coolection of specimen

7/30/2019 Coolection of Specimen

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SPECIMEN COLLECTION

SPECIMEN

Specimen may be defined as a small quantity of a substance or object, which

shows the kind and quality of the whole sample

PURPOSE

1. To know the normal function of the body2. To make diagnosis and prescribe treatment3. To know the progress or regress of the diseases4. To know the effect of special treatment and drugs5. To assess the general health of the patient

PRINCIPLES OF SPECIMEN COLLECTION

1. Contaminated and improperly collected specimen will produce false results whichwill adversely affect in diagnosis and treatment

2. Provide proper instruction and explanation to patients such as when to collect,what to collect, how to collect and quantity

3. Equipments used for collection should be neat and dry4. Collect all kind of specimen at morning if possible5. For culture specimen, use sterile container6. Label the container with name, age, sex, MRD no, date, time and specimen name

Types of specimen collection

1. Urine- routine and culture2. Stool- routine and culture3. Sputum- routine and culture4. Blood- routine and culture


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COLLECTION OF URINE SPECIMEN FOR ROUTINE TEST

DEFINITION

Collection of a small quantity of urine sample in a clean container for testing it in the lab

setting

PURPOSE

To identify and measure the presence of abnormalities in urine such as whiteblood cells, red blood cells, casts, puss cells, pH, sugar, albumin and specific

gravity

CHARACTERISTICS OF URINE

Volume

An amount of 1000 to 2000 ml of urine is excreted in 24hours. It may vary according to

the water intake in the season. In winter output is more and summer it is less

Variation in urine volume

1. Abnormal increase in volume is called polyuria.2. Decreased quantity of urine or below 500ml in 24 hours is known as oliguria3. Total absence or marked decrease in urine is known as anuria

Color and the normal urine: Normal colour is pale yellow or umber or straw colored

depends up on the concentration. If quantity increases the color will be pale yellow anddecreases it becomes deep yellow

Variations or abnormal colours:

1. Bright red- indicates presence of blood in urine (hematuria)2. Pink- indicates small amount of blood in urine3. Smoky brown- blood pigments4. Milky white- chyluria due to filariasis, pus in blood

Turbidity and appearance: The normal urine is clear with no deposit

Odor: normal urine has aromatic odour

Specific gravity: it varies from 0.010 to 1.025

Alkalinity or acidity pH value: it varies from 4.6 to 8

ARTICLES

A clean tray containing,

1. Clean, wide mouthed plastic container2. Bed pan or urinal3. Soap and water4. Lab investigation forms


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5. Clean gloves6. Appropriate labels marked with full name, age, sex, MRD number, date, time,

name of the ward and name of the test to be done

PROCEDURE

S.NO STEPS RATIONALE

1 Identify the patient Check physicians

order and provide privacy if needed

Obtain specific instruction and

confirming the necessity of doing this

procedure

Privacy allows patient to relax and

reduce embarrassment

2 Explain the procedure to the patient

with special instructions about clean

and wash the genital areas with soap

and water thoroughly

Female: Wash the urethralmeatus and surrounding area.

Male: Hold the penis with onehand and cleanse the end of

penis moving the centre to

outside using soap and water.

For helpless patient: Thenurses should do the perineal

care.

Give labelled container and instruct

the patient not to wet the label on the

container.

Washing genital area prevents

contamination of urine specimen.

Labelling helps in identification of

samples.

3 Ask the patient to void the first and

last part of the urine stream into the

urinal or toilet and collect the middle

part of the stream into the specimen

container and do not touch inside of

the container.

Collecting midstream urine avoids

contamination of the specimen with

organisms normally present on the

skin. Four ounce (120ml) is required

for the test.

4 Ask the patient to place the filled

container in allotted place.

Unnecessary placement causes

contamination.

5 With gloved hand place the specimen

container in polythene bag.

Protects the health workers from

contamination of urine.6 Send specimen to the lab with

completed, signed lab form within

15minutes or refrigerate it.

To prevent decomposition of urine.

7 Remove gloves and wash hands.

8 Record the procedure in the nurses

note and lab register.

It act as a proof.


