Chapter 015

Special Nonblood
Collection Procedures
Chapter 15
Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

Learning Objectives
Lesson 15.1: Special Nonblood
(Slide 1 of 3)
1. Describe six kinds of urine samples, explain how

each is collected, and state one use for each.
2. Instruct a patient how to collect a midstream clean-
catch urine specimen.
3. Explain how a urine sample can be collected from
an infant, and state at least one limitation.
4. Discuss why a fecal sample may be requested, list
three types of samples, and describe collection
methods.

Learning Objectives
(Slide 2 of 3)
5. Discuss how and why semen samples may be

collected.
6. Explain the proper procedure for collecting a throat
sample and a nasopharyngeal sample.
7. Explain the reason and the procedure for collecting
a sweat electrolyte/chloride sample.
8. Describe how cerebrospinal fluid is collected, and
explain how the tubes collected should be
distributed.

Learning Objectives
(Slide 3 of 3)
9. Define each of the following terms, and list at

least one reason for collecting each fluid:
a. pericardial fluid
b. peritoneal (ascitic) fluid
c. pleural fluid
d. synovial fluid
10. Explain how amniotic fluid is formed, and
describe three reasons for testing it.
11. Explain the reasons and the procedures for
collecting breath, saliva, and gastric samples.
Why Collect a Urine Specimen?
 Urine is created by the kidneys as they filter the

blood
 Urine contains excess salts, waste products, and
small amounts of the many types of molecules that

naturally circulate in the bloodstream
 For this reason, urine provides a valuable snapshot
of the inner workings of the body

Types of Urine Specimens
(Slide 1 of 2)
 A random specimen can be collected at any time

 It is used to screen for obvious metabolic
abnormalities by measuring the presence of protein,

glucose, blood, and other significant constituents of
urine
 A first morning specimen, also called an 8-hour
specimen, is collected immediately after the patient

awakens
 It is a concentrated specimen that ensures the detection of
chemicals or pathogens that may not be found in a more
dilute, random sample
Types of Urine Specimens
(Slide 2 of 2)
 A timed specimen is a series of samples often

collected over 24 hours and combined to provide a
single, large specimen
 It is used to measure the amounts of protein, creatinine,
and hormones
 The typical procedure is to have the patient void and
discard the first morning sample, and then collect and
combine all urine for the next 24 hours, ending at the
same time as the patient started the test the previous
day

for Urine Specimens
 The most common procedure for collecting many
types of urine specimens is known as the
midstream clean catch
 It is collected after the patient has passed several
milliliters of urine
 This allows microorganisms from the urethra to be
flushed out and not collected in the sample

Midstream Clean Catch
 Clean the genitalia

 For women, use sterile soap to cleanse the area
surrounding the urethra
 For men, use towelettes with benzalkonium and alcohol;
for uncircumcised men, retract the foreskin for cleaning
 Collect the sample
 Specific procedures for sample collection may differ
between institutions
 Finish the collection
 Cap the container. Refrigerate or add preservatives if
necessary. Label the specimen with the patient’s name
and the date and time of collection

Pediatric Collection
 Pediatric specimens for routine urinalysis can be
collected using a soft, clear plastic bag with an adhesive
that fits over the genital area of the child
 Once the bag is attached, a diaper is put on over the bag
 This is not a sterile collection

Catheter Collection
 A catheterized urine sample is collected by a

physician, nurse, or medical assistant
 A catheter (narrow plastic tube) is inserted
through the urethra into the bladder

 This technique may be used for a culture and
sensitivity (C&S) test when a urinary tract

infection is suspected and obtaining a normal
clean-catch specimen is not possible

Suprapubic Aspiration
 A suprapubic aspiration sample is collected by a

physician
 A needle is inserted through the abdominal wall
into the bladder for collection of a sample

 The specimen is used for bacterial culture of
anaerobes (bacteria that do not grow in the

presence of oxygen) and for cytologic (cell)
examination in cases of suspected bladder cancer

