SPECIMEN COLLECTION
SPECIMEN COLLECTION
DEFINATION
• It is the procedure of obtaining the required
amount of fluid / tissue for laboratory
examination
PURPOSE
• To provide a specimen for laboratory analysis so as to:
confirm clinical diagnosis
Monitor therapeutic level of drugs
Monitor progress of a patient
Plan interventions
Indications for specimen collection
• Blood disorders
• Patient requiring close monitoring of drug levels
• Septicaemia
• Inpatients suspected to have cancer
• When culture and sensitivity is required
• Patients suffering from infections in which the
causative organism needs to be identified
• Patients with renal disease
Types of specimen
• Blood
• Tissue
• Urine
• Stool
• Pus
• Sputum
• Vomitus
Defination
• Procedure required of obtaining the required
amount of fluid/tissue for laboratory
examination
• Purpose
• They are required asan aid to diagnosis to
guide to treatment ,monitor therapeutic levels
of drugs,monitor progress of patient and plan
interventions
General rules /principles followed
when collecting specimens
• Sufficient amount in an appropriate contact be
collected
• The specimen should be collected without
contamination
• One should use a sterile container if the specimen
is for bacterialogical examination
• The specimen must be sent to the lab
accompanied by appropriate requisition forms and
clearly labelled with details such as age,sex,
IP/NO , type of specimen,date and time of
collection,signature of who ordered the specimen
• N/B If a specimen is being is being send away from the
hospital the label should have: name and address of
hospital,
• The specimen should be sent to the lab immediately
after collection
• Any specimen kept in the ward for inspection by the
incharge or doctor should be covered to avoid
contamination
• After collecting the specimen write the report on the
cardex to avoid repeation or failure to collect
• Always explain to the patient before removing any
specimen in order to gain cooperation
1. BLOOD SPECIMEN COLLECTION
DEFINITION:
It is fluid sample obtained from an artery or vein.
PURPOSE:
Diagnosis of blood disorders
for blood compatibility before transfusion
INDICATIONS
Anaemia
Blood disorders
Pre and post operative preparation
Antenatal investigations
Infective conditions
Collecting a Blood Specimen (Venipuncture)
– Veins are a major source of blood for laboratory testing, as
well as routes for IV fluids or blood replacement.
– The nurse should be skilled in venipuncture to avoid
unnecessary injury to veins.
– Blood tests can yield valuable information about
nutritional, hematological, metabolic, immune, and
biochemical status.
– The nurse is often responsible for collecting blood
specimens; however, many institutions have specially
trained technicians to draw blood.
ASSESSMENT
• Condition of the client to establish stability of the procedure
and any assistance if needed
• Clients understanding of the need for sample collection to
allay anxiety and promote cooperation
• Clients risk associated with the procedure to be able to plan
for untoward reactions and identify any contra indications
• Equipment required to be able to ascertain availability and
promote efficiency in specimen collection
• Appropriateness of the working environment for staff and
clients safety
PLANNING
A. SELF
Wash hand
Assemble equipment
Label the specimen container or bottle
B. CLIENT
Explain procedure and obtain informed consent
REQUIREMENTS
Tray containing the following:
• Spirit
• Sterile topical cleaner
• Receiver for soiled swabs
• A tourniquet
• Assorted specimen bottles
• A pair of scisors
• A lab request form
• Gloves
• 2 blood slides
• Sterile lancet/needle
• Syringes (5ml, 10ml, 20ml)
• A vacutainer
• Labels
• Sharps container
Types of vacutainers for blood
specimen collection
• Pupple/lavender –for whole blood for complete
blood count blod typing
• Has edta (potassium salt) which is a strong
coagulant
• Grey –for blood glucose determination has
sodium flouride and potassium oxalate to inhibit
glucolytic enzymes in blood oxalates
• Light Blue- has sodium citrate anticoagulate used
for coagulation assays (prothrombin time)
• Red – used in biochemistry, immunology and
serology. Has a clot additives
IMPLEMENTATION
STEPS
o Take equipments to the bedside for efficiency of proceure
o Provide privacy
o Wash hand and put on gloves to minimize transfer of micro
organisms
o Clean the site with spirit swabs in circular motion
o Apply torniquet 2-3 inches above the identified site for easy
visibility
o Ask the client to make a fist
o Mount syringe with an appropriately sized needle
Steps cont,d
o Assess the site with a needle and prick, then draw 2-5mls of
blood
o Release torniquet
o Remove needle and apply pressure using a sterile swab for 2
min
o Dispose the needle and syringe in sharps container
o Remove gloves and dispose appropriately
o Position client comfortably
o Put samples in a biohazard bag and send to laboratory
immediately
o Inform the client when the results is to be collected
Needle and Syringe Method
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Needle and syringe method. Blood collects in the barrel as the
plunger is pulled back.