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COLLECTION OF URINE FOR URINE CULTURE

DEFINITION

Collection of a small amount of urine, i.e.30 to 60ml for detecting the presence and

growth of micro organisms in the sample

PURPOSES

1. To culture pathogenic micro organisms present in the urine2. To determine antibiotic sensitivity of the pathogens in the urine

ARTICLES

A clean tray containing

1. Sterile urine container in a plastic cover2. Scissors (optional)3. Lab forms4. Soap and water5. Bed pan or urinal6. Appropriate labels marked with full name, age, sex, MRD number, date, time,

name of the ward and name of the test to be done

PROCEDURE

S.NO ACTION RATIONALE

1 Identify the patient Check physiciansorder and provide privacy if needed

Obtain specific instruction andconfirming the necessity of doing this

procedure

Privacy allows patient to relax and

reduce embarrassment

2 Explain the procedure to the patient

with special instructions about clean

and wash the genital areas with soap

and water thoroughly

Female: Wash the urethral meatus and

surrounding area

Male: Hold the penis with onehand and cleanse the end of

penis moving the centre to

outside using soap and water

For helpless patient: The nursesshould do the perineal care and

assist in giving bedpan or urinal

Give labelled container and instruct the

patient not to wet the label on the

container

Washing genital area prevents

contamination of urine specimen.

Labelling helps in identification of

samples

3 Instruct to open specimen containerand place cap with sterile inside surface

Contaminated specimen will lead toinaccurate reporting of culture and


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up and not to touch inside of container

and lid

sensitivity

4 Ask the patient to void the first and last

part of the urine stream into the urinal

or toilet and collect the middle part of

the stream into the specimen containerand do not touch inside of the

container (midstream sample)

Collecting midstream urine avoids

contamination of the specimen with

organisms normally present on the

skin.

5 Replace cap securely on specimen

container, cleanse any urine form

external surface of the container

Prevents transfer of micro organism

6 Ask the patient to place the filled

container in allotted place

Unnecessary placement causes

contamination

7 With gloved hand place the specimen

container in polythene bag

Protects the health workers from

contamination of urine

8 Send specimen to the lab with

completed, signed lab form within

15minutes

To prevent decomposition of urine

9 Remove gloves and wash hands

10 Record the procedure in the nurses

note and lab register

It act as a proof

Special consideration

1. Patients who are catheterized should have the specimen withdrawn using a sterileneedle and syringe from the catheters sample port. Clamp the collection tube for

about 30 minutes before taking samples

2. Urine sample should be sent to lab immediately within 30 minutes if notrefrigerate it and culture done within 24hours

3. About 30 minutes prior to collecting the specimen, patient may be advised todrink fluids unless contraindicated

24 hours urine specimen

For a 24hours urine specimen, all urine voided in a 24 hour period is collected.

The collection is initiated at a specific time, which is noted, and the client is askedto empty his bladder at that time. The urine is discarded. After this all the urine iscollected in a common receptacle for the next 24hours. Usually, it is done from

6AM to 6AM of next day


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STOOL/FAECES ROUTINE TEST AND CULTURE

Collection of stool specimen for specific or routine test

PURPOSE

1. To identify specific pathogens2. To determine the presence of blood, ova and parasites3. To determine the presence of fat4. To do gross examination of stool characteristic such as colour, consistency and

odour

NORMAL CHARACTERISTICS OF FAECES

1. Colour: light to dark brown2. Odour: pungent smell3. Frequency; 1 to 2 times per day4. Quantity: 4 to 5 ounces per day5. Composition: 30percent of water, shed epithelium from intestine, a considerable

quantity of bacteria and a small quantity of nitrogenous waste matter

ABNORMAL CHARACTERISTICS OF FAECES

Color

1. Tarry, black stools: bleeding in the upper gastro intestinal tract2. Black color stools: melena, administration of iron or charcoal3. Clay color stool: obstruction to the flow of bile4. White color stool: presence of barium salts after barium tests

