Skill 304
Dr.
Mohammad
Marie
Lecture \ 4
Learning objectives
 To know what is the meaning of blood culture.
 To recognize types of urine samples .
 To learn procedure of urine specimen collection.
 To learn procedure of sputum specimen collection.
 To learn some information about fecal specimen
collection.
Blood culture
Blood culture
 Blood culture : is a microbiological culture of blood.
It is employed to detect infections that are spreading
through the bloodstream (such as bacteremia
or septicemia amongst others). This is possible
because the bloodstream is usually a sterile
environment.
 N.B : blood does not have a normal microbial flora .
Blood culture
 Whenever possible blood should be collected before
antimicrobial treatment has started .
1- when the patient has recurring fever collect the blood
as the temperature begins to rise .
2- for other patients collect the blood as soon as possible
after receiving the request .
* To increase the chance of isolating a pathogen it is
usually recommended that at least two specimens are
collected at different times.
Urine collection
 Un timed urine sample (random) ( single sample )
 Timed urine sample ( 24 H sample )
 First Morning Specimen
 Midstream Clean Catch Specimen
 Catheter Collection Specimen
 Pediatric Specimen
Urine collection
1- Random Specimen
 This is the specimen most commonly sent to the
laboratory for analysis, primarily because it is the
easiest to obtain and is readily available.
 This specimen is usually submitted for urinalysis and
microscopic analysis, although it is not the specimen
of choice for either of these tests.
 Random specimens can sometimes give an inaccurate
view of a patient's health if the specimen is too diluted
and analytic values are artificially lowered.
Urine collection
 As the name implies, the
random specimen can be
collected at any time. Although
there are no specific guidelines
for how the collection should
be conducted, avoiding the
introduction of contaminants
into the specimen is
recommended. This requires
explicit instructions to patients
so that they do not touch the
inside of the cup or cup lid.
Urine collection
2- Timed Collection Specimen
 Among the most commonly performed tests requiring
timed specimens are those measuring creatinine,
urine urea nitrogen, glucose, sodium, potassium that
are affected by diurnal variations.
 A timed specimen is collected to measure the
concentration of these substances in urine over a
specified length of time .
Urine collection
1- You should collect every drop of urine during each 24hour period. It does not matter how much or little
urine is passed each time, as long as every drop is
collected.
2- Begin the urine collection in the morning after you
wake up, after you have emptied your bladder for the
first time.
3- Urinate (empty the bladder) for the first time and
flush it down the toilet. Note the exact time (e.g, 5:00
AM). You will begin the urine collection at this time.
Urine collection
4- Collect every drop of urine during the day and night
in an empty collection bottle. Store the bottle at room
temperature or in the refrigerator.
5- If you need to have a bowel movement, any urine
passed with the bowel movement should be collected.
6- Finish by collecting the first urine passed the next
morning, adding it to the collection bottle. This
should be within ten minutes before or after the time
of the first morning void on the first day (which was
flushed). In this example, you would try to void
between 4:50 and 5:10 on the second day.
Urine collection
 It is not recommended that the
patient void directly into the 24 hour
collection container due to the
preservative acid content inside the
container.
 The patient is encouraged to void into
a separate (beaker style collection
with pour spout ) cup and pour the
contents into the 24 hour collection
container during the collection
process.
Urine collection
3-First Morning Specimen
 This is the specimen of choice for urinalysis and
microscopic analysis, since the urine is generally more
concentrated (due to the length of time the urine is
allowed to remain in the bladder) .
 Also called an 8-hour specimen, the first morning
specimen is collected when the patient first wakes up
in the morning, having emptied the bladder before
going to sleep.
Urine collection
4- Midstream Clean Catch Specimen
 This is the preferred type of specimen for culture and
sensitivity testing because of the reduced incidence of
cellular and microbial contamination.
 Patients are required to first cleanse the urethral area with
soap . The patient should then void the first portion of the
urine stream into the toilet. These first steps significantly
reduce the opportunities for contaminants to enter into the
urine stream. The urine midstream is then collected into a
clean container . This method of collection can be
conducted at any time of day or night.
Urine collection
Urine collection
5- Catheter Collection
Specimen
 This assisted procedure is
conducted when a patient
is bedridden or cannot
urinate independently. The
healthcare provider inserts
a Foley’s catheter into the
bladder through the
urethra to collect the urine
specimen.
Urine collection
6- Pediatric Specimen
 For infants and small
children, a special urine
collection bag is adhered
to the skin surrounding the
urethral area. Once the
collection is completed,
the urine is poured into a
collection cup or
transferred directly into an
evacuated tube with a
transfer straw.
sputum
 Material required is From the lower respiratory tract
expectorated by deep coughing .
 Sputum specimen collection can be either selfexpectorated or mechanically obtained.
 Sputum samples should be collected in the morning
before breakfast if possible , because sputum collects
during the night.
PROCEDURE
1- Wash hands thoroughly
2- Assemble necessary equipment.
3- Confirm the patient’s identity using two patient
identifiers.
4- Tell the patient that :
* you will collect a specimen of sputum (not saliva)
and explain the procedure.
* The cup is very clean. So Don’t open it until you are
ready to use it.
PROCEDURE
5- Instruct the patient to sit in a chair or at the edge of
the bed. If the patient cannot sit up place him in high
Fowler’s position.
* Place the head of the bed at 30° for semi-Fowler's, 45° to 60° for
Fowler's, and 90° for high Fowler's
PROCEDURE
6- Ask the patient to rinse his/ her mouth with water
(avoid mouthwash solution or toothpaste).
7- Tell patient to cough deeply and expectorate directly
into the specimen container. Ask the patient to
produce at least 15ml of sputum.
PROCEDURE
8- Cap the container and if necessary, clean its exterior.
Sputum collection
 Purpose :
For the detection of the causative agent of pneumonia or
tuberculosis .
Examples of common causative agents of bacterial
pneumonia:
 Streptococcus pneumoniae,
 Haemophilus influenzae,
 Staphylococcus aureus,
 Klebsiella pneumoniae,
 Escherichia coli, and
 Pseudomonas aeruginosa.
Fecal
 Collect the stool in a dry, clean, leak-proof container.
 Make sure no urine, water, soil or other material gets in the
container.
 Insure that the specimen containers are sealed
well. Reinforce with parafilm or other suitable material.
 Insert the container in a plastic bag.
 Certain drugs and compounds will render the stool
specimens unsatisfactory for examination. The specimens
should be collected before these substances are
administered, or collection must be delayed until after the
effects have passed.