 10:00 PM)
• request the DPD courier to come to your desired address by clicking the link on the sampling day fill out the referral and informed consent
• collect the urine sample according to the instructions, and hand it to the courier to send to the laboratory
• after the analysis is completed, the results will be delivered to your requested email or mailing address within 2-3 working days (from the moment the laboratory receives the sample).

Payment details:
Recipient: Polyclinic Breyer, Ilica 191, Zagreb
Model (if needed): 00
Reference number: patient's date of birth (example 03031980)
IBAN: HR4323600001102324280
Payment description (purpose of payment): Patient's name
Our OIB: 02278114891

ORDERING SAMPLE COLLECTION VIA DPD COURIER SERVICE: link
The code needed for shipping can be requested from our staff.

INSTRUCTIONS FOR ANONYMOUS TESTING:
If you wish, testing can also be done anonymously, and in that case, we need a code under which you want your sample to be recorded, which should be entered under the LAST NAME field (e.g., pet's name, profession, a number…), the address where you want the shipment to be received, and the address (email or postal) for sending the results.

Men can take a sample to prove the presence of the HPV virus themselves.

The HPV swab kit (transport medium and swab) with instructions can be picked up at the reception of the Breyer Polyclinic or requested to be sent to any address in Croatia, for an additional fee*.

The patient takes the swab at home and brings it to the laboratory or sends the swab back to the laboratory for processing by mail.

The swab is rubbed firmly (as much as can be tolerated - to the point of pain) against the skin of the tip of the penis, perineum and the area around the anal opening, in order to obtain as many cells as possible in the sample. The swab is then immersed in the transport medium, rinsed well in the liquid, and part of the swab stick is broken off so that the swab remains in the tube immersed in the medium. The tube is then closed tightly, marked (name and surname) and brought to one of our laboratories for processing or ordered to be sent to the laboratory by mail.

It should be noted that if the sample is not of adequate quality (too few cells), it will not be possible to obtain a result, even though the test has been performed. Therefore, if the patient is not sure that he can take an adequate sample, we recommend that the sample be taken by a urologist.

*A sampling kit can be collected at the reception for a fee of €7.00. The test price is subsequently reduced by €7.00 when paying for the test.

*If the mail service is used, an additional fee of €26.00 is required on top of the test price (including delivery and collection by courier and monitored transport in both directions).

For sampling, it is necessary to acquire a set* containing a swab and a tube with liquid PCR medium.
The swab should be inserted 2-3 cm deep into the rectum/colon, rotated and held for a few seconds at the sampling site. Then the swab should be removed, immersed in the tube with the medium. The swab stick should be broken off at the designated place (so that the tube with the immersed swab can be properly closed), leaving the swab in the medium with the tube tightly closed.

The sample can be submitted for processing during the work day to any location or sent by mail for analysis.

*The sampling set can be picked up at the reception of the Breyer Polyclinic for a payment of €7.00 . The test price is subsequently reduced by €7.00 when paying for the test. If the mail service is used, an additional payment of €26.00 is required on top of the test price (including delivery and collection by courier and monitored transport in both directions).

For sampling, it is necessary to prepare a sterile container that can be purchased at a pharmacy or collected at the reception of the Breyer Polyclinic.

The genitals should be washed with soap, rinsed thoroughly with running water and not wiped.

Before giving the ejaculate, it is necessary to remove the skin folds and urinate with a strong stream to wash away the urethral flora and prevent contamination of the sample with skin flora. The ejaculate is immediately placed in a sterile container and delivered to the laboratory within 2 hours.

A prostate sample is given by agreement with a urologist in a urology office, following the procedure as for ejaculate. The sample should be delivered to the laboratory within 2 hours.