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Collection of Sputum Specimen (Adult & Pediatric) (11.25 AP)

Collection of Sputum Specimen (Adult & Pediatric) (11.25 AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Diagnostic Tests and Procedures

11.25 AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
February 28, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 11.25AP

Original
Revision

Page
1
of 4

Title: Collection of Sputum Specimen (Adult
& Pediatric)

I. PURPOSE

To provide guidance for collecting a sputum specimen for diagnostic study.

II. POLICY

A. The provider will write an order for sputum diagnostic studies.
B. If nursing is unsuccessful in obtaining a specimen, an order should be obtained for
“RT to induce sputum” according to previous order. The nurse may place this
order.
C. When handling all body fluids, follow UWHC Administrative Policy 13.07,
Standard Precautions & Transmission-based Precautions (Isolation) for Inpatient
Settings.

III. EQUIPMENT

A. Gloves, mask and goggles
B. Patient label
C. Sterile specimen container
D. Health Link order entry or UWHC #1280625 Microbiology Lab Request form
during computer downtime

IV. PROCEDURE

A. Identify the patient prior to collection by using two patient specific identifiers
(refer to UWHC Clinical Laboratories Policy 1502.5.06, Acceptance Policy for
Specimen Identification).
B. Determine type and number of specimens ordered by provider.
1. If the patient has a strong cough reflex, an ample sputum specimen may be
produced independently.
2. To prepare the patient, ideally have the patient drink plenty of fluids on
the evening before the test unless contraindicated.
3. Attempt to obtain the sample first thing in the morning before breakfast
and ideally before the patient receives antibiotics. If the patient has already
eaten breakfast, wait at least an hour before trying.
C. Collection of patient specimen
1. Hand hygiene should be performed, according to UWHC Administrative
Policy 13.08, Hand Hygiene.

Page 2 of 4

2. Follow standard and transmission-based precautions according to UWHC
Administrative Policy 13.07, Standard Precautions & Transmission –
based Precautions (Isolation) for Inpatient Settings.
3. Position patient in a chair, at the side of the bed or in high-Fowlers
position.
4. Have the patient rinse his or her mouth with plain water and spit it out. Do
not allow the patient to brush teeth or use mouthwash at this time.
5. Uncap the specimen cup, keeping it sterile.
6. Have the patient take several deep breaths, exhale and perform a series of
short coughs. Expectorate sputum into the sterile container. The quantity
of specimen should be at least 1-2 mL.
7. Cap the specimen cup. Clean the exterior as needed.
8. Label specimen container (not lid) by applying a patient identification
sticker with collection time/date and the category of specimen (i.e., culture
and sensitivity, gram stain, fungus or cytology). Label the specimen
container in the presence of the patient according to UWHC Clinical
Laboratories Policy 1502.5.06, Acceptance Policy for Specimen
Identification.
9. All specimens should be placed in a biohazard specimen bag before
sending to the Lab. Discard gloves and perform hand hygiene according to
UWHC Administrative Policy 13.08, Hand Hygiene.
10. Use the appropriate requisition. Send to laboratory as soon as possible.
Include time, date and method of sputum collection.
D. The Patient with an Artificial Airway (Endotracheal Tube or Tracheostomy)
1. Additional Equipment
a. Sterile sputum trap
b. Appropriate size sterile suction kit.
i. Adult patients with artificial airways: The size of the suction
catheter may be estimated by doubling the internal diameter
of the artificial airway and adding 2 (i.e., size 6+=6+6+2=14
French catheter).
ii. Pediatric patients with artificial airways: The size of the
suction catheter may be estimated by doubling the airway
size.
2. Procedure
a. Perform hand hygiene according to UWHC Administrative Policy
13.08, Hand Hygiene.
b. Prepare patient and equipment for tracheal suctioning.
c. Don clean gloves and apply mask and goggles
d. Open packaging on sterile sputum trap and maintain sterility of
connections.
e. Connect the male adaptor (short spout of the trap) of sputum trap
to the wall suction tubing.
f. Turn the suction gauge to the appropriate negative pressure level.
Clamp the hose to assure the suction level will not be too high
when suction is being applied.
i. Children 0-5 years: 60-80 mmHg
ii. Children 5-10 years: 80-100 mmHg
iii. Adults: 80-120 mmHg

Page 3 of 4

g. Open the suction kit. Don sterile gloves. Wrap the suction catheter
around the sterile gloved dominant hand.
h. Hold the sputum trap with the non-dominant hand (which is now
no longer sterile). Connect the rubber tube of the sputum trap to
the suction end of the suction catheter, keeping the connection
sterile. Do not suction saline from disposable cup into sputum trap
as this will contaminate the specimen.
i. Pre-oxygenate patient as appropriate.
j. Suction patient. Do not instill saline into endotracheal tube prior to
suctioning unless necessary to clear obstructed tube or facilitate
movement of very thick secretions through the catheter into the
sputum trap.
k. Repeat suctioning procedure until sputum is visible in the trap. If
patient requires additional suction passes or irrigation of
endotracheal tube with saline in order to completely clear airway,
sputum trap may be removed and suction catheter attached to the
suction connecting tubing with non-sterile hand once specimen has
been obtained.
l. Using the non-sterile hand, disconnect the suction tubing from the
sputum trap, keeping the male adaptor tip on the suction tubing.
m. Disconnect the suction catheter from the sputum trap while
maintaining sterility of the rubber suction catheter port on the
sputum trap.
n. Seal sputum trap by connecting the open end of rubber suction
tubing of the sputum trap over the male adaptor of the trap.
o. With suction still on, rinse the suction tubing with normal saline
until clear.
p. Label sputum trap with patient identification sticker, collection
time/date and category of specimen (i.e., culture and sensitivity,
gram stain, fungus or cytology) in the presence of the patient.
i. If the patient is in isolation, wipe the outside of the specimen
container with hospital disinfectant and place in a biohazard
specimen bag.
ii. All specimens should be placed in a biohazard specimen bag
before sending to the Lab.
q. Use the appropriate requisition. Send to laboratory as soon as
possible. Include time, date and method of sputum collection.
r. Discard equipment. Position the patient for comfort and safety.
Perform hand hygiene before leaving patient’s room.

V. UWHC CROSS REFERENCES

A. Clinical Laboratories Policy 1502.5.06, Acceptance Policy for Specimen
Identification
B. UWHC Administrative Policy 13.07, Standard Precautions & Transmission-based
Precautions (Isolation) for Inpatient Settings
C. UWHC Administrative Policy 13.08, Hand Hygiene
D. Nursing Patient Care Policy 7.17AP, Tracheal Suctioning of the Patient without
an Artificial Airway (Adult & Pediatric)

Page 4 of 4

E. Nursing Patient Care Policy 7.19A, Care of the Patient with a Tracheostomy Tube
(Adult)
F. Nursing Patient Care Policy 7.19P, Care of the Patient with a Tracheostomy Tube
(Pediatric)
G. Nursing Patient Care Policy 7.11A, Care of the Intubated Patient (Adult)
H. Nursing Patient Care Policy 7.11P, Care of the Intubated Patient (Pediatric &
Neonatal)

VI. REFERENCE

Kowalak, J. P. (Ed.) (2009). Specimen collection and testing. In Nursing Procedures
(5th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

VII. REVIEWED BY

Clinical Nurse Specialist, Acute Medical & Progressive Care
Clinical Nurse Specialist, PICU
Director, Respiratory Care
Respiratory Care Supervisor
Respiratory Care Supervisor - AFCH
Nursing Patient Care Policy and Procedure Committee, February 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive