Collecting a urine specimen is a common medical procedure used for diagnostic testing and monitoring various health conditions.

PROCEDURE FOR URINE COLLECTION

• Instruct patient to wash perineum
• Instruct to avoid directly into clean, dry container or into bedpan and then transfer
• Instruct not be contaminate outside of container
• Instruct to collect 3/4^th of container
• Wear gloves while handling urine

Urine Collects from Catheter

• Clamp tubing for about 15 to 30 minutes before obtaining sample
• Wash hands thoroughly
• Disconnect bladder drainage tubing
• Cover distal end of drainage tube with sterile gauze till procedure is over
• Clean tip of urinary catheter with antiseptic
• Release clamp and collect urine in container
• Remove gauze and discard in K-Basin
• Reconnect tubing
• Wear glove while handling urine

After Care

• Clean the outer part of the container
• Label the container
• Send immediately to laboratory with laboratory request
• Wash hands thoroughly
• Record the procedure in nurse’s record sheet

24 Hours Urine Collection

Collection of 24 hours urine specimen means the collection of all the time voided in 24 hours, without any spillage of wastage

Purpose

• To detect kidney and cardiac conditions
• To measure total urine protein and creatinine
• To measure total urine electrolytes, ketogenic steroid, oxalate, porphyrins, drugs and vitamins

Normal Characteristics of Urine

• Volume: 1000-2000 ml excreted in 24 hours
• Appearance – clear
• Odor – aromatic color, if kept for some time, ammonia smell
• Color – straw or amber in color
• Reaction – acidic
• Specific gravity – 1.010 to 1.020
• Constituents of urine – 96 % water, 2% urea, and 2% uric acid. Urates, creatine chlorides, phosphates, sulfates and oxalates also may be present in minute’s quantities

Preliminary Assessment

Check

• Doctor order for any specific instructions
• General condition and diagnosis of the patient
• Self care ability of the patient
• Mental status to follow directions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the sequence of the procedure
• Provide privacy
• Keep the articles at the bedside
• Obtain laboratory request and container

Equipment

• Bedpan or urinal
• Dry container (24 hours collection bottle)
• Clean pouring (measuring) jar
• Funnel

Procedure

• Before beginning 24 hours urine collection, patient is asked to void
• Discard the sample and note the time
• Document the starting time of urine collection in the nurses record
• Advise not to spill urine
• All urine passed over next 24 hours is collected in large container
• Exactly 24 hours after, patient is instructed to void and specimen is included

After Care

• Send the sample immediately to the laboratory with laboratory request
• Replace the articles after cleaning
• Record the procedure in the nurse’s record sheet

General Instructions

• The entire collected urine should be stored in a covered container in a cool place
• Add preservatives to the urine to prevent decomposition and multiplication of bacteria, e.g. boric acid, formalin, chloroform, etc
• The urine should be thoroughly mixed and all or part sent to the laboratory in a clean bottle
• Requisition form must be duly filled and signed

URINE CULTURE

Collection of midstream specimen of urine without contaminating container and urine specimen. A urine culture is a laboratory test used to detect and identify the presence of bacteria or other microorganisms in a urine sample. It is commonly ordered when a urinary tract infection (UTI) is suspected or to monitor the effectiveness of treatment.

Purpose

• To collect uncontaminated urine specimen for culture and sensitivity test
• To detect the microorganism causes urinary tract infection (UTI)
• To diagnose and treat with specific antibiotic

General Instructions

• Urine should be collected in sterile containers
• Urine specimens for culture should be collected in the morning
• After washing the perineal area and drying collect a midstream specimen of urine in a sterile bottle
• For bedridden patients cauterized specimen of urine is taken

Preliminary Assessment

Check

• The doctors order for specific instruction
• The general condition and diagnoses of the patient
• Self-care ability of the patient
• Mental status to follow instructions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Provide privacy
• Arrange the articles at the bedside
• Collect and arrange the culture bottle – from the laboratory
• Keep the laboratory request ready

Equipment

• Basin and soap
• Towel and sterile gloves
• Gauze pads 2-3 (if present on strict bed rest)
• Sterile culture bottle
• Laboratory request form
• Sterile K-Basin

Procedure

• Instruct patient to clean perineum with soap and water
• Open container and leave cover facing inside up
• Instruct patient to void into sterile K-Basin. If patient is unable to get out of bed
• Instruct patient to void directly into sterile container
• Collect 30-50 ml (1/2 – 3/4  of container) at mid-stream point of voiding
• Emphasize first and last portions of voiding to the discarded
• Cap container securely without touching inside of lid

After Care

• Label container with patients name, hospital number and date
• Send container to laboratory immediately with lab request
• Record the procedure in nurse record sheet and register in microbiology laboratory notebook

Collecting a stool specimen is a common diagnostic procedure used to analyze fecal matter for various reasons, such as detecting infections, parasites, or gastrointestinal disorders.

