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Course: Fundamentals of Nursing�Topic: Specimen Collection

The Nurses International Community

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Module Goals

Learners will be able to:

Accurately collect specimens for blood, stool, urine, and swabs.
Maintain standard- and transmission-based precautions.
Identify proper disposal of the used items.
Understand the general nursing consideration during specimen collection.

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Types of Specimen

Blood Specimen
Stool Specimen
Urine Specimen
Sputum Specimen
Wound cultures
Other Specimen: Amniotic fluid, Synovial Fluid, Saliva, Solid tissue

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Blood Specimen: Arterial Sampling

Who performs: Nurse/ lab technicians/ Doctors/Trained personnel
Where: In hospital Environment from radial or femoral artery
Why: To identify metabolic, respiratory and acid-base disorders
When: Anytime of the day
How:

Perform Allen's Test before withdrawing blood.
A catheter or a syringe with needle (pre heparinized) is placed in an artery, to puncture an artery.
Use aseptic technique, about 1 mls of blood is withdrawn form the artery.
Place the syringe in ABGs analyzer machine.
If analysis is not done at the point of care, transported in crushed ice.

WHO, 2010

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Technique to Draw Arterial Blood Sample

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Blood Specimen: Venipuncture

Who performs: Nurse/ lab technicians/ Doctors/Trained personnel: Depends on scope of practice.
Where: In hospital, clinics, labs from veins(median cubital veins).
Why: To diagnose diseases/conditions, function of the organs, evaluate the treatment or effect of the medications, to identify risk factors.
Types: Complete blood count, Blood chemistry, Blood Enzymes, Blood clotting tests, Blood test to assess heart disease risk.

National Heart,

Lungs and blood Institute, n.d.

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Blood Specimen: Venipuncture

When: Depends upon the type of tests performed

(e.g. Blood Culture: Before antibiotics is started)

On empty Stomach :

Fasting blood glucose and triglycerides, lipid panel, Vitamin B12, Gamma-glutamyl transferase (GGT).

Any time of the day:

Complete blood count, Liver function test, cardiac markers, etc.

Method:

For the proper steps of vein puncture, click here.

Proper color vacutainer for proper blood sample.

Proper site: Preferred vein median cubital veins.

National Heart,

Lungs and blood Institute, n.d.

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Tube guide for common Tests

https://www.alfredhealth.org.au/contents/resources/clinical-resources/Tube-Guide-for-Common-Tests-V1.6.pdf

Cap Color	Tests
Pale Lilac (EDTA, 10 mls)	Hb, Retics, cell surface markers, HBA1c, BNP, PTH
Red ( Plain Blood, serum) without gel 10 mls	Cytotoxic antibodies, platelets
Blue (Citrate, 2.7 mls)	Coagulations- PT, INR, APTT, Fibrinogen, D-Dimer, Factor VIII, factor IX
Gray ( Fluoride Oxalate) 2mls	Lactate, Fasting or timed glucose, Glucose tolerance tests
Yellow Gold (plain blood;m serum with gel) 8.5 mls	Calcium, immunoglobulins, Vitamin D, Hep A, B, C; Herpes, Rubella, Syphilis, varicella, Toxoplasma, Antibodies
Pale green (Heparin with gel) 5 mls	Most urgent biochemistry, LFT, Lipids, Iron, Troponin, Osmolality
Pink (EDTA, 6mls)	Crossmatch,
Yellow (ACD 8.5 ml)	Human Leukocyte Antigens

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Blood Specimen: Finger Prick

Health Direct, 2020

Who performs: Nurse/ lab technicians/ Doctors/Trained personnel: Depends on scope of practice.
Where: In hospital, clinics, labs from finger tips.
Why: To rule out presence of disease condition.

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Blood Specimen: Finger Prick

Types: Rapid HIV tests, Blood glucose tests, blood clotting, anemia, lipids, basic chemistry panels, covid-19 test and more.
What: Involves a small amount of capillary blood taken from finger end with a quick prick.
How:

Chose the site: usually finger, heel of foots for infants.
Prepare the site: Clean the sites, with soap and water or with alcohol swabs and air dry.
Prick the tip of the finger, squeeze to obtain blood.
Obtain the sample in the kit/glucometer as shown in Image 2.
For proper steps of the blood glucose checking procedure, click here.

Doyle & McCutcheon, 2015

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Blood Specimen: Blood Culture

University of Michigan Health, 2020

Used to detect the presence of bacteria or fungi in the blood.
Test procedure:

A healthcare professional will draw the blood sample. The sample is most often taken from a vein in your arm.

Perform a surgical preparation and withdraw approx. 10 ml of blood and inoculate directly into a specialized “blood culture media” bottle (e.g. Oxoid Signal System).

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Critical Thinking Question

A client in your ward who has central venous catheter complains of fever and the doctor has recently added antibiotics and blood culture tests.