Odor

1. Melena and dysentery: foul smellFrequency

1. Diarrhea: increased frequency2. Constipation: decreased frequency

Consistency and form

1. Watery stools: diarrhea2. Rice water stools: cholera3. Pea soup stools: typhoid fever

Appearance

1. Fresh blood in large amounts: bleeding piles2. Blood and mucus stool: amoebic or bacillary dysentery3. Worms or worm segments in stools: parasitic cysts, ova or larvae


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GENERAL INSTRUCTIONS

1. Faecal specimens should be collected in the early stages of disease, preferablybefore the antibiotic treatment is given

2. Stool specimen should collect in a sterile container (using a scoop which isattached to the lid itself)

3. After collection, the lid should be immediately replaced tightly4. After proper labelling, the collected stool should be handed over to the laboratory

without delay, i.e. within 15 minutes

ARTICLES


1. Appropriate specimen container (sterile)2. Spatula (clean for routine and sterile for culture)3. Bedpan or portable commode4. Gloves5. Waste paper

PROCEDURE

S NO STEPS RATIONALE

1 Explain the procedure to the patient To obtain co-operation

2 Obtain lab request and container For proper documentation and sending

the specimen to lab

3 Provide privacy It provides comfort

4 Arrange the articles at the bedside Saves time and energy

5 Provide bed pan if necessary and

instruct the patient to defecate into

clean dry bedpan or commode

6 Instruct to not to contaminate

specimen with stool

7 Wear gloves To avoid infections

8 Collect the stool specimen with clean

spatula for routine stool examination

and with sterile spatula for culture

test

9 Close it with lid tightly10 Remove gloves

11 Wrap spatula in a waste paper and

discard appropriately

12 Label specimen container with

patient name, hospital number ward

name and date and time of collection

13 Send to lab immediately, within 15

minutes

Fresh specimen provides more

accurate results

14 Replace equipments

15 Record procedure in nurses record

with time and date


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SPUTUM CULTURE

Collection of coughed out sputum for culture studies to identify respiratory

pathogens

PURPOSES

1. To detect the micro organism, that causes respiratory tract infections2. To treat with specific antibiotics

CHARACTERISTICS OF SPUTUM

Quantity: normally no sputum is expectorated but the amount of sputum coughed up in

24 hours varies with the disease

Consistency: the sputum may be classified into various types according to the

consistency and appearance. E.g. serous, frothy, mucoid, purulent, seropurulent and

hemorrhagic

Odor: normally the sputum is odorless, in case of respiratory tract infections the sputum

will be foul smelling.

Color: sputum consists of mucus may be colourless and translucent

1. Yellowish color: presence of pus2. Blackish sputum: excessive smoking3. Blood: hemoptysis4. Red and frothy sputum: fresh bleeding from lungs5. Greenish colour: bronchiectasis6. Brown colour: gangrenous condition of the lungs7. Rusty colour: pneumonia

GENERAL INSTRUCTION

1. Collect the sputum in the early morning.2. Do not use any antiseptic mouth washes prior to sputum collection.3. If sterile specimens are required- sterile bottle with cover is given to the patient.4. Collect at least 10ml of sputum for sputum culture test.

ARTICLES

A clean tray containing

1. Sterile Specimen container2. Sputum cup3. Tissue paper/ gauze pieces4. Clean gloves5. Kidney basin


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PROCEDURE

S.NO ACTION RATIONALE

1 Check physicians order

2 Arrange all the articles

3 Explain the client that the specimen,must be taken at morning before

brushing teeth

To obtain overnight accumulatedsecretions

4 Ask the patient to sit erect in bed if

possible

Provide easy access for collection of

specimen

5 Wash hands, put on gloves and wear

mask if necessary

To prevent transmission of infection

6 Keep sterile specimen container ready

for the sample and take a tissue paper

in hand

7 Remove lid of container and place with

inner side facing upwards

Prevents contamination

8 Instruct the patient to take deep

breaths and then cough out deeply

It helps to loosens the secretions and

obtain adequate specimen

9 Explain the patient to spit the sputum

into the sterile container without

touching the side of it.