Here’s a general guide on collecting a stool specimen:

1. Gathering Materials:
   • Use a clean, dry container with a tight-fitting lid. Healthcare providers often provide specific containers for stool collection.
   • Consider using disposable gloves to maintain hygiene during the collection process.
2. Timing:
   • Collect the stool sample as soon as possible after it is produced to ensure the accuracy of the results.
3. Avoid Contamination:
   • Make sure the stool does not come into contact with urine or toilet bowl water.
   • Some healthcare providers may recommend using a plastic wrap or disposable plastic container placed in the toilet bowl to catch the stool.
4. Collection:
   • Using a clean plastic or wooden spatula, tongue depressor, or a similar device, collect a small amount of stool (about the size of a walnut) from different areas of the stool sample.
   • Place the sample into the container, ensuring that it is well-sealed to prevent leakage and contamination.
5. Labeling:
   • Label the container with your name, date of collection, and any other information required by your healthcare provider.
6. Transport to the Laboratory:
   • Deliver the stool specimen to the laboratory as soon as possible after collection. Some tests may require the sample to be delivered within a specific timeframe.
7. Storage:
   • If immediate delivery is not possible, store the specimen in the refrigerator until you can transport it to the laboratory.
8. Special Instructions:
   • Some tests may require additional instructions, such as collecting multiple samples over consecutive days or following a specific diet before collection. Follow any guidelines provided by your healthcare provider.
9. Preservation Solutions:
   • In some cases, the healthcare provider may provide a preservative solution to mix with the stool sample. Follow the instructions for using any provided solutions.
10. Documentation:
    • Document any relevant symptoms or information that may aid in the interpretation of the test results.

STOOL-ROUTINE TEST AND CULTURE

Collection of stool specimen for specific or routine tests (stool culture to detect abnormal characteristics)

Purpose

• To identify specific pathogens
• To determine presence of blood, ova and parasites
• To determine presence of fat
• To do gross examination of stool characteristics such as color, consistency and color

Normal Characteristics of Feces

• Color: light to dark brown
• Odor: pungent smell
• Frequency: 1-2 times per day
• Quantity: 4-5 ounces per day
• Composition: 30% water, shed epithelium from the intestine, a considerable quantity of bacteria and a small quantity of nitrogenous matter
• Stool of infants: at birth, the stool of infants is dark green and it is called “meconium”

Abnormal Characteristics of Feces

Color

• Tarry black stools – bleeding in the upper gastro-intestinal tract
• Black color stool – melena, administration of iron or charcoal
• Clay colored stool – obstruction to the flow of bile
• White colored stool – presence of barium salts after barium tests

Odor

Melana and dysentery – foul smell

Frequency

• Diarrhea – increased frequency
• Constipation – decreased in frequency and low residue diet

Consistency and Form

• Watery stools – diarrhea
• Rice water stools – cholera
• Pea soup stools – typical of typhoid fever

Appearance

• Fresh blood in large amounts – bleeding piles
• Blood and mucus stool – amoebic or bacillary dysentery
• Worm or segments or worms in stool – parasitic cysts, ova or larvae

General Instructions

• Fecal specimens are collected for chemical bacteriological or parasitological analysis
• Fecal specimens should be collected in the early stages of disease preferably before antibiotic treatment is given
• Stool specimens should be collected in a sterile container (making use of the scoop provided in the container) with a tight-fitting leak proof lid
• After collection, the lid should be immediately replaced tightly
• After proper labeling, the collected stool should be handed over to the laboratory without delay

Preliminary Assessment

Check

• The doctors order for any specific instructions
• General condition and diagnosis of the patient
• Assess the self-care ability
• Mental status to follow instructions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Provide privacy
• Arrange the articles at bedside
• Obtain laboratory request and container

Equipment

• Appropriate specimen container
• Spatula (clean for routine, sterile for culture)
• Bedpan or portable commode
• Gloves
• Waste paper

Procedure

• Instruct patient to defecate into clean dry bedpan or commode
• Instruct not to contaminate specimen with urine
• Nurse to wear gloves while collecting specimen
• Collect stool specimen with clean spatula for routine stool test and with sterile spatula into culture container
• Cover the container tightly

After Care

• Remove the gloves
• Wrap spatula in waste paper and discard appropriately
• Label specimen container with name, hospital number, and date
• Send to laboratory immediately (fresh specimen provides more accurate results)
• Replace equipment and after cleaning
• Record the procedure in nurse’s record sheet

Collecting a sputum specimen involves obtaining a sample of mucus and other respiratory secretions from the lower respiratory tract. This type of specimen is often used to diagnose respiratory infections, identify the presence of bacteria or fungi, and assess the effectiveness of treatment.

