SPECIMEN COLLECTION
SPECIMEN
Specimen may be defined as a small quantity of a substance or object, which
shows the kind and quality of the whole sample
PURPOSE
1.
2.
3.
4.
5.
To
To
To
To
To
know the normal function of the body
make diagnosis and prescribe treatment
know the progress or regress of the diseases
know the effect of special treatment and drugs
assess the general health of the patient
PRINCIPLES OF SPECIMEN COLLECTION
1. Contaminated and improperly collected specimen will produce false results which
will adversely affect in diagnosis and treatment
2. Provide proper instruction and explanation to patients such as when to collect,
what to collect, how to collect and quantity
3. Equipments used for collection should be neat and dry
4. Collect all kind of specimen at morning if possible
5. For culture specimen, use sterile container
6. Label the container with name, age, sex, MRD no, date, time and specimen name
Types of specimen collection
1.
2.
3.
4.
Urine- routine and culture
Stool- routine and culture
Sputum- routine and culture
Blood- routine and culture
COLLECTION OF URINE SPECIMEN FOR ROUTINE TEST
DEFINITION
Collection of a small quantity of urine sample in a clean container for testing it in the lab
setting
PURPOSE

To identify and measure the presence of abnormalities in urine such as white
blood cells, red blood cells, casts, puss cells, pH, sugar, albumin and specific
gravity
CHARACTERISTICS OF URINE
Volume
An amount of 1000 to 2000 ml of urine is excreted in 24hours. It may vary according to
the water intake in the season. In winter output is more and summer it is less
Variation in urine volume
1. Abnormal increase in volume is called polyuria.
2. Decreased quantity of urine or below 500ml in 24 hours is known as oliguria
3. Total absence or marked decrease in urine is known as anuria
Color and the normal urine: Normal colour is pale yellow or umber or straw colored
depends up on the concentration. If quantity increases the color will be pale yellow and
decreases it becomes deep yellow
Variations or abnormal colours:
1.
2.
3.
4.
Bright red- indicates presence of blood in urine (hematuria)
Pink- indicates small amount of blood in urine
Smoky brown- blood pigments
Milky white- chyluria due to filariasis, pus in blood
Turbidity and appearance: The normal urine is clear with no deposit
Odor: normal urine has aromatic odour
Specific gravity: it varies from 0.010 to 1.025
Alkalinity or acidity pH value: it varies from 4.6 to 8
ARTICLES
A clean tray containing,
1.
2.
3.
4.
Clean, wide mouthed plastic container
Bed pan or urinal
Soap and water
Lab investigation forms
5. Clean gloves
6. Appropriate labels marked with full name, age, sex, MRD number, date, time,
name of the ward and name of the test to be done
PROCEDURE
S.NO
1
STEPS
Identify the patient Check physician’s
order and provide privacy if needed
2
Explain the procedure to the patient
with special instructions about clean
and wash the genital areas with soap
and water thoroughly
 Female: Wash the urethral
meatus and surrounding area.
 Male: Hold the penis with one
hand and cleanse the end of
penis moving the centre to
outside using soap and water.
 For
helpless
patient:
The
nurses should do the perineal
care.
Give labelled container and instruct
the patient not to wet the label on the
container.
Ask the patient to void the first and
last part of the urine stream into the
urinal or toilet and collect the middle
part of the stream into the specimen
container and do not touch inside of
the container.
Ask the patient to place the filled
container in allotted place.
With gloved hand place the specimen
container in polythene bag.
Send specimen to the lab with
completed, signed lab form within
15minutes or refrigerate it.
Remove gloves and wash hands.
Record the procedure in the nurse’s
note and lab register.
3
4
5
6
7
8
RATIONALE
Obtain
specific
instruction
and
confirming the necessity of doing this
procedure
Privacy allows patient to relax and
reduce embarrassment
Washing
genital
area
prevents
contamination of urine specimen.
Labelling helps in identification of
samples.
Collecting midstream urine avoids
contamination of the specimen with
organisms normally present on the
skin. Four ounce (120ml) is required
for the test.
Unnecessary
placement
causes
contamination.
Protects the health workers from
contamination of urine.
To prevent decomposition of urine.
It act as a proof.
COLLECTION OF URINE FOR URINE CULTURE
DEFINITION
Collection of a small amount of urine, i.e.30 to 60ml for detecting the presence and
growth of micro organisms in the sample
PURPOSES
1. To culture pathogenic micro organisms present in the urine
2. To determine antibiotic sensitivity of the pathogens in the urine
ARTICLES
A clean tray containing
1.
2.
3.
4.
5.
6.
Sterile urine container in a plastic cover
Scissors (optional)
Lab forms
Soap and water
Bed pan or urinal
Appropriate labels marked with full name, age, sex, MRD number, date, time,
name of the ward and name of the test to be done
PROCEDURE
S.NO
1
ACTION
Identify the patient Check physician’s
order and provide privacy if needed
2
Explain the procedure to the patient
with special instructions about clean
and wash the genital areas with soap
and water thoroughly
Female: Wash the urethral meatus and
surrounding area
 Male: Hold the penis with one
hand and cleanse the end of
penis moving the centre to
outside using soap and water
 For helpless patient: The nurses
should do the perineal care and
assist in giving bedpan or urinal
Give labelled container and instruct the
patient not to wet the label on the
container
Instruct to open specimen container
and place cap with sterile inside surface
3
RATIONALE
Obtain
specific
instruction
and
confirming the necessity of doing this
procedure
Privacy allows patient to relax and
reduce embarrassment
Washing
genital
area
prevents
contamination of urine specimen.
Labelling helps in identification of
samples
Contaminated specimen will lead to
inaccurate reporting of culture and
4
5
6
7
8
9
10
up and not to touch inside of container
and lid
Ask the patient to void the first and last
part of the urine stream into the urinal
or toilet and collect the middle part of
the stream into the specimen container
and do not touch inside of the
container (midstream sample)
Replace cap securely on specimen
container, cleanse any urine form
external surface of the container
Ask the patient to place the filled
container in allotted place
With gloved hand place the specimen
container in polythene bag
Send specimen to the lab with
completed, signed lab form within
15minutes
Remove gloves and wash hands
Record the procedure in the nurse’s
note and lab register
sensitivity
Collecting midstream urine avoids
contamination of the specimen with
organisms normally present on the
skin.
Prevents transfer of micro organism
Unnecessary
placement
causes
contamination
Protects the health workers from
contamination of urine
To prevent decomposition of urine
It act as a proof
Special consideration
1. Patients who are catheterized should have the specimen withdrawn using a sterile
needle and syringe from the catheter’s sample port. Clamp the collection tube for
about 30 minutes before taking samples
2. Urine sample should be sent to lab immediately within 30 minutes if not
refrigerate it and culture done within 24hours
3. About 30 minutes prior to collecting the specimen, patient may be advised to
drink fluids unless contraindicated
24 hours urine specimen
For a 24hours urine specimen, all urine voided in a 24 hour period is collected.

The collection is initiated at a specific time, which is noted, and the client is asked
to empty his bladder at that time. The urine is discarded. After this all the urine is
collected in a common receptacle for the next 24hours. Usually, it is done from
6AM to 6AM of next day
STOOL/FAECES ROUTINE TEST AND CULTURE
Collection of stool specimen for specific or routine test
PURPOSE
1.
2.
3.
4.
To identify specific pathogens
To determine the presence of blood, ova and parasites
To determine the presence of fat
To do gross examination of stool characteristic such as colour, consistency and
odour
NORMAL CHARACTERISTICS OF FAECES
1.
2.
3.
4.
5.
Colour: light to dark brown
Odour: pungent smell
Frequency; 1 to 2 times per day
Quantity: 4 to 5 ounces per day
Composition: 30percent of water, shed epithelium from intestine, a considerable
quantity of bacteria and a small quantity of nitrogenous waste matter
ABNORMAL CHARACTERISTICS OF FAECES
Color
1.
2.
3.
4.
