Sexual Assault Examination
Each facility or agency has a specific protocol for specimen collection in cases involving sexual assault. Specimens can be collected from various sources, including blood, hair, nails, tissues, and such body fluids as urine, semen, saliva, and vaginal secretions. In addition, evidence can be obtained from the results of diagnostic tests, such as computed tomography and radiography. Regardless of the protocol or specimen source, accurate and precise specimen collection is essential in conjunction with thorough, objective documentation because in many cases this information will be used as evidence in legal proceedings.
Many institutions have a Sexual Assault Nurse Examiner (SANE) available to care for patients who are victims of sexual assault. SANEs are skilled rape crisis professionals who can evaluate the victim and collect specimens. They may also be called upon at a later date to testify in legal proceedings.
If you’re responsible for collecting specimens in a sexual assault, follow these important guidelines:
Know your facility’s policy and procedures for specimen collection in sexual assault cases.
When obtaining specimens, be sure to collect them from the victim and, if possible, from the suspect.
Check with local law enforcement agencies about additional specimens that may be needed; for example, such trace evidence as soot, grass, gravel, glass, or other debris.
Wear gloves and change them frequently; use disposable equipment and instruments if possible.3
Avoid coughing, sneezing, or talking over specimens or touching your face, nose, or mouth when collecting specimens.
Include the victim’s clothing as part of the collection procedure.
Place all items collected in a paper bag.3
Nursing Alert
Never allow a specimen or item considered as evidence to be left unattended.
Document each item or specimen collected; have another person witness each collection and document it.
Label each specimen in the presence of the patient to prevent mislabeling.4
Obtain photographs of all injuries for documentation.3
Include written documentation of the victim’s physical and psychological condition on first encounter, throughout specimen collection, and afterward.
Equipment
Nonlubricated gloves ▪ Wood’s lamp ▪ examination paper ▪ clean paper bags (one for each article of clothing) ▪ swabs for collecting specimens ▪ comb ▪ EDTA tube ▪ supplies for venipuncture (See “Venipuncture,” page 781) ▪ camera for photographs ▪ Optional: tetanus shot, antibiotics, human immunodeficiency virus (HIV) prophylaxis.
When possible, obtain a special Sexual Assault Evidence Collection Kit, which contains the necessary items for specimen collection based on the evidence required by the local crime laboratory. The kit also contains a form that the examiner must complete, sign, and date. Keep in mind that when collecting specimens of moist secretions, you’ll typically use a one-swab technique; for dry secretions, use a two-swab technique.
Implementation
Ensure patient privacy throughout the collection procedure.3
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