What will be your initial interventions for this client?

Why would you do so?

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Specimen Collection: Urine Specimen

What: Urine specimen.

Who: Anyone; to rule out diseases, conditions, infections, kidney function.
Types:

Morning Specimen: In the early morning.
Clean catch midstream: Any time of the day.
24 hours: Collected for whole 24 hours.

Note: client should receive instructions (verbal/written) for each urine specimen collection.

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Urine Specimen: Morning Catch Urine

Need to empty bladder before sleep and not urinate during the night
Collected the first void in the morning.
If the specimen is collected at home: Refrigerate the urine specimen cold and deliver to lab ASAP.
Keeping the specimen cold preserves the specimen.
Specially done in the younger toilet-trained children.
The urine container should be properly labelled as per the requirement of the facility.

Children's Minnesota, 2021

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Urine Specimen: Midstream Urine

A mid-stream urine sample means not collecting the first or last part of urine that comes out.
This reduces the risk of the sample being contaminated with bacteria from the hands, skin around the urethra.
Can be collected at any time of day unless advised otherwise.
Sample of random specimen: taken any time during the day.

National Health Services, 2019

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24-HOUR URINE COLLECTION

Check the reference laboratory manual for the correct preservative for the test ordered.

Instruct the client as follows:

• Excrete all the urine into the toilet and record the time.

• Collect all urine from that day until the same time the following day. At the end of this time, void one last time and add this sample to the container.

• Store the urine in the refrigerator or on ice and transport as soon as possible to the laboratory.

At the laboratory, measure the volume of urine and record if required by the reference laboratory. Separate two aliquots of urine and label both adequately. Include the 24 urine volume on the labels. Send one to the reference laboratory and keep one in the facility laboratory refrigerator until completed results from the reference laboratory are received.

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Urine Specimen: Midstream Urine

National Health Services, 2019

The collection of the specimen should be made with aseptic non-touch technique.
Antiseptic solutions or wipes should be used to wipe the genitalia from front to back.
The rim of the container should not touch the genitalia.
The client should void a small amount into the toilet first.
The obtained specimen should be labelled per the facility policy.

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Urine Specimen: 24 hours Urine Collection

John Hopkins Medicine, n.d

Urine is collected in a special container over a full 24-hour period.
One or more plastic containers would be provided.
Purpose: To diagnose kidney problems (determines creatinine clearance, amount of protein, hormones , minerals and other chemical compounds.

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Urine Specimen: 24 hours Urine Collection

May be asked to start the collection at a specific time.
Usually asked to start in the morning after first void.
A special pan that fits in the toilet (for female) or urinal (for male) would be provided.
After voiding, it should be transferred to the collecting jar.
Once collected, it is taken to the lab.
Container labeled as pet the facilities policies.
The container must be kept cool until the urine is returned to the lab.

John Hopkins Medicine, n.d.

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Critical Thinking Question

A physician orders a urine specimen form a client who has indwelling catheter. The nurse takes a sterile container to the client’s room and collects the urine specimen from bag.

What practice you observe was wrong?

How should the nurse have things done differently?

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Specimen Collection: Stool

National Health Services, 2019

Purpose: Diagnose or rule out a particular health condition in the digestive system

e.g. gastroenteritis, inflammatory bowel diseases.

Collected in a completely clean (sterile) container.
Make sure the stool does not touch the inside of the toilet.
Place something in the toilet to catch the stool,( potty or an empty plastic food container)or plastic wrap over the rim of the toilet.
Can be collected at any time of the day unless otherwise.

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Specimen Collection: Stool

Collected in a clean, dry screw-top container.
Use the spoon or spatula that comes with the container to collect the stool (aim 1/3rd full/about the size of a walnut).
Sample of stool must be fresh – if it is not, the bacteria in it can multiply and the results are invalid.
Should be stored in a fridge in a sealed plastic bag if not handed it in straight away.
For process of stool collection please click here.

National Health Services, 2019

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Specimen Collection: Sputum

Why: Diagnose infections(bacterial/fungal) in respiratory tract/lungs.

Necessary amount: About 5 mls (1 teaspoon).

Time:

First thing in the morning.
Sometimes doctor may order 3 consecutive test (For tuberculosis).
As per hospital personnel or doctors instruction/suggestion.
Collect specimens only at that time unless instructed to do otherwise.

Carteret Health Care, n.d

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Specimen Collection: Sputum

Method: In a sterile sputum collection container

After the specimen is obtained, it is sent to the laboratory within two hours.

Collection : For the proper steps of sputum collection click here.

After the Specimen is Collected

Transport specimen within two hours to the lab and give directly to lab personnel.
When consecutive morning specimens are ordered, each specimen has to be transported to the lab within 2 hours of time frame.