Urine Samples for Drug Testing
 Urinalysis can reveal the presence of many types of

drugs and metabolites in the bloodstream
 Drug testing is becoming increasingly common in
outpatient settings, driven by the concern for a

drug-free workplace
 Collection and handling procedures must follow
chain of custody (COC) guidelines because the

sample may be used in a legal proceeding or in
decision making regarding employment or athletic
participation

Why Collect a Fecal Specimen?
 The two most common reasons for ordering a

fecal sample are to look for intestinal infection and
to screen for colorectal cancer
 Microscopic examination of feces reveals the
presence of intestinal ova and parasites (O&P)

from organisms such as Giardia and tapeworm
 Feces can be cultured to look for diarrhea-causing
bacterial diseases such as cholera or Salmonella

Types of Fecal Specimens
 A random specimen is used for most

determinations, including bacterial cultures, O&P,
and fats and fibers
 Occult blood specimens are collected after 3 days
of a meat-free diet
 A 72-hour stool specimen is used for quantitative
fecal fat determination

 Rarely called for
 Ordered when a random specimen is positive for excess
fat

Occult Blood Specimen
 Collected after 3 days of meat-free diet

 Also avoid:
 broccoli, turnips
 raw fruits and vegetables
 horseradish
 vitamin C supplements
 pain relievers, such as Motrin and aspirin
 Several types of special test cards are available,
which may be prepared by the patient at home and
sent in

Collection Procedure
for Fecal Specimens
 Patients should be given the appropriate collection
container and instructed to defecate into it, not the
toilet, which would contaminate the sample with
cleaning compounds
 Patients should also be instructed to avoid
contamination of the specimen with urine

 Specimens should be kept at room temperature
until delivery to the laboratory

Why Collect a Semen Specimen?
 Semen specimens are used to determine whether

viable sperm are present in the semen, either for
fertility testing or to assess the success of a
vasectomy

Collection Procedure
for Semen Specimens
 The patient should be instructed to avoid ejaculation
for 3 days before the collection
 The sample should be ejaculated into a sterile plastic
container
 The time of the collection should be recorded
because sperm die quickly, and viability analysis is

based on the time elapsed since collection
 For fertility testing, the volume of semen is also
important, so the patient should report whether the

sample collected is complete or partial

Why Collect a Throat Specimen?
 A throat culture sample (throat

swab) is used to diagnose a
throat infection
 In particular, the sample is used

to determine whether the
infection is caused by group A
Streptococcus bacteria, for
which antibiotics are an
effective treatment

Why Collect a
Nasopharyngeal Specimen?
 A nasopharyngeal (NP) culture is used to diagnose
whooping cough, croup, pneumonia, respiratory
syncytial virus (RSV), and other upper respiratory
tract infections

Collection Procedure for
Nasopharyngeal Specimens
 The sample is collected using a cotton- or
Dacron-tipped sterile wire
 Swab is passed carefully through nostril to reach
back of nasopharynx
 Rotated gently to collect mucus sample and then
removed
 Swab is placed in either transport media or
growth media, depending on test to be performed

Why Collect a Sweat
Electrolyte/Chloride Specimen?
 Sweat electrolytes (SEs) are the salts, including
chloride, present in normal sweat
 The sweat electrolyte/chloride test is performed as
part of the diagnosis for cystic fibrosis

Collection Procedure for Sweat
Electrolyte/Chloride Specimens
 Sweat electrolyte/chloride specimens are subjected
to the iontophoretic pilocarpine test, which
requires special training
 Sweating is induced by applying a weak electrical
current (known as iontophoresis) and the drug

pilocarpine to the test area

Cerebrospinal Fluid Specimens
 Cerebrospinal fluid (CSF) circulates in the brain

and spinal cord, where it provides nourishment
and removes wastes from the central nervous
system
 It is most commonly collected by lumbar puncture
(spinal tap), in which a needle is inserted between

the vertebrae at the base of the spine
 Three to four tubes are collected in sterile plastic
containers and numbered in the order of collection

