Collection of Specimen

Presented by: Navjot Kaur

Asstt. Lecturer
College of Nursing
 Introduction
• After admission of a child to the hospital, the
nurse may carry out or assist with certain
diagnostic procedures, including collection of
urine, stool specimens, nasopharyngeal,
throat, sputum specimens, blood specimen
and cerebrospinal fluid specimen.

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 Contd…..
• Sometimes it become necessary to restrain
the child to carry out anxiety producing
procedures to obtain specimen.
• When specimens are obtained, they must be
accurately labeled and accompanied by the
appropriate slip when sent to the laboratory.

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 Various types of specimen
• Urine specimens
• Stool specimens
• Blood specimens
• Throat, nasopharyngeal and sputum
specimens
• Cerebrospinal fluid specimens

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 Urine specimen
Two types of urine collection is needed:

• Routine urine specimen

• Clean catch specimen

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 Routine urine specimen
• It is easy to collect the urine from older children who can
cooperate with either mother or nurse. It is relatively difficult in
case of infants.
• In case of infants the urine specimen can be collected with the
application of urine collectors.
• The pediatric urine collectors are made of clear, pliable, plastic
material secured to a sponge ring.
• The nurse should wash her hands before the application of urine
collector, the skin of genitalia must be cleansed and thoroughly
dried, the sponge ring coated with pressure –sensitive adhesive,
is attached firmly without wrinkles around the genitalia.

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 Contd……
• The collection bag is first attached to the
perineum in the girl, then gently attached
upward to the symphysis.
• For boys, the penis and scrotum are inserted
into the opening of the bag and adhesive
portion of the bag is pressed securely against
the skin, especially in the perineal area.
• A diaper is placed in position to prevent the
infant from kicking or pulling the bag off.
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 Contd…..
• The infant or toddler is placed in semi-fowler
position so that the urine can flow into the
bag.
• The nurse must check the bag frequently to
prevent the urine from leaking and to obtain
fresh specimen for laboratory investigation.

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 Clean catch specimen
• It gives a rough estimate of number of bacteria
present. In order to obtain a clean-catch
specimen from an infant or small child the
genitalia should be cleaned using cotton balls
wet in soap and water, then rinsed with an
antiseptic solution.
• When washing the female genitalia different
cotton ball be used for each stroke made from
above the clitoris downwards to the anus.
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 Contd…….
• The stroke should cleanse the meatus first, then
move outward to the perineum. After genitalia are
thoroughly cleansed, the skin is rinsed with sterile
water and dried with a sterile gauge sponge.
• It is important that all the antiseptic solution be
removed so that it cannot interfere with the
bacteria in the urine and cause a false-negative
result on culture. A sterile urine collecter is then
applied.

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 Contd….
• When a clean catch urine specimen is to be obtained
from a male infant, the meatus and glans penis are
cleansed with an antiseptic solution, rinsed with
sterile water and patted dry with sterile gauge sponge.
The foreskin of the male is retracted and the meatus
and glans penis are cleaned in the same manner.
• A sterile urine collector is then applied. When the
child has voided, the urine is emptied into a sterile
container. Atleast 1 to 2 ml of urine is required for
culture.

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 Contd……
• To obtain a clean catch specimen from a
preschool or older child who can cooperate,
cleanse the genitalia as described. A girl can
sit on a training chair beneath which a sterile
basin is placed or she can void into the sterile
specimen bottle.
• A male child can void into a sterile urinal or
directly into a sterile specimen bottle.

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 Contd…
• When obtaining a clean catch specimen from
older children or adolescent, the procedure is
same as that for adults.
• The nurse explains the procedure to the child
and warns the child about the coldness of the
cleansing solution and supervises the
procedure. Parents may assist with the
collection of the urine if the child is not
embarrased by their presence.
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 Catheterized specimen for culture
• If bacteria is present in a clean catch specimen,
a catheterized specimen may be needed for
culture. For infants and children, a size 8 to 10
foley’s catheter may be used.
• Two catheters should be in readiness, since the
first to be used may be accidently
contaminated.
• Solutions used to clean the genitalia is mainly
betadene.
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 Points to be stressed during catheterization

• The nurses hands must be washed with soap

and water.
• The genitalia are cleansed with cotton balls
dipped in cleansing solution.
• The tip of the sterile catheter should be
lubricated with sterile saline solution before
insertion into the urethral meatus.
• The procedure must be done under good light.

