Collection of Specimen

8/2/2019 Collection of Specimen

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URINE

Normal Urine Consist Of 96% WaterAnd 4% Solutes. Organic SolutesInclude Urea, Ammonia, Creatinine,And Uric Adic. Urea Is The Chief

Organic Solute. Inorganic SolutesInclude Sodium, Chloride, Potassium,Sulfate, Magnesium, And Phosphorus.Sodium Chloride Is The MostAbundant Inorganic Salt. Variations In

Color Can Occur.


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CHARACTERISTIC OF NORMAL AND ABNORMAL URINE

CHARACTERISTIC NORMAL ABNORMAL

Amount in 24 hours 1,200-1,500 ml Under 1,200 ml

A large amount over intake

Color, clarity Straw, amber

Transparent

Dark amber

Cloudy

Dark orange

Red or dark brown

Mucous plugs, viscid

thick

Odor Faint aromatic Offensive

Sterility No microorganisms present Microorganisms present

pH 4.5-8 Over 8

Under 4.5

Specific gravity 1.010-1.025 Over 1.025

Under 1.010

Glucose Not present Present

Ketone Bodies (acetone) Not present Present

Blood Not present Occult (microscopic)

Bright red


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Urine is also a common specimen type. Some tests,such as a urinalysis, require a random sample, whileother quantitative tests require urine to be collected

over a 24 hour period.


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TYPES OF URINE COLLECTION:

ROUTINE (RANDOM) URINE SPECIMEN

Specimen container with lid, bedpan, Urinal and toilet

tissue for client on bed rest, clean gloves, biohazard bag, laboratory

request form

To obtain baseline microscopic data

As part of the physical examination or at various times during

hospitalization

To collect urine specimen safely for urinalysis


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:

Check Doctors orderIdentify client, provide privacy, explain procedure, and how he or she

can cooperate.Wash hands

Put on glovesInstruct client who is able and ambulatory to do perineal care. For non-

ambulatory client or bed ridden client, perform perineal care.Have client void into specimen container, bedpan or urinal.

Measure and record output, if required.Pour urine (approximately 30-60 ml) into the specimen container and

cap firmly.


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Label the specimen container with the clients name, room,

number, date and time of collection,Place specimen in a biohazard bag.Send it to the laboratory as soon as possible with the

laboratory request form and record in the laboratory log book.Ensure clients safety and comfort. Return for needed

assessments, evaluation or follow-up.Clean working areaRemove and dispose glovesWash handsChart: document the date, time, amount of collection, and any

unexpected findings such as color difference, presence of blood,

sediment. If necessary, record the urine volume on the intake

and output record.


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MIDSTREAM (CLEAN-CATCH) URINE SPECIMEN

urine specimen cup with lid, 2x2 gauze padsand povidone iodine solution, basin with water, soap, washcloth,towel, clean gloves, bedpan/urinal, tissue, bath blanket, pad,biohazard bag, laboratory request form, wee-bag for infants

Suspected presence of pathogenic organisms in urinary tractReplaces random urine collection because it provides a virtuallyuncontaminated specimen without the need for catheterization.

Presence of indwelling catheter

to collect the cleanest possible urine specimen


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Check doctors orderIdentify client, provide privacy, and explain procedure and how he or she can

cooperate.Raise the bed to the level of your waistCover the client with bath blanket, remove the top covers and put the pad (and

bedpan for females) in place.Wash hands

Put on clean glovesWith soap and water, cleanse the female perineum and area around the meatus

or cleanse the male penis. Dry.

With a gauze soaked povidone solution, clean as follows:a. For females:

i. Separate the labiaii. Cleanse one side of the labia from front to backiii. Cleanse the other side of the labia from front to backiv. Cleanse from front to back over the meatus

For males, cleanse in a circular motion from meatus downward; repeat with

remaining gauze soaked povidone iodine solution.


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For infants,

i. Clean the surface with soap and water.ii. Apply a plastic urine container (wee bag), sticky part around the

male infants penis or vulva (for females).Do not include or cover the

rectum.iii. Check every 30 minutes if infant has urinated. Remove plastic urine

collection bag if infant has urinated and specimen is obtained.