Specimen Collection
• Collecting a Blood Specimen (Venipuncture)
(continued)
– Possible risks of venipuncture
• Anticoagulant therapy
• Low platelet count
• Bleeding disorders
• Presence of arteriovenous shunt or fistula
• After breast or axillary surgery performed on that side
– Abnormal clotting abilities, medications, and
compromised circulation can further impair blood flow.
Specimen Collection
• Collecting a Blood Specimen (Venipuncture)
(continued)
– Collection methods
• Syringe with a needle attached
– The blood is drawn into the barrel by pulling back on the
plunger.
– After the blood is collected, it is transferred to a test tube
Specimen Collection
• Collecting a Blood Specimen (Venipuncture)
(continued)
– Collection methods
• Vacutainer system
– Has a needle, a needle and tube holder, and an evacuated
tube with rubber stopper.
– When the vein is punctured, blood flows into the tube.
– This allows the collection of many blood specimens with one
venipuncture.
– After a tube fills, it is removed and a new one is attached to
the holder.
A, Parts of the Vacutainer. B, Blood
collects in a Vacutainer tube
(A, from Zakus, S.M. [1995]. Clinical procedures for medical assistants. [3rd ed.]. St. Louis: Mosby. B,
from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Performing the venipuncture.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Labeling the blood tube.
Collecting a Blood Specimen
(Venipuncture)
– Selecting a venipuncture site
• The basilic and cephalic veins in the antecubital space
are the most common venipuncture sites.
• These veins are large and near the skin surface.
• Hand veins are often alternative sites.
• Before selecting the vein, select the arm to be used.
• Avoid the arm on the side of a mastectomy or on the
side of a paralysis.
• If the patient has IV access, do not use that arm.
• Do not use the arm with an access site for
hemodialysis.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Selecting a venipuncture site. A, Inner arm. B, Dorsal surface of
hand.
Performing the venipuncture.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
EVALUATION
Evaluate:
1.Clients reaction during and after procedure
2.For bleeding
3.Characteristics of the blood
DOCUMENTATION
Document the following:
1. Procedure done
2. Any deviation from normal
3. Action taken
4. Outcomes of evaluation
URINE SPECIMEN COLLECTION
DEFINITION:
It is the process of obtaining a urine sample from the
urinary bladder either directly from the urethra
or by use of urinary catheterization.
PURPOSE:
1. To analyse urinary sample for clinical judgement
2. To monitor therapeutic interventions
INDICATIONS
To rule out pregnancy
Routine medical examination
Renal failure
Diabetes mellitus
Sexually transmitted infections
dehdration
ASSESSMENT
• Condition of the client to establish stability of the procedure
and any assistance if needed
• Clients understanding of the need for sample collection to
allay anxiety and promote cooperation
• Clients risk associated with the procedure to be able to plan
for untoward reactions and identify any contra indications
• Equipment required to be able to ascertain availability and
promote efficiency in specimen collection
• Appropriateness of the working environment for staff and
clients safety and comfort
PLANNING
SELF:
1. Wash hands
2. Assemble equipments
3. Label the specimen container/bottle
CLIENT:
1. Explain procedure
2. Obtain informed consent
REQUIREMENTS
• Specimen bottles/containers
• Laboratory request forms
• Urine measuring jug
• Syringe/needles
• Spirit
• Dry swabs
• Gloves
• Labels
• Toilet paper
• Soap
REQUIREMENTS CON,D
• Water for washing bowl
• Funnel
• Urine collection bag for paediatrics and receiver for soiled
swabs
• Artery forceps/clamps
• Bedpan
• Sharp container
• 24hr urine collection bottle if indicated
IMPLEMENTATION
STEPS:
A. ROUTINE URINE COLLECTION
If client is able to give specimen independently, give instructions
as follows:
o Clean vulva/penis with soap and water to promote hygiene and
prevent contamination
o Pass approximately 30mls of urine directly into bottle
o Pass the remaining into the toilet/bedpan/urinal
o Wipe vulva/penis with toilet paper
o Properly dispose urine from the bedpan/urinal
If client requires assistance:
Wash hands put on gloves
Clean client vulva /penis with soap and water
Hold bottle for client to pass urine directly into it
Allow the rest of the urine to go into the bedpan/urinal
Dry the vulva/penis with toilet paper
Properly dispose urine from the bedpan/urinal
if client has an indwelling catheter:
Wash hands put on gloves
Mount needle to syringe
Clamp drainage tube
Using antiseptic swab entire port
Insert the needle at about 45degrees just above where the
catheter is attached to drainage port
Draw 3mls for culture or 20mls for routine urinalysis
Transfer the urine to appropriate container and close lid
Discard needle into sharps container
Unclamp the catheter
B. MIDSTREAM SPECIMEN…………………………………
if client is independent instruct him/her as follows:
Clean vulva/penis with soap and water
Open specimen bottle without touching inside
Initiate urine stream and allow first flow into the toilet
Pass mid flow into bottle
Pass rest into the toilet
Wipe and dry self
If client needs assistance follow above instructions with the nurse
cleaning \nd collecting specimen
If client has an indwelling catheter clamp for 30 mins and follow
instructions for routine sample
C.12/24 HR URINE SPECIMEN COLLECTION
• EXPLAIN PROCEDURE TO THE client and provide
specimen bottle
• Void the initial urine into the toilet
• All subsequent specimen collected should be passed into urine
jug before emptying into specimen bottle to avoid spilling
• The last specimen after 12/24hrs should be collected
• Label and send to lab within 15-20 min of collection for
accuracy
EVALUATION
Evaluate:
Clients compliance with saving all urine for accurate results
Characteristics of specimen to facilitate intervention as we
wait for results
Urine drainage system to ensure it is intact and patent to
promote sterility
DOCUMENTATION
Document by recording:
Procedure
Amount and characteristic of urine obtained
Any deviation from normal
Action taken
Outcomes of evaluation
STOOL SPECIMEN COLLECTION
DEFINITION:
It is the process of obtaining a stool sample from the rectum
or colostomy
PURPOSE:
To analyse/test the specimen for diagnostic purposes
INDICATIONS
o infective conditions
o worm infestations
o gastroenteritis
o peptic ulcer disease
ASSESSMENT
ASESS:
o The clients condition to establish suitability of procedure
o Clients level of understnding to fill in knowledge gaps
o Clients risk associated with obtaining the sample
o The equipment required or assistance to promote efficiency of
collection
o Appropriateness of the working environment
PLANNING
SELF:
• Wash hands
• Assemble equipments
• Label container
CLIENT:
• Explain procedure to client
• Obtain informed consent
REQUIREMENTS
Tray containing:
Stool specimen container
Wooden spatula
Lab request forms
Gloves
Air freshener
Toilet paper
Bedpan if required
IMPLEMENTATION
STEPS:
Explain procedure and obtain consent to allay anxiety and gain
cooperation
Independent client give stool container instructions :
Pass urine first into the toilet to avoid stool contamination
with urine
Place tissue on toilet seat/floor and pass stool for easy sample
collection
Using spatula scoop stool (1 teaspoonful or 1/3 of specimen
container) in order to achieve an adequate amount
Cover the specimen container
NB:
1. For clients who need assistance wash hands don gloves and
follow above procedure
2. If client has loose motion hold the container directly above the
anus
Discard the remaining stool into the toilet, spatula into the pedal
bin
Remove gloves and wash hand
Make sure the specimen is labelled and send to the lab
immediately
Collecting a stool specimen
(From Sorrentino, S.A. [2004]. Mosby’s textbook for nursing assistants. [6th ed.]. St. Louis: Mosby.)
.
Collecting a stool specimen
(From Sorrentino, S.A. [2004]. Mosby’s textbook for nursing assistants. [6th ed.]. St. Louis: Mosby.)
.
EVALUATION
1. Proper hand washing before and after procedure to minimize
micro organism transfer
2. Client compliance with stool collection
3. Characteristics of specimen for accuracy of results
DOCUMENTATION
Record
Procedure, date and time of collection
Amount and characteristics of stool obtaind
Action taken and outcomes of evaluation
SPUTUM SPECIMEN COLLECTION
DEFINITION:
The process of obtaining a sample from the respiratory tract
PURPOSE:
1. To facilitate analysis of the specimen for diagnosis
2. For treatment of respiratory conditions
INDICATIONS
Bronchitis
Pulmnary tuberculosis
Other respiratory infections
Lung cancer and tumours
ASSESSMENT
ASSESS:
1. Condition of the client to determine assistance needed
2. Clients understanding of the need for sputum to fill in
knowledge gaps and promote cooperation
3. Clients possible risk associated with sputum collection/deep
breathing exercises to identify any contraindication to
procedure
4. Time of last meal taken to avoid gastro-intestinal irritation
5. Equipment needed to promote efficiency
6. Appropriateness of the working environment for both client
and nurses comfort
PLANNING
SELF:
Wash hands
Assemble equipment and labe speimen bottle
CLIENT:
Explain the procedure
Obtain informed consent
REQUIREMENTS
Tray containing:
Sputum mug
Specimen container
Lab request form
Gloves
Mask
Toilet paper
IMPLEMENTATION
STEPS:
• Take equipments to the bed side for effectiveness and
efficiency
• Screen/draw the curtains for privacy
• Explain procedure to the patient to allay anxiety and gain
cooperation
• Wash hands and don gloves
• Instruct client to:
a. Take 3-4 deep breaths to stimulate cough reflex
b. Cough and expectorate after full inhalation to promote
removal of secretions
c. Spit directly into the specimen container and cover it
• Give tissue paper to the client to promote comfort and hygiene
• Remove gloves dispose appropriately and wash hands
• Position client and remove secretions from the bed
• Send the sample to the laboratory immediately
EVALUATION
EVALUATE:
1. If proper hand washing was done before and after procedure
2. Clients compliance with sputum collection
3. Clients pattern of breathing through out the procedure
4. Characteristics of the sputum specimen
Collecting a sputum specimen by suction.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Collecting a sputum specimen by suction
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
.
Collecting a sputum specimen by expectoration
(Grimes, D. [1991]. Infectious diseases, Mosby’s clinical nursing series. St. Louis: Mosby.)
.
DOCUMENTATION
• RECORD:
1. Procedure
2. Deviation from the normal
3. Action taken
4. Outcomes of evaluation
SWAB SPECIMEN COLLECTION
DEFINATION:
It is the process of obtaining a specimen of pus/tissue fluid using
a sterile swab/pad.
PURPOSE:
To faclitate the aanalysis of the specimen for diagnostic reasons
INDICATIONS:
Infected wounds
Suppuration of throat
Suspected pelvic inflammatory disease
Infections of the genital tract
Ear/eye swab
ASSESSMENT
ASSESS:
Condition of client to establish Suitability of the procedure
Clients understanding of the need for swab collection
Possible risks associated with obtaining the swab to identify
contraindications to procedure
Equipment/assistance needed to promote efficiency
Appropriateness of the working environment for comfort of
the client and nurse
PLANNING
SELF:
wash hands
assemble equipment
label the specimen container
CLIENT:
explain the procedure
obtain informed consent
REQUIREMENTS
Tray containg:
Sterile swab
Wooden spatula
Torch
Surgical mask
Sterile speculum for cervix examination
Sterile dressing pack
Warm sterile water gauze swab
Specimen container
Lab request form
Sterile gloves
Trolley for wound dressing if necessary
Culture media labels
IMPLEMENTATION
STEPS:
o Take equipment to the bed side for easy accessibility
o Screen/draw curtains for privacy
o Explain procedure to client
o Position the client
o Wash hands and don gloves
a. Wound swab
1. Remove sterile swab and rotate swab on the
wound
2. Replace swab into its container
3. Continue procedure for wound dressing
Wound culture tube
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
.
Aerobic culture tube
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
.
b. Throat swab
• Ask client to open mouth wide and put tongue out
• Depress tongue slightly with spatula
• Directly light to back and ask client to say “aaaa”
• Gently and firmly sweep over the inflamed throat area with
swab taking care not to touch tongue with swab
• Replace swab into container
• Remove gloves and wash hands
c. Ear swab
1. Gently pull the pinna upwards and backwards(adults),
downwards and backward (children)
2. Insert swab and rotate gently into the extended canal
3. Replace swab into the container
4. Clean the ear
5. Remove gloves , dispose appropriately then wash and dry
hands
6. Reposition client and screen the bed
7. Send sample to lab immediately
d. Nose swab
1. Moisten the swab with sterile water before inserting into the
nose
2. Insert the swab gently into nose and rotate it towards tip of
mucosa
3. Replace swab into container
4. Remove gloves wash and dry hands
5. Leave client comfortable
e. High vaginal swab
1. Position client in lithotomy position
2. Direct light source into perineum
3. Wash hands and glove
4. Warm speculum in sterile water
5. Using non dominant hand separate labia in order to expose
the vaginal orifice
6. Take swab as high as possible around the fornices
7. Replace swab into container
8. Remove speculum noting characteristic of discharge
9. Decontaminate speculum
10. Clean client using gauze and assist into
comfortable position
11. Remove gloves and wash hands
12. Label and send specimen to laoratory
EVALUATION
EVALUATE:
1.proper hand washing before and after
procedure
2.client compliance with high vaginal swab
collection
3.characteristic of discharge /swab specimen
Specimen Collection
• Collecting a 24-Hour Urine Specimen
– This is required for tests of renal function and
urine composition.
– The entire volume of urine from a 24-hour period
is collected.
– If urine is accidentally discarded or contaminated
or the patient is incontinent, restart the time
period.
Specimen Collection
• Measuring Blood Glucose Levels
– The use of a meter to measure blood glucose is a
more meaningful test for use by persons with
diabetes than testing urine for the presence of
glucose.
– A skin puncture can be easily performed by the
patient at home and provides more accurate
information than does the urine glucose/acetone
determination test.
Measuring Blood Glucose Levels
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Measuring blood glucose levels.
Skill: blood sugar measurements
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Measuring blood glucose levels.
Skill: blood sugar measurements
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Measuring blood glucose levels.
Measuring Blood Glucose Levels
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Measuring blood glucose levels.
Measuring Blood Glucose Levels
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. (3rd ed.).
St. Louis: Mosby.)
Measuring blood glucose levels.
DOCUMENTATION
RECORD:
1.The procedure in the nursing notes
2.Amount and characteristics of discharge
3.Action taken
4.Outcome of evaluation
REFERENCE
•Potter. P. A, Perry. A.G. (2006). Clinical Nursing
Skills & techniques. (6th ed.). elsiever mosby. St
Louis Missouri. …………………
•Nursing council of Kenya (2009). Manual of
clinical procedures. (3rd ed.). Kenya
