5 Specimen

1
Specimen
collection
FON for MW by S.A 04/12/2024
Learning Objectives:
 At the end of this chapter, students will be able to:

 Explain at least one reason for collecting specimen
like sputum, blood, urine or stool
 Demonstrate correct collection of urine specimens
 Demonstrate correct collection of a stool specimen
 Demonstrate correct collection of a sputum specimen
 Demonstrate correct collection of a blood specimen

Specimen collection
3

Specimen Collection
 Specimen collection refers to collecting

various samples such as, stool, urine,
blood and other body fluids or tissues,
from the patient for diagnostic or
therapeutic purposes

Cont..
5
 Because only medical history can’t lead to the accurate

diagnosis of the patient’s problem
 Laboratory examinations of specimens such as; urine,

blood, sputum, stool, throat swab, vaginal swab, wound
drainage etc provide important adjunct information for
diagnosing health care problems and also provide a
measure of the response to therapy.

Cont..
6
 Laboratory test contribute vital information about the

clients health
 Correct diagnosis and therapeutic decision rely, in part,
on the accuracy of the test result
 Adequate patient preparation, specimen collection, and
specimen handling are essential prerequisites for
accurate test results

Common mistakes affecting all types of specimen are:
 Failure to label specimen correctly and to provide all

pertinent information required on the test request form
 Insufficient quantity of specimen to run the test
 Failure to use the correct container /tube for appropriate

specimen preservation
 Inaccurate and incomplete patient instruction prior to

collection
Cont..
8
 Failure to tighten specimen container, resulting in

leakage and/or contamination of the specimen
 Failure to maintain the specimen at appropriate

temperature

The test requisition/request form should
contain:
9
 Patient’s name, address, age, sex, ward and bed

number, ID (if any)
 clearly marked test request
 Name and address of ordering person
 Type (or source of the specimen)
 Clinical information
 Date and time of collection

The specimen should be labeled with:
10
 Patient’s full name

 Medical record no
 Date and time of specimen collection
 Specimen source (it indicated)
 Sign of the person who conducted the procedure
 Unless it is labeled with this information the specimen will
be rejected.

General considerations for specimen
collection
11
 wear gloves to protect self from contact with body

fluids.
 Get request for specimen collection and identify the
types of specimen and the patient
 Give adequate explanation to the patient.

Cont.…
12
 Assemble and organize all the necessary materials

 Get the appropriate specimen container and it should be
clearly labeled have tight cover to seal the content and
placed in the plastic bag or racks, so that it protects the
laboratory technician from contamination while handling
it.
specimen container and it should be clearly labeled
The patient's identification (name, age, card number, the ward
The types of specimen and method used (if needed).
The time and date.
Cont.…
13
 Put the collected specimen into its container

without contaminating outer parts of the container
and its cover.
 All the specimens should be sent promptly to the
laboratory

Collecting Stool Specimen
14
 Analysis of stool specimen can provide information about a

client’s health condition.
 Some of the reasons for testing stool /feces include
 To determine the presence of occult (hidden) blood;
Bleeding can occur as a result of ulcer, inflammatory
disease, or tumors.
 To analyze for dietary products and digestive secretions .e.g.
presence of excessive fat in stool (steathorrhea) can indicate
faulty absorption of fat from small intestine and a decrease
in amount of bile indicate obstruction of bile flow.
Cont..
15
 To detect the presence of ova and parasite

 To detect the presence of bacteria or virus, by culture
 For laboratory diagnosis, such as microscopic
examination, culture and sensitivity tests.

Equipment
16
Clean bedpan or commode

Wooden spatula or applicator
Specimen container
Tissue paper
Laboratory requests
Disposable glove, for patients confined in bed
Bed protecting materials
Screen

Procedure
17
1. For ambulatory patient

Give adequate instruction to the patient to
 Defecate in clean bedpan or commode (toilet)
 Avoid contaminating the specimen by urine, menstrual
period because these may affect the laboratory
analysis.
 Void before collecting the specimen
 Transfer the sample (specimen) to the container using
spatula or applicator

Cont.…
18
For patients confined in bed

1. Prepare the patient's unit
 Provide privacy by drawing screen, closing windows and doors
2. Prepare the patient
 Put on gloves
 Position the patient
 Place bed protecting materials under the patient's hips
 Assist the patient and place the bed pan under the patient's buttocks
 Give patient privacy
 Remove the bedpan and keep on safe place by covering it
 Comfort the patient
Cont.…
19
3. Obtain stool sample

 Take the sample using spatula or applicator without
contaminating the container.
 The amount of stool specimen to be taken depends on the
purpose, but usually takes.
 3.5 gm. sample from formed stool, 15-30 ml sample from liquid
stool
 Visible mucus, pus or blood should be included into sample
stool specimen taken.

Cont.…
20
4. Care of equipment and the specimen collected.

 Handle and label the specimen correctly
 Send the specimen to the laboratory
immediately
 give proper care of all equipments used.
5. Documentation and report

Collecting Urine Specimen
21
Purpose
 To identity components of urine
 To determine the presence
of legal or illegal drugs

 To determine pregnancy
 To diagnose disorder
 Routine laboratory analysis and culture
and sensitivity tests
Types of urine specimen collection
22
 Clean voided urine specimen

 Clean catch or midstream specimen: - is used
when specimen relatively free of MOs is required.
 The client’s urinary meatus is cleaned and the
patient is told to void into the toilet, stop the
urinary flow and then void midstream urine into a
clean container and finish voiding on the toilet.
 The specimen is taken immediately to the lab.

Sterile urine specimen
23
 Specimen from catheter: - may be necessary

when the client is unable to void or already has a
catheter in place.
 Urine should not be collected from the collection
bag; it should be directly obtained from the
catheter.

Timed urine specimen
24
 It is two types
 Short period  1-2 hours
 Long period  24 hours

Cont..
25
 24hrs urine specimen: - is used to measure accurately

renal function for certain substances such as creatinine,
urine urea nitrogen, glucose, sodium, potassium…
 often started early in the morning after the client’s first
void, the first void is discarded and the time is noted as
the beginning of the 24hrs period during which all
urine is saved /collected

Random urine specimen: -
26
 As the name implies the specimen is collected at any time.

 This is the specimen most commonly sent to the
laboratory for analysis, because it is easier to obtain and
readily available.
 This specimen is usually submitted for urinalysis and
microscopic analysis, although it is not a specimen of
choice for either of these tests.

Equipment
27
 Disposable gloves
 Specimen container
 Laboratory requisition form
 Water and soap or cotton balls and antiseptic
solutions (swabs).
 Urine receptacles (i.e. bedpan or urinals)
 Bed protecting materials
 Screen (if required)

Procedure
28
For ambulatory patients

 Give adequate instruction to the patient about
 The purpose and method of taking specimen
 Assist the patient to move to the toilet

Cont…
29
ii) For patient confined in bed

1. providing privacy
2. Prepare the patient
 Put on gloves Place bed protecting materials under
patient's hips
 Assist the patient
 Assist the pt or clean the vulva or penis thoroughly
using soap and water or antiseptic swabs

Cont.…
30
3. Obtain urine specimen

 Ask patient to void
 Let the initial part of the voiding passed into the
receptacle (bed pan or urinal) then pass the next part (the
midstream) into the specimen container.
 Hold the vulva or penis apart from the specimen container
 Don't allow the container to touch body parts
 Collect about 30-60 ml midstream urine
 Handle the outside parts of the container
 Remove the glove

Cont…
31
4. Comfort the patient

5. Care of the specimen and the equipment
 Handle and label the container correctly
 Send the urine specimen to the laboratory immediately
together with the completed laboratory requested
forms
 Empty the receptacles content properly
 Give appropriate care for the used equipments

Cont.…
32
6. Document pertinent data and report, such as

 Specimen collected, amount, time and
date.
 Consistency of the urine
 Patients experience during voiding

Cont..
33
Collecting a Sterile Urine Specimen

 Sterile urine specimen collected using a catheter in
aseptic techniques

Collecting a Timed Urine Specimen
34
Purpose
 For some tests of renal functions and urine
compositions, such as:- measuring the level of or

hormones, such as adrenocortico steroid hormone
creatinine clearance or protein quantization tests.

Equipment
35
 Urine specimen collecting materials

 Format for recording the time, date started and end,
and the amount of urine collected on each patient's
voiding during the specified period for collection.

Procedure
36
1. Patient preparation
 Adequate explanation to the patient about the purpose of
the test, when it begins and what to do with the urine

 Label the specimen container to include date and time of
each voiding as well as patient's identification data

 Containers may be numbered sequentially (e.g. 1 st, 2nd,
3rd etc) in case of 24-hours urine collection.

Cont.…
37
2.Collecting the urine

 Usually it begin in the morning
 Before you begin the timing, the patient should void
and do not use this urine (It is the urine that has been
in the bladder some time)
 Then all urine voided during the specified time ( 24
hours) is collected in the container
 At the end of the time ( 24 hr the patient should void
the last specimen, and added to the rest.
 Ensure that urine is free of feces

Collecting sputum specimen
38
 Sputum is the mucus secretion from the lungs,

bronchi and trachea, but it is different from saliva.
 The best time for sputum specimen collection is in
the mornings up on the patient’s awaking (that have
been accumulated during the night).
 If the patient fails to cough out, the nurse can
obtain sputum specimen by aspirating pharyngeal
secretion using suction.

Purpose
39
 Sputum specimen usually collected for:

 Culture and sensitivity test (i.e. to identify the
microorganisms and sensitive drugs for it)
 Cytological examination
 Acid fast bacillus (AFB) tests
 Assess the effectiveness of the therapy

Equipment
40
 Disposable gloves
 Specimen container
 Laboratory requisition form
 Mouth care (wash) tray

Procedure
41
1. Patient preparation
 teach pt about the difference between sputum and saliva,
how to cough deeply to raise sputum.
 Position the patient, usually sitting up position. Also
postural drainage can be used.
 Give oral care, to avoid sputum contamination with
microorganisms of the mouth
 Avoid using tooth pest because it alters the result

Cont…
42
2. Obtain sputum specimen

 Put on gloves
 Ask pt to cough deeply to raise up sputum
 Take usually about 15-30 ml sputum
 Ask pt to spit out the sputum into the specimen
container
 Make sure it doesn't contaminate the outer part of
the container.
 Cover the cape tightly on the container

Cont.…
43
3. Comfort the patient

4. Care of the specimen and the equipment
5. Document the amount, color, consistency of
sputum, (thick, watery, tenacious) and
presence of blood in the sputum.

Throat swab
44
posterior pharyngeal swab
WHO/CDS/EPR/ARO/2006.1
Collecting Blood Specimen
45
 Venous blood is drown for most tests, but

arterial blood is drawn for blood gas
measurements.

Cont..
46
Arterial blood
 Difficult to identify
 Blood flows with pumping pressure
 Control of blood collection is difficult
 Difficult to stop the blood
Venous blood
 Easy to identify
 Better control on flow of blood
 Blood can be stopped

Cont..
47
 The hospital laboratory technicians obtain most

routine blood specimens.
 Venous blood is drown for most tests, but arterial
blood is drawn for blood gas measurements.

Cont..
48
Venous blood
• infants: 0.5 – 2 ml
• children: 2 – 5 ml
• adults: 5 – 10 ml

Purpose
49
 To assess the bloods normal cells & other components

 To determine the presence of abnormalities or disease
causing organisms
 Specimen of venous blood are taken for complete
blood count, which includes
 Complete blood count
 including Hgb
 and Hct,
 WBC with differential count etc.

Cont..
50
 To measure serum electrolyte and acid-base balance

 To evaluate renal function test by measuring blood urea
and creatinine
 To evaluate serum osmolarity (fluid balance)
 For monitoring serum drug levels. e.g. digoxin,
 For blood chemistry e.g. to evaluate serum enzyme level
 To evaluate blood glucose level
 To measure arterial blood gases
 To know blood group etc

Equipment
51
 Sterile gloves
 Tourniquet
 Antiseptic swabs
 Dry cotton (gauze)
 Needle and syringe
 Identification/ labeling: name, age address, etc.
 Laboratory requisition forms
 Specimen container with the required diluting or

preservative agents (: anticoagulant).

Cont..
52
 Vein puncture – is the procedure of using a needle to

withdraw blood from a vein
 It is often done from the inside surface of the forearm
near the elbow, called antecubital space. Here the
veins are near the surface and are easy to see or feel.

Cont..
53
 Venipuncture is one of the most routinely performed

invasive procedures and is carried out for any of
following reasons:
 to obtain blood for diagnostic purposes;
 to monitor levels of blood components
 to administer therapeutic treatments including medications,
nutrition or chemotherapy;
 To collect blood for later use in patients requiring transfusions

Procedure
54
 Patient preparation
 Instruct the pt what to expect and for fasting (if
required)
 Position the pt comfortably
 Observe standard precautions put on gloves
 Select and prepare the vein sites to be punctured
 Usually the large superficial veins used such as,
brachial or median cubital veins

Cont..
55
 Apply tourniquet firmly 15-20 cm about the selected

sites. It must be tight enough to obstruct vein blood
flow, but not to occlude arterial blood flow.
 If the vein is not sufficiently to dilate massage the vein
from the distal towards the site or encourage the pt to
clench and unclench repeatedly.
 Clean the punctured site using antiseptic swabs

Cont..
56
 Obtain specimen of the venous to blood

 Adjust the syringe and needles
 Clean/disinfect the area with alcohol swab, dry with sterile
cotton swab
 Puncture the vein sites
 Release the tourniquet when you are sure in the vein
 Withdraw the required amount of venous blood specimen
 Withdraw the needle and hold the sites with dry cotton
 Put the blood into the specimen container
 Made sure not to contaminate outer part of the container
Cont..
57
Comfort the patient

Care of the specimen and the equipment
 Label the container
 Shake gently (if indicated to mix)
 Send immediately to laboratory, accompanying the
request
 Give care of used equipments
Documentation and reporting

…
58
Observations and Recording of Signs and

Symptoms of the Patient
Chart
 It is a written record of history, examination, tests,
diagnosis, and prognosis response to therapy

Purpose of Patients Chart
59
 For diagnosis or treatment of a patient while in the hospital

(find after discharge)
 For maintaining accurate data on matters demanded by courts
 For providing material for research
 For serving an information in the education of health

personnel
 For securing needed vital statistics
 For promoting public health

General Rules for Charting
60
 Spelling Make certain you spell correctly

 Accuracy
 Completeness No omission, avoid unnecessary
words or statement
 Exactness Record what you see avoid saying
(condition better)
 Legibility
 Neatness
 Composition / arrangement
Cont.…
61
 Sentences need to be complete and clear, avoid repetition

 Don’t overwrite
 Don’t leave empty spaces in between
 Time of charting
 All orders should be written and signed.
 Color of ink Black or blue (red for transfusion, days of
surgery)
 Patients or relatives and friends of patients are not
allowed to read the chart when necessary but can have
access if allowed by patientFON for MW by S.A 04/12/2024
Cont.…
62
Orders of Assembling Patients Chart

 History sheet
 Personal and social data
 Order sheet
 Doctor’s progress notes
 Nurses notes
 Vital sign sheet (graphics)
 Intake and output recording sheet
 Laboratory and other diagnostic reports

Quiz
63
 Purpose of examination of urine.

 Mention purposes for sputum specimen collection.
 How can you obtain sterile urine specimen?

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1

 At the end of this chapter, students will be able to:

FON for MW by S.A 04/12/2024

FON for MW by S.A 04/12/2024

 Specimen collection refers to collecting

FON for MW by S.A 04/12/2024

 Because only medical history can’t lead to the accurate

 Laboratory examinations of specimens such as; urine,

FON for MW by S.A 04/12/2024

 Laboratory test contribute vital information about the

FON for MW by S.A 04/12/2024

 Failure to label specimen correctly and to provide all

 Failure to use the correct container /tube for appropriate

 Inaccurate and incomplete patient instruction prior to

 Failure to tighten specimen container, resulting in

 Failure to maintain the specimen at appropriate

FON for MW by S.A 04/12/2024

 Patient’s name, address, age, sex, ward and bed

FON for MW by S.A 04/12/2024

 Patient’s full name

FON for MW by S.A 04/12/2024

 wear gloves to protect self from contact with body

FON for MW by S.A 04/12/2024

 Assemble and organize all the necessary materials

 Put the collected specimen into its container

FON for MW by S.A 04/12/2024

 Analysis of stool specimen can provide information about a

 To detect the presence of ova and parasite

FON for MW by S.A 04/12/2024

Clean bedpan or commode

FON for MW by S.A 04/12/2024

1. For ambulatory patient

FON for MW by S.A 04/12/2024

For patients confined in bed

3. Obtain stool sample

FON for MW by S.A 04/12/2024

4. Care of equipment and the specimen collected.

5. Documentation and report

FON for MW by S.A 04/12/2024

of legal or illegal drugs

 Clean voided urine specimen

FON for MW by S.A 04/12/2024

 Specimen from catheter: - may be necessary

FON for MW by S.A 04/12/2024

FON for MW by S.A 04/12/2024

 24hrs urine specimen: - is used to measure accurately

FON for MW by S.A 04/12/2024

 As the name implies the specimen is collected at any time.

FON for MW by S.A 04/12/2024

FON for MW by S.A 04/12/2024

For ambulatory patients

 The purpose and method of taking specimen

 Assist the patient to move to the toilet

FON for MW by S.A 04/12/2024

ii) For patient confined in bed

FON for MW by S.A 04/12/2024

3. Obtain urine specimen

FON for MW by S.A 04/12/2024