Have the client begin to void into bedpan or urinal, then into the specimen

container (30-50 ml; 5-10 ml for urine culture and sensitivity testing), thencomplete voiding into the bedpan or urinal.Cap the specimen container firmly, and label with the name of the client, room

number, date and time of urine collection.Lower the head of the bed, replace the covers and remove the bath blanket.

Place the specimen in a biohazard bag.Ensure clients safety and comfort. Return for needed assessments, evaluation

or follow-up.Send urine specimen to laboratory with the laboratory request form and

record in the laboratory log book.

Remove and dispose gloves

Wash hands


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COLLECTING URINE SPECIMEN FROM AN INDWELLING CATHETER

cotton balls with alcohol, antiseptic wipe

(povidone iodine), 25G needle, 10 ml to 20 ml syringe, tubeclamp/ crimp or rubber band, sterile specimen cup with lid, cleangloves, biohazard bag, laboratory request form.

If the presence of pathogens is suspected.

to collect a sterile urine specimen from an

indwelling catheter.


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Check doctors orderIdentify client, provide privacy, explain procedure and how he or

she can cooperateWash handsPut on gloves

Crimp or clamp the drainage tube at least 3 inches (7.5 cm) belowthe sampling port to let urine collect in the tubing for 20 to 30

minutes to one hour.

Note: Make sure that you unclamp the drainage tube after

collecting the specimen to prevent urine backflow, which may causebladder distention and infection.When you see urine under the access site, clean the sampling port

with alcohol/antiseptic wipe and let it air dry.


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Methods:

a.) If you are using a needle with syringe, wipe with an antiseptic or alcohol

pad the area where the catheter joins the drainage tube (distal). Inject the

needle at a 45 degree angle. Introduce the needle diagonally to allow selfsealing of the rubber material of the catheter. This will prevent leakage of

urine via the puncture site.

b.) If you are using a needleless system, wipe the sampling port with an

antiseptic wipe or alcohol pad, then attach the uncapped syringe to thesampling port. Position it perpendicular to the center of the port, press the tip

against the port and twist gently to lock it in.

c.) If the catheter is not made of rubber, or has no sampling port, wipe the

area where the catheter joins the drainage tube with an alcohol pad.

Disconnect the catheter and allow urine to drain into the sterile specimen

container. Avoid touching the inside of the sterile container with the catheter,

and do not touch anything with the catheter drainage tube to avoid

contamination. When you have collected the specimen, wipe both connection

sites with an alcohol pad and join them.


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Slowly withdraw the urine sample, and then unscrew the syringe from

the port (needleless system). A 10 to 30 ml urine specimen is adequate.Transfer the urine sample into the specimen container and discard the

syringe and needle in an appropriate sharps container.

Unclamp the drainage tube

Label the specimen container with the clients name, date and time of

urine collectionPlace the container in a biohazard bag for transport or send it to

laboratory with laboratory request form and record in the laboratory log

book.

Ensure clients safety and comfort. Return for needed assessments,

evaluation or follow-up.Remove and dispose gloves

Wash hands


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24 HOUR URINE SPECIMEN

bedpan, plastic receptacle for toilet if client has bathroom

privileges, large specimen container with preservative if necessary and a cap

or stopper, ice-filled basin, posted (reminder) sign, clean gloves, bedpan,

urinal, graduated container or cylinder, laboratory request form, large

biohazard bag or container.

When analysis of urine components, such as hormones, proteins, and

electrolytes is necessary (e.g., renal calculi, renal failure,

phaechromocytoma)

Do not begin this procedure if the client is scheduled for discharge or if

other urine or kidney testing is required

.

to collect 24 hours worth of urine and provide necessary

baseline data.


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Check doctors orderIdentify client, provide privacy, explain procedure and how he or she

can cooperateSet up equipment and post reminder sign

Wash handsPut on gloves

Instruct the client:Do not put toilet paper in the urine containerDo not mix feces with urine

Do not discard any urine

Notify the nurse for each voiding


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Wash hands after each voidingAdd preservative to the specimen, if needed. The container

must remain in ice-filled basin for the duration of the collectionperiod.

