Biological Samples.

Collection and Transportation Procedures

The procedures that are carried out to obtain the different types of biological samples have
como objetivo realizar análisis hematológicos, bioquímicos, microbiológicos e inmunológicos de cada uno de los
liquids and bodily fluids obtained.
The sample analysis process consists of three stages:

1. Preanalytical. Includes the preparation of the patient and the necessary materials for the collection of samples.
(based on the doctor's request), and its subsequent storage and transport to the laboratory.
2. Analytics. Includes the performance of sample analyses by laboratory professionals and the
issuance of the report with the obtained results.
[Link] the assessment of the analysis report by the doctor to reach a
diagnosis, as well as the prescription of the most appropriate treatment.

Fig. 9.1. The samples obtained can be, among others, urine, blood, feces, sputum, vomit, liquid
cerebrospinal fluid, seminal fluid, skin, hair, and nails.

1.1. Request for evidence

The request is made by the doctor based on the signs and symptoms presented by the patient, in order to reach
a diagnosis.
The request must always be made in writing, on a special printed form or request for evidence form, in the
that must be stated:

Have some idea, not literal

1.2. Obtaining samples

Considering the characteristics and pathology of the patient, the sample collection can be done in:

The laboratory where the analysis will be conducted, in the case of outpatient patients who go there after being
cited for the test and to submit the duly completed application form by the doctor.
The patient's residence, when they are unable to travel to the laboratory as a result of their
disease.
The hospital's plant, when the patient is admitted and cannot go to the laboratory. In this case, the staff
The sanitary personnel will be responsible for taking the samples and the request form for analytical tests to the laboratory for its
analysis.

The TCAE intervenes in the process of obtaining biological samples by performing the following tasks:

Preparing the patient and all the necessary material.

Assisting during the sample collection procedure.
Collecting all the material.
Settling the patient after obtaining the sample (if they are hospitalized).

A. Aspects to consider in sample collection

Accompany the samples of the application form for the analytical test, with all the data correctly.
fulfilled.
Explain to the patient the precautions they should take into account before the collection or taking of samples.
Collect the samples under the best aseptic conditions possible and following the pre-established protocols.
for each type of sample.
Do not contact the samples with antiseptics or disinfectants.
Take the sample as soon as possible and in the appropriate amount for your study.
Identify the sample with the label that contains the data from the request flyer.
Always handle the samples with gloves to avoid the risk of contagion.
Take all necessary precautions for the proper maintenance of the sample, its conservation and
transport for subsequent analysis.
Use disposable containers when possible, handling them with care.
Process the containers as if they were biological waste.

NOTE: In general, nursing staff is responsible for obtaining and collecting biological samples.
Solo en casos excepcionales, el médico lleva a cabo este procedimiento, como ocurre con las muestras de líquido
cerebrospinal or with a certain type of exudates.

2. Urine samples
Laorina is an amber yellow translucent liquid with a characteristic odor, formed in the kidneys and stored.
in the bladder and is expelled to the outside through the urethra.
The collection of urine samples is carried out by the nursing auxiliary technician (TCAE), always under the supervision of the nursing staff.
Urine analyses provide important information in a large number of pathological processes, and their aim is to
detection of possible diseases of a functional or organic nature.

2.1. Characteristics and alterations of urine

Parameter Normal conditions Alterations

Aspect Clear and limpid. Turbidity. Due to the presence of pus, blood, proteins,
When left at rest, crystals, bacteria, etc.
a certain degree may appear
of turbidity by the
sedimentation.

Diuresis The normal urine volume Polyuria. Urine volume greater than approximately 2500 ml/day.
(amount) that is eliminated in 24 hours
oscillates between 850 and 2,500 Oliguria.
ml. Urine volume less than 500 ml/day.

Anuria. Urine flow lower than approximately 50-100 ml/day.

Color Clear, transparent and colored Bluish-green. Indicates the presence of bacteria.
yellow, although it can vary
based on food and Reddish brown. Indicates the presence of blood (hematuria).
liquids ingested or lost.
Dark brownish. Indicates the presence of bilirubin (urine)
colúrica).

Bright orange. Decreased diuresis due to medications

such as rifampicin, levodopa and metronidazole.

Red. Due to the ingestion of beetroot and foods that contain it.
natural colorants or excess vitamin B.
Smell It is characteristic due to the Ammoniacal. Old urine (urea is transformed into ammonia).
presence of substances
volatile. It can vary in Ketonic (fruits). It is produced by dehydration or by the
function of the diet, the rise in glucose (diabetics).
concentration, the treatment
pharmacological, etc. Putrid. Due to an infectious process.

Fecal. Indicates contamination by feces.

Composition Water (95%), sodium, Glucosuria. Presence of glucose in the urine.

chlorine,
ammonia, creatinine, acid
uric and bicarbonate. Proteinuria. Presence of proteins in the urine (more than 50
mg/day.

Bacteriuria. Presence of microorganisms in the urine.

Hematuria. Presence of red blood cells in the urine (more than 3 mm3).

Leukocyturia. Presence of more than 5,000 leukocytes/mm3.

Pyuria. More than one million leukocytes/mm3.

Foam When shaking the sample, it forms The persistence of the foam for a time indicates the
white and abundant foam presence of proteins and bile pigments.
that disappears quickly.

Density It oscillates between 1,010 and 1,020 The decrease in density indicates a possible nephrosis.
g/l. diabetes insipidus, etc.

The increase in density indicates fever, nephritis, etc.

