Prepared by Mrs / Hamdia Mohammed

1. Specimen collection Prepared by Mrs / Hamdia Mohammed

2. At the end of this lecture each student should be able to: 1. Define purposes of a specimen collection. 2. Explain the different type of specimen collection. 3. Identify the universal precautions. Learning Objectives:-

3. 6. List necessary information included in laboratory request form. 7. Identify nursing responsibilities associated with specimen collection Learning Objectives cont :-

4. Purposes of laboratory test • Assist in the diagnosis of pathological conditions. • Evaluate the client’s progress and to regulate treatment. • Prevent or reduce the severity of disease.

5. Rule 1: - Consider ALL patients potentially infectious. Rule 2: - Assume ALL blood, body fluids and tissues are contaminated. Rule 3: - Assume ALL used needles or other sharps are contaminated. STANDARD PRECAUTIONS (Universal precautions): These are based on three rules:-

6. Type of Specimens 1- Urine 2- Blood 3- Stool 4- Sputum 5- Wound culture sample

7. Types of Urine Specimen • Random specimen. • Midstream specimen. • Sterile specimen. • 24-Hour urine collection. • Supra pubic needle aspiration of the bladder.

8. Random specimen (clean voided) A random routine urine specimen can be collected with a client voiding naturally. Uses:- * Routine Urine analysis testing * PH * Glucose level

9. Client’s instruction - The client’s void into a clean urine cup, urinal, or bedpan. - Client’s drinks a glass of fluid before the procedure about 30 minute. - A client should be voided before defecating .

10. Devices for collecting and measuring urine A - Bedpan, fracture pan and Urinal containers for male patient used to collect urine from non ambulatory patients B - Specimen hat : container that is placed interiorly on the toilet, underneath the seat. Used to collect urine. Specimen cup container

11. Placing bedpan against buttocks while patient is on his side. - Patient raising self in bed for bed pan.

12. 2. Midstream urine specimen to obtain a specimen relatively free of the microorganisms growing in the lower Urethra. Uses Urine culture

13. Client’s instruction - Cleansing of the external genitalia. - Allowing the initial portion to escape. - The clients collects the specimen during the middle portion of voiding . - Remove specimen container before flow of urine stops and the client finishes voiding into bedpan or toilet .

14. 3. Sterile specimen Obtaining urine specimen from an indwelling catheter. Uses - Urine culture. - Specific gravity: (urine concentration or the amount of solutes metabolic wastes and electrolytes) present in urine .

15. Obtaining a urine specimen from a patient with an indwelling catheter. (A)First, use a swab moistened with an antiseptic to clean the area where the sterile needle will be introduced. (B)Then insert the needle and withdraw a specimen of urine.

16. Nurse guidelines • Washes hands and wear gloves. • Uses a sterile syringe to withdraw urine. • Urine specimen is not collected for culture from a urine drainage bag.

17. 4. 24-Hour Urine Collections Purpose - To assess the ability of the kidney to concentrate and dilute urine. - To determine disorders of glucose metabolism.

18. 5. Suprapubic aspiration Indication : • Patient with UTI. • In neonate. • Young infants. • Patient whom catheterization is contraindicated. • Suspected anaerobic bacteriuria .

19. Guidelines • The client’s should have a full bladder. • Properly disinfected of the skin. • 19 or 20 gauge needle is passed through the skin into the bladder . • Urine is aspirated into a syringe

20. Wash hands Confirm the identity of the patient Explain the procedure Assemble all necessary equipment Put the patient in comfort position Blood collection

21. Check both arms to select the larger and fuller veins. Apply the tourniquet. Ask the patient to open and close his/her fist so their veins become prominent. Clean the venipuncture site with the alcohol swab in a circular motion. Blood collection cont.

22. Insert the stopper of the first tube to be drawn into the adaptor. Insert the needle into the vein with the bevel facing upward. Fill the tube until the vacuum is exhausted. Place a cotton ball or 4 x 4 square piece of gauze over the site. Blood collection cont.

