Nurses play an important role in the care, management, diagnosis and treatment of patients in the hospital and the community. Often, nurses are required to collect specimen from patients for diagnostic purposes. Specimen collected can range from resected tissue to a small sample of urine.
As usual, the nurse must obtain an informed consent from the voluntary patient. This is done for two purposes. The first being that it makes the specimen collection easier if the patient knows what is going on and is usually willing to help. The second being that the patient has the right to know.
Specimen are collected, most of the time for diagnostic purposes. Sometimes specimen are saved (temporarily) until they are visually inspected by the treatment team or the attending physician.
Figure 1. Specimen jar similar to this may be used to collect a specimen of urine. Many different specimen jars are available on the market .
Good reliable specimen help diagnose disorders, help in controlling infection and aid to direct treatment where it is needed most.
Specimen must be collected in a safe and accurate manner. Contaminants will interfere with diagnosis and cause wastage of time and money. After placing the specimen in the clean container always to remember to label it. Close and or seal the container. The type of closure will depend upon the purpose and type of specimen.
When a specimen has been collected and sent to the pathology with a requisition which has been appropriately completed, it is important to enter a note in the patient's notes so that the treatment team knows that it has been done and pathology services can be called for results.
The method and speed of transport must be considered. If you are sending a specimen of arterial blood for blood gas analysis it is important to pack it ice and rush the specimen to the laboratory. A specimen for C&S can always be placed in the incubator to be transported to the lab the next day. Assuming that the specimen is collected on the night shift.
Urine Specimen – Types
To the casual observer a urine specimen is a urine specimen. However, to the trained professional there are significant differences between urine specimen and the purposes for which they can be used.
Clean Catch
The patient is provided a small container and the patient is asked to micturate (pass urine) in this sterile container. Such specimen can be used for ward tests and if sterile, can be sent to the laboratory.
Midstream specimen of urin
This is a cleaner specimen. By passing urine and stopping (midstream) the urine which is passed first helps remove any external debris, bacteria and clean the urethra. For collecting this type of specimen the Nurse will need a specimen container, cleaning swab, a cleaning agent (sterile water) and clean gloves.
If the patient is able to collect the specimen then instruct him/her to clean the external genitalia. Pass urine, stop passing urine, pass urine into the sterile container, empty the bladder into the toilet. Finally, seal the container.
Send the sealed container with the requisition to the laboratory. Do appropriate documentation. This method of specimen collection cannot be used for legal purposes because the collection is not witnessed and it is not done by a professional. For legal purposes the collection process is more intensive and the patient must be given a specimen to keep so that he may sent it to a laboratory of his choice for independent testing.
24 Hour urine collection
This specimen collection involves the collection of all urine which is passed over a period of 24 hours. As usual, explain the procedure to the patient to obtain his cooperation. It may be helpful to place a notice of the bathroom door to remind the patient not to forget to save his urine.
At start time, (for example 07.00hrs.) get the patient to empty his / her bladder. This specimen is discarded. The patient has an empty bladder. Record start and end times, record date. All urine passed subsequently is collected for 24 hours. At 07.00hrs the patient is asked to empty his bladder for the last time. Urine voided at this time is collected.
Depending on the type of test that is to be done, pathology should provide an appropriate container with the right preservative. If there is no preservative you may want to keep the specimen iced in order to prevent or reduce the “bad smell” of stale urine.
Pediatric specimen
Very young children have limited control over their bladder and void whenever they have the urge. So obtaining a pediatric specimen can be a problem.
Clean the external genitalia of your client. Put on a collection bag. New collection bags are suitable for both male and female patients. This specimen is considered a clean catch not a sterile specimen. If a sterile specimen is needed then it will be necessary to catheterize the patient.
Catheter Specimen
As the name implies, in these situations, a specimen of urine is obtained by catheterizing the patient or by collecting the specimen from an existing catheter. Where a patient has already been catheterized the following equipment will be needed: a medi-wipe, a clamp, a 10 ml syringe, a sterile hypodermic needle, sterile specimen container, and an existing catheter drainage system with a collection port.
Clamp the catheter below the collection about 15 minutes before collection is due. Clean the collection port with the medi-wipe, assemble the syringe and needle. Aspirate 10ml of urine from the catheter. Put the collected urine in the sterile container and send it off to the lab with the appropriately completed requisition form. Make sure to unclamp the catheter.
Document the procedure in the patient's notes.
Caution: Catheterization of a patient must be done by a trained professional. This may be a physician, Registered Nurse, an Enolled Nurse, or anyone who is deemed competent by your employing authority.