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 Contd….
• When catheterizing a male infant or child, grasp
the penis, holding both sides and in an erect
position. Insert the catheter slowly and gently.
• The catheter should be inserted slightly beyond
the point at which urine begins to flow.
• After the urine ceases to flow into a sterile
container, the catheter is removed slowly and
the tip held up so that urine does not soil the
area.
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 Twenty four hour urine collection
• When collecting a 24 hour urine specimen, the
nurse must discard the first voiding or diaper,
the apply the bag to the child’s genitalia and
records the starting time. During the collection
the urine must be stored. After the 24 hour
period, the bag is removed and urine is
delivered promptly to the laboratory for
testing.

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 Stool collection
• A stool specimen is collected by using the tip
of a tongue blade to transfer a passed stool to
a covered specimen cup. The specimen should
not be contaminated by urine.
• If a stool specimen cannot be obtained, a
rectal swab may be done by gently inserting a
swab into it.

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 Blood specimen
• These are obtained for determination of the
degree of illness, for diagnosis or for
evaluation of therapy.
• These may be collected by physicians, nurses
and lab technicians.

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 Contd…….
• In infants and young children only larger veins
may be used. Mummy restraint is used while
collecting blood specimen.
• After the needle has been removed a firm
pressure for 3 to 5 mins should be put on the
vein.
• While the infant is restrained the nurse must
provide him with some diversional therapy.

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 Contd….
• Children of all ages are fearful of needles and
they mistakenly believe that this loss will
endanger their life.
• The nurse must explain to them that blood is
constantly being produced and that small amount
removed in this way cannot harm them.
• Peripheral capillary blood samples are taken from
children from finger stick method.
• In infants heel stick is used.
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 Contd……
• The infant’s foot is held firmly in the nurse’s
hand, the area is cleansed with alcohol and
the heel is punctured on the outer aspect to
prevent injury to the medial planter artery.
• After the specimen is collected, pressure with
dry gauge or swab is applied to the area until
bleeding ceases.

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 Throat, nasopharyngeal and sputum
specimen
• This procedure is usually uncomfortable for
the child. A brief explanation is given to the
child just before the procedure is carried out.
• These specimens are placed in sterile
containers the inside of which should not be
contaminated.
• The time of collection is to written on the label
on the specimen.

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 Throat
• A sterile swab is used to obtain a throat
culture. When doing this procedure, the nurse
should not touch the swab with the lips or
tongue.
• If the child cannot hold the mouth open, a
tongue blade can be used.
• The swab is then placed n a sterile container
and send to laboratory.

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 Nasopharynx
• A sterile swab on a flexible wire is used to
obtain a specimen from the nasopharynx. The
swab is inserted through a nostril, bending the
wire downward through the nasal passage
until it reaches the nasopharynx.

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 Sputum
• A suction device called as mucus trap is used
to obtain a sputum specimen from a child who
is too young to cough productively.
• The children who are old enough to cough
deeply and productively may be instructed to
do so in order to obtain a sputum specimen
from the bronchi and lungs.

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 Cerebrospinal fluid specimen
• LP or spinal tap is done to obtain CSF fluid for
culture and sensitivity determination, to test
for cell count, globulins, proteins and sugar in
CSF, to determine the level of intracranial
pressure, to reduce intracranial pressure to
identify any hemorrhage in the central
nervous system.

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 Contd……
• The nurse explain the procedure and its
purpose to the child and steps involved in it.
• The nurse will assist the child to lie on the side
with the knees bent.
• The child must be told about the coolness felt
when the skin is cleansed and the importance
of remaining absolutely still throughout the
procedure.

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Contd….
• Prior to the procedure local anesthesia is given.
• The nurse’s most important responsibility is to
assist with a spinal tap is firm restraint of the
child in such a way that the back is rounded and
parallel with the side of the treatment table, in
order to open the lumber space.
• The nurse must observe the child’s colour and
respirations during the procedure to determine
whether the child’s chest expansion is impaired.
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 Contd…..
• In the procedure a needle is inserted into the
lumber area (L3-L4) is preferred.
• A manometer may be attached to the needle
to determine the cerebrospinal fluid pressure.
• The CSF is collected in tubes that are
accurately labeled and numbered.
• After lumber puncture the child is usually kept
flat in the bed.

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 Contd…….
• The vital signs must be monitored according to
the policy.
• This procedure may be done either on an
outpatient basis or when the child is
hospitalized.

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