Checklist for sputum specimen collection

Student Name:……………………….. Group No………

Items Done Done Not
Incorrectly done
Assessment
1- Check doctor order accuracy.
2- Check infant identification and explain the procedure
to the mother.
3- Ensure you take the specimen at the early morning
Planning
4- Gather the equipment
Implementation
5- Wash hands and wear non sterile gloves, an apron and
a facemask.
6- Position the baby in upright position or semi fowler
position.
7- The baby’s mouth should be rinsed with water before
the sample is collected, according to age by asking him
or by a syringe or wipe with cotton ball or gauze.
8- Administer a prescribed sodium chloride 0.9%
nebulizer, as doctor order.
9- Make perfect chest physiotherapy after nebulizer by a
cupped hand from down to upward in the right and left
chest.
10- If a neonate in NICU on endotracheal tube:
a-attach the sputum trap to suction catheter and turn
on suction

b-Give neonate a 100% oxygen cycle in one minute.

c-Disconnect the endotracheal tube from other tubs of

ventilator and insert the suction catheter deeply in the
endotracheal tube and suction for less than 30 second
then stop suction.

d-Reconnect the endotracheal tube with ventilator and

give neonate another 100% oxygen cycle.
 Items Done Done Not
Incorrectly done
11- If neonate has tracheostomy:
a-insert the suction catheter through it and make a
suction for few seconds

12- If neonate without intubation:

a-insert the suction catheter orally to throat and
suction for few seconds

13- A young child.

a-Wait until the child urge to cough

b-Wipe the sputum with cotton applicator and drop in

to specimen container

14- An older child:

a-Instruct the child to take three deep breath and on
the third breath expectorate into the specimen
container

b-Take the sputum cup from the child

15- Be ensuring that the specimen is sputum not saliva and

secretion.
16- Observe the sputum for color, odor, amount and any
abnormality.
17- Cover the sputum container without touching the inside
cup or the inside of cover. In case of sputum trap,
disconnect it from suction system.
18- Remove gloves, apron and facemask then
decontaminate hands
19- Label the specimen with appropriate information.
20- Send the specimen to the lab immediately
21- Record the procedure and signature
Total Score

Comment:

Demonstrator signature:
 Checklist for capillary blood specimen collection
Student Name:……………………….. Group No………
Items Done Done Not
incorrectly done
Assessment
1- Check doctor order accuracy.
2- Check infant identification and explain the procedure to
the mother.
Planning
3- Gather the equipment
Implementation
4- Wash hands and wear non sterile gloves.
5- Select a puncture site:
The heel is commonly used for child below 2 years.
-finger stick is commonly used above 2 years.
-ear lope is less commonly used.
*avoid calluses, scars or lesions.
6- Place the child extremities in a dependent position when
using the finger or heel site. if the heel site use, leg
dorsiflexion position used.
7- Gently milk the site you used by alternately squeezing
and releasing.
8- Cleanse the site with alcohol swap and let area to dry.

9- Puncture the site with sterile lancet using a sharp quick

flexion motion.
10- Wipe off the first two drops of blood with a piece of dry
gauze or a cotton ball.
11- Collect the specimen in appropriate container for the test
you performing.
12- A-if you collect on a filter paper, thoroughly saturate the
area indicated on the paper by placing the paper directly
on puncture site and milking the blood on the paper

B-if using the capillary tube hold it horizontally and fill

the tube to the marked end of the tube and cover the end
of the tube with your finger when transferring the
specimen to sealing clay or other testing material.
 Items Done Done Not
incorrectly done
C-if using capillary tube for for capillary blood gases you
should:
1-heparinize the tube first then take the blood specimen as
before.
2-ensure that there no gas bubbles between blood
specimen inside capillary tube.
13- Cover the tube ends by its rubber cover.
14- Put a tube in a cup or bag with crushed ice.
15- Apply pressure to the puncture site using a cotton ball or
dry gauze.
16- Apply a small adhesive bandage over the puncture site
and reassure that bleeding has stopped.
17- Label the specimen tube and send it immediately to
laboratory.
18- Remove gloves and wash hands.
19- Record the procedure and signature
Total score

Comment:

Demonstrator signature:
 Checklist for Gastrostomy Care
Student Name:……………………….. Group No………
Items Done Done Not
incorrectly done
Assessment
1- Check doctor order accuracy.
2- Check infant identification and explain the procedure to mother.
Planning
3- Gather the equipment
Implementation
4- Wash hands and wear sterile gloves.
5- With sterile artery, remove the old tap and dressing
6- Observe for any signs of infection or bleeding.
7- Remove the gloves.
8- Wear other sterile gloves and use another artery.
9- By sterilized gauze, wash skin around stoma with warm water,
then the 1-2 cm tube away from the stoma site in one direction for
one time, then dry with gauze.
10- Put a piece of gauze in petadine , apply it to the skin around stoma
in one direction and discard
11- Use another piece of gauze with petadine to swap 1-2 cm of the
tube.
12- Dry the petadine with gauze.
13- Soak gauze in tincture benzoin and apply it to the stoma, let it
dry. (this product in children younger than 6months without doctor
consult)
14- Cut v shape gauze and apply it to the stoma then put/secure
loosely with adhesive tape.
15- Secure the extension tube to the skin on abdomen on another site
with tap
16- Remove the gloves and wash hands.
Documentation:
17- Record and report any abnormalities
Total score
Comment:
Demonstrator signature:
 Checklist for Colostomy Care
Student Name:……………………….. Group No………
Items Done Done Not
incorrectly done
Assessment
1- Assess child redness, condition
2- Explain procedure to the mother
Planning
3- Gather the equipment
Implementation
4- Wash hands and wear sterile gloves.
5- Put child in supine position for best care
6- Expose the stoma site
7- Place a clean towel across the patient abdomen
under the existing pouch
8- Remove the pouch by drawing it from upward to
downward and assess the stool color, amount, odor,
discharge, blood or pus, then discard it if it was a
closed pouch, and clean if it open pouch
9- Remove the skin barrier, hold skin during removing
it
10- Use the paper tissue to remove the excessive stool
from the stoma.
11- Observe for signs of infections or bleeding in stoma
site
12- Cleanse skin surrounding stoma site with small
sterilized dressing or gauze with soapy water if skin
intact ,in one direction with one gauze ,then by
another gauze rinse with water in the same
technique then dry by patting gently
(Note: If skin irritated or not intact, clean with
petadine instead of soapy water ,after cleaning first
with water)
13- Uses warm water only to cleans the stoma site gently
14- Use the measurement guide to determine the stoma
 Items Done Done Not
incorrectly done
size
15- Cut the skin barrier to fit stoma size but not very
adjacent to stoma tissues
16- Apply the new skin barrier but note that ulcerated
or eroded skin should be covered with barrier
powder or gel.
17- and pouch , make sure the pouch is not leaking
18- Remove solid equipment
19- Remove the gloves and wash hands.
20- Give health education about colostomy care& signs
of infections
Documentation
21- Record and report any abnormalities
Total Score

Comment:

Demonstrator signature: