SPECIMEN COLLECTION
TERMINAL LEARNING OBJECTIVE
Given the appropriate equipment and guidance, you will be able to collect specimens for diagnostic testing
INTRODUCTION
In any clinical setting, diagnostic testing is likely to be a large part of the soldier medic's responsibility. Your duties may routinely include patient care before, during, and after the test; performing or assisting with the test or, at times, teaching the patient how to perform the test and collecting and labeling specimens and ensuring their timely delivery to the laboratory.
General principles for throat culture and sputum collection
Throat culture
(1) A sample of both the mucus and the secretions from the back of the throat is obtained on a cotton tipped applicator and applied to a slide or culture medium, which is then incubated in the laboratory to determine what organism if any is present.
(2) Drug sensitivity determinations may also be done to determine which drug is most effective against a particular organism. This test also determines which drugs the organism is resistant to.
(3) A culture may be done within a matter of hours to rule out the presence of the streptococcus organism. This test does not rule out any other organism. The quick strep test is done in cases of suspected strep infection, so that antibiotic therapy can be initiated.
Sputum specimens
(1) Reasons for cytology study
(a) Study cells that may be malignant
(b) Determine organisms causing infection
(c) Identify blood or pus in the sputum
(1) Sputum is best obtained in the morning, before breakfast, after secretions have accumulated in the respiratory tract during the night
(2) Usually, specimens are collected on 3 successive days
(3) Best to have the patient brush their teeth and rinse their mouth so saliva and oral debris do not contaminate the specimen
(4) Patient should be taught that sputum is matter ejected from the lower respiratory tract through the mouth and that saliva is an unsatisfactory specimen.
(5) Patient should be instructed to inhale deeply and cough deeply on exhalation. About a teaspoon of sputum is needed for a specimen.
(6) Sputum should be coughed directly into a sterile specimen container that is then covered with a sterile lid, properly labeled, and sent to the laboratory
(7) A note should be charted in the patient's record about the character of the sputum, including amount, appearance, and odor
(8) Explain to patient that if sputum cannot be obtained, an induced sputum specimen may be required
NOTE: Precautions should be taken in the care and disposal of sputum. Gloves and a mask should be worn and hands washed after contact with sputum. All tissues are discarded as contaminated material.
General principles
(1) Reason - stool specimen yields information about the patient related to the functioning of the gastrointestinal system and its accessory organs (See C191W026, Treat Gastrointestinal Symptoms)
(2) Explain the reason for the test to the patient
(3) The best time of day to collect a stool specimen is soon after breakfast
(4) Patient should be instructed that a stool specimen is to be saved
(5) Patient should be instructed to notify the soldier medic as soon as there is an urge to defecate
(6) Give the bedpan to the patient when they are ready
(7) Use tongue blades and wear gloves when transferring the stool specimen to the specimen cup
(8) Some specimens must be kept warm to keep any parasites alive until the specimen is examined in the laboratory
(9) Always label the specimen container with the patient's name, SSN and all pertinent information
(10) Always send an appropriate lab slip with the container
(1) Purpose - to ascertain the presence of occult blood that is not visible
(2) Each method of testing has a specific procedure that must be followed in order to obtain accurate results (i.e. food restrictions and number of days to collect smear)
(3) Manufacturer's instructions or hospital procedure manual should be consulted for specifics
(1) Urinalysis is the laboratory examination of a urine specimen. Analysis of the urine is a common way of securing data about a person's health state.
(2) The soldier medic is responsible for instructing the patient about urine collection techniques or for obtaining specimen from the patient
(3) A cooperative patient can be instructed to put specimen into a clean or, in some instances, a sterile container. Care should be taken that the outside of the container is not contaminated.
NOTE: Precautions similar to those when handling blood are appropriate with all body fluids.
Mid-stream (clean-catch)
(1) Reason for obtaining a mid-stream:
(a) Obtain a sample that has been in the bladder an extended period of time
(b) Provide accurate information of the function of the kidneys the presents of pathogenic organisms, and the excretion of electrolytes that are normally used for body functions (i.e., potassium)
(2) Patient voids a little urine, which is discarded; the specimen is collected during mid-stream, and the last urine in the bladder is also discarded
(3) Procedure
(a) Wear gloves
(b) For the female
(1) Spread the labia well, and keep them apart until the specimen is obtained.
(2) Clean the area at the external meatus with sterile gauze or cotton balls and antiseptic soap and water.