Tarry, black stools: bleeding in the upper gastro intestinal tract
Black color stools: melena, administration of iron or charcoal
Clay color stool: obstruction to the flow of bile
White color stool: presence of barium salts after barium tests
Odor
1. Melena and dysentery: foul smell
Frequency
1. Diarrhea: increased frequency
2. Constipation: decreased frequency
Consistency and form
1. Watery stools: diarrhea
2. Rice water stools: cholera
3. Pea soup stools: typhoid fever
Appearance
1. Fresh blood in large amounts: bleeding piles
2. Blood and mucus stool: amoebic or bacillary dysentery
3. Worms or worm segments in stools: parasitic cysts, ova or larvae
GENERAL INSTRUCTIONS
1. Faecal specimens should be collected in the early stages of disease, preferably
before the antibiotic treatment is given
2. Stool specimen should collect in a sterile container (using a scoop which is
attached to the lid itself)
3. After collection, the lid should be immediately replaced tightly
4. After proper labelling, the collected stool should be handed over to the laboratory
without delay, i.e. within 15 minutes
ARTICLES
A clean tray containing,
1.
2.
3.
4.
5.
Appropriate specimen container (sterile)
Spatula (clean for routine and sterile for culture)
Bedpan or portable commode
Gloves
Waste paper
PROCEDURE
S NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
STEPS
Explain the procedure to the patient
Obtain lab request and container
Provide privacy
Arrange the articles at the bedside
Provide bed pan if necessary and
instruct the patient to defecate into
clean dry bedpan or commode
Instruct to not to contaminate
specimen with stool
Wear gloves
Collect the stool specimen with clean
spatula for routine stool examination
and with sterile spatula for culture
test
Close it with lid tightly
Remove gloves
Wrap spatula in a waste paper and
discard appropriately
Label
specimen
container
with
patient name, hospital number ward
name and date and time of collection
Send to lab immediately, within 15
minutes
Replace equipments
Record procedure in nurse’s record
with time and date
RATIONALE
To obtain co-operation
For proper documentation and sending
the specimen to lab
It provides comfort
Saves time and energy
To avoid infections
Fresh
specimen
accurate results
provides
more
SPUTUM CULTURE
Collection of coughed out sputum for culture studies to identify respiratory
pathogens
PURPOSES
1. To detect the micro organism, that causes respiratory tract infections
2. To treat with specific antibiotics
CHARACTERISTICS OF SPUTUM
Quantity: normally no sputum is expectorated but the amount of sputum coughed up in
24 hours varies with the disease
Consistency: the sputum may be classified into various types according to the
consistency and appearance. E.g. serous, frothy, mucoid, purulent, seropurulent and
hemorrhagic
Odor: normally the sputum is odorless, in case of respiratory tract infections the sputum
will be foul smelling.
Color: sputum consists of mucus may be colourless and translucent
1.
2.
3.
4.
5.
6.
7.
Yellowish color: presence of pus
Blackish sputum: excessive smoking
Blood: hemoptysis
Red and frothy sputum: fresh bleeding from lungs
Greenish colour: bronchiectasis
Brown colour: gangrenous condition of the lungs
Rusty colour: pneumonia
GENERAL INSTRUCTION
1.
2.
3.
4.
Collect the sputum in the early morning.
Do not use any antiseptic mouth washes prior to sputum collection.
If sterile specimens are required- sterile bottle with cover is given to the patient.
Collect at least 10ml of sputum for sputum culture test.
ARTICLES
A clean tray containing
1.
2.
3.
4.
5.
Sterile Specimen container
Sputum cup
Tissue paper/ gauze pieces
Clean gloves
Kidney basin
PROCEDURE
S.NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
ACTION
Check physician’s order
Arrange all the articles
Explain the client that the specimen,
must be taken at morning before
brushing teeth
Ask the patient to sit erect in bed if
possible
Wash hands, put on gloves and wear
mask if necessary
Keep sterile specimen container ready
for the sample and take a tissue paper
in hand
Remove lid of container and place with
inner side facing upwards
Instruct the patient to take deep
breaths and then cough out deeply
Explain the patient to spit the sputum
into the sterile container without
touching the side of it.
Close the container without touching
inside of it
Provide client with tissue paper and a
comfortable position
Replace articles
Wash hands
Provide mouth care if patient needs it
or encourage patient to carry out oral
hygiene
Document obtained specimen with
name, age, sex, MRD number, date
and
time
of
collection
and
characteristics of the specimen and
send specimen to lab
RATIONALE
To obtain
secretions
overnight
accumulated
Provide easy access for collection of
specimen
To prevent transmission of infection
Prevents contamination
It helps to loosens the secretions and
obtain adequate specimen
Prevents
contamination
of
the
specimen
To clean the lips
Documentation serves as an evidence
SPUTUM CULTURE FOR AFB
The reason AFB or TB culture is recommended is to confirm the diagnosis of TB.
