specimen collection

Assessment Technologies Institute Resources

  • Morgan Haecke, MBA, MSN, RN, CNE, NCSN Assessment Technologies Institute provides educational software and resources.

  • Gosnell, K., & Cooper, K. (2023) authored "Foundations and adult health nursing (9th ed.)", published by Elsevier - Evolve.

  • Access websites:

    • Assessment Technologies Institute: https://www.atitesting.com/

    • Vitalsource for Foundations and Adult Health Nursing: https://online.vitalsource.com/books/9780323827065

Learning Objectives

  • Documentation: Understand the necessary documentation of the patient’s condition before, during, and after laboratory or diagnostic testing.

  • Nursing Interventions: Discuss interventions to prepare patients for diagnostic examinations.

  • Patient Teaching: Explore guidance students should give regarding diagnostic testing.

  • Nursing Role: Describe the nurse's role in specimen collection procedures.

  • Specimen Collection Guidelines: Overview guidelines for effective specimen collection.

  • Rationales for Collection: Explain reasons behind collecting specific specimens.

  • Specimen Labeling: Identify appropriate labeling for collected specimens.

  • Urine Specimens: List the steps involved in obtaining urine specimens.

  • Stool Specimens: Discuss the procedure for stool specimen collection.

  • Sputum Specimens: State the correct procedures for collecting sputum specimens.

  • Outcome: By the end of the session, students will exhibit comprehensive knowledge of these areas.

Diagnostic Examination

  • Purpose: May be performed by healthcare providers at the patient’s bedside or in specialized rooms for both therapeutic and diagnostic reasons.

  • Nurse's Knowledge: Fundamental for the success of the procedure in protecting patient rights, which include ensuring informed consent.

Role of the Nurse in Specimen Collection and Diagnostic Testing

  • Preparation and Verification:

    • Verify the provider’s order and confirm informed consent (written or verbal).

    • Reinforce the provider’s explanation and ensure patient understanding.

    • Assess for allergies (e.g., iodine) or contraindications.

  • Patient-Centered Care:

    • Gather necessary equipment, anticipating both provider and patient needs.

    • Identify the patient using two identifiers.

    • Maintain privacy by closing curtains and draping appropriately.

    • Provide emotional support and clear communication during uncomfortable procedures.

  • Safety and Infection Control:

    • Perform hand hygiene and use appropriate PPE as per CDC/OSHA guidelines.

    • Utilize aseptic techniques to prevent contamination during specimen collection.

  • Specimen Handling and Documentation:

    • Label specimens accurately and complete laboratory requisitions.

    • Send specimens promptly to the lab in a biohazard bag or designated container.

    • Document the procedure, specimen type, time, and patient response appropriately.

Patient Teaching

  • Explain: Clearly articulate the purpose, process, and expectations regarding diagnostic tests.

  • Discuss: Address dietary restrictions such as fasting, medication holds, and specific timing considerations (e.g., NPO, morning samples).

  • Reinforce: Emphasize the importance of correct timing for obtaining accurate results.

  • Inform: Notify patients about any special equipment, locations, or pre-procedure medications required.

  • Address: Sensitively handle any anxiety or embarrassment experienced by patients, providing reassurance.

  • Teach: Encourage a question-asking atmosphere to enhance understanding before proceeding with tests.

Specimen Collection Guidelines and Purpose

  • Patient-Centered Preparation:

    • Provide clear explanations and consider the patient’s capability of understanding.

    • Serve as emotional support, addressing anxieties and providing reassurance, particularly for children and families.

  • Safety and Infection Control:

    • Follow test prerequisites (e.g., fasting, specific sampling times).

    • Engage in hand hygiene practices before and after glove use, wearing gloves and utilizing aseptic techniques for all specimen types.

Best Practices for Specimen Collection and Handling

  • Collection and Handling Techniques:

    • Ensure the correct container, timing, and quantity for specimen collection.

    • Avoid contamination by collecting specimens prior to initiating antibiotic therapy whenever possible.

    • Properly label specimens with patient identifiers and deliver them to the lab without delay.

