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Chapter 52
Specimen Collection
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
In Practice: Collecting
Specimens and Samples
Refer to Nursing Care Guidelines 52-1.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Alert
• Always wear clean gloves when collecting specimens of
urine, stool, sputum, wound drainage, or blood.
• Thorough and consistent handwashing before and after
any contact with clients and their specimens limits
spread of microorganisms that cause disease.
• It also protects the specimen from inadvertent
contamination by the nurse’s hands.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Urine Specimen
• Information obtained
– Client’s recovery or decline
– Assessment of kidney and/or liver status
– Presence of legal and illegal drugs
– Pregnancy
– Identification of specific disease-causing organisms
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Keeping Intake and Output Records
• Indicator of nutritional and fluid balance.
• Order is given to “record food and fluid intake” or
“I&O + calorie count.”
• Over 24 hours, a person’s normal fluid I&O will be
approximately the same, or balanced.
• Amounts recorded for I&O are measured in milliliters
(mL).
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Concept
• Some normal situations can cause the fluid intake and
output to be quite different.
• For example, during very hot weather, fluid is lost
through perspiration, but it cannot be measured.
• Eating extra salt may cause a temporary retention of
water in the tissues.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Fluid Intake and Output
• Fluid intake
– All fluids consumed through the gastrointestinal
(GI) system
– Fluids taken as part of intravenous (IV) therapy
or total parenteral nutrition (TPN)
• Fluid output
– Includes all fluids excreted from the body by any
means
• Maintain IV fluids record.
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Measuring Fluid Intake
• Measure all fluids
– Enteral intake: by gastrointestinal (GI) system
• By mouth
• Count ice as ½ water
• Tube feeding
– Parenteral intake: peripheral lines (not GI system)
• Intravenous (IV) therapy
• Total parenteral nutrition (TPN)
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Measuring Output
• Measure
– Urine
– All other fluids leaving body
• Wound drainage
• Emesis
• Watery diarrhea
• Bleeding
• Returns from nasogastric (NG) suction tube
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Nursing Alert
• Before giving fluids to a client, find out if the client is on
I&O. Do not fill a water pitcher or empty one unless you
are sure of the procedure used for recording I&O in your
facility.
• Do not empty a bedpan or urinal without first finding out
if the client’s I&O is being recorded or if a urine specimen
is required.
• Enlist the aid of the client or family, when possible, to
assist with tracking intake and output and reporting
when the water pitcher is empty or when the client has
voided (urinated).
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Concept
• The urinary output of an infant or incontinent adult can
be determined in several ways:
– A special specimen collection bag can be used.
These are also available for adults, but are rarely
used.
– The infant diaper, Depends-type adult diaper, or
sanitary napkin can be weighed and compared to the
weight of the same item when dry. The weight can
then be converted, using a chart, to urine volume.
• Urine specimens can be collected in the same manner
– Specimen hat.
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Measuring Urine Specific Gravity
• Urine specific gravity
– An indicator of the concentration of urine as
compared with pure water
– Measured with a urinometer or hydrometer
• Normal range
– 1.010 (dilute) to 1.025 (highly concentrated)
– High specific gravity could indicated dehydration
of fluid retention
– Low specific gravity could indicate a disorder such
as diabetes insipidus or excessive use of diuretic
medications
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Collecting Urine Specimens
for Examination
• Urinalysis
– Components of urine identified
• Urine specimens are collected
– At the beginning of treatment
– When illness is present
– To check for the presence of legal or illegal drugs
– To determine a pregnancy
– To check for infection
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Nursing Alert
• Place all specimens in leak-proof containers.
• Keep the outside of these containers clean and dry.
• Place them into plastic biohazard bags for transport to
the laboratory.
• Label containers before use. In some facilities, you must
also label the bag.
• Be sure to include the appropriate lab request form, so
the laboratory staff knows which tests to complete.
• In many facilities, the request is entered on the computer
as well.
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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
In Practice: Collecting Clean-Catch
or Midstream Urine Specimens
• *Refer to Nursing Care Guidelines 52-3.
• Label container
• Instruct client to cleanse the urethral area thoroughly
• Instruct female client to cleanse from front to back and to
cleanse each side with a separate wife, saving the last for the
urethral area itself
• Instruct the male client to cleanse the penis using a circular
motion and going outward from the urethral meatus
• Instruct client to then void a small amount into the toilet and
then void into the sterile container (catching the midstream
urine), then void the remainder into the toilet
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Nursing Alert
• In some cases, such as when doing drug testing, an
observed urine specimen must be obtained.
