9.

SPECIMEN COLLECTION

A. Urine specimen:
1. Clean single specimen/urine analysis/urine detail report (d.r):
Purposes:
 To check the kidney function
 To aid in diagnosis
 To assess the effectiveness of the therapy.
 To determine the progress of the client.
Equipment:
1. Clean specimen container (urine D/R bottle).
2. Bed pan or urinal.
3. Measuring jug.
4. Toilet tissues.
5. Disposable gloves.
Procedure:
 Don disposable gloves.
 Have the client void in a clean bedpan or urinal or if possible, have the client void
directly into the specimen container.
 Collect at least 50 ml of urine.
 Place the lid tightly on the specimen container and wash the urine that splashed
outside the container.
 Label the container and send it to the lab as soon as possible.
 Wash hands and document.

2. Clean voided/midstream/ sterile voided specimen:

Purpose:
To check the bacteriological culture. (C/S)
Equipment:
 Sterile specimen container (urine C/S bottle).
 Disposable gloves.
Procedure:
 Instruct the client to drink plenty of fluid at least 30 minutes before collecting
urine specimen.
 Instruct the client not to void and notify the nurse if they desire to void.
 Assist the client to clean the perineum, including the urethral orifice and surrounding
area.
 Open the specimen container to receive urine. Avoid contaminating the inside of the
container by exposing it to air or unnecessary touching.
 Have the client void a small amount of urine and discard it.
 Have the client void the rest of the urine directly into the specimen container.
 Remove specimen container before flow of urine stops.
 Place the lid tightly on the specimen container and wash the urine that splashed
outside the container.
 Label specimen bottle and send to the lab within 15 minutes.
 Wash hands and document in the nurse's notes.

3. Timed urine specimen (24-hour's urine collection):

Purpose:
 1. To measure the level of creatinine in urine.
2. To assess hormone levels such as adrenocortical steroids.
3. To determine the amount of glucose excreted in urine.
4. To detect the presence and quantity of protein.
5. To evaluate kidney function and metabolic activity.

Equipment:
 24-hour urine collection bottle.
 Disposable gloves.
Procedure:
1. Place sign indicating 24-hour urine collection on the client's bedside.
2. Instruct client to save all urine during 24 24-hour period.
3. Start collection of urine according to the 24-hour cycle at a time specified.
4. Label the container (24-hour urine collection bottle) and place it in an appropriate
location (near the patient's bed).
5. Discard first random urine specimen and note the time for the beginning of test.
6. Collect all urine voided after that for the next 24 hours period.
7. Have client void to collect the last specimen as close as possible to the end' of
8. the time period.
9. Measure and record volume of urine voided if client is on intake and output (I/O)
monitoring.
10. Send entire specimen to lab.
11. Remove sign and remind the client that specimen collection period is completed.
12. Wash hands and document in nurses notes.

Sterile specimen from a catheter

Purpose:

1. To collect urine specimen for diagnostic examination (D/R – detailed report).

2. To obtain urine for culture and sensitivity (C/S) testing.
3. To identify urinary tract infections (UTIs).
4. To detect abnormalities in urine composition.
5. To ensure accurate, contamination-free laboratory results.

Equipment:
 Disposable gloves
 3 cc/5 cc syringe
 Spirit swab.
 Specimen bottle.
 Clamp.
Procedure:
1. Clamp the catheter from the Foley's site 30 - 45 minutes before collecting the
specimen.
2. Wipe the area above the clamp where the needle will be inserted with alcohol swab.
3. Insert the needle at a 30° - 40° angle.
4. Withdraw 30 ml of urine.
5. Transfer the urine to the specimen container. Make sure the needle should not touch
the outside of the container if C/S bottle is used.
6. Cap and label the container and send it to the lab.
7. Unclamp the catheter.
 8. Wash hands and document in the nurse’s notes.

A. Stool Specimen
Purposes:
 To aid in diagnosis such as, hemorrhage, infection, malabsorption problem etc.
 To assess the effectiveness of therapy.
 To determine client's progress.
Stool test includes:
 Stool D/R.
 Stool Culture.
 Microscopic test to check the presence of blood.
Equipment:
1. Specimen container.
2. Tongue blade/scoop.
3. Bed pan with plastic bag.
4. Toilet tissues
5. Disposable gloves.

Procedure:
1. Ask client to void before defecation to keep specimen free from urine.
2. Provide bedpan to the client to pass stool.
3. Inspect stool for any unusual appearance, (presence of fresh or old blood, pus
4. or mucus).
5. Don disposable gloves, and take 2-3 scoops of stool into the specimen container with
the help
6. of tongue blade.
7. Wrap the used tongue blades in a paper towel and discard.
8. Label specimen bottle and send to lab as soon as possible.
9. Wash hands and document in nurses notes.

Variations for stool specimen:

 Collection of stool specimen after an enema and liquid stool:
 Let bed pan contents stand for 5-10 minutes.
 Discard the top fluid and take 2-3 scoops of stool into the specimen container with the
help of tongue blade.
 Follow all the above steps from stool specimen collection.

Sputum Specimen
Purposes:
1. Sputum specimens are usually collected for the following reasons:
2. Culture and sensitivity: to identify a specific microorganism and its drug sensitivities.
3. Cytology: to identify the origin, structure, function and pathology of cells present.
4. To identify presence of Acid Fast Bacillus (AFB).
5. To assess the effectiveness of therapy.
 Equipment:
1. Specimen container.
2. Tissue paper.
3. Disposable gloves.
Procedure:
1. Collect specimen early in the morning or after respiratory therapy and
2. postural drainage:
3. Don disposable gloves.
4. Ask the client to rinse their mouth with water.
5. Ask the client to breathe deeply and then cough up 1-2 tablespoons or 15 - 30 ml of
sputum from the lungs.
6. Have the client use a tissue to cover their mouth when coughing. Ask the client to
hold the container and to expectorate directly into the specimen container.
7. Avoid contaminating the inside of the container by exposing it to air or unnecessary
touching.
8. Assess the colour, odour, consistency and amount of the sputum.
9. Label specimen container and send to the lab as soon as possible, or refrigerate if
there is any delay in sending.
10. Offer mouthwash to the client.
11. Wash hands and document.

Vomitus Specimen
Purposes:

1. To identify the cause of vomiting.

2. To detect the presence of blood.
3. To confirm ingestion of toxic substances.
4. To examine undigested food particles.
5. To perform laboratory analysis for microorganisms or chemicals.

Equipment:
 Specimen container.
 Emesis basin/ Kidney tray.
 Tissue paper.
 Disposable gloves.
Procedure:
 Provide a clean emesis basin to client to collect vomitus.
 Don disposable gloves
 Take 1 '" 2 ounces of vomitus in specimen container, cap securely, and label
 Measure and record volume of vomitus if client is on intake and output monitoring
 Send specimen to lab as soon as possible or keep for observation by the physician
 as ordered.
 Wash hands and document.

Precautions:
 The urine must be clear before testing it for albumin in order to get the correct result.
 If the urine is cloudy, filter it by filter paper
o (This does not lessen the albumin content)

10. Urine dipstick/Multistix Test:

Multistixs are commonly used to check specific gravity, pH, and the presence of Glucose,
Albumin, Ketones, Occult blood, Bilirubin, Protein, Urobilinogen, Nitrite, and Leukocytes in
urine.
Equipment:
1. Fresh urine specimen in clean container.
2. Multistix.
3. Multistix color chart.
4. Disposable gloves.
5. Tissue paper
Procedure:

S. No Steps Rationale Results

S U
1. Wash hands To prevent cross-
contamination and maintain
infection control.
2. Identify the client and explain the To ensure correct patient
procedure identification and gain
cooperation.
3. Check the expiry date on the To ensure accuracy and
Multistix bottle. reliability of test results.
4. Don disposable gloves and obtain To prevent contamination and
a fresh urine specimen in a clean protect from exposure to body
container. fluids.
5. Remove one strip from the bottle To prevent exposure of
and close the bottle tightly. remaining strips to moisture
and air.
6. Don disposable gloves and obtain
a fresh urine specimen in a clean
container.
7. Remove one strip from the bottle
and close the bottle tightly.
8. Immerse designated tip into the To allow reagents to react
urine and remove it immediately. properly without
oversaturation. To allow
reagents to react properly
without oversaturation.
9. Tap the edge of the strip while To remove excess urine and
holding it horizontally against the prevent color mixing between
container. reagent pads.
10. Wait for few seconds (as specified To allow adequate chemical
on the bottle). reaction time for accurate
results.
11. Compare test strip with color chart To correctly interpret results
printed on the bottle in good light. according to the
manufacturer’s standard.
12. Documentation To record findings for
continuity of care and future
reference.
 A. ketone test:
Ketones are the end product of fatty acid. They are excreted in the urine because of
incomplete fat metabolism for example incase of fasting, starvation, low intake of
carbohydrate and uncontrolled diabetes mellitus
Purpose:
To determine presence of ketones in urine.
Methods:
b. Multistix.
B. Test for urine pH:
Urinary pH is the measurement of the concentration of hydrogen ions in urine which
indicates the acidity or alkalinity of the substance. Discrete measurements of pH are
made on a scale of 1 to 14, in which the value 7 is neutral, below 7 is acid and above
7 is alkaline (base). The normal pH of urine is 4-8.
Methods:
 Multistix.
 Litmus paper.
Equipment:
1. Fresh urine specimen.
2. Red and Blue litmus paper.
3. Disposable gloves.

Procedure:
1. Check physician orders
2. Wash hands
3. Don disposable gloves.
4. Obtain fresh urine specimen in a clean container.
5. Dip litmus paper in the urine. If blue litmus paper turns red or if red litmus paper
remains red, the urine is acidic. If blue litmus paper remains blue or red litmus paper
turns blue, then the urine is alkaline.
6. Wash hands and document the findings.

C. Test for specific gravity of urine:

A high specific gravity indicates dehydration or a disease that increases water reabsorption by
the kidney, causing concentrated urine. A low specific gravity is the result of overhydration or
a disease that affects the kidneys' ability to concentrate solutes in urine.
Purposes:
 To assess fluid intake and output.
 To assess the hydration status.
 To assess the kidney function.
Equipment:
1. Disposable gloves
2. Fresh urine specimen in a clean container
3. Multistix reagent strips
4. Multistix colour chart (on the bottle)
5. Timer or watch
6. Tissue paper or gauze
7. Documentation sheet
Methods:
1. Wash hands thoroughly.
2. Identify the client and explain the procedure.
3. Check the expiry date on the Multistix bottle.
4. Don disposable gloves.
5. Obtain a fresh urine specimen in a clean container.
6. Remove one strip from the bottle and close it tightly.
7. Immerse the reagent end of the strip briefly into the urine specimen and remove
immediately.
8. Tap the edge of the strip gently against the container to remove excess urine.
9. Hold the strip horizontally and wait for the time specified on the Multistix bottle
(usually 30–60 seconds).
10. Compare the specific gravity pad on the strip with the color chart on the bottle in good
light.
11. Note and record the specific gravity reading.
12. Dispose of the strip and gloves properly.
13. Wash hands and document findings in the client’s record.