Prevents contamination of the

specimen

10 Close the container without touching

inside of it

11 Provide client with tissue paper and a

comfortable position

To clean the lips

12 Replace articles13 Wash hands

14 Provide mouth care if patient needs it

or encourage patient to carry out oral

hygiene

15 Document obtained specimen with

name, age, sex, MRD number, date

and time of collection and

characteristics of the specimen and

send specimen to lab

Documentation serves as an evidence


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SPUTUM CULTURE FOR AFB

The reason AFB or TB culture is recommended is to confirm the diagnosis of TB.

Secondly, the culture test can be followed by susceptibility testing, which is very useful,since many cases are now multi-drug resistant, and the drugs susceptibility results can

be used to modify the treatment and make it more specific for the patient.

PURPOSE OF TEST

Positive AFB cultures identify the particular mycobacterium causing symptoms, and

susceptibility testing on the identified organism gives the doctor information about how

resistant it may be to treatment.

GENERAL INSTRUCTION

1. It is preferably collect an early morning sputum specimen before brushing orrinsing the mouth.

2. Deeply coughed specimen, preferred.3. Recommended screening procedure: 3 first morning specimens collected on 3

successive days. However, 3 samples collected at 8 hour intervals will be

accepted. Have patient rinse mouth well with water to avoid contamination with

food particles and mouth flora

4. Minimum volume 2mlTEST RESULT INTERPRETATION: Growth or No Growth with sensitivity pattern

PROCEDURE: see the procedure of sputum culture


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COLLECTION OF BLOOD FOR ROUTINE TEST

DEFINITION

Obtaining blood sample by venipuncture for routine lab investigation

PURPOSE

1. To detect the micro organisms2. To treat the disease condition with correct antibiotics3. To detect the right antibiotic to kill the particular micro organism


1. Special kind of tubes with coloured top are using for blood sample collection2. Colour coding of the top depends upon the kind of blood test. E.g. red indicates

biochemistry, lavender or violet indicates pathology, blue indicates clotting

studies

ARTICLES


1. Mackintosh and towel2. Clean gloves (optional)3. Surgical spirit or betadine solution4. Disposable syringe 5ml or 10ml with needles5. Cotton swabs6. Specimen container- test tube or bottle7. Paper bag8. Kidney tray9. Tourniquet10.Lab requisition form11.Adhesive tapes

PROCEDURE


1 Check the physicians order2 Identify the patient Ensures co-operation from patient

3 Explain the procedure to patient

4 Wash hands and put on clean gloves To prevent infection and avoid getting

blood in hands

5 Select and examine the veins,

visualize the vein, including the

antecubital area, wrist, dorsum (back)

of the hand and top of foot (if

necessary). Choose the appropriate

wide vien to be drawn by touching the

skin over the vien in a circular motion.

Select a vein that is visible, palpable

and fixed to the surrounding tissues

so that it does not roll away


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6 Instruct the patient to extend his arm.

Hold the arm straight at the elbow

with fist clenched.

Proper positioning increases the

visualization of veins

7 Apply the tourniquet 5 to 15cms

above the selected site with just

sufficient pressure to obstruct venousflow

A tourniquet when applied increases

venous pressure and makes the vein

more prominent and easier to enter

8 Cleanse the skin with alcohol swabs

(or betadine if alcohol is not available)

in a circular motion; centre to

periphery. Allow to dry it.

Cleansing the skin reduces the

number of micro organism

9 Fix chosen vein with thumb and draw

the skin taut immediately below the

site before inserting the needle to

stabilize the vein.

The vein may slip and move under the

skin when the needle approaches its

outer surface, especially in elderly,

extreme thin patient and diabetic

patient.

