c5-NONBLOOD SPECIMEN COLLECTION.docx

NONBLOOD SPECIMEN COLLECTION ============================ Urine specimens --------------- One of the most commonly performed diagnostic tests involves urine specimens. Many providers order a urinalysis because it is low-cost, low-risk, and can provide valuable information about a patient\'s condit...

NONBLOOD SPECIMEN COLLECTION ============================ Urine specimens --------------- One of the most commonly performed diagnostic tests involves urine specimens. Many providers order a urinalysis because it is low-cost, low-risk, and can provide valuable information about a patient\'s condition (glucose levels, hormone levels). Providers order a variety of urine tests (routine, 24-hour, culture and sensitivity \[C&SJ, drug testing) to aid in diagnosing conditions. Urine specimens are collected using various methods (random, first morning urine, fasting, clean-catch midstream, catheter, suprapubic). Following the proper steps when performing each method of collection helps provide the most accurate test results. For example, some hormone levels are higher in the morning. Therefore, to achieve the most accurate results, this is when these specimens should be obtained. With every urine specimen collection, provide all information possible to help the patient perform the collection properly. Allow the patient to ask questions and repeat information when necessary. Provide written information if the patient needs or requests it. When performing urine testing, wear gloves and change gloves between specimens. Perform the tests on a flat surface and keep the specimen as stable as possible to prevent accidental spilling. Random collection ----------------- The most commonly performed urine test is the routine or random collection, which means there are no preparations or time restrictions. However, the time of the collection must still be documented. The facility will provide guidelines on the method to perform a routine urine collection. Common instructions that can be used for all urine specimen collections include the following: - Wash hands before and after handling urine specimens. - Label all specimens on the side of the container (not the lid). - Wear gloves at all times and change gloves between specimens. - Confirm patient identification by using at least two patient identifiers. - Always use a sterile specimen container. - Label all specimens in front of the patient. - Promptly test or transport specimens. - Dispose of urine per facility guidelines (unless contaminated with blood, which needs to be disposed of as biohazard waste per OSHA). The patient performs urine specimen collection through detailed instruction provided by medical personnel. Each urine test has specific collection requirements to ensure the best results. Special urine tests requiring more detailed urine specimen collection processes include glucose tolerance test (GTT), postprandial, 24-hour urine collection, and drug testing. Glucose tolerance test ---------------------- Follow the basic recommendations for a urine specimen collection, with the special instructions required for the tests. When performing a GTT, confirm that the patient is fasting (usually for 12 hr.). Blood and urine tests should be performed at the same time in the order recommended by the facility. The collections must occur together, usually every 1 or 2 hr. Make sure the collections are performed on time and the time is accurately documented. If the specimens are not collected on time, document the reason and the actual time of collection. Postprandial test ----------------- A postprandial urine test requires a patient to void and then eat a meal. A urine specimen is collected 2 hr. after a patient eats a prescribed amount of carbohydrates or glucose solution. For patients who have diabetes mellitus, this test monitors the effects of a prescribed insulin dosage. For patients who do not have diabetes mellitus, this test is a screening tool. 24-hour urine collection ------------------------ For 24-hour urine collection, the patient receives a container (with a lid) large enough to hold 3 to 4 liters of fluid. Instruct the patient to void and discard the first morning urine specimen, then initiate the collection process after discarding that morning specimen. Inform the patient if there are any special handling instructions-such as when the specimen is expected to be returned, and if refrigeration is necessary. Drug testing ------------ When performing a urine test that determines what nonprescription drugs a patient has in their system, both privacy of the patient and accuracy of the results are very important. Some urine tests performed for drug screenings may be monitored. A chain of custody form can accompany the collection process. Confirm that the form is completely filled out. Everyone who handles the specimen must sign and date the form. The facility can have other instructions for performing this type of collection. Because these tests may be used in legal situations, make sure to understand and perform all steps required. Clean-catch midstream collection -------------------------------- A clean-catch midstream urine specimen collection requires collection of the middle volume of urine. Inform the patient to void a small amount of urine into the toilet, and then begin the collection. Stop collecting the urine before the urine flow is complete by moving the container. Then finish voiding into the toilet. Culture and sensitivity. To perform a clean-catch midstream urine specimen collection for C&S testing, provide the patient with additional instructions. To help prevent contamination from bacteria on the surface of the labia or penis, use an antiseptic wipe to cleanse the genitals prior to the collection. The wipes are an antiseptic of choice of the facility. Never use alcohol, peroxide, or iodine to cleanse the area; these harsh antiseptics can hurt the patient or damage delicate tissue. With most tests, the urine is collected into a sterile container that has a lid placed on it, and then the urine is transported into another vessel. Another method of performing a urine test is by chemical analysis using the reagent strip method. Urine is collected in a sterile container. A reagent strip is dipped into the urine for the time ordered by the type of test, removed, and analyzed. Wear gloves when dipping the reagent strip and throughout the duration of test. The absorbent pads for each chemical test on the reagent strip will change colors depending on the level of the substance in the patient\'s urine. Use the analysis chart provided with the reagent strips to determine the level of substance by matching colors as closely as possible. Perform this test in adequate lighting to help match colors correctly. Dispose of the used reagent strip in a biohazard bag. Other nonblood specimens ------------------------ You may perform other nonblood collections (saliva, sputum, fecal, semen specimens) or perform buccal or throat swabs. ### Saliva specimens Performing specimen collection for a saliva test begins with many of the same requirements of collecting blood and urine: introducing yourself, confirming you have the correct patient using at least two patient identifiers, washing your hands and donning gloves. These specimens are used to test for hormone, alcohol, and drug levels. Usually kits are available with instructions on how to perform the test. If instructions are not available, check with the facility for proper procedures. Make sure that all specimens are labeled in front of the patient and brought to the laboratory promptly. ### Sputum specimens Not to be confused with saliva (fluid from the oral cavity), a sample for a sputum test is collected from the lungs, trachea, and bronchi. Instruct the patient to take a deep breath and expectorate by coughing deeply and spitting the thick matter from their lungs into the specimen container. Follow the instructions at the facility for the procedures for collecting this specimen. Make sure to introduce yourself, identify your patient, wash your hands, and don gloves. It is better to collect this test before or several hours after a patient eats to prevent vomiting. A larger volume of sputum is available in the morning after it has accumulated throughout the night. Make sure that all specimens are labeled in front of the patient and brought to the laboratory promptly. ### Fecal specimens You may also be asked to obtain a fecal specimen. Fecal tests are performed to determine if a patient has a possible bacterial infection, parasites, and occult blood. Specific dietary instructions may be necessary prior to the patient collecting a specimen. Make sure to know these requirements and be able to instruct your patient on the proper preparation for the test. To help make sure that the test is as accurate as possible, use a clean container with a lid. Place labels on the specimens in front of the patient, and on the container (not the lid-a label on the lid can be misplaced when the lid is removed). Placing the label on the container helps keep the specimen properly identified. ### Semen specimens Semen specimens are used to perform sperm counts to help assess fertility. They can also be used to help prove identity in rape cases. Like urine and blood specimen collections, introduce yourself and confirm patient identity with at least two patient identifiers. Wash hands and don gloves before handling semen specimens. Patients should be instructed on how long to refrain from ejaculation prior to specimen collection. Check with the facility for exact requirements. Handling instructions include collection into a sterile container. Do not use a condom; many condoms contain spermicides, which will adversely affect test results. Keep the specimen warm and protect it from light. To help ensure accurate test results, the specimen should be brought to the laboratory for testing within 2 hr. (1 hr. is preferred). All specimens must be labeled. ### Throat swab A throat swab is a culture specimen usually obtained to test for strep throat. You will perform the test with a kit that has instructions for proper procedures. If there are no instructions, review facility requirements for the test. For throat swab collections, wipe both tonsils, the throat, and all areas that look inflamed or infected with the swab. Wash hands before and after performing the test. Wear gloves and change them between patients. Stand to the side of the patient when performing the test or wear a mask to protect yourself from airborne contamination. Label all specimens in front of the patient and test the collection or take to the laboratory promptly. ### Buccal swab A buccal swab differs from a throat swab in where the specimen is collected. A buccal swab is collected from the inside of the cheek in the mouth to collect a patient\'s DNA. When performing a buccal test, introduce yourself, properly identify the patient with at least two patient identifiers, wash hands, and don gloves. Perform the specimen collection per the facility\'s instructions. Commonly the collection is performed by gently rubbing a sterile swab against the inside of the patient\'s cheek. Place the used swab in an appropriate container, labeled in front of the patient and transport accordingly.