    • Transport specimens in biohazard bags or in line with specific laboratory requirements.

  • Clinical Judgment:

    • Early and accurate collection procedures utilizing aseptic techniques contribute to accurate lab outcome reliability and overall evidence-based care.

Specimen Collection Documentation Requirements

  • Laboratory Request Form:

    • Verify the laboratory requisition form includes:

    • Patient’s name, age, sex, and medical record number (MRN).

    • Date, time, and unit/floor/location of specimen collection.

    • Type and source of the specimen.

    • Requested investigation (specific test name).

    • Current antimicrobial therapy (if applicable).

    • Ordering provider’s details and their signature.

    • Contact details for results clarification.

  • Nursing Accountability:

    • Cross-check that the specimen label aligns with the requisition form.

    • Ensure documentation is timely recorded in the Electronic Health Record (EHR).

    • Report any collection delays or errors in adherence to policy guidelines.

Rationales for Specimen Collection

  • Early Collection: Facilitates earlier pathogen detection before antibiotic therapy administration.

  • Aseptic Technique: Reduces contamination risks during collection procedures.

  • Adequate Quantity: Ensures improved laboratory accuracy for testing results.

  • Proper Storage: Maintains the integrity of the specimen for accurate future analysis.

Collecting Urine Specimens

  • Purpose: Collecting urine specimens helps identify a multitude of clinical conditions, including:

    • Urinary tract infections (UTIs)

    • Symptoms such as fever, frequency, urgency, dysuria, hematuria, flank pain, and abnormal urine characteristics (e.g., cloudiness, odors).

  • Types of Urine Specimen Collections:

    • Midstream/Clean Catch Urine Collection

    • Sterile Urine Sample Collection via Catheter Port

    • 24-Hour Urine Collection

Midstream/Clean Catch Urine Collection Procedure

  • Preparation:

    • Perform a perineal cleanse:

    • Females: Separate labia, cleanse from front to back using antiseptic wipes.

    • Males: Retract the foreskin (if present), cleanse meatus circularly outward.

  • Collection Process:

    • Position the patient, assist if necessary, and initiate voiding.

    • Discard the first 30 mL of urine into the toilet, collect the midstream portion, and complete the rest into the toilet.

    • Secure the lid of the container without touching the inner sides, and dispose of gloves properly before hand hygiene.

  • Post-collection: Send specimen promptly to the lab and document the procedure while teaching the patient adequately.

Sterile Urine Collection via Catheter Port

  • Preparation Techniques:

    • Clamp tubing for 30 minutes prior to collection.

    • Clean the catheter port using an alcohol prep pad and withdraw 5–10 mL of urine for collection.

  • Post-collection Steps:

    • Transfer the urine into a sterile container, label appropriately, and unclamp the catheter afterward.

    • Send the specimen immediately and document the process while educating the patient.

24-Hour Urine Collection Protocol

  • Collection Guidelines:

    • Start with an empty bladder, discarding the first voided urine.

    • Collect all urine produced over the next 24 hours, refrigerating or placing on ice to maintain integrity.

    • Avoid contamination with fecal matter or tissues.

    • Properly label start and end times of collection and account for menstruation, if occurring.

    • Send specimen promptly post-collection and document procedures made with patient teaching in consideration.

Collecting Stool Specimens

  • Purpose: Stool specimens are analyzed for various clinical reasons, including:

    • Infection determination, bleeding abnormalities, or detecting parasites, ova, and bacteria.

    • Observations typically include amount, color, consistency, and presence of fats.

General Stool Specimen Collection Procedure

  • Procedure Initiation:

    • Clearly explain the procedure and provide a clean collection device to the patient.

    • Instruct the patient to avoid contamination with urine.

    • Utilize a tongue blade or collection hat to collect the sample responsibly.

    • Ensure the specimen is labeled, bagged, and sent to the lab promptly, especially for O&P specimens (Stat priority).

  • Documentation and Education: Reinforce patient education while accurately documenting the collection.