* Move the gauze or cotton balls from the meatus toward the anus
* Use one piece of gauze or one cotton ball for each stroke
(3) Have the patient void about 30 cc then discard this urine
(4) Position the sterile specimen container near but not touching the meatus and ask them to void forcibly if she is lying down. This prevents collecting a specimen that has dribbled down across the perineal area.
(c) For the male
(1) Retract the foreskin to expose the glans penis in the uncircumcised male patient
(2) Clean the area of the external meatus with sterile gauze or cotton balls and antiseptic soap and water
* Move gauze or cotton ball in a circular manner at the meatus, and move down the shaft of the penis a few inches
* Use one piece of gauze or one cotton ball for each stroke
(3) Have the patient void about 30 cc then discard this urine
(4) Have patient void directly into the sterile container
(5) Have patient stop before he empties bladder
(6) Return foreskin to its normal position to prevent swelling and irritation of the glans penis
NOTE: With male patients, a sterile urinal may be used if unable to urinate into cup. With female patients, a sterile bedpan may be used if unable to urinate into cup.
(d) Label specimen container appropriately and send specimen to the laboratory
(1) Explain the reason for the procedure to the patient
(2) Gather all supplies and equipment and bring to the patient's bedside
(3) Make the patient as comfortable as possible in bed
(4) If patient is uncooperative or disoriented you may need assistance
(5) Clean the tops of all bottles with a betadine solution
(6) Attach the needle to the syringe
(7) Apply the tourniquet
(8) Wash hands
(9) Don gloves and clean the drawing site with a betadine solution
(10) Draw at least 10 cc of blood from the patient (5 cc's is needed for each bottle)
(11) Loosen the tourniquet
(12) Remove the syringe and needle while applying pressure to the site
(13) Replace the needle on the syringe with another sterile needle
(14) Inject 5 cc of blood into anaerobic bottle and do not allow air to enter the bottle
(15) Replace the needle on the syringe with another sterile needle
(16) Inject 5 cc of blood in the aerobic bottle and while the needle is still in the bottle, disconnect it from the syringe so that air enters the aerobic bottle, if IAW local SOP.
(17) Gently mix the blood with the solution in both bottles
(18) Label both bottles with patient identifying information and type of culture, ie, aerobic or anaerobic
(19) Prepare lab slip and take slips and specimens to the lab immediately
(20) Place a band aid over the patient's venipuncture site
(1) Glucose is the type of suger present in the blood. Many disease processes can affect the metabolism of glucose and the level of glucose in the blood. Diabetes is a classical example of a disease process that alters the blood glucose level.
(2) A rapid method of measuring and monitoring blood glucose is by doing a D-Stick.
(1) Wash hands
(2) Gather supplies
(3) Explain the procedure to the patient
(4) Have the patient wash hands with warm water
(5) Assist the patient to a comfortable position
(6) Remove a test strip from the container. Turn on the meter. Check that the code number on the strip matches the code number that appears initially on the monitor screen (or follow the manufacturer's instructions).
(7) Prepare the lancet by twisting off the cap. Arm the automatic device by pushing back the plunger until it clicks. Attach the lancet. Remove the cap, keeping the tip sterile.
(8) Put on gloves
(9) Select the site on the patient's finger for puncture. Gently massage the finger toward the intended puncture site. Keeping the finger in dependent position.
(10) Clean the site with alcohol prep and allow the area to dry thoroughly. (Patients may omit this step at home).
(11) Prick the side of the patient's finger with a lancet and squeeze gently. Use a cotton ball to wipe away the first drop of blood if recommended for the particular meter.
(12) Gently touch the drop of blood to the strip's target area or use a pipette as instructed. Have the patient hold a clean cotton ball to the puncture site for a few seconds.
(13) Insert the strip as far as it will go into the meter with the target area facing the red dot on the meter (or follow the manufacturer's directions for the specific meter).
(14) Read test results in 15 to 60 seconds on the meter face. Remove the strip and turn off the meter.
(15) Dispose of equipment properly. Remove gloves and wash your hands.
(16) Record blood glucose reading on proper forms. Check to see if the patient is on insulin coverage.
SUMMARY
During the past two periods, we have discussed specimen collections. As a future solider medics, one of your many responsibilities will be the collection and submission of specimens. You should realize, as with all procedures you perform, the importance of accuracy and expediency in carrying out these tasks.