After the specimen is obtained, replace the lid tightly on the cup and return to the laboratory within two hours. Gargle and rinse your mouth with water just after you get up and before you collect the specimen. This helps to eliminate accumulated cells arid normal bacteria that may interfere with your test results. Inhale repeatedly to the full capacity of your lungs and exhale the air with an explosive cough.
This should produce mucus from the lungs that is to be expectorated into the container. Transport specimen within two hours to the lab and give directly to lab personnel. When more than one specimen has been ordered, collect specimens on consecutive mornings. Transport each specimen as collected to the laboratory. Sputum Specimen Collection Amount to Collect The necessary amount of sputum for most tests is 5 ml about 1 teaspoon. It is secreted from goblet cells found in the surface epithelium lining the airways of the respiratory tract and from seromucous glands in the connective tissue layer beneath the mucosal epithelium.
Sputum expectoration is abnormal and there is always an underlying pathological cause. Such causes include:. Secretions in the lower airways create an ideal environment for the growth of bacteria Dougherty and Lister, and the presence of infection can increase and change the nature of mucus leading to the need to expectorate and cough. The aim of sputum collection is to identify the bacterial, viral or fungal cause of a suspected infection and its sensitivities to antibiotics.
A specimen is indicated if patient has:. It is difficult to accurately assess the amount of sputum produced but it may be described by its colour and consistency.
It is important to consider the characteristics of sputum as part of an overall patient assessment. Sputum may be described using the following terms Richardson, , which can aid diagnosis of the cause:. Yellow, orange or green sputum is commonly associated with bacterial or viral infection Dougherty and Lister, Red sputum indicates the presence of blood and may suggest tuberculosis or cancer Richardson, , or infection, particularly in bronchiectasis and fungal growths such as aspergilloma in immunocompromised patients.
Expectorating large amounts of white frothy sputum may be a sign of pulmonary oedema. Sputum samples can be obtained using a non-invasive or invasive method and ideally should be collected before antibiotics are started. Invasive methods include oropharyngeal or endotracheal suctioning; these are used with patients who are intubated. A sputum trap is connected to the suction catheter to collect the sputum Fig 1 Brekle, Obtaining sputum using suctioning requires specific skills and nurses need to be aware of potential side-effects, including hypoxia, cardiac instability and mucosal trauma Dougherty and Lister, This article describes non-invasive methods.
It is important to note that droplets and aerosols may be generated when collecting sputum specimens, so health professionals should use personal protective equipment as stipulated in local policies includinggloves, apron and face masks Brekle, Patients should be provided with an explanation of the specimen required, pointing out the difference between oral secretions and sputum.
They should be instructed to sit up and take several deep breaths to loosen secretions before giving a deep cough to release the sputum. Ideally, the specimen should be no less than the size of a small fingernail. It is important to assess whether patients experience pain related to respiration — particularly when coughing, for example following chest or abdominal surgery, as this can prevent them taking deep breaths and expectorating. Analgesia should be given and their pain reassessed before attempting to collect a specimen.
Patients should also be encouraged to support any wounds using their hands or a pillow Dougherty and Lister, Prescribed nebulised sodium chloride 0. Physiotherapists can also assist patients with coughing techniques and can teach other clinical staff the active cycle of breathing techniques to help with chest clearance.
Ensuring the patient is well-hydrated can help increase sputum production and the likelihood of obtaining a useful sample. Ideally specimens should be obtained in the morning as secretions pool in the lung overnight, providing an environment in which bacteria can replicate Dougherty and Lister, ; this is particularly important when testing for tuberculosis. Collecting the sample before breakfast also reduces the risk of contaminating the sample with food.
Patients should be advised to not clean their teeth or use a mouthwash before specimen collection as this may kill the bacteria. It is important to check that the sample contains sputum, as samples contaminated with oropharyngeal secretions and saliva are difficult to interpret and can be misleading Brekle, Contamination of the sample can result in inappropriate or delayed treatment.
Professional responsibilities This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols. Tagged with: Assessment skills: specimen collection Newly qualified nurses: practical procedures.
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