Common Body Fluid Collections
 Synovial fluid
 Site: Joint space
 Diagnosis of joint disorders and pain reduction
 Peritoneal fluid
 Site: Peritoneal (abdominal) cavity
 Diagnosis of ascites (abnormal increase of peritoneal fluid)
 Pleural fluid
 Site: Pleural cavity (surrounding lungs)
 Diagnosis of pleural pneumonia
 Pericardial fluid
 Site: Pericardium (surrounding the heart)
 Diagnosis of pericarditis

Amniotic Fluid Specimens
 Amniotic fluid is the fluid within the amniotic sac,

developed within the uterus, that bathes and
cushions the developing fetus
 It is formed by the metabolism of fetal cells, by
the transfer of water across the placental

membrane, and in the third trimester by fetal urine
 Amniotic fluid is collected by a physician in a
procedure known as amniocentesis

Breath Specimens
 Analysis of breath is used to
diagnose:
 Small intestinal bacterial over
growth
 Malabsorption syndromes
 Helicobacter pylori infections
 Collection procedures
 Patient is given substance to
ingest; its metabolic by-products
are measured in breath
 Urea breath test is used to
diagnose H. pylori infections

Saliva Specimens
 Saliva specimens can be used to measure:

 Hormones (estrogen, testosterone, cortisol)
 Alcohol or other drugs
 Collection procedures
 Saliva specimens for hormone testing are typically
frozen and packaged in ice before sending to laboratory
for testing; patients receive a kit
 Day/night before saliva collection, patient should avoid
using facial lotions and creams
 Oral fluid mouth swab drug test
 Patient should avoid mouthwash for 20 minutes before
collection
Gastric Fluid
 Gastric fluid, or stomach fluid, is used to assess

abnormal acid secretion under basal and
stimulated conditions
 Or other pathologic changes that would indicate
disease, such as presence of red blood cells, yeast, or
pus from a wound
 Collection procedure for gastric fluid
 Patient must fast 10-12 hours before procedure
 Nasopharyngeal tube passes through nose and throat
into the stomach; stomach is emptied of its contents

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Special Nonblood

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 1

1. Describe six kinds of urine samples, explain how

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 2

5. Discuss how and why semen samples may be

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 3

9. Define each of the following terms, and list at

 Urine is created by the kidneys as they filter the

small amounts of the many types of molecules that

of the inner workings of the body

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 5

 A random specimen can be collected at any time

abnormalities by measuring the presence of protein,

specimen, is collected immediately after the patient

 A timed specimen is a series of samples often

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 7

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 8

 Clean the genitalia

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 9

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 10

 A catheterized urine sample is collected by a

through the urethra into the bladder

sensitivity (C&S) test when a urinary tract

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 11

 A suprapubic aspiration sample is collected by a

into the bladder for collection of a sample

anaerobes (bacteria that do not grow in the

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 12

 Urinalysis can reveal the presence of many types of

outpatient settings, driven by the concern for a

chain of custody (COC) guidelines because the

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 14

 The two most common reasons for ordering a

presence of intestinal ova and parasites (O&P)

bacterial diseases such as cholera or Salmonella

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 15

 A random specimen is used for most

fecal fat determination

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 16

 Collected after 3 days of meat-free diet

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 17

contamination of the specimen with urine

until delivery to the laboratory

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 19

 Semen specimens are used to determine whether

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 21

because sperm die quickly, and viability analysis is

important, so the patient should report whether the

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 22

 A throat culture sample (throat

 In particular, the sample is used

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 23

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 24

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 25

part of the diagnosis for cystic fibrosis

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 26

current (known as iontophoresis) and the drug

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 27

 Cerebrospinal fluid (CSF) circulates in the brain

(spinal tap), in which a needle is inserted between

containers and numbered in the order of collection

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 29

Copyright © 2020 by Elsevier Inc. All Rights Reserved. 31