Here’s a general guide on collecting a sputum specimen:

1. Timing:
   • Collect the sputum sample in the morning, if possible, as the respiratory secretions are usually more concentrated at this time.
2. Patient Preparation:
   • Rinse your mouth with water to reduce contamination of the specimen with oral bacteria.
   • Take deep breaths to help bring up sputum from the lower respiratory tract.
3. Collection Technique:
   • Cough deeply to produce sputum from the lungs.
   • Spit the sputum directly into a sterile, screw-capped container provided by the healthcare facility.
   • If the sputum is difficult to produce, inhaling steam or using a nebulizer with a saline solution may help.
4. Avoid Contamination:
   • Minimize saliva contamination by making sure the sputum comes from the lungs, not the oral cavity.
5. Quantity:
   • Collect an adequate amount of sputum (usually about 5-10 mL) to ensure accurate testing.
6. Labeling:
   • Label the container with your name, date of collection, and any other information required by your healthcare provider.
7. Transport to the Laboratory:
   • Deliver the sputum specimen to the laboratory as soon as possible after collection.
   • If immediate delivery is not possible, store the specimen in the refrigerator to prevent bacterial overgrowth.
8. Documentation:
   • Document any relevant symptoms, such as coughing, shortness of breath, or fever, that may assist in the interpretation of test results.
9. Special Instructions:
   • Some tests may require additional instructions, such as collecting multiple samples over consecutive days or following specific treatment protocols. Follow any guidelines provided by your healthcare provider.
10. Preservation Solutions:
    • Your healthcare provider may provide a preservative solution to mix with the sputum sample. Follow the instructions for using any provided solutions.

SPUTUM CULTURE

Collection of coughed out sputum for culture studies to identify respiratory pathogens

Purpose

• To detect abnormalities
• To diagnose disease condition
• To detect the microorganisms causes respiratory tract infections
• To treat with specific antibiotics

Characteristics of Sputum

• Quantity: normally, no sputum is expectorated the amount of sputum coughed up in 24 hours varies with the diseases
• Consistency: the sputum may be classified into various types according to its consistency and appearances, e.g. serous, frothy, mucoid, purulent, seropurulent and hemorrhagic
• Odor: normally the sputum is odorless in case of lung abscess; carcinoma and bronchiectasis the sputum will bed foul smelling
• Color: sputum consists of mucus it may be:

Colorless and translucent

Yellowish color – presence of pus

Blackish sputum – excessive smoking

Blood – hemoptysis

Red and frothy sputum – freshly bleeding from lungs

Rusty color – altered hemoglobin as seen in pneumonia

Greenish color – bronchiectasis

Brown color – gangrenous condition of the lungs

• If sputum examined microscopically, a few WBC and epithelial cells may be seen. Eosinophils are found in such conditions as asthma. RBC is found only when there is hemoptysis. The main organism that is looked for in stained sputum is tubercle bacilli (AFB)

General Instructions

• Give water proof disposal sputum mug on the previous evening and instruct to raise the material from the lungs by coughing and not the saliva
• Collect the sputum in the morning
• Ask the patient to rinse the mouth with plain water. Do not use any antiseptic mouth washes
• If sterile specimens are required sterile bottle with cover is given to the patient

Preliminary Assessment

Check

• The doctors order for specific instructions
• General condition and diagnosis of the patient
• Self-care ability
• Mental status to follow instructions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Arrange the articles at the bedside
• Provide privacy if needed

Equipment

• Sterile sputum container
• Sputum mug or cup
• Tissue paper
• K-basin

Procedure

• Instruct to collect specimen early morning before brushing teeth, to obtain overnight accumulated secretions
• Instruct to remove and place lid facing upward
• Instruct not to contaminate inside of lid and container, as well as outside of container
• Instruct to cough deeply and expectorate directly into specimen container
• Collect at least 10 ml of sputum
• Close the container immediately sputum is collected

After Care

• Label the container with patients name date and hospital number
• Send specimen to laboratory immediately along with request
• Replace the equipment after cleaning
• Wash hands thoroughly
• Record the procedure in nurse’s sheets

A blood smear, also known as a peripheral blood smear or peripheral blood film, is a diagnostic test used to examine the different types of blood cells under a microscope. It provides detailed information about the size, shape, and relative abundance of red blood cells, white blood cells, and platelets.