Discard the first voided specimen.Have the client void a few minutes before end of collection to

collect all urine in the bladder within the 24 hour period. Usually

started at 7 oclock in the morning.Place labeled specimen in a large biohazard bag or container

and transfer to laboratory immediately, with the laboratory

request form and record in the laboratory log book.Ensure clients safety and comfort. Return for needed

assessments, evaluation or follow-up.

Remove and dispose glovesWash hands


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STOOL

Normal feces are made of about 75% water and 25%

solid materials. They are soft but formed. if the feces are

propelled very quickly along the large intestine, there is

not time for most of the water in chyme to be reabsorbed

and the feces will be more fluid, containing perhaps 95%

water. Normal feces require a normal fluid intake; feces

that contain less water may be hard and difficult to expel.

Feces are normally brown, chiefly due to thepresence of stercobilin and urobilin, which are derived

from bilirubin(a red pigment in bile).


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CHARACTERISTIC OF NORMAL AND ABNORMAL URINE

CHARACTERISTIC NORMAL ABNORMAL

Color Adult: Brown

Infant: Yellow

Clay or white

Black or tarry

Red

PaleOrange or green

Consistency Formed, soft, semisolid, moist Hard, Dry

Diarrhea

Shape Cylindrical (contour of rectum)

About 2.5 cm (1 inch) in diameter inadults

Narrow, pencil-shaped, or stringlike

stool

Amount Varies with diet (about 100-400 g per

day)

Odor Aromatic: affected by ingested food

and persons own bacterial flora

Pungent

Constituents Small amounts of undigested

roughage, sloughed dead bacteria

and epithelial cells, fat, protein, dried

constituents of digestive juices (e.g.,

bile pigments, inorganic matter)

Pus

Mucus

Parasites

Blood

Large quantities of fatForeign Objects


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COLLECTING A STOOL SPECIMEN (Fecalysis)

bedpan or bedside commode of necessary, specimen

container with lid, clean gloves, two tongue depressors, paper towel

or paper bag, toilet tissue, biohazard bag, laboratory request form

To detect the presence of unusual components, such as parasites

or occult blood

to collect stool sample for urinalysis


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Check doctors order

Determine the reason for collecting stool specimens ordered forlaboratory analysis and the correct method of obtaining and

handling.Identify client, provide privacy, and explain procedure and how

he or she can cooperate.

Instruct the client to call or notify the nurse when he feels theurge to defecate.When the client is ready, wash hands and put on gloves.Assist with bedpan (if bedridden), or bedside commode, or assist

to the bathroom (if ambulatory)

NOTE: instruct the client to void first before defecating.Once the stool is obtained, put on gloves and use the tongue

depressors to place the required specimen into the container. Take

a thumb size (one teaspoonful or I inch) of well-formed stool

quantity of feces in 3 different areas of the stool.


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Wrap the tongue blade in a paper towel and discard it.Close and label the container with the clients name, date and time

of stool collectionPlace the specimen in a biohazard bagSend to the laboratory with laboratory request form and record in

the laboratory log book as soon as possible. Fresh specimens providethe most accurate result.Assist the client with perineal care as necessaryClean the work areaEnsure the clients safety and comfort. Return for needed

assessments, evaluation or follow-upRemove and dispose glovesWash hands


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PERFORMING HEMOCCULT TEST/ FECAL OCCULT BLOOD TEST

Hemoccult test slide folders, clean gloves, woodenapplicator, hemoccult developing solution, watch with second

hand sweep (or timer)

Screening test for blood in the feces that is not visible to the

naked eye

Menstruation and for 3 days afterward


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Instruct the client about the purpose of the test and have the client

defecate in a collection containerCheck the condition of the reagent and note their expiration date.

Use only fresh reagent and discard outdated ones. Protect from

moisture, heat and light.Observe (for documentation or reporting) stool characteristics:

color, odor, shape, consistency and sizeWash handsPut on clean glovesWith an applicator, obtain a small specimen of feces and smear a

thin layer in the first box of the cardboard hemoccult slide. With the

opposite tip of the applicator, obtain a second specimen of feces

from another location and smear it thinly in the second box of the

cardboard hemoccult slide.


