NCM 103:

FUNDAMENTALS OF
NURSING PRACTICE
(Skills)
D. SPECIMEN COLLECTION

- involves collection of body fluids

and secretions suspected of containing
infectious organisms for culture and
sensitivity tests.
Preparing the Patient

Provide the patient, in advance, with

appropriate collection instructions and
information on fasting, diet, and medication
restrictions when indicated for the specific
test
Specimen Labelling, and Storage

• Specimens must be collected in an appropriate

specimen container to maintain the integrity of the
specimen.
• Test Information Sheets specify the type of container or
collection kit that should be used to collect the sample.
• After collection, label the specimen container with the
patient’s full name or code (for anonymous testing), date
of collection and one other unique identifier such as the
patient’s date of birth or Health Card Number. Failure to
provide this information may result in rejection or testing
delay.
Specimen Labelling, and Storage

• Complete all fields of the laboratory requisition:

include, the patient’s full name or code (for
anonymous testing), date of birth, Health Card
Number (must match the specimen label), enter the
name of the analysis(es) under test description,
source of specimen, date of onset, date of collection,
physician name and address, and clinical diagnosis.
• Place the specimen in the biohazard bag and seal
the bag.
Specimen Labelling, and Storage

• Insert the completed requisition in the pocket on the

outside of the sealed biohazard bag.
• Most specimens should be stored between 2-8°C.
Specific handling/storage information is included in the
test-specific Kit Instruction Sheets and
Test Information Sheets.
Packaging and Transportation

• All specimens must be

packaged carefully to avoid
breakage or leakage of the
specimen.
• The packaging of all
diagnostic specimens,
cultures or biological
products must be handled in
accordance with hospital
policy.
D. SPECIMEN COLLECTION

1.COLLECTING A
SPUTUM SPECIMEN
 may be ordered if a
bacterial, viral or fungal infection
of the pulmonary system is
suspected.

EQUIPMENT:
 sterile sputum specimen
container
 disposable gloves
 goggles or safety glasses
GUIDELINES FOR SPUTUM COLLECTION

1.The mouth should be free of any foreign matter. If available, the

mouth may be rinsed with filtered or sterile water prior to
collection.
2.Sputum should be coughed from deep in the chest and coughed into
the plastic collection bottle. To reduce the likelihood of
transmission to others, patients are encouraged to collect their
sputum specimens outdoors whenever possible.
3.Sputum specimens will be collected in the early morning if possible.
4.A hot drink or breathing deeply over a steam vessel (i.e. pan of
boiling water) may help raise sputum.
5.A specimen of 1-2 teaspoons in volume is adequate. The container
should not be more than ½ full. Following collection, the green
top will be placed securely on the plastic bottle.
GUIDELINES FOR SPUTUM COLLECTION

6.Unless instructed otherwise, collect 3 sputum specimens

on 3 consecutive days.
7.The specimen bottle must be labeled with the patient’s
name, date of birth and the date the specimen was
collected.
8.The laboratory slip must be completed with the patient’s
name, date of birth and the date the specimen was
collected.
GUIDELINES FOR SPUTUM COLLECTION

10. The specimen will be sent to the laboratory same day

as it is collected unless otherwise instructed. If
specimens are not transported immediately, they will be
refrigerated.
11.A minimum of 3 sputum samples will be collected at
least monthly for active TB cases to ensure they
convert to smear and culture negative.
12.Patients who have difficulty in raising sputum and need
to have sputum specimens induced will be
referred to their physician for this procedure.
I
PROCEDURE:

1. Explain procedure to patient. If patient may have

pain with coughing, administer pain medication if
ordered. If patient can perform task without
assistance after instruction, leave container at
bedside with instructions to call nurse as soon as
specimen is produced.
2. Assemble equipment.
3. Perform hand hygiene.
4. don disposable glove and goggles.
5. Adjust bed to comfortable working position. Lower
side rail closer to you. Place patient in semi-fowler’s
position. Have patient rinse mouth with water before
beginning procedure.
6. Instruct patient to inhale deeply and cough. If
patient has had abdominal surgery, assist patient
to splint abdomen.
7. If patient produces sputum, open the lid to the
container and have patient expectorate specimen
into container.
8. If patient believes he or she can produce more
specimen, have the patient repeat the procedure.
9. Close lid to container. Offer oral hygiene to patient.
10. Remove gloves. Perform hand hygiene.
11. Label container.
12. Record the time the specimen was collected and
sent and the nature and amount of secretions.
SPUTUM TRAP
Fisherbrand sputum
collection system
COLLECTING A STOOL SPECIMEN

 a stool specimen may be ordered as a means

of evaluating the feces, for example for
ova, parasites, or other pathogens that
may be causing diarrhea.