BLOOD SMEAR

It is a process of taking two to three drops of blood by pricking the fingertip by using a lancet. Thereby smearing the expressed drop of blood on the slide

Purpose

• To diagnose blood-borne disease such as filarial and malaria
• To detect carcinogenic cells
• To detect abnormal blood cell counts

General Instructions

• The lancet (needle) used for communicable disease, e.g. HIV. Patients discard after use
• The slides should be clean and fresh
• The procedure should do in an aseptic manner
• The person doing blood smear should wear clean gloves

Preliminary Assessment

Check

• Doctors order for specific instructions
• General condition and diagnosis
• Mental status to follow instructions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Provide privacy if needed
• Arrange articles at bedside
• Obtain request from the doctor
• Obtain slide from the laboratory or arrange technician from the laboratory
• Make the patient to sit or lie in the bed comfortable

Equipment

A clean tray containing:

• Clean slides – 2
• Sterile needle in a container (lancet)
• Methylated spirit in a bottle
• Paper bag
• Cotton swab

Procedure

• Wear clean gloves
• Clean the patient’s fingertip with spirit opposite side away from you
• Press the fingertip and give a prick with the sterile needle
• Allow a drop of blood to fall on each slide
• Make the smear by taking one slide on your left hand and another with the right hand
• Make the smear with the edge of the slide by spreading the blood. Make 2 or 3 slides
• Provide spirit swab to apply gentle pressure
• Wrap the dry slide in the patient’s record form and dispatch it to the laboratory as soon as possible
• The second slide used for spreading the blood films may now be used for the next patient and another clean slide from the pack will be used as a spreader

After Care

• Dry and send the slide to the laboratory for examination
• Replace the articles after cleaning
• Remove the gloves
• Wash hands thoroughly
• Record the procedure in the nurse’s record sheet

Blood Smear Collection Procedure

1. Holding the patient’s left hand, palm upwards, select the third finger from the thumb. (the big toe can be used with infants. The thumb should never be used for adults or children)
2. Puncture the ball of the finger with a sterile lancet, using a quick rolling action. Apply gentle pressure to the finger to express the first drop of blood and wipe it away with a dry piece of cotton wool. Make sure that no strands of cotton remain on the finger to be later mixed with the blood
3. Working quickly and handling clean slides only by the edges, collect the blood as follows
4. Apply gentle pressure to the finger and collect a single small drop of blood, about this size, on the middle of the slide. This is for the thin film
5. Apply further pressure to express more blood and collect two or three larger drops, about this size, on the slide, about 1 cm from the drop intended for the thin film (see illustration). Wipe the remaining blood away from the finger with a piece of cotton wool
6. Thin film. Using a second clean slide as a “spreader” and, with the slide with the blood drops resting on a flat, firm surface, touch the small drop with the spreader and allow the blood to run along its edge. Firmly push the spreader along the slide, keeping the spreader at an angle of 45 degree. Make sure that the spreader; is in even contact with the surface of the slide all the time the blood is being spread
7. Thick film. Always handle slides by the edges or by a corner to make the thick film as follows. Using the corner of the spreader, quickly join the drops of blood and spread them to make an even, thick film. The blood stirred but can be spread in circular or rectangular form with 3 to 6 movements. The circular thick film should be about 1 cm (inch) in diameter
8. Label the dry thin film with a soft lead pencil by writing across the thicker portion of the film the patient’s name or number and the date. Do not use a ballpoint pen for labeling the slide. Allow the thick film to dry with the slide in a flat, level position, protected from flies, dust and extreme heat

DEFINITION

A blood culture is a diagnostic test performed to detect the presence of bacteria, fungi, or other microorganisms in the bloodstream. It is a crucial tool in diagnosing bloodstream infections (bacteremia or fungemia), sepsis, and other systemic infections.