Hemoccult (Occult Blood) Test Protocol

  • Dietary Restrictions: Prior to the test, inform patients to avoid certain foods (e.g., red meat, certain fruits, vegetables, and medications) for three days.

  • Sample Collection Process:

    • Collect stool samples from two separate areas of one specimen.

    • Label, bag appropriately, and send to the lab (or perform on-unit if applicable).

    • Record and interpret results accurately for clinical significance.

Collecting Sputum Specimens

  • Purpose: Various tests including culture, sensitivity, cytology, and acid-fast bacillus identification can be conducted on the sputum.

  • Content: Sputum contains mucus, cellular debris, microorganisms, and may include blood or pus originating from the lungs.

Sputum Specimen Collection Techniques

  • By Expectoration:

    • Position the patient in a Fowler’s position, encourage deep breathing, and prompt cough.

    • Collect 2–10 mL of sputum in a sterile container and ensure it's sent immediately, as bacteria multiply rapidly.

    • Provide mouth care afterward and ensure patient comfort.

  • By Suction:

    • Employ sterile technique for collection using a suction catheter and trap; preoxygenate if indicated.

    • Apply suction no longer than ten seconds, collect sputum, secure the trap, and dispatch swiftly to prevent contamination.

    • Document characteristics of the specimen collected and the patient's tolerance throughout the procedure.

Wound Specimen Collection

  • When to Collect: Assess for purulent drainage, fever, chills, malaise, or elevated white blood cells (WBC).

  • Pain Management: Administer pain medication 30 minutes before dressing change if necessary for comfort during the procedure.

  • Collection Timing: Obtain cultures at the moment wounds are dressed and exposed.

Culture Techniques:

  • Aerobic Culture:

    • Use a sterile swab from viable tissue or fresh exudate, place back into the tube, and crush the ampule to coat the swab with medium.

  • Anaerobic Culture:

    • Aspirate drainage from deeper wound sites using a sterile syringe, expel air, and inject into sterile vacuum containers filled with appropriate media.

  • Documentation: Label specimen, enclose in a biohazard bag, and ensure prompt lab sending with detailed documentation including specimen site, type, collection method, patient response, and educational efforts.

Throat and Nose Cultures

Throat Culture Procedure

  • Collection:

    • Tilt the patient's head back, utilize a tongue blade and penlight to visualize tonsils or inflamed areas, swabbing carefully to avoid lip or tongue contact.

  • Post-collection:

    • Place the swab in culture medium and ensure it’s subsequently labeled, bagged, and sent to the lab.

    • Document the collection process and provide comfort to the patient.

Nose Culture Procedure

  • Procedure:

    • Ask the patient to blow their nose and select the most open nostril for insertion.

    • Place a swab or nasopharyngeal culture stick carefully into the nostril, then deposit it in the medium.

    • Label, bag, and forward promptly to the lab; dispose of materials followed by hygiene procedures, and document the process completed.

Home Care Considerations for Specimen Collection

  • Urine Specimens: Recommend refrigeration for preservation pre-lab delivery with prompt transport.

  • Stool Specimens: Stress the use of provided collection hats/devices to minimize contamination; assist older adults as necessary.

  • Sputum Specimens: Educate patients on the correct techniques and emphasize the necessity for timely lab return.

Specimen Rejection Scenarios

  • Mistaken Samples: During a busy clinical shift, a student nurse assists in several collections that are later rejected by the laboratory:

    • Wound culture: Rejected due to lack of date or time label.

    • Urine sample: Contaminated with stool, rendering it invalid.

    • Sputum sample: Mislabeled as saliva, resulting in a false-negative outcome.

Key Points Summary

  • Specimens are vital for obtaining critical data for diagnosing and planning patient care.

  • Clear explanations of procedures are essential to enhance patient cooperation.

  • Uphold patient privacy, safety, and cultural sensitivity standards in every procedure.

  • Consistently utilize gloves and adhere to strict infection control practices throughout collection procedures.

  • Always collect the correct specimen amount, ensure proper container usage, and label all specimens accurately.