Secondly, the culture test can be followed by susceptibility testing, which is very useful,
since many cases are now multi-drug resistant, and the drugs susceptibility results can
be used to modify the treatment and make it more specific for the patient.
PURPOSE OF TEST
Positive AFB cultures identify the particular mycobacterium causing symptoms, and
susceptibility testing on the identified organism gives the doctor information about how
resistant it may be to treatment.
GENERAL INSTRUCTION
1. It is preferably collect an early morning sputum specimen before brushing or
rinsing the mouth.
2. Deeply coughed specimen, preferred.
3. Recommended screening procedure: 3 first morning specimens collected on 3
successive days. However, 3 samples collected at 8 hour intervals will be
accepted. Have patient rinse mouth well with water to avoid contamination with
food particles and mouth flora
4. Minimum volume 2ml
TEST RESULT INTERPRETATION: Growth or No Growth with sensitivity pattern
PROCEDURE: see the procedure of sputum culture
COLLECTION OF BLOOD FOR ROUTINE TEST
DEFINITION
Obtaining blood sample by venipuncture for routine lab investigation
PURPOSE
1. To detect the micro organisms
2. To treat the disease condition with correct antibiotics
3. To detect the right antibiotic to kill the particular micro organism
GENERAL INSTRUCTIONS
1. Special kind of tubes with coloured top are using for blood sample collection
2. Colour coding of the top depends upon the kind of blood test. E.g. red indicates
biochemistry, lavender or violet indicates pathology, blue indicates clotting
studies
ARTICLES
A clean tray containing,
1. Mackintosh and towel
2. Clean gloves (optional)
3. Surgical spirit or betadine solution
4. Disposable syringe 5ml or 10ml with needles
5. Cotton swabs
6. Specimen container- test tube or bottle
7. Paper bag
8. Kidney tray
9. Tourniquet
10. Lab requisition form
11. Adhesive tapes
PROCEDURE
S.NO
1
2
3
4
5
STEPS
Check the physician’s order
Identify the patient
Explain the procedure to patient
Wash hands and put on clean gloves
Select and examine the veins,
visualize the vein, including the
antecubital area, wrist, dorsum (back)
of the hand and top of foot (if
necessary). Choose the appropriate
wide vien to be drawn by touching the
skin over the vien in a circular motion.
RATIONALE
Ensures co-operation from patient
To prevent infection and avoid getting
blood in hands
Select a vein that is visible, palpable
and fixed to the surrounding tissues
so that it does not roll away
6
7
8
9
10
11
12
13
14
15
16
17
Instruct the patient to extend his arm.
Hold the arm straight at the elbow
with fist clenched.
Apply the tourniquet 5 to 15cms
above the selected site with just
sufficient pressure to obstruct venous
flow
Cleanse the skin with alcohol swabs
(or betadine if alcohol is not available)
in a circular motion; centre to
periphery. Allow to dry it.
Fix chosen vein with thumb and draw
the skin taut immediately below the
site before inserting the needle to
stabilize the vein.
Hold the syringe between the thumb
and last three fingers with the bevel
up and directly in line with the course
of the vein. Insert the needle quickly
and smoothly under the skin into the
vein
Obtain blood sample by gently pulling
back on the plunger
Release the tourniquet as soon as the
specimen is obtained and ask the
patient to open the fist
Apply sterile gauze piece to puncture
site without applying pressure and
withdraw needle slowly along the line
of vein
Request patient to apply gentle but
firm pressure to site for 2-4 minutes
Remove the needle from the syringe
as soon as possible after withdrawing
blood, gently eject the blood sample
into the appropriate container without
forming bubbles in the test tube or
bottle
Invert the tube gently several times to
mix blood with anticoagulant where
applicable. For some tests blood is
allowed to coagulate in the test tube
Label specimen correctly and send to
laboratory
immediately
with
completed requisition forms
Proper
positioning
visualization of veins
increases
the
A tourniquet when applied increases
venous pressure and makes the vein
more prominent and easier to enter
Cleansing the skin reduces
number of micro organism
the
The vein may slip and move under the
skin when the needle approaches its
outer surface, especially in elderly,
extreme thin patient and diabetic
patient.