BLOOD CULTURE

Collection of blood for blood culture is a sterile procedure. Surgical (scrub) preparation and techniques are used in collection, storage, transport of blood sample

Purpose

• To detect the microorganisms
• To treat the disease condition with correct antibiotics
• To detect the right antibiotic to kill the particular microorganism
• When the patient has chills or a temperature hike

General Instructions

• Special type of culture bottles are used for blood culture sample collection
• All blood culture bottles should be carefully examined for clarity of media, any medium showing turbidity should not be used
• Only disposable syringes and needles should be used for collection of blood
• The top of the bottle must be carefully disinfected (with 70% alcohol) just before the bottle is inoculated
• Blood should never be taken from an IV line or above the IV line
• If blood culture bottles are available, blood should be immediately added to the culture medium (broth)
• If blood culture bottles are not available blood may be transported in a sterile tube containing a sterile anticoagulant solution
• The amount of blood collected is 10 ml for adult, 2-5 ml for children and 1-2 ml for infants and neonates
• Blood for culture should be taken before antibiotics are administered

Preliminary Assessment

Check

• The doctors order for specific instructions
• General condition and diagnosis of the patient
• Mental status to follow instruction
• Self-care ability of the patient
• Articles available in the unit such as culture bottles, etc

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Arrange the articles at the bedside
• Obtain laboratory request and culture bottles
• Arrange extra help (if needed any)
• Label and number the container in order wise

Equipment

• Mackintosh and towel
• Surgical gloves
• Surgical dressing packs to clean the skin over the vein
• Surgical spirit and betadine solution
• Disposable syringe 10 ml with needles
• Culture bottles – 3
• Cotton swabs
• Paper bag and K-basin
• Tourniquet

Blood Sample Collection for Culture

1. The area of blood culture sample is cleaned with anti-microbial agent
2. Tourniquet applied for bleed sample collection and needle inserted
3. Blood culture sample collected in aseptic technique
4. Blood culture sample placed in the culture bottle

Procedure

• Choose the vein to be drawn by touching the skin before it has been disinfected
• Cleanse the skin over the venipuncture site in a circle approximately 5 cm in diameter with 70 % alcohol, rubbing vigorously
• Starting in the center of the circle, apply 2% iodine (or povidone iodine)
• Allow the iodine to remain on the skin for at least 1 minute
• Insert the needle into the vein and withdraw blood
• After the needle has been removed, the site should be cleaned with 70% alcohol again
• Apply gentle pressure with cotton ball over the punctured site
• Transfer the blood in the syringe in to the culture bottles

After Care

• Clean the culture bottle led with spirit swab
• Insert the needle and pour blood into culture bottle
• Mix the solution and blood gently by moving sideways
• Label the culture bottles and send immediately to the laboratories
• Replace the articles after cleaning
• Remove the gloves and wash hands thoroughly
• Record the procedure in the nurse’s record sheet

A throat swab, also known as a pharyngeal swab, is a common diagnostic test used to collect samples from the back of the throat for microbiological analysis. This procedure is often performed to identify the presence of bacteria or viruses causing throat infections, such as streptococcal bacteria (Streptococcus pyogenes) or respiratory viruses.

THROAT SWAB

The specimen is collected from the patients with upper respiratory tract infection. The upper respiratory tract can be the site of several types of infection

Purpose

• To detect the causative microorganism
• To diagnose the disease condition
• To detect the correct antibiotics for effective treatment

Indications

• Pharyngitis sometimes involving tonsillitis and giving rise to a “sore throat”
• Nasopharyngitis
• Otitis media
• Sinusitis
• Epiglottis

General Instructions

• Pharyngitis is by far the most frequent one most cases of pharyngitis have a viral etiology and follow a self-limiting course
• Approximately 20%  are caused by bacteria and usually require treatment with appropriate antibiotics
• Specimen should be collect by a physician or other trained personnel
• Swab can be collected after asking the patient to gargle with sterile saline

Preliminary Assessment

Check

• The doctors order for any specific instructions
• General condition and diagnosis
• Mental status to follow instructions
• Self-care ability of the patient
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Arrange the articles at the bedside
• Provide privacy if needed
• Obtain laboratory request and specimen container
• Place the patient comfortably in sitting or semi-sitting position

Equipment

• Sterile or clean gloves
• Specimen container
• Gauze pieces
• Paper bag and K-basin
• Torch light (if needed)
• Tongue depressor

Procedure

• The patient should sit in from of a light source
• Tongue should be kept down with a tongue depressor and a cotton wool swab is rubber vigorously over each tonsil, over the back wall of the pharynx and over any other inflamed area
• Care should be taken not to touch the tongue or buccal surfaces
• It is preferable to take 2 swabs from the same area
• One can be used to prepare a smear, while the other is placed into glass or plastic sterile container

After Care

• Label and send the container immediately to the laboratory
• Discard the disposable items used
• Replace the articles after cleaning
• Wash hands thoroughly
• Record the procedure in the nurse’s record sheet