Specimen Collection

1. Specimen Collection Module 15

2. Introduction • Laboratory tests are important in helping to diagnose patient problems. In order to assist with accuracy in diagnosis, the nurse should know: • the rationale for the test to be conducted • what equipment will be needed • how the patient should be prepared • the correct way to collect and handle the specimen • how to care for the patient afterward.

3. General Guidelines • Step I – Read the physician’s order • Step 2- Prepare the patient • Step 3 – Gather equipment • Step 4 – Follow safety measures • Universal precautions are always used for collecting and handling specimens. • Specimens are transported in bio-hazard bags ALWAYS! • Transport specimens immediately to the lab.

4. Urine Testing Clean Voided Specimen Clean Catch Specimen Sterile specimen Timed specimen

5. Why are urine specimens collected? • To determine if infection is present. • To determine specific gravity • To evaluate treatment. • To determine if acetone is present. • To determine if blood, glucose, protein, is present. • To test the ph of urine • To determine kidney function

6. Clean Voided Specimen • A clean voided specimen is used for routine examination. • Many patients are able to void directly into the specimen container; or if unable, may use bedpan or urinal.

7. Collecting the Specimen • Wash hands/don gloves • Pericare to be done. • Keep the labia separated. • Instruct patient to void • Allow some urine to escape • Then catch the urine that follows. • Allow the last portion of the urine stream to escape. • Carry out completion actions • Label specimen and send to lab for testing.

8. Clean-Catch or Midstream Urine Specimen • Done for routine UA, cytology, or for Culture and sensitivity (C&S) • For C&S, use a sterile container. • For all others, use a clean container.

9. Culture and Sensitivity • Culture means to swab part of the specimen onto a Petri dish for growth of bacteria • Sensitivity means to assess these bacteria for antibiotics to which they are sensitive

10. Cultures • Generally have to grow for 24-72 hours • However, a physician will generally start antibiotics based on the PRESUMED organism • When sensitivity is done, the antibiotic may be changed if necessary

11. Clean Catch Urine Specimen • Instruct patient how to obtain a clean specimen: • Clean with 3 soapy sponges or towelettes • Hold vulva apart while voiding • Void first part of stream into toilet, bedpan or urinal • Void next part of stream into clean or sterile container

12. Clean Catch Urine Specimen • Do not allow anything to touch inside of container • Place lid on container, place in bio-hazard bag, label and send to lab • Clean bedpan or urinal • Remove gloves, wash hands

13. Clean Catch Urine Specimen • Document: • patient teaching • equipment used • Appearance • amount of specimen • method used for collection • time sent to lab

14. Critical Thinking • Mrs. X. was instructed to collect a clean catch urine and when she returned the container to you, you noticed that there was pubic hair in the cup. • What would you do?

15. Sterile Urine Collection • Usually collected from catheter • There are two main ways to collect urine: 1. Insertion of an in and out catheter just to collect the specimen

16. Sterile Urine Collection 2. Closed system collection - collect from the catheter tubing. • Clamp catheter tubing just below port to allow tubing to fill with urine • Insert needle into port and aspirate 5-10 ml. • Empty syringe contents into sterile specimen cup and send to lab **Must be fresh, uncontaminated urine. NEVER collect from the bedside bag.

17. 24-Hour Urine Collection • All urine for 24 hours must be collected in a receptacle that is generally kept on ice • Everyone (patient, family, staff) must be instructed NOTto discard the urine • Sent to lab at end of 24 hours for analysis

18. The BAD news is… • Even if “just one specimen” is discarded, the test is not valid! And must be restarted!

19. Sputum Specimen Collection • May be done for cytology or C&S • Use STERILE container if for C&S • Best to collect in the morning when secretions have gathered in the bronchioles. Do not collect just after a meal. • Explain that need SPUTUM not saliva.

20. Sputum Specimen Collection • Instruct not to use mouthwash or brush teeth just prior to collection • Sit the patient up, if possible • Tell the patient to take 3 deep breaths and then cough into the container without touching inside of container.

21. Sputum Specimen Collection • Instruct to obtain ~15 cc. Close and give to nurse. • Wearing gloves, cover, bag, label • Send to the lab within 30 minutes • Offer patient oral care • Document patient teaching, equipment used, appearance, consistency and amount of specimen, patient response and time sent to lab

22. Critical Thinking • The nurse is assigned to care for Mr. Y. today. Today’s activities include: • Bathing • Sputum collection • Ambulation in room • Assist with breakfast • Prioritize how you would carry out these activities: 1. 2. 3. 4.

23. Stool Collection • May be done for Ova and Parasites (O&P), Guaiac, and/or amoebas • Only small amount of stool (1 inch of formed stool or 15-30 cc loose stool) is needed • May be done for 3 subsequent defecations • Send to lab WHILE WARM—YUK!

24. Stool Collection • Explain why specimen is needed • Provide bedpan or hat • Provide privacy • Wearing gloves, transfer stool with a tongue blade to container • Place into bio-hazard bag, seal, and label • Send immediately to lab

25. Stool Collection • Remove gloves and wash hands • Document patient teaching, equipment used, appearance of stool, and time sent to lab

26. Hemoccult Test • Assess for blood in the stool • Procedure: • Use tongue blade, obtain stool. • Place thin smear of stool in box on cardboard slide. • Obtain second specimen from different part of stool. • Smear stool in second slide • Close slide cover

27. Hemoccult Testing • Turn over and place drop of developing solution on box • Read results after 30-60 seconds.

28. Hemoccult testing Negative results (No blue color) Positive results (blue color means blood)

29. Culturing Microorganisms • A wound culture is a laboratory test in which microorganisms from a wound are grown in a special growth medium. • It is done to find and identify the microorganism causing an infection in a wound or an abscess. If a microorganism is found, more testing is done to determine the antibiotics that will be effective in treating the infection.

30. Culturing Microorganisms • To enable healing and prevent the spread of infection to other body tissues, the infecting microorganisms must be killed. A wound culture discovers which type of microorganism is causing the infection and the best antibiotic with which to kill it.

31. Procedure • Using a sterile culturette swab, press the swab into the wound or material. Then the nurse should gently turn the swab to collect as much tissue or fluid as possible. • Take the second culturette swab and do the same in another site. • Following collection, place swab back in the sterile plastic sleeve.

32. After placing in the sterile holder, break the ampule at the bottom of the container to release the transport medium that will nourish the microorganisms until get it to the lab. •   Label specimen and send to lab • Note:- should NOT collect specimen from surface of wound or material. Surface material is contaminated with normal surface bacteria and will give false results.