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Close the cardboard hemoccult slide cover and turn it over to the

reverse side. Open the cardboard flap on the reverse side and apply

two drops of the hemoccult developing solution to the guaiac

paper. Apply the exact amount of solution specified (one or two

drops) to ensure the accuracy of the test.As soon as you apply the developing solution, start keeping track

of the time. If you notice a bluish discoloration on the guaiac paper

30 to 60 seconds after applying the solution, the sample containedoccult blood. Consider the results positive if both samples show a

positive result.

Dispose of the hemoccult slide and feces in a biohazard waste

container

Ensure clients safety and comfort. Return for neededassessments, evaluation or follow-up.Remove and dispose glovesWash hands


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SPUTUM SPECIMENmouthwash (i.e., saline water or as prescribed), facial

tissues, sterile specimen container with tight-fitting cap, emesis

basin, biohazard bag, clean gloves, laboratory request form

To identify abnormalities or the presence of suspected pathogens

Coughing is contraindicated for the client recovering from spinal,

neurologic, or optic surgery

to obtain fluid samples from the lung area safely for

analysis


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Wash hands

Identify client, provide privacy, explain procedure and how he or she

can cooperateWash handsPut on glovesGive emesis basin to the client and instruct to clear his nose, throat,

and rinse the mouth to decrease contamination of the sputumNOTE: do not use astringent mouthwash because its alcohol content

may destroy the microorganisms present in the sputum. Also, avoid

toothpaste.

Give the opened sterile specimen container to the clientHave the client deep breathe 3 to 5 times and cough and deposit

sputum directly into the container. If the client requires suctioning,

use sterile suctioning tip or mucus trap. Obtain about 1 teaspoon of

sputum (1 to 2 tablespoon [15 to 30 ml])


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Quickly cap and securely seal the containerProvide tissue, mouthwash and emesis basin for the client or assist

with oral care as needed.Label the specimen as to the clients name, the date and time ofsputum collection.Place specimen container inside a biohazard bagSend to the laboratory as soon as possible with laboratory request

form and log in the laboratory book.NOTE: before sending the specimen to the laboratory, examine it to

make sure it is actually sputum, not saliva, because saliva will produce

inaccurate results.Clean the work are

Ensure clients safety and comfort. Return for needed assessments,evaluation or follow-upRemove and dispose glovesWash hands


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Blood collection, or phlebotomy, is usually performed by labassistants but is often done by ward staff. Proper technique, asshown here, will decrease the chances of hemolysis, which is acommon interference.

BLOOD COLLECTION


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Blood can be collected in a varietyof tube types that contain differentadditives. Shown here are thevarious tubes, which are identifiedby its stopper colour. When wholeblood is needed, the sample iscollected into a tube containing ananticoagulant. Examples of whole

blood tubes are the mauve topused for Hematology tests, andthe blue top which is used forcoagulation studies. If serum isneeded, blood is often drawn into

a gold top, which contains a clotactivator and gel separator tomake centrifugation andalliquoting easier.


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OBTAINING A FINGERSTICK BLOOD SUGAR

Disposable exam gloves Alcohol sponge

Lancet Blood glucose meter Reagent strip or test strip for the blood glucose meter being used Sharps container Plastic bag for used supplies


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1. Perform your beginning procedure actions.

2. Wipe the patients finger with the alcohol sponge. Allow the alcohol to dry.3. Pierce the sides of the middle or ring finger using the lancet.4. Discard the lancet in the sharps container.5. Squeeze the sides of the finger gently to obtain a drop of blood.

6. Hold the puncture site directly over the reagent strip and place a hanging

drop of blood onto the reagent pad. If using the Glucometer Elite, place thetest strip next to the puncture site and allow the test strip to withdraw the

blood into the center tube.7. Insert the strip into the meter, if this was not done previously.8. Wipe the patients finger with the alcohol sponge and allow to dry. Apply

pressure until bleeding stops. Apply a bandage, if necessary.9. Wait the designated period of time for the meter you are using. An audible

beep will indicate when the value is displayed on the screen.10. Perform your procedure completion actions

Documents

Collection of Specimen