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Sputum Induction (3.30)

Sputum Induction (3.30) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Patient Assessment

3.30

3.30 Sputum Induction
Category: UWHC Clinical Policy
Policy Number: 3.30
Effective Date: March 1, 2016
Version: Revision
Section: Respiratory Care Services

I. PURPOSE

Sputum induction is used to obtain sputum for diagnostic purposes when patients are unable to spontaneously
produce an adequate specimen. The procedure uses nebulized hypertonic saline solution to irritate the airway,
liquefy secretions, promote coughing, and allow expectoration of secretions.

II. CONTRAINDICATIONS

A. Active bronchospasm
B. Active hemoptysis

III. POLICY

A. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the appropriate
indications for the therapy are present.
B. Therapy will be provided in accordance with a provider’s order.
C. Scheduling for outpatient requests:
1. Adults: contact the UWHC Pulmonary Clinic RT, 669-7024.
2. Children: contact AFCH Sedation Clinic, 263-9540 or Peds Specialty Clinic 263-6420.
D. AFB specimen collection requires the following:
A negative air flow room whether in the inpatient setting or outpatient setting.
1. Adult Outpatient Rooms: UWHC B6/284 or B6/285
2. Pediatric Outpatient: AFCH Sedation Clinic room 3, 1232.
3. Three consecutive smears collected at least eight hours apart. One of the samples should be an
early morning sample.
E. Patients with reactive airway disease will be pre-treated with a bronchodilator.
F. Oral swab specimens for children are collected by the pediatric house staff and pulmonary clinical nurse
specialists.

IV. EQUIPMENT

A. Appropriate Laboratory Specimen Request Form and patient labels.
B. Small volume nebulizer.
C. Sputum specimen container.
D. 3% hypertonic saline.
E. Appropriate personal protective equipment including a particle respirator mask if the sample is being sent
for AFB smear.

V. PROCEDURE

A. Review and acknowledge the provider's order.
B. Review the patient’s chart.
C. Print the lab requisition form and patient labels (see related link).
D. Identify the patient using two patient identifiers.
E. Determine if a sputum induction is necessary. It may not be if the patient can spontaneously cough or has
an artificial airway in place to facilitate suctioning.
F. If the patient requires nasotracheal suctioning to obtain a specimen, contact the provider and obtain an
order to suction the patient.



G. Obtain an order to administer a bronchodilator for all patients with reactive airway disease.
H. Have the patient rinse their mouth and gargle with hypertonic saline to decrease oral flora. Do not use
mouthwash.
I. If the induction is being done for AFB smear, the patient must be in a negative airflow room with
respiratory isolation.
J. Nebulize hypertonic saline until the patient is able to produce a specimen or 30 minutes has passed.
K. Have the patient expectorate the sputum sample into the appropriate container.
L. Place the patient label, date, and time on the specimen container prior to exiting the patient’s room.
M. Use the “buddy system” to double check that the patient’s label matches the patient and that the label is
securely attached to the container. A “buddy” can be an RT, RN, NA or MD.
N. Place the specimen container in a bag, seal it, and send it to the lab with the requisition.
O. Inductions for AFB in all outpatient settings:
1. Clean all surfaces with disinfectant wipes.
2. Close door and allow air exchange for one hour.
3. Place a sign on the door notifying all who enter to wear a particulate filter mask.
P. If the patient is not able to expectorate a sample:
1. Leave a sputum container at the bedside and instruct the patient to expectorate a sample when
able, and notify the RN.
2. Discard the requisition form.
3. Re-enter the order for the lab per previous order (see related link).
4. Notify the provider via a progress note.

VI. REFERENCES

A. Respiratory Care Services P&P’s:
1. #2:27 “Aerosolized Medication Treatment (USN)”
2. #3:42 “Tracheal Bronchial Suctioning”
B. UWHC Policy #13.17 “Control of Tuberculosis.”







Approved by Director and Medical Director of Respiratory Care.

Original copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].