Tabla 9.1. Características de la orina y alteraciones más frecuentes.

2.2. Urine collection

Urine is collected to perform the following tests:

Elemental or routine analysis: sample from a single urination.

Urine culture or microbiological analysis: sterile urine sample.
Diuresis control: collection of urine for 12 or 24 hours.

A. URINE COLLECTION FOR ELEMENTAL OR ROUTINE ANALYSIS

Objective: to collect a urine sample for analysis and to determine its physical characteristics (color, quantity,
density, odor, etc.), perform biochemical tests (presence of proteins, glucose, ketone bodies, blood,
etc.) and perform a microscopic examination of the urinary sediment.
Sample characteristics: although a random sample collected throughout the day can be used, it is
preferably take the sample of the first morning urine or, if not possible, of the urine excreted 3 or 4 hours later
hours since the last urination.
Quantity: it is usually sufficient to obtain a minimum volume of 10 to 12 ml, although ideally, about
50 ml. (although when pouring into the tube only about 10 ml fit)

Procedure 1 READ
Material resources
Disposable gloves, wedge or bottle and absorbent pad (bedridden patients), sterile containers for collecting the
sample (Fig. 9.3), labels to identify the samples in which the patient data is reflected, printed
request for analytical tests.
Fig. 9.3. Sterile vials for collecting a urine sample.

Action protocol:
Wash your hands, put on gloves, and prepare the materials.
2. Explain to the patient what will be done and ask for their collaboration if necessary.
3. Provide them with privacy.
4. If the patient can get out of bed, explain in detail how to collect the sample.
to start, you should discard the first part of the urination and then collect the rest of the urine in the jar
sterile until it is full.
5. If the patient is bedridden, the absorbent pad and the wedge should be placed under their pelvis. Then, there is
to position the patient in a supine position with the legs flexed. Then, they should be asked to perform the
urination and, finally, collect the sample in the sterile jar.
6. Cover the container and put the sample identification label on it.
7. Tidy up the room and make the patient comfortably settled.
8. Remove the gloves and wash your hands.
9. Once the entire protocol has been carried out, the sample must be sent to the laboratory as soon as possible.
brevity. If it is not possible, it should be kept in the refrigerator until the analysis can be performed.
10. Note on the nursing sheet any incidents observed while performing the technique.

If a vacuum extraction system is used:

Collect the sample in a sterile container as explained earlier.

2. Introduce the vacuum tube with its holder into the jar containing the sample and press to pierce it.
Urine passes into the tube due to the vacuum system.
3. Remove the tube when the urine stops flowing and label it.
4. Send the sample to the laboratory immediately. If this is not possible, store it in the refrigerator until its
shipment.
 Fig. 9.4. Urine container with vacuum tube.

B. URINE COLLECTION FOR UROCULTURE OR MICROBIOLOGICAL ANALYSIS

Objetivo:recoger una muestra de orina en condiciones de asepsia para realizar su estudio bacteriológico y
diagnose urinary infections.
Sample characteristics: collect a sample of the first morning urine. Discard the first and the
last part of urination, and take the sample of the mid portion.

Procedure 2 TO READ
Material resources
Equipment for genital cleaning (wedge, sterile gauze, water, soap or saline solution), absorbent pad (patient
couching), disposable gloves, sterile vials for sample collection (Fig. 9.5), labels of
identification. In addition, in the case of a catheterized patient, the equipment for urine collection will consist of
["antiseptic","gauze","syringe","needle","hemostatic forceps","sterile vial","identification labels"]
Protocol of action:
Wash your hands and put on gloves.
2. Explain to the patient what is going to be done and ask for their cooperation if necessary.
3. If the patient can get out of bed, it is important to show them how to wash their genitals (without
soap and drying with sterile gauze) and how to proceed at the moment of collecting the middle part of
urination, discarding the first and the last.
4. If the patient is bedridden, it is necessary to perform genital washing.
5. If he is male, place the wedge under his pelvis and ask him to start urinating on it (discard the first one).
part) and continue in the sterile jar, collecting the middle part. If it is a woman, separate the labia majora and
minors, and indicate that he/she should urinate as before (at and 9.6b).
6. Close the jar with the sample, ensuring it is properly labeled and identified.
7. Remove the wedge and clean the patient.
8. Gather all the material and make the patient comfortably settled.
9. Send the sample immediately to the laboratory; if not possible, store in the refrigerator for 24 hours as
maximum.
10. Take off the gloves and wash your hands.
11. Note the incidents in the nursing sheets.

Fig. 9.6.a) Cleaning of genitals in a bedridden woman; b) urine sample collection.

Patients with urinary catheter:

The probe is clamped with crille tweezers, for example, we wait 10-15 minutes for it to collect urine and then the collecting bag is removed.
the plastic collector is placed underneath.

If we want a sterile sample for diapered patients, first, an aseptic cleaning is performed.
meticulously in the area around the urethral opening with a disinfectant solution (antiseptic).
Then the Nelaton catheter (with lubricant on the tip) is gently inserted into the urethra. The catheter reaches
 the bladder and urine are discharged into a sterile container and the catheter is removed. The Nélaton catheter for women is
shorter than that of men for obvious reasons.

C. URINE COLLECTION FOR DIURESIS CONTROL

Procedure 3
Objective: to determine the amount of urine eliminated over 12 or 24 hours for quantitative analysis and the
execution of functional tests.
Material resources
Wide-mouth graduated containers with a large capacity, labeled with the patient's information, gloves
disposable.

