Procedure 66 Collecting A Throat Culture Procedure …...Procedure 67 Collecting A Sputum Specimen...

Chapter 10 Specimen Collection

Procedure 66 Collecting A Throat Culture

Procedure 67 Collecting A Sputum Specimen

Procedure 68 Collecting A Specimen For Gastric Analysis

Procedure 69 Collecting A Midstream Urine Sample

Procedure 70 Collecting A 24-Hour Urine Specimen

Procedure 71 Collecting A Sterile Urine Specimen From An Indwelling Catheter

Procedure 72 Obtaining A Urine Specimen Using The Speci-Cath® Collection Device

Procedure 73 Collecting And Testing A Stool Specimen For Occult Blood

Procedure 74 Obtaining A Fingerstick Blood Sugar

PERFORMANCE REVIEW CHECKLIST

Procedure 66

Collecting A Throat Culture

Name of Patient Care Technician ________________________ Date of Program ______ to ______

Social Security Number or Identification Number _______________________________

Program Code Number (if any) _________________

S=Satisfactory PerformanceU=Unsatisfactory Performance

Place a full signature to correspond with each set of initials appearing below.

Supplies needed:

• Disposable exam gloves• Surgical mask• Tongue blade• Flashlight or penlight• Culturette container

Initials Corresponding Signature of Instructor Title

Procedure Guidelines S/U Date Initials S/U Date Initials

1. Perform your beginning procedure actions.

2. Ask the patient to tilt the head back. Place a tongue blade on the tongue, then check the back of the throat with a flashlight for red or inflamed areas.

3. Remove the tongue blade and flashlight.

4. Remove the culturette from the plastic tube.

5. Depress the tongue with the tongue blade, using your nondominant hand.

6. With your dominant hand, swab the throat from side to side with the culturette. Avoid the tongue.

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Instructor Signature Date

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Student Signature Date

7. Remove the culturette and insert it in the plastic tube. Crush the ampule of transport medium in the bottom of the tube. Push the swab down into the medium.

8. Perform your procedure completion actions.



Procedure 67

Collecting A Sputum Specimen






Supplies needed:

• Disposable exam gloves• Surgical mask• Gown, mask, goggles, if needed, or according to facility policy• Emesis basin• Sputum collection container• Alcohol or other disinfectant




2. Instruct the patient to rinse the mouth with water, then spit it into the emesis basin.

3. Advise the patient to take several deep breaths, then expectorate sputum from the lungs into the collection device. Expectorate means to spit or eject fluid from the mouth. After the patient’s sample is in the collection device, cap the device securely.

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4. After the specimen is obtained, handle the container with gloves. Disinfect the outside of the container with alcohol or facility-approved disinfectant solution before affixing the label or handling the container with your hands.




Procedure 68

Collecting A Specimen For Gastric Analysis






Supplies needed:

• Disposable exam gloves• Supplies for nasogastric tube insertion• Sterile irrigation kit, or bulb syringe and medium-size basin• 12 sterile specimen collection containers with lids, labeled #1 through #12




2. Insert a nasogastric tube, if not already in place (Procedure 58).

3. Tape the nasogastric tube securely to the patient’s nose, according to facility policy.

4. Attach the bulb syringe to the nasogastric tube. Withdraw the gastric contents. Discard in the basin.

5. Wait 15 minutes.

6. Collect 4 additional gastric specimens, each 15 minutes apart. Place each specimen in a separate container, using the containers labeled #1 through #4.

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7. Inform the RN when the last specimen has been collected. He or she will administer an injection to stimulate acid production in the stomach.

8. Wait 15 to 30 minutes, or the time designated by facility policy.

9. Collect 8 additional gastric fluid specimens, each 15 minutes apart. Place these in the specimen collection containers labeled #5 through #12.

10. Obtain instructions from the RN on whether to leave the nasogastric tube in place or remove the tube.




Procedure 69

Collecting A Midstream Urine Sample






Supplies needed:

• Disposable exam gloves• Bedpan, urinal, commode, or toilet• Paper towel• Midstream urine collection kit OR

— Washbasin of water— Soap or facility-approved cleansing solution— Towel— 3 sterile 4 x 4 gauze sponges— Sterile specimen collection cup with lid— Transport bag with biohazard label— Plastic bag for used supplies




2. Cleanse the labia in the female with soap and water or a facility-approved cleansing solution.

a. Separate the labia with the thumb and forefinger.

b. Wipe down one side of the inner labia from front to back; wipe only once. Discard the gauze sponge.

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c. Wipe down the opposite side of the inner labia from front to back; wipe only once. Discard the gauze sponge.

d. Wipe down the center of the inner labia from front to back; wipe only once. Discard the gauze sponge.