• In this case, the nurse must actually observe the client
voiding into the specimen container.
• Be aware that there are a number of methods used to
avoid detection when giving a false urine specimen.
• If you are expected to obtain accurate urine samples for
drug testing, you will require special inservice education.
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In Practice: Collecting a
24-Hour Urine Specimen
• Refer to Nursing Procedure 52-4.
• Discard the first void and document the time
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Collecting the Fractional Urine Specimen
• Determines amounts and characteristics of urine during
various periods (“fractions”) of the day
– Often obtained for 6 hour periods
• Collect specimens according to hospital policy
or
• Refer to collection method in text
• Store all specimens on ice or in a specimen refrigerator
during 24 hour urine collection period
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An Indwelling Catheter
• Take care not to allow the collecting bag to be
elevated above the level of the bladder.
• Obtaining a one-time catheterized urine specimen
– Residual urine volume
• Strict sterile technique
• 40% of all nosocomial infections are related to
infections of the urinary tract.
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Nursing Alert
• Strict sterile technique must be followed in doing
catheterization to prevent urinary tract infections.
• The Centers for Disease Control reports that 40% of all
nosocomial infections are related to infections of the
urinary tract.
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The Stool Specimen
• Provides information about the functioning of the GI
system and its accessory organs
• Two common tests
– Occult blood = “hidden” or unseen blood
– Ova and parasites (O&P)
• Indicates presence of intestinal parasites (worms)
or their eggs (ova)
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The Stool Specimen, cont.
• Hemoccult or Hematest
– A test for occult (hidden) blood in stool or body secretions
– May need to scrape feces out of attends/diapers using a
tongue depressor to obtain a specimen
– NEVER leave the Hemoccult solution bottle in the client’s
room—it can cause blindness if accidentally used as an eye
drop. (Most containers look like an eye drop container!)
– Observe smear for a blue discoloration
• Guaiac
– Substance that causes the tested occult blood to change
color
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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Alert
• Be aware that false-positive results may occur with guaiac
tests.
• “False-positives” can be caused by the client having consumed
large amounts of rare red meat or certain foods, such as
radishes, tomatoes, beets, horseradish, or some melons.
• In addition, the client should not take more than 250 mg per
day of vitamin C and should not take aspirin or nonsteroidal
anti-inflammatory drugs (NSAIDs) for 3 days before the test.
• Usually, three separate specimens are collected on three
separate days before a determination of positive or negative is
made. If test results are repeatedly positive, additional
examinations are necessary.
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Sputum Specimen
• Used to determine presence of tubercle bacillus
(causative organism for tuberculosis)
• Obtain soon after client awakens in the morning
– Sputum accumulates in airways at night
• Expectorate = to cough up secretions
• Document sputum amount, color and consistency
• Label container appropriately with date, time, amount,
color, consistency and time sent to lab
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Alert
• The sputum specimen is considered highly contaminated.
Treat it with caution.
• Paper tissues used by any client also are considered
contaminated. Dispose of them properly.
• Wear gloves when handling tissues and sputum
specimens and when providing nursing care if the client
is coughing up sputum.
• Goggles and a mask or full face shield may be necessary
to protect the nurse from droplet secretions, particularly
if the client is coughing or spitting. (A “spit shield” is also
available. This is a net-type device that is placed over the
client’s head so he or she cannot spit at others.)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Blood Specimen
• Taken at admission to healthcare facility
• Assesses blood’s normal cells and other components
• Determines presence of abnormalities or disease
organisms
• Venipuncture
– Puncture of a vein, usually with a needle
– Blood often drawn in the AC space, jugular or
femoral vein is used in children
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The Blood Specimen, cont.
• Blood culture
– Identifies disease-causing organism
– Draw BC’s prior to antibiotic therapy!
• Drug sensitivity test
– Determines medications that will kill or arrest the
growth of that organism
• C&S = culture and sensitivity
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The Blood Specimen, cont.
• Nurses who draw blood need specialized instruction and
supervised practice in venipuncture.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
NURSING PROCEDURES
• 52-4
• 52-5
• 52-6
• 52-7
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