Action protocol

1. Explain to the patient how to collect the urine and for how long:

12-hour urine
Start the collection at 8:00 PM on the indicated day, collecting it until 8:00 AM the following day, that is,
for 12 hours.

24-hour urine
1. The patient must discard the first urine of the morning and, from that moment on, collect all urine until the
first urine of the following morning included, that is, over 24 hours.

2. Measure the total amount of urine (diuresis) and send this data to the laboratory, along with a sample of the urine.
total (after mixing the urine from all urinations).
All samples must be kept in the refrigerator until they are sent to the laboratory.

D. URINE COLLECTION IN INFANTS AND YOUNG CHILDREN

In the case of lactating individuals and young children, the sample collection will be done in sterile and disposable bags.
polyethylene that has a self-adhesive surface to facilitate its placement and fixation. If the children are older
For 3 years, the same procedure is used as in adults. In children younger than that age and in newborns
newborns, urine is obtained directly from the bladder by suprapubic puncture.
Objective: to collect a urine sample in sterile and disposable bags.
Material resources
Equipment for cleaning the genitals (basin, sterile gauze, water, saline solution), sterile bag and
self-adhesive urine collection (Fig. 9.8a), identification labels, sterile container, disposable gloves.

Protocol of action

Wash your hands and put on gloves.

2. Carefully clean the genitals and then dry the area with sterile gauze.
3. Open the bag and place it over the baby:

For children, insert the penis into the bag and attach the adhesive to the skin.
For girls, place the bag over the two folds of skin on each side of the vagina (labia majora)

4. Put the diaper on the baby (over the bag).

5. Wait for the child to urinate and, when finished, remove the bag immediately.
6. If the bag is closed, extract the contents with a syringe and needle. If it is open, empty the contents into the
sterile container.
7. If the child does not urinate, remove the bag every 30 minutes to avoid contamination.
8. After finishing, clean the genital area and dry it to prevent skin irritation.
Send to the laboratory in a labeled jar.
10. Tidy up the room and make the child comfortably settled.
11. Remove gloves and wash hands.
 12. Write down the procedure and any incidents on the nursing sheet.

Fig. 9.8. Pediatric collector.

3. BLOOD SAMPLES
Depending on the type of analysis requested by the doctor, the blood sample may be of capillary origin.
venous-arterial
Generally, blood sample collection is performed by nursing staff. However, the nursing assistant
he must know all these techniques, as he is responsible for:

Prepare all the necessary materials.

Prepare the patient.
Send the samples or take them personally to the laboratory.

3.1. OBTAINING CAPILLARY BLOOD

The extraction can be performed by the TCAE if supervised by a GE and is the preferred method in children, especially in newborns.
born.

Procedure 5
Objective: to obtain a capillary blood sample from the hand, earlobe, or heel, when required.
small amount: hematocrit value, coagulation, leukocyte formulas, blood groups, blood glucose, etc.
Material resources
Sterile lancets or puncture devices, sterile gauze or cotton, antiseptic (povidone-iodine, etc.)
heparinized capillaries or tubes for this type of sample or glass slides or test strips (control of the
blood glucose), modeling clay, disposable gloves. (know them more or less, not literally)

Action Protocol

Explain to the patient what will be done and ask for their collaboration if necessary.
2. Wash your hands and put on the gloves.
3. Select the area where the puncture will be performed:

Children up to 4 years: on the sole of the foot.

Adults: in the earlobe or in the fingertip of the hand.

4. Prepare the area by performing a light massage to promote vasodilation.

5. Disinfect and let dry.
6. Perform the puncture quickly and with a single motion, so that the lancet or the device
the puncture should be perpendicular to the skin or puncture area ().
7. Discard the first drops of blood and then fill the capillary up to 2/3, or the container of
collection of the sample.
8. Cover the capillary with modeling clay to send it to the laboratory.
9. Press with cotton on the puncture area.
10. Gather all the material and dispose of it in the specific containers.
11. Leave the patient comfortably settled.
12. Note the procedure and incidents on the nursing sheet.
Fig. 9.9. Capillary blood extraction procedure.

3.2. OBTAINING VENOUS BLOOD

The extraction is performed by the nursing staff by puncturing the veins in the bend of the elbow.
(cephalic, median, and basilic), from the arms, hands, or legs.
For the extraction of these samples, the patient must fast for 8 hours prior to the test.
Sometimes, a special diet and/or the suspension of certain medications is necessary.
It can be done with a needle and syringe, with a vacuum system, or blood for blood culture.

Procedure 6. Venous blood extraction with needle and syringe

Objective: to obtain a blood sample with the patient fasting to perform hematological analyses.
biochemical, microbiological, immunological, etc.
Material resources
Disposable needle and syringe, sterile gauzes or cotton, antiseptic, compressor, hypoallergenic adhesive tape or
band-aids, disposable gloves, properly labeled sample collection tubes.
Protocolo de actuación

1. Explain to the patient what is going to be done and ask for their collaboration if necessary.
2. Wash your hands and put on gloves.
3. Place the patient lying down (on a stretcher or bed) or sitting, with the arm in which the puncture will be performed.
discovered and supported.
4. Place the compressor a few centimeters above the bend of the elbow (or the chosen area) to
increase the pressure in the vein and facilitate its localization.
5. Ask the patient to open and close their hand two or three times and to keep it closed (this facilitates the
localization of the vein).
6. Palpate the vein and disinfect the area with a gauze soaked in antiseptic.
7. Fix the vein by stretching the skin and subcutaneous tissue.
8. Perform the puncture (when the disinfectant has dried) placing the needle at an angle of
about 30-45° relative to the skin and with the bevel facing up. The plunger will be slightly raised to
facilitate the release of blood.
9. Remove the compressor when the vein has been cannulated and aspirate gently by pulling the plunger.
obtain the necessary blood.
10. Remove the needle and compress the area with gauze or cotton, securing it with hypoallergenic tape.
11. Distribute the blood into the tubes, which must be correctly labeled.
12. Send the sample to the laboratory as soon as possible for analysis.
13. Gather all the material and leave the patient comfortably settled.

Fig. 9.10. Venous blood extraction with syringe and needle.

Procedure 7. Venous blood extraction with vacuum system

Objective: to obtain a blood sample using a vacuum system for hematological analysis.
biochemical, microbiological, immunological, etc.
Material resources
Vacuum system, needle and/or butterfly attached to the vacuum system, hermetic tubes (sealed under vacuum), gauze
sterile or cotton, antiseptic, compress, hypoallergenic tape or band-aids, disposable gloves.
[Link] vacuum extraction with butterfly valve
Action Protocol

1. Explain to the patient what is going to be done and ask for their cooperation if necessary.
2. Wash your hands and put on gloves.
3. Position the patient and follow the same procedure as in the venous blood extraction with a needle.
syringe
4. Place the needle in the vacuum system holder to perform the puncture. Then, insert the tube.
inside the support and press against the internal needle to pierce the stopper. The blood will flow into the
interior of the tube.
5. When the tube is full, remove it without taking the needle out of the vein.
6. This maneuver is repeated as many times as necessary, depending on the tubes that need to be filled.
7. At the end, remove the compressor, then the needle, and compress the area with cotton, holding it with
hypoallergenic tape.
8. Send the sample to the laboratory as soon as possible.
9. Gather all the material and make the patient comfortably settled.
10. Remove the gloves and wash your hands.

Fig. 9.11. Venous blood extraction with vacuum system.

Procedure 8. Venous blood extraction for blood culture

Objective: to obtain a blood sample when the patient presents a fever spike for conducting a study.
microbiological using culture media. It is necessary to perform three extractions (in three different veins), with
an interval of 15 or 30 minutes between them. IN FACT, 1 is taken from one arm and 15 MINUTES from the other.
Material resources
Extraction material, containers with culture media for aerobes and anaerobes (see procedures 6
and described on the previous pages.
Action protocol

1. Perform the puncture of the vein following the established procedure (Procedure 6: extraction of
venous blood with needle and syringe.
2. Prepare the jars with the culture media.
3. Unscrew the outer plugs and disinfect.
4. Introduce the necessary blood in each vial by piercing the stopper and holding the plunger of the
syringe
5. Cover the jars with the outer lids.
6. Place the identification labels.
7. Send to the laboratory as soon as possible.
8. Gather all the materials and make the patient comfortably settled.
9. Take off the gloves and wash your hands.
 Fig. 9.12. Aerobic and anaerobic blood culture bottles, and material for blood extraction.

3.3. OBTAINING ARTERIAL BLOOD

Procedure 9
Objective: to determine the concentrations of gases (O2and CO2in the blood (arterial gasometry) and to evaluate the
effectiveness of ventilation and the state of the acid-base balance of the organism. The puncture is performed in the artery.
radial or in the cubital, although it can also be done in the brachial or femoral arteries.
Material resources
Heparinized gas syringe (to prevent coagulation) and needles of different sizes, anesthetic solution
and antiseptic (povidone-iodine), sterile gauze and hypoallergenic adhesive tape, sterile gloves.
The syringe is taken to a machine (Gascmeter) that measures the values. NOTE: Gases can be measured in different
types of blood (arterial, capillary, and venous). The arterial blood sample should be placed on ice to prevent the
oxygen consumption by red blood cells in the blood, and send it without delay to the laboratory for analysis. To
At the same time, the partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) dissolved in the blood is measured, the
acidity (pH) and the concentration of bicarbonate ions ([HCO3-]). A theoretical curve is also used to calculate the
oxygen hemoglobin saturation (SatO2).
Protocol of action

1. Explain to the patient what is going to be done and ask for their cooperation.
2. Wash your hands and put on the gloves.
3. Place the patient in the proper position and locate the artery by palpating the pulse.
4. Disinfect the area with a gauze or a cotton ball moistened with antiseptic.
5. Apply the anesthetic and wait a few seconds.
6. Fix the artery by pressing between the middle and index fingers.
7. Perform the puncture by inserting the needle at a 35° angle relative to the perpendicular of the artery.
Deepen 1-2 cm and aspirate gently. Avoid letting air enter the syringe.
8. Remove the syringe and needle, and apply firm pressure on the area for a few minutes.
9. Quickly send the syringe with the sample to the laboratory, which will be sealed with a rubber stopper.
10. Gather all the materials and make the patient comfortably settled.
11. Take off the gloves and wash your hands.
12. Record the procedure and incidents in the nursing sheet.

Fig. 9.13. Procedure for arterial blood extraction.

4. FECAL SAMPLES
The waste products derived from the digestion process that reach the rectum and exit the body.
outside through the year.
The collection of stool samples is carried out for:

Determine the presence of blood (hidden hemorrhages), parasites, proximate principles, and other types of
components.
Conduct microbiological studies (stool culture).

The TCAE is the person responsible for collecting this type of samples in cases where the patient
He cannot do it alone. It must be done while respecting his privacy at all times.

4.1. Characteristics and alterations of feces

The parameters that define the normal characteristics of stool are color, odor, consistency, composition,
amount and frequency of elimination.
Parameter Normal characteristics Alterations

Color Yellowish in the infant and Red color. Intake of sweets, tomatoes, beets.
dark brown in the adult. It may etc.
vary depending on the
foods that are ingested. Dark color. Intake of spinach, blueberries,
licorice, etc., administration of some medication,
presence of blood, bile pigments, etc.

Smell Acre, depends on the Change due to the presence of blood or infection.
nutrition.

Consistency Thick and pasty, Liquid. Diarrhea.

depending on the time that
stay in the colon. Hard. Due to the decrease in the amount of water
(constipation).

Composition Water, food no Increase of pigments

digested, dead bacteria, bile (dark), decrease of these
fat, pigments, cells of pigments (light or whitish), absence of
the mucous membranes. pigments (acolorless).

Excess fat. Steatorrhea.

Mucus or pus. Inflammatory or infectious process.

Blood. Coming from the upper parts of the apparatus

digestive (mop) or of the last ones
bleeding (rectal).

Quantity and It depends on the type of diet Increase the number of bowel movements
frequency that is ingested. If the diarrheal. Diarrhea.
nutrition is rich in
meats and fish, the feces Decreases the number of daily bowel movements or the
they are scarce, but if it is rich defecation is delayed or is
in fruits and vegetables Difficulties. Constipation.
(waste), are abundant
(the usual, about 150 g).
The normal frequency is 1
3 bowel movements/day.
Table 9.2. Main characteristics of feces and most common alterations.

4.2. Collection of stool samples

The collection for the removal of feces, if the patient cannot do it alone, is carried out using
wedge (review the technique for placing the wedge).
A. General procedure for the collection of stool samples

Procedure 10
Objective: to collect the patient's stool elimination and, when necessary, to take a sample of it.
to make your analysis.
Material resources
Equipment for the cleaning and hygiene of the patient's genital and anal area (gauze, water, soap or saline solution and
bowl), jars for collecting stool samples with identifying labels (Fig. 9.14), wedge, gloves
disposable.
Action protocol
Explain to the patient what is going to be done and ask for their cooperation.
2. Wash your hands and put on gloves.
3. Place the wedge under the patient so they can defecate on it (they should not urinate on it).
4. Collect the sample with the spoon included in the jar or with the spatula. Close the jar and
label it correctly.
5. Send the sample to the laboratory as soon as possible.
6. Clean the patient and make them comfortable. Collect all the material.
7. Take off the gloves and wash your hands.
8. Write down the procedure on the nursing sheet along with all the observed incidents.
9. If the sample is for performing a coproculture:

The sample must be taken under maximum sterility conditions with a sterile swab.
Deposit the sample in the sterile container and send it to the laboratory for analysis.

10. If the patient can collect the sample themselves, they are explained the collection protocol.
so that it can be done correctly and can be used for analysis.
In children under two years of age, the sample collection is carried out with a bag that adheres to the
anal area. This way, contamination risks are avoided.

B. Collection of stool samples for the study of parasites

In the days leading up to the sample collection, the patient should not take certain medications (antidiarrheals,
antacids, those that contain bismuth salts, barium radiological contrasts, and suppositories) nor foods that
they leave a lot of waste.

Procedure 11
Objective: to collect a stool sample over three consecutive days for the study of parasites.
Material resources
General stool collection, sterile container with spoon, identification labels.
Protocol of action

1. Collect the feces following the general procedure. Make the collection in a sterile container using a spoon.
2. Identify the sample with a properly filled label.
3. Keep the sample at room temperature until it is taken to the laboratory.
Process the sample within 24 hours.

Fig. 9.15. Sterile container for stool sample for parasite study (coproparasitological diagnosis).

C. Stool sample collection for the study of pinworms. Graham technique

Procedure 12
Objective: to collect the eggs of pinworms from the margins of the anus for subsequent analysis. The sample must be
pick it up for three consecutive days.
Material resources
Adhesive tape (transparent cellophane), microscope slide, tongue depressor.
Action protocol
 1. Collect the sample first thing in the morning, without washing the area (at night, the female lays the
eggs on the margins of the year.
2. Place a piece of cellophane, with the adhesive side facing out, at one end of a tongue depressor.
3. Separate the patient's buttocks and apply pressure to the perianal region and the margins of the anus.
4. Place the adhesive tape on a slide (sticky side facing the glass) and send the sample to the
laboratory.

Fig. 9.16. Sample collection procedure for the study of pinworms.

5. SAMPLES OF SPUTUM AND VOMIT

5.1. The sputum

They expel the secretion coming from the lower respiratory tract, which is expelled to the outside through the
In normal conditions, it has no smell.

A. Types of sputum
Considering its characteristics, the sputum can be:

Serous: clear, watery or foamy, abundant and low in viscosity (acute pulmonary edema).
Mucous: whitish, with a large amount of mucus and very viscous (bronchitis, asthma).
Purulent: yellowish green (bronchopulmonary infections).
Mucopurulent: yellow-green or brown (bronchopulmonary infections).
Dull: gold or reddish yellow (pneumonia caused by pneumococcus).
Hemoptysis (coughing up blood): blood-stained or brownish (tuberculosis, cancer of
lung)

B. Collection of sputum samples

The objective of analyzing a sputum sample is to determine its characteristics:

Macroscopic: color, volume, consistency, quantity, and odor.