10 Hold the syringe between the thumb

and last three fingers with the bevel

up and directly in line with the course

of the vein. Insert the needle quickly

and smoothly under the skin into the

vein

11 Obtain blood sample by gently pulling

back on the plunger

Use minimal suction to prevent

haemolysis of blood and collapse of

vein

12 Release the tourniquet as soon as the

specimen is obtained and ask thepatient to open the fist

13 Apply sterile gauze piece to puncture

site without applying pressure and

withdraw needle slowly along the line

of vein

Slow withdrawal of the needle is less

painful and reduces trauma

14 Request patient to apply gentle but

firm pressure to site for 2-4 minutes

Firm pressure over puncture site

prevents leakage of blood into

surrounding tissues with subsequent

hematoma development

15 Remove the needle from the syringe

as soon as possible after withdrawing

blood, gently eject the blood sample

into the appropriate container without

forming bubbles in the test tube or

bottle

Gentle ejection of blood prevents

haemolysis

16 Invert the tube gently several times to

mix blood with anticoagulant where

applicable. For some tests blood is

allowed to coagulate in the test tube

Gentle handling of specimen prevents

risk of haemolysis

17 Label specimen correctly and send to

laboratory immediately withcompleted requisition forms

Specimen should reach the laboratory

with the minimum of delay foroptimum reliability


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18 Dispose the needle and syringe in

appropriate containers

Avoids possible spread of blood borne

disease

19 If there is any spill, Clean all spills

with sodium hypochlorite solution

Avoids possible spread of blood borne

diseases

20 Record in the patients chart the

procedure and the tests for which thesample was sent to the laboratory

21 Replace the tray with the reusable

articles in proper place


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COLLECTION OF BLOOD FOR CULTURE TEST

DEFINITION

Collection of blood for culture to determine presence of micro organisms in the

blood


3. Blood culture should be taken before antibiotic treatment4. For children, 2-5ml and neonate 1-2ml of blood is required for culture

investigation

5. Blood should never taken from IV line6. Special kind of culture bottles are using for blood sample collection7. All blood culture bottles should be carefully examined for clarity of media, any

medium showing turbidity or cloudiness should not be used.

8. Only disposable syringes and needles should be used for collection of blood9. The top of the bottle must be carefully disinfected just before the bottle is

inoculated

10.Blood should never be taken from an IV line or above the IV line11.

If blood culture bottles are available, blood should be immediately added to theculture medium

12.If blood culture bottles are not available, blood may be transported in a steriletube containing a sterile anticoagulant solution

13.The amount of blood collected is 10ml for adult, 2 to 5 ml for children and 1 to 2ml for infants and neonates

ARTICLES


1. Blood culture bottles2. Cotton swabs3. Spirit4. Syringe 10-20ml and needle5. Povidone iodine or betadine solution6. Sterile gloves7. Tourniquet8. Laboratory requisition forms

PROCEDURE


1 Assess the physicians order for bloodculture investigation

Obtains knowledge of samples to becollected and the reason for doing


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culture

2 Explain procedure to the patient and

provide a comfortable position

Gains co-operation of the patient

during the procedure

3 Wash hands. Don sterile gloves Reduces transmission of micro

organisms and maintains aseptic

technique4 Apply tourniquet above the puncture

site and palpate the venipuncture site

Restricts blood flow and promotes

easy visibility of veins

5 Wipe the site with 70% alcohol in a

circular manner from centre to

periphery for approximately 5cm in

diameter and allow to dry

6 Cleanse the site again with betadine

starting from centre in even widening

circles. Allow the betadine to remain

on the skin for at least one minute.

Clean the site with 70% alcohol

Avoids contamination and maintains a

sterile field

7 Puncture the site and draw 10ml of

blood

Restore circulation

8 Remove the tourniquet once the

blood is collected

9 Remove the needle and apply

pressure to the puncture site with dry

cotton simultaneously

Stops bleeding from puncture site

10 Change the needle with a fresh

needle before injecting the blood into

the bottles11 Remove the metal cover on the cap

of culture bottles and push 10ml of

blood into the bottles be careful not

to touch the sides of the bottle

Maintains strict aseptic technique

12 Mix the blood and culture media by

shaking the bottle gently

13 Discard the contaminated articles.

14 Remove gloves

15 Wash hands Prevents transmission of infection

16 Fill the lab requisition formappropriately and label the bottles

with patients name, identification

number, date and time of collection

17 Transfer the specimen to the lab

immediately

18 Record the procedure in the patients

chart with date and time of collection

Communicates adequate information

to members of health care

professionals

19 Repeat the procedure within an

interval of 30minutes to one hour as

per the number of samples requiredfor different puncture sites.


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coolection of specimen

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