Editing Nursing Skills and Procedures (section)

== Specimen Collection ==

General rules: label at the bedside in the presence of the patient, use the correct container and preservative, avoid contaminating the inside of the lid, transport promptly, and document collection time. Cultures are ideally obtained before the first dose of antibiotics.

* '''Clean catch midstream urine''': cleanse the meatus front to back with the provided wipes, begin voiding into the toilet, then catch the midstream portion without stopping the stream. This flushes urethral flora.
* '''Sterile urine from an indwelling catheter''': clamp the tubing distal to the port for about 15 to 30 minutes, disinfect the port, withdraw with a sterile syringe, and unclamp. Never collect from the drainage bag, which contains stagnant colonized urine.
* '''24 hour urine''': discard the first void and start timing at that moment, collect every void for 24 hours, keep the specimen chilled or on ice as required, and include the final void at the end of the period. A discarded void invalidates the collection and it starts over.
* '''Sputum''': best obtained early in the morning before eating, after rinsing the mouth with plain water, never mouthwash, which is antimicrobial. Instruct the patient to take several deep breaths and cough deeply from the lungs. Saliva is not a specimen. For acid-fast bacilli, serial early morning specimens on separate days are typical.
* '''Stool for ova and parasites''': no barium, mineral oil, laxatives, or antacids for the preceding period specified by the laboratory, and the specimen must not be contaminated with urine or toilet water. Warm stool for parasites goes to the laboratory promptly.
* '''Stool for occult blood''': avoid red meat, and depending on the test, certain medications such as nonsteroidal anti-inflammatory drugs and anticoagulants, and high-dose vitamin C, which can cause false results.
* '''Blood cultures''': two sets from two separate sites, obtained before antibiotics, using rigorous skin antisepsis with chlorhexidine allowed to dry. Fill the aerobic and anaerobic bottles per policy.
* '''Wound culture''': cleanse with normal saline first, then swab viable tissue in the wound bed using a rotating motion. Do not swab pus, slough, or eschar.
* '''Throat culture''': swab the tonsillar pillars and posterior pharynx, avoid the tongue and uvula, and be prepared for gagging.