EQUIPMENT:
tongue blade (2)
Clean specimen container
biohazard bag
PROCEDURE:

1. Gather necessary equipment. Place disposable collection

container on toilet or bedside commode to catch stool
without urine. Instruct patient not to discard toilet paper
with stool. Tell patient to call you as soon as bowel
movement is completed.
2. Perform hand hygiene and put on gloves.
If random collection is needed:
3. After patient has passed a stool, use a clean tongue blade
to obtain specimen and place it in a dry, clean, urine-free
container.
4. Collect as much of the stool as possible to send to the
laboratory. If patient is wearing a diaper, the stool may be
collected from diaper.
5. Place lid on container, label with patient’s data, and place
container in small biohazard bag.
6. Remove gloves from inside out.
7. Perform hand hygiene
8. Transport specimen to laboratory while stool is
still warm. If immediate transport is impossible,
check with laboratory personnel or policy manual as
to whether refrigeration is contraindicated.
If stool is collected for ova or parasites:
9. Follow above steps. DO not refrigerate specimen.
Some institutions require ova and parasite specimen
to be placed in container filled with preservatives;
check institutional policy.
10. Document amount, color and consistency of stool
sent.
COLLECTING A URINE SPECIMEN FOR CULTURE

 is an assessment measure to
determine the characteristics of
patient’s urine.

EQUIPMENT:
moist towelette or alcohol wipe
disposable gloves
sterile specimen container
adhesive collection bag (infants)
syringe with blunt-tipped needle (for
specimen collection from a catheter)
 PROCEDURE:

For the adult who is capable of self-care:

1. Explain procedure to the patient, including
performing hand hygiene before and after
specimen collection. Instruct patient to wipe
perineal area from front to back or meatus of
penis with moist towelettte. Instruct male
patient who is not circumcised to retract
foreskin and clean glans of penis.
2. Have patient void about 25 ml into toilet, stop
stream, collect specimen and then finish
voiding. Tell patient not to touch the inside
of the container or the lid.
3. Have patient place lid on container. Don
gloves and label container with patient’s name,
date, time and person collecting specimen.
PROCEDURE:

4. Place container in biohazard bag. Remove

gloves and perform hand hygiene
5. Transport specimen to laboratory as soon as
possible. If unable to take specimen to
laboratory immediately, refrigerate it.
6. Document specimen sent, odor, amount, color
and clarity of urine.
 For very young children and infants:

1. Explain steps to a young child, if old enough and to the

parents. Talk to the child at child’s level, stressing that no
pain will be involved.
2. Perform hand hygiene and don disposable gloves.
3. If the child is old enough, follow the steps as for an adult.
For an infant, remove the diaper. Perform thorough
perineal care: for girls, spread labia and cleanse area; for
boys, retract foreskin if intact and cleanse glans of penis.
Pat skin dry.
4. Remove paper backing from adhesive faceplate over labia
or over penis. Gently push faceplate so that seal forms on
the skin. Take care to not contaminate inside of bag when
applying because it is considered sterile.
 For very young children and infants:

5. Apply clean diaper over bag. Remove gloves and

perform hand hygiene. Check bag frequently to see
whether child has voided.
6. As soon as enough urine is in collection bag, perform
hand hygiene and don gloves. Gently remove bag by
pushing skin away from bag. Using sterile scissors, cut
corner of bag and pour urine into sterile container.
7. Perform perineal care and reapply diaper.
8. Follow actions 3 to 6 in the
adult section of the procedure.
For the patient with an indwelling urinary catheter:

CONSIDERATIONS:
• The only way to get an uncontaminated sterile
urine specimen from a urinary catheter is to
remove old catheter and insert new catheter.
This is the recommended method for obtaining a
culture and sensitivity.
• Some catheters are not re-sealable and you risk
introducing bacteria into the system if punctured
to obtain a specimen.
• It is preferable to obtain early morning specimen
due to concentration of sediment.
For the patient with an indwelling urinary catheter:

CONSIDERATIONS:
• Keep urine specimen refrigerated to prevent
chemical changes, if unable to transport specimen
to the lab immediately.
• The urine should be withdrawn from a port on the
tubing if available. If not available, the catheter may
be punctured with syringe and needle only if the
catheter is rubber and is self-sealing.
• Silastic, silicone or plastic catheters are not self-
sealing and should not be punctured with a needle.
For the patient with an indwelling urinary catheter:

1. Explain procedure to patient. Organize equipment at bedside.

2. Perform hand hygiene and don disposable gloves.
3. Clamp or kink off drainage tubing near urinary catheter distal
to the port. Remove lid from specimen container, keeping
the inside of the container and lid-free from contamination.
4. Cleans e aspiration port with alcohol wipe and allow port to
air dry.
5. Insert the blunt tipped needle into the port. Slowly aspirate
enough urine for specimen (usually 5ml is adequate).
Remove blunt-tipped needle from port.
6. Slowly inject urine into specimen container. Dispose of
needle and syringe appropriately.
7. Perform action 3 through 6 in the adult section of this
procedure.