Cleanse the penis in the male patient with soap and water or a facility-approved cleansing solution.

a. Retract the foreskin.

b. Cleanse the penis in a circular motion, beginning at the urethra; wipe only once. Discard the gauze sponge.

c. Cleanse the penis in another circle, extending to a larger area than the first; wipe only once. Discard the gauze sponge.

d. Cleanse the penis in another circle, extending to a larger area; wipe only once. Discard the gauze sponge.

3. Instruct the female patient to hold the labia apart after cleansing, or hold them apart with your gloved hand.Instruct the male patient to keep the foreskin retracted until after voiding, or hold it with your gloved hand.

4. Instruct the patient to begin voiding in the bedpan, urinal, toilet, or commode.

5. Without stopping the flow of urine, place the specimen collection cup under the urine stream. Collect an adequate amount of urine in the cup: 30 mL to 50 mL, or according to facility policy.

6. Remove the specimen cup, cap it, and place it on a paper towel. Allow the patient to finish voiding in the toilet.

7. Instruct the patient to wash hands. Assist, if necessary.




Procedure 70

Collecting A 24-Hour Urine Specimen






Supplies needed:

• Disposable exam gloves, box• 4-liter collection bottle with lid, or special container used by facility • Bedpan, urinal, commode, or specimen collection device• Graduated container for measuring and transferring urine• Refrigerator or basin of ice to store collection container• Plastic bag for toilet tissue and used supplies




2. Ask the patient to void. Discard this urine.

3. Begin timing the specimen collection.

4. Each time the patient voids, record intake and output, if ordered. Transfer the specimen to the collection container. Refill ice in the storage container as often as necessary.

5. At the end of 24 hours, stop the collection. Ask the patient if he or she needs to void, and add this sample to the container.

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Procedure 71

Collecting A Sterile Urine Specimen From An Indwelling Catheter






Supplies needed:

• Disposable exam gloves• Catheter clamp or rubber band• Sterile specimen collection container• Alcohol sponge• 20-mL to 30-mL syringe with 25-gauge needle• Disposable or reusable incontinent pad• Sharps container• Paper towel



1. Clamp the catheter below the collection port for 10 or 15 minutes.


3. Remove the lid from the sterile specimen cup. Place the cup on a paper towel. Place the lid with the inside up on the table.

4. Wipe the collection port with the alcohol sponge. Allow the alcohol to dry.

5. Remove the cap from the needle. Turn the bevel of the needle facing up. Insert the needle into the collection port at a 30- or 45-degree angle.

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6. Gently pull back the plunger, withdrawing the urine sample. Collect at least 10 mL of urine, or follow your facility policy. Remove the needle from the collection port.

7. Remove the clamp or rubber band from the catheter.

8. Transfer the urine into the collection cup. Depress the plunger gently to avoid splashing.

9. Do not recap the needle. Discard the needle and syringe in the sharps container.




Procedure 72

Obtaining A Urine Specimen Using The Speci-Cath® Collection Device






Supplies needed:

• Disposable exam gloves• Washcloth• Towel• Bath blanket• Washbasin• Soap and water• Underpad• Male, female, or pediatric Speci-Cath® collection kit containing:

— 8 Fr. vinyl catheter attached to test tube, with cap and label— Sterile gloves— 3 povidone-iodine swabsticks— Fenestrated drape— Sterile packet of water-soluble lubricant

• Plastic bag for used supplies




2. Place the underpad under the patient’s buttocks.

3. Position and drape the patient for perineal care.

4. Apply gloves.

5. Provide perineal care.

6. Discard used supplies.

7. Wash your hands.

8. Adjust or position the lighting, if necessary.

9. Clean the overbed table. Disinfect the table, if soiled, or if required by facility policy.

10. Open the Speci-Cath® kit and establish a sterile field.

11. Place the plastic bag for used supplies at the foot of the bed, or in another convenient location. Position the bag so that you do not have to cross over sterile supplies to discard soiled items.

12. Apply sterile gloves.

13. Open the sterile packages on the sterile field and arrange supplies as needed.

14. Open the package of povidone-iodine swabsticks.

15. Open the package of lubricant.

16. Lubricate the tip of the catheter. The lubricant should cover the catheter for approximately 2 inches for a female and 4 to 5 inches for a male.

17. Pick up the fenestrated drape. Stand away from the bed and hold the drape away from your body, allowing it to unfold.

18. Fold the drape back, over your gloves.

19. Position the hole in the center of the drape over the perineum. If it is necessary to lift the penis to position the drape, use your nondominant hand. This hand will be contaminated after touching the patient’s skin and cannot be used to contact sterile supplies.