Microscopic: cytological and microbiological study.
Biochemicals: determination of pH, enzymes, and other chemical elements.

Procedure 13
Material resources
Sterile container, labels for identification, disposable tissues or gauze, disposable gloves, equipment
special sample collection, aspiration system (in patients who do not cooperate, are unconscious or
tracheostomized), sterile field cloth (tracheostomized patients).

Protocol of action (common to all patients)

1. Explain to the patient what is going to be done and ask for their cooperation if necessary.
2. Wash your hands and put on the gloves.
a) Conscious patient who collaborates

1. Ask the patient to rinse their mouth to avoid contamination of the sample by microorganisms.
of the upper respiratory tract.
2. Ask him to take a deep breath two or three times and to cough on the last breath to release the
sputum (should not release saliva or nasal secretions).
3. Collect the sample by placing the open sterile container directly at the mouth.
4. Close the container (to avoid contamination), label it correctly, and send it to the laboratory.
5. Gather all the materials and make the patient comfortably settled.
6. Clean the room.
7. Record the incidents in the nursing sheet.

b) Unconscious patient

Introduce the collector probe into the patient's nostrils and connect it to the vacuum system.
2. Perform sputum aspiration by inserting a bottle into the system for sample collection.
3. Disconnect the suction system when the sample is obtained.
4. Label the jar to send it to the laboratory.

c) Patient with tracheostomy

Place the sterile field cloth around the tracheostomy opening.

2. Introduce the suction probe into the opening and suction several times.
3. Collect the sample in the sterile jar, close, label, and send to the laboratory.
4. Collect the material and position the patient.
5. Remove the gloves and wash your hands.

5.2. Vomiting
Vomiting is the abrupt and violent expulsion of gastric contents through the mouth. It is a
reflex action that occurs as a result of stimulation of the medulla oblongata.

A. Types of vomit
Considering its content and characteristics, vomit can be:

Nutritional: contains foods at different levels of digestion.

Watery: contains gastric juice, is light in color, has an acidic taste and intense smell.
Biliary: contains bile, is yellowish-green in color.
Purulent: contains pus coming from the respiratory or digestive system, but has been digested.
Hematic: contains blood from the digestive system. If it is red, it is undigested blood.
(hematemesis) and if it is black, it is digested blood. Vomiting that resembles coffee grounds, in the form of clots.
Fecaloid: contains fecal matter from the intestine. It is dark in color and has a foul smell.

B. Collection of vomit samples

Procedure 14
Objective: to study certain alterations of the functions of the digestive system to confirm or detect the
existence of hemorrhages, toxic infections, presence of Helicobacter pylori, poisoning by toxins or drugs and
other pathologies.
NOTE: Helicobacter pylori: the infection caused by this bacterium is a bacterial infection that leads to inflammation of
stomach (gastritis), gastroduodenal ulcer, and certain types of stomach cancer.
Material resources
Sterile container for sample collection, labels for identification, spatula, disposable tissues
gas, towels, basin, disposable gloves.
Protocol of action (common to all patients)
 1. Explain to the patient what is going to be done and ask for their cooperation.
2. Wash your hands and put on gloves.
3. If the patient is conscious, instruct them on how to take the sample supervised by the TCAE.
4. If the patient is unconscious, lay them on their side to prevent choking on vomit.
5. Place the basin near the patient's mouth and collect as much sample as possible with a spatula.
possible to facilitate the doctor's assessment of its characteristics.
6. Transfer the sample to a sterile container and label it for shipping to the laboratory.
7. Wash and clean the patient, making sure they are comfortably settled. If the patient requests it and it is allowed, they are...
rinse your mouth to remove the remnants of vomit.
8. Gather all the materials and clean what is necessary.
9. Take off the gloves and wash your hands.
10. Record the procedure and all incidents observed on the nursing sheet.

6. CEREBROSPINAL FLUID (CSF) SAMPLES

Sample collection carries certain risks for the patient. Generally, it is collected in three tubes.
sterile with screw cap: one for biochemical study, another for microbiological study (the cloudiest one) and
the last for cell research. The sample collection is carried out by the doctor with the staff of
nursing.

Procedure 15
Objective: to rule out infectious, neurological, or any other type of processes.
Material resources
Antiseptic solution and sterile gauze, needles and syringes for the administration of anesthetic, local anesthetic,
change to perform the puncture, sterile container for sample collection, surgical drapes (one of them
(fenestrated), disposable gloves.
Protocol of action (common to all patients)

1. Explain to the patient what is going to be done and ask for their cooperation.
2. Wash your hands and put on gloves.
3. Place the patient in a lateral decubitus position with the knees bent and close to the abdomen; the chin
tucked to the chest (fetal position). This achieves hyperflexion of the spine.
4. Place a surgical drape under the patient and the fenestrated drape over the puncture area.
5. Disinfect the area with antiseptic and administer the local anesthetic.
6. Perform the puncture between the L3-L4 or L4-L5 vertebrae with the trocar (it has a guide inside) and extract the
guarantee for the LCR to be released. Generally, the puncture system is equipped with a manometer that
measure the initial pressure of the cerebrospinal fluid.

7. Samples are collected in sterile containers, avoiding touching the tip of the puncture needle.
8. Label them correctly and send them to the laboratory.
9. Remove the trocar and clean the area by pressing with a sterile gauze.
10. After the puncture, the patient will remain at rest for at least 2 hours in a supine position.
11. Collect all the materials and note the incidents on the nursing sheet.

Fig. 9.18. Collection of cerebrospinal fluid samples

7. Exudate samples
The collection of exudate samples is carried out by the doctor or nursing staff. The nursing assistant helps prepare the patient and the
necessary materials, during the sample extraction and in the shipment to the laboratory.

7.1. General procedure for the collection of exudate samples

Procedure 16
Objective: to conduct microbiological studies to rule out any infectious process.

Material resources

Gases and dressings, antiseptic and sterile saline solution, water, soapy solution and towels, sterile swab with transport tube, labels of
identification, disposable gloves.

Protocol of action

1. Explain to the patient what is going to be done and ask for their cooperation.

2. Wash your hands and put on the gloves.

3. Clean the area from which the exudate sample will be taken.

Fig. 9.19. Swabs for collecting exudate samples: a) open; b) closed.

4. Place the patient in the most appropriate position for each case, open the tube and gently pass the swab over the area where it
he/she is going to take the sample, making circular movements.

5. Introduce the swab into the transport tube, trying not to touch the edges, and close it.

6. Place the identification label and send the sample to the laboratory as soon as possible.

7. Collect the entire room and leave the patient comfortably settled.

8. Note the incidents on the nursing sheet.

7.2. Specific procedure for collecting different types of exudates

The general protocol for collecting exudate samples must be adapted to each specific type.

Type of
Protocol of action
exudate

Nasal Take the sample by inserting the sterile swab through the nostrils to the nasopharynx and rotating it.
gently.
2. Place the swab in its transport tube, identify it correctly and send it to the laboratory.

Pharyngeal 1. Take the sample with a sterile swab gently passing it over the tonsils, the pharynx, or any
area that is affected, avoiding touching the tongue and the walls of the mouth. To facilitate the maneuver, depress
the tongue with a depressor.
2. Place the swab in its container and send the sample, properly labeled, to the laboratory.
immediate; if not possible, keep it in the refrigerator at 4 ºC.

Conjunctival Take the sample with a sterile swab moistened in a saline solution and gently pass it through the
lower conjunctiva, from the outer angle of the eye to the inner.
To use a swab for each eye.
3. Place the swab in its packaging, identify it properly and send it to the laboratory.

Optical 1. Clean the ear canal beforehand with an antiseptic.

2. Yes exudate appears, take the sample with a sterile swab.
3. Use a swab for each ear.
4. Place the swab in its container, properly labeled, and send it to the laboratory.
5. Yes There are no exudates, take the sample using special procedures.
Urethral 1. Take the sample with a sterile swab.
2. Place the patient in a supine position and insert the swab into the urethral canal, or squeeze the
urine.
3. It is important to take the sample in the morning, before the first urination, or after having been
4 hours without urinating.

Vaginal Put the patient in gynecological position.

2. Introduce the vaginal speculum (into the vagina) and take the sample with a sterile swab, rotating it.
about the area where the exudate is most abundant.
3. Introduce the swab into its sleeve, attach the properly identified label, and send it to the laboratory.
4. If the sample is for a vaginal cytology, once obtained, make a slide with the swab on a
slides and dye with the usual dyes.

Wounds Disinfect the area from which the sample will be taken to avoid contamination.
2. To take The sample is taken directly with a sterile swab, introducing it into the wound.
3. Yes the wound is very extensive, take the sample by touching different areas.
4. Introduce the swab into its sleeve, label it, and send it directly to the laboratory.

Table 9.3. Procedures for the collection of different types of exudates.

8. Other types of samples

In addition to the described samples, others can be analyzed, such as gastric and duodenal contents, seminal fluid, skin, hair, nails and
any type of tissue in the organism.

Procedure 17. Collection of gastric and duodenal content samples

Objective: to obtain samples of gastric and/or duodenal content for the diagnosis of certain pathologies affecting the digestive system.

Material resources

All the necessary material to carry out gastric or intestinal probing (tubes, stethoscope, large syringe, lubricant, sterile gauze and
bowl), sterile jars for sample collection, properly labeled, disposable gloves.

Protocol of action

1. Explain to the patient what is going to be done and ask for their cooperation.

2. Wash your hands and put on the gloves.

3. Perform the nasogastric or nasoenteric intubation, depending on the type of sample requested by the doctor.

4. Check that the probe is correctly placed.

5. Obtain the sample by aspirating the contents with the syringe through the probe.

6. Place the sample in the sterile container, label it, and send it quickly to the laboratory.

7. Remove the catheter, collect all the material and arrange the patient.

8. Remove the gloves and wash your hands.

9. Record the incidents in the nursing sheet.

Procedure 18. Collection of semen samples

Objective: to obtain a semen sample to determine the volume of the ejaculate, the motility and morphology of the sperm.
to make a count of them for infertility studies.

Material resources

All the necessary materials for the patient's genital hygiene (sterile gauze, water, soap or saline solution, and towels), sterile jar,
identification labels.

Action protocol
 1. Explain to the patient how to collect the sample.

2. Generally, the sample is collected at home (through masturbation or interrupted intercourse) or in the laboratory (through
masturbation.

It is recommended to collect the sample after two or three days of sexual abstinence.

4. Wash the genitals and collect the sample in a wide-mouth container.

5. Close the jar and label it correctly to take it to the laboratory, along with the request form. No more time should pass.
of 2 hours from the sample collection.

6. Re-clean the genital apparatus.

Procedure 19. Sampling of skin, hair, and nails

Objective: This type of sample is generally taken for the study of infections caused by fungi.

Material resources

Scalpel or bistoury, tweezers, gauze, 70º alcohol, sterile jar or Petri dish, identification labels, disposable gloves.

Action protocol for skin and hair samples

1. For skin samples, scrape the superficial scales from the edge of the injured area with a lancet or a scalpel.
Take hair samples, pluck the broken hairs with tweezers, and scrape off the scales and scabs from the injured area.

2. Collect the obtained material in sterile containers or Petri dishes.

3. Place the label with the completed data and send it to the microbiology laboratory for analysis.

Protocol for action for nail samples

1. Wash the area with gauze and 70° alcohol; let it dry.

2. Collect the sample in sterile containers by scraping the lesions or the affected area with a lancet or scalpel. If possible, cut
some fragment of the nails.

3. Label correctly and send to the laboratory for analysis.

9. Conservation and transport of samples

In order not to alter the results of the analyses, it is important to preserve the samples and transport them to the laboratory under proper conditions.
appropriate, following the pre-established protocols in each healthcare center or laboratory. Urine samples for urine culture may
to remain refrigerated for up to 24 hours without altering the bacterial flora. But that time should never be exceeded.

All samples must be accompanied by the request form for the tests prescribed by the doctor.
The conservation and transport systems of samples depend on each healthcare center or each particular laboratory.

9.1. Sample preservation

In order for the samples to be in ideal conditions, no more than one hour should pass from their collection until their analysis; if not
If possible, they should be kept refrigerated at a temperature between 4-6 ºC, depending on the type and characteristics of these samples.

Fig. 9.21. Approved system for the transportation of clinical samples.

The conservation and analysis recommendations for the different types of samples are indicated in Table 9.4.
Sample Conservation Recommendations for analysis

Urine Keep at 4 °C or with preservative (to avoid the The microscopic analysis of the sample must be performed.
proliferation of microorganisms. within 2 hours following pickup.

Microscopic analysis must be performed within 2 hours. For the analysis of photosensitive substances, it is necessary to
following the collection of the sample. keep the sample protected in topaz jars
(amber color).
For the analysis of photosensitive substances, keep the
show in topaz jars (amber color) or protected with
any other means.

Blood In general, keep at room temperature (1-25 °C). Perform the analysis within 2 hours following its
pickup.
Plasma and serum without formed elements at 4-6 °C.

Freezing temperature for plasma and serum (without

-18 °C.

Feces Keep refrigerated at 4-6 °C. Send to the laboratory within 2 or 3 hours after its
pickup.

Sputum Keep at room temperature. Immediate analysis, or within the next 2 to 3 hours after
its collection.
If only the study of mycobacteria is requested, refrigerate at 4-
6 °C.

LCR Keep at room temperature or at 37 °C (if not possible Immediate analysis, especially if there is suspicion of
the immediate analysis). meningitis.

It should not be refrigerated if infection is suspected by

anaerobes.

Exudates Maintain at room temperature in a means of transport. Immediate analysis, or within the 2 or 3 hours following
his collection.

Content Keep at room temperature. Immediate analysis, especially if there is suspicion of

gastric tuberculosis.

Seminal fluid Keep at room temperature. Analysis in the first 2 hours after its
obtaining.

Skin, hair, and nails Keep at room temperature for several days (samples for Take into account the effects of conservation
the study of fungi. they can alter the samples and modify the results
of their analysis.

Table 9.4. Conservation procedures and recommendations for the analysis of biological samples.

9.2. Transport of samples

The personnel involved in the transportation process must have the necessary training and experience to ensure compliance.
the requirements specified in the current regulations and thus meet the following objectives: (at least read them)
A. Types of containers for transportation

Different types of containers are used for the transport of biological samples, each specific according to the
characteristics and the size of the sample (Table 9.5.).

Depending on the type of sample to be transported, a specific type of container will be chosen.

When the sample is taken in a place different from the laboratory where the analysis will be conducted, containers will be used for
shock-resistant transport, in which the tubes with all the samples will be placed.

When it is necessary for the samples to be refrigerated, special containers that carry a refrigerant inside will be used.
It is important not to break the cold chain to avoid altering the samples.

If the samples carry a risk of contamination, current regulations for such cases must be taken into account. They should go
well protected and meet all security guarantees.

Containers Characteristics

Primary They are containers in which samples are deposited and transported.

Deben ser estancos y estar debidamente etiquetados e identificados.

Secondary They are containers (secondary packaging) that allow the transportation of one or several receptacles.
primary.

They must be airtight and contain absorbent material to soak the sample in case of
spillage.

They must be correctly labeled and identified.

Tertiaries They are containers (tertiary packaging) that allow the transportation of one or more secondary containers.

They must be resistant to breakage and impact.

Tabla 9.5. Características y tipos de recipientes para la recogida y el transporte de las muestras biológicas: a) primarios; b) secundarios; c)
tertiary.

B. Sample preparation for transport

The transport process must be carried out properly, adhering to the requirements specified in the current regulations. Some
of these requirements are:
C. Most commonly used transport systems

Depending on the characteristics of the healthcare facility, different systems are used for transporting samples:

In large hospitals, a pneumatic tube system is used, which are plastic compartments lined internally with
materials that protect the sample containers. Through a complex system of tubes, the samples move from the
services in which the samples have been taken to the laboratory.

The hand delivery system is also used. In this case, the healthcare personnel (generally, the nursing assistant) collects the samples.
properly identified and places them, along with the request slip, in a sealed container to take them
directly to the laboratory.