Use minimal suction to prevent
haemolysis of blood and collapse of
vein
Slow withdrawal of the needle is less
painful and reduces trauma
Firm pressure over puncture site
prevents leakage of blood into
surrounding tissues with subsequent
hematoma development
Gentle ejection of blood prevents
haemolysis
Gentle handling of specimen prevents
risk of haemolysis
Specimen should reach the laboratory
with the minimum of delay for
optimum reliability
18
19
20
21
Dispose the needle and syringe in
appropriate containers
If there is any spill, Clean all spills
with sodium hypochlorite solution
Record in the patient’s chart the
procedure and the tests for which the
sample was sent to the laboratory
Replace the tray with the reusable
articles in proper place
Avoids possible spread of blood borne
disease
Avoids possible spread of blood borne
diseases
COLLECTION OF BLOOD FOR CULTURE TEST
DEFINITION
Collection of blood for culture to determine presence of micro organisms in the
blood
GENERAL INSTRUCTIONS
3. Blood culture should be taken before antibiotic treatment
4. For children, 2-5ml and neonate 1-2ml of blood is required for culture
investigation
5. Blood should never taken from IV line
6. Special kind of culture bottles are using for blood sample collection
7. All blood culture bottles should be carefully examined for clarity of media, any
medium showing turbidity or cloudiness should not be used.
8. Only disposable syringes and needles should be used for collection of blood
9. The top of the bottle must be carefully disinfected just before the bottle is
inoculated
10. Blood should never be taken from an IV line or above the IV line
11. If blood culture bottles are available, blood should be immediately added to the
culture medium
12. If blood culture bottles are not available, blood may be transported in a sterile
tube containing a sterile anticoagulant solution
13. The amount of blood collected is 10ml for adult, 2 to 5 ml for children and 1 to 2
ml for infants and neonates
ARTICLES
A clean tray containing,
1.
2.
3.
4.
5.
6.
7.
8.
Blood culture bottles
Cotton swabs
Spirit
Syringe 10-20ml and needle
Povidone iodine or betadine solution
Sterile gloves
Tourniquet
Laboratory requisition forms
PROCEDURE
S.NO
1
STEPS
Assess the physician’s order for blood
culture investigation
RATIONALE
Obtains knowledge of samples to be
collected and the reason for doing
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Explain procedure to the patient and
provide a comfortable position
Wash hands. Don sterile gloves
Apply tourniquet above the puncture
site and palpate the venipuncture site
Wipe the site with 70% alcohol in a
circular manner from centre to
periphery for approximately 5cm in
diameter and allow to dry
Cleanse the site again with betadine
starting from centre in even widening
circles. Allow the betadine to remain
on the skin for at least one minute.
Clean the site with 70% alcohol
Puncture the site and draw 10ml of
blood
Remove the tourniquet once the
blood is collected
Remove the needle and apply
pressure to the puncture site with dry
cotton simultaneously
Change the needle with a fresh
needle before injecting the blood into
the bottles
Remove the metal cover on the cap
of culture bottles and push 10ml of
blood into the bottles be careful not
to touch the sides of the bottle
Mix the blood and culture media by
shaking the bottle gently
Discard the contaminated articles.
Remove gloves
Wash hands
Fill
the
lab
requisition
form
appropriately and label the bottles
with patient’s name, identification
number, date and time of collection
Transfer the specimen to the lab
immediately
Record the procedure in the patient’s
chart with date and time of collection
Repeat the procedure within an
interval of 30minutes to one hour as
per the number of samples required
for different puncture sites.
culture
Gains co-operation of the patient
during the procedure
Reduces
transmission
of
micro
organisms and maintains aseptic
technique
Restricts blood flow and promotes
easy visibility of veins
Avoids contamination and maintains a
sterile field
Restore circulation
Stops bleeding from puncture site
Maintains strict aseptic technique
Prevents transmission of infection
Communicates adequate information
to
members
of
health
care
professionals