20. Use the swabsticks to cleanse the genitals:


Female patient: Separate the labia with the nondominant hand. This hand is now contaminated. Wipe the swabstick across the labia from top to bottom, on the side opposite where you are standing. Use one stroke, then discard the swabstick. Pick up another swabstick and repeat the procedure on the labia closest to you. Discard the swabstick. Pick the last swabstick and cleanse the center of the labia from top to bottom. Discard the swabstick. Keep the labia separated throughout the procedure. Do not let go after cleansing.

Male patient: Pick up the penis with the nondominant hand. This hand is now contaminated. Retract the foreskin of the penis. Beginning at the urinary meatus, wipe the penis with a swabstick in a circular motion. Discard the swabstick. Pick up another swabstick and repeat the procedure, cleansing outward from the meatus in a circle. Discard the swabstick. Pick up the last swabstick and cleanse in a circle beyond the second circle. When done, you should have cleansed a large area. Discard the swabstick.

21. Pick up the test tube.

22. Insert the catheter:

Female patient: Visualize the urinary meatus. Tell the patient you will be inserting the catheter now. Instruct the patient to cough. This will help relax the urinary sphincter. Insert the catheter into the urethra, threading it into the bladder (about 21⁄2 or 3 inches) until urine flows. If urine does not flow immediately, hold the catheter in place until urine drains. If no urine flows, the catheter may be in the vagina. Leave it in place. You must get another Speci-Cath® and repeat the procedure. Leaving it in place will make it easier to find the urethra the next time.


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Remove it after the catheterization is successful. If an assistant is helping you, continue to hold the labia apart, and send him or her for another Speci-Cath®. When he or she returns, have the assistant open the Speci-Cath®. Grasp it with your sterile hand and repeat the procedure.

Male patient: Hold the penis upright with your nondominant hand. Insert the catheter into the meatus. Tell the patient you will be inserting the catheter now. Instruct the patient to cough while you are inserting the catheter. The patient may also bear down, as if to urinate. Encourage him to continue throughout the procedure. Advance the catheter until urine flows.

Never force a catheter. If you meet resistance and are unable to advance the catheter, stop the procedure and notify the RN.

23. Fill the test tube completely, then withdraw the catheter slowly.

24. Pull the end of the catheter. This will remove it from the top of the test tube. Discard the catheter in the plastic bag. Snap the top of the test down, sealing the tube.

25. Replace the foreskin in the male patient.

26. Remove the drape. Discard it in the plastic bag.




Procedure 73

Collecting And Testing A Stool Specimen For Occult Blood






Supplies needed:

• Disposable exam gloves, 2 pair• Bedpan, commode, or specimen collection device• Tongue blade• Hemoccult® test kit, or other brand of guaiac test• Guaiac developing solution• Plastic bag for used supplies




2. Assist the patient with the bedpan or commode, or position the specimen collection device in the toilet.

3. Provide privacy until the patient has a bowel movement. Instruct him or her to signal when finished, and return promptly.

4. Apply gloves.

5. Assist the patient with cleaning the perineum, handwashing, and returning to bed, as necessary.

6. Using the tongue blade, collect a small amount of stool.

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7. Prepare the slide for testing according to the instructions on the package:

a. Apply a thin layer of stool on panel one.

b. Obtain a second small specimen from a different part of the stool. Apply a thin layer to panel two.

c. Turn the package over.

d. Lift the flap.

e. Apply 2 drops of developing solution on each panel of stool, and to the control at the bottom of the slide.

f. Within 60 seconds, compare the results with the color changes described on the package. If the sample turns blue, this suggests the presence of blood.




Procedure 74

Obtaining A Fingerstick Blood Sugar

Note: This procedure is generic and applies the principles used for most blood glucose meters. Follow the directions for the meter and strip you are using. The operating directions are slightly different for each.






Supplies needed:

• Disposable exam gloves• Alcohol sponge• Lancet• Blood glucose meter• Reagent strip or test strip for the blood glucose meter being used• Sharps container• Plastic bag for used supplies




2. Wipe the patient’s finger with the alcohol sponge. Allow the alcohol to dry.

3. Pierce the sides of the middle or ring finger using the lancet.

4. Discard the lancet in the sharps container.

5. Squeeze the sides of the finger gently to obtain a drop of blood.

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6. Hold the puncture site directly over the reagent strip and place a hanging drop of blood onto the reagent pad. If using the Glucometer Elite®, place the test strip next to the puncture site and allow the test strip to withdraw the blood into the center tube.

7. Insert the strip into the meter, if this was not done previously.

8. Wipe the patient’s finger with the alcohol sponge and allow to dry. Apply pressure until bleeding stops. Apply a bandage, if necessary.

9. Wait the designated period of time for the meter you are using. An audible beep will indicate when the value is displayed on the screen.



Procedure 66 Collecting A Throat Culture Procedure …...Procedure 67 Collecting A Sputum Specimen...

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