Carteret Health Care, n.d

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Specimen Collection: Wound Swab

University of Michigan Health, 2020

Used to detect infections in open wounds or on burn injuries.
Procedure:

Done in sterile environment with aseptic techniques.
A special swab stick is used to collect a sample from the site of your wound (shallow wound).
In case of a deep wound, a needle may be used to aspirate content and send it for culture.
Performed by competent healthcare provider.

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Specimen Collection: Nasal Swabs

McFee D, 2020

Insert flexible wire shaft swab through the nares parallel to the palate until resistance is encountered or the distance is equivalent to that from the ear to the nostril of the client indicating contact with the nasopharnyx.
Gently, rub and roll the swab.
Leave the swab in place for several seconds to absorb secretions before removing.
Place NP and OP swabs immediately into a sterile vial.

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General Nursing Considerations: Specimen Collection

Always take consent :

Explain the procedure.
Reason of specimen collection.
Ensure client understood the whole process.
Explain the time taken for procedure and when result will be made available.

Collected at the right time:

Some test should be carried out in empty stomach or at specific time of the day.

Shepherd, 2017

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General Nursing Considerations: Specimen Collection

Take all the necessary precautions based on the client’s condition:

Follow proper hand hygiene.
Ensure aseptic techniques.
Use necessary PPE to prevent splash, or transmission (E.g droplet transmission, airborne transmission).
Hospital environmental hygiene principles.
Safe use and disposal of sharps.
Avoid cross contamination.
Ensure the safety of all the staffs collecting or handling the specimen.

Shepherd, 2017

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General Nursing Considerations: Specimen Collection

Label the sample as per hospital Protocol:

Client’s name, hospital number/registration no
Date of birth
Unit/Department/ward
Date and time of specimen collection
Type of specimen (Blood, sputum, urine)
Label if it is biohazard or high risk specimen (e.g Covid-19 nasal specimen)

Shepherd, 2017

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Specimen Collection: Nasal Swabs

Transport specimen as per hospital protocol:

Specimens should be sent to the laboratory as soon as possible after collection, delays can affect the result.
If transportation is not made immediate , follow the local guidelines about storage of specimens.

Document the procedure in appropriate form or section (Nursing Sheet)

Shepherd, 2017

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Cultural Considerations

In some cultures, female clients do not want a male or male clients do not want female caregivers to examine, touch or obtain specimens.

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References:

Carteret Health Care. (n.d.). Patient education: Sputum Specimen Collection. Retrieved on 18^th of August 2021 from https://www.carterethealth.org/patient-education/laboratory/sputum-specimen-collection/

Children's Minnesota. (2021, November). Patient & Family Education Materials: Urine Collection( First Morning). Retrieved on 16th of August from https://www.childrensmn.org/educationmaterials/childrensmn/article/16683/urine-collection-first-morning/

Doyle, G.R., McCutcheon, J.A. (2015). Clinical Procedures for Safer Patient Care. Victoria, BC: BCcampus. https://opentextbc.ca/clinicalskills/chapter/8-1-introduction-2/

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References:

Mahoney, J. J., Ellison, J. M., Glaeser, D., & Price, D. (2011). The effect of an instant hand sanitizer on blood glucose monitoring results. Journal of diabetes science and technology, 5(6), 1444–1448. https://doi.org/10.1177/193229681100500616

McFee D. (2020). COVID-19 Laboratory Testing/CDC Guidelines. Disease-a-month : DM, 66(9), 101067. https://doi.org/10.1016/j.disamonth.2020.101067

National Health Service. (2019, August 27). Infections: How should I collect and store a pee (urine) sample? https://www.nhs.uk/common-health-questions/infections/how-should-i-collect-and-store-a-urine-sample/

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References:

National Health Service. (2019, August 27). Infections: How should I collect and store a pee (urine) sample? https://www.nhs.uk/common-health-questions/infections/how-should-i-collect-and-store-a-urine-sample/

Health Direct. (2020, July). Diabetes testing and monitoring. Reterived on 15th of Agust 202 from https://www.healthdirect.gov.au/diabetes-testing-and-monitoring

National Heart, Lungs, and Blood Institute. (n.d). Health Topic: Blood test. Retrieved on 15th of August 2021 from https://www.nhlbi.nih.gov/health-topics/blood-tests#:~:text=Blood%20tests%20help%20doctors%20check,thyroid%2C%20and%20heart%E2%80%94are%20working

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References:

Shepherd, E. (2017). Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen. Nursing Times [online]; 113: 7, 45-47.

University of Michigan Health¹. ( 2020). Health Library: Blood Culture. Retrieved on 15th of August 2021 from https://www.uofmhealth.org/health-library/hw3603#hw3609

University of Michigan Health². ( 2020). Health Library:Skin and Wound Culture. Retrieved on 15th of August 2021 from https://www.uofmhealth.org/health-library/hw5656

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References:

WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organization; 2010. 5, Arterial blood sampling. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138661/

Zisquit J, Velasquez J, Nedeff N. Allen Test. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507816/

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