23. Remove gloves and dispose of in a properly identified biohazard bag or container. Wash hands thoroughly after phlebotomy . verify that the information on the sample tubes match is the requisition form Blood collection cont.

24. Blood Culture • Used to detect bacteria or fungi in the systemic circulation. • Performed by sampling peripheral blood using a no-touch or asepticvenipuncture method. • At least 10ml blood should be withdrawn and dispensed into two blood culture bottles, one for aerobic and one for anaerobic culture.

25. Stool Specimens Purpose: 1- To determine the presence of occulted blood for presence of (ulcers, inflammatory disease or tumors). 2- To analyze for dietary products. 3- To detect the presence of ova and parasites. 4- To detect the presence of bacteria or viruses.

26. Patient Guidelines for Stool Collection • Defecate in a clean container . • Do not contaminate the specimen with urine or menstrual discharge. • Void first so urine is not in stool sample. • Do not place toilet tissue in the bedpan or specimen container. • Notify the nurse as soon as possible after defecation and when specimen is available.

27. Sputum Specimen # Sputum : Is the mucous secretion from the lung bronchi, and trachea # Saliva: the clear liquid secreted by the salivary glands in the mouth

28. Purpose of Sputum Specimens • For culture • For cytology (to identify structure and pathology of cells such as to identify cancer in the lung • For acid fast bacillus to identify the presence of TB

29. Time for collected - In the morning. - During postural drainage. - Use pharyngeal suctioning when a client can not cough .

30. Throat culture Sample collected from the mucosa of the oropharynxand tonsillar regions using culture swab - Puts clean gloves. - Inserts the swab into oropharynx and runs swab along the tonsils and are on the pharynx that are red or contain exudates.

31. WHO/CDS/EPR/ARO/2006.1

32. Nasopharyngeal swab • Tilt head backwards • Insert flexible fine-shafted polyester swab into nostril and back to nasopharynx • Leave in place a few seconds • Withdraw slowly; rotating motion WHO/CDS/EPR/ARO/2006.1

33. Wound culture sample 1- An aerobic specimen (Superficial Wounds ) 2- Anaerobic specimen (Deep Wounds: or abscess culture )

34. A.To collect an aerobic specimen • Lightly palpate wound edges to detect localized areas of drainage collection • Clean a wound with normal saline to remove skin flora. • Use sterile swab from a culturette tube

35. To collect an aerobic specimen cont. • If wound edges are separated the nurse gently inserts the tip of the swab into the wound to collect deeper secretions .

36. To collect an aerobic specimen cont. • After collecting the specimen the nurse returns the swab to the culturette tube, and caps the tube. • Sends the labeled specimen to the laboratory.

37. B. To collect anaerobic specimen • Clean site by wiping with sterile saline or 70% alcohol. • The nurse uses a sterile syringe tip to aspirate drainage from inner wound. • Afterward the nurse apply a sterile needle to the syringe. • Expels the air from syringe and needle and place a cork over needle to prevent entrance of air.

38. The client’s name. • Hospital number. • Age and gender . • Exact nature and source of the specimen. • Diagnosis. • Date and time of specimen collection. • Ordering physician (Test requested or laboratorytest desired). • Antimicrobial therapy ( medication as antibiotic ) . laboratory request form should beincluded the following Information:-

39. Nursing responsibilities associated with specimen collection • Provide client comfort, privacy and safety • Explain the purpose of the specimen collection • Explain the procedure • Use the correct procedure for obtaining a specimen • Hand washing & Use aseptic technique.

40. Nursing responsibilities associated with specimen collection cont. • Note relevant information on the laboratory requisition. • Make sure that the specimen label is found. • Transport the specimen to the laboratory promptly. • Report abnormal laboratory finding to health care provider.

42. THANK YOU