Sputum Collection
Secreted by mucous membranes lining the bronchioles, bronchi, and trachea, sputum helps protect the respiratory tract from infection. When expelled from the respiratory tract, sputum carries saliva, nasal and sinus secretions, dead cells, and normal oral bacteria from the respiratory tract. Sputum specimens may be cultured for identification of respiratory pathogens.
The usual method of sputum specimen collection, expectoration, may require ultrasonic nebulization, hydration, chest percussion, and postural drainage to help mobilize the secretions.
Tracheal suctioning is contraindicated within 1 hour of eating and in patients with esophageal varices, nausea, facial or basilar skull fractures, laryngospasm, or bronchospasm. It should be performed cautiously in patients with heart disease because it may precipitate arrhythmias.
Equipment
For Expectoration
Sterile specimen container with tight-fitting cap ▪ gloves ▪ specimen label ▪ laboratory request form and laboratory biohazard transport bag ▪ facial tissues ▪ emesis basin ▪ mask ▪ goggles or face shield ▪ supplies for oral hygiene ▪ Optional: aerosol (10% sodium chloride, propylene glycol, acetylcysteine, or sterile or distilled water), as ordered.
For Tracheal Suctioning
#12 to #14 French sterile suction catheter ▪ water-soluble lubricant ▪ laboratory request form and laboratory biohazard transport bag ▪ specimen label ▪ sterile gloves ▪ mask ▪ goggles ▪ sterile in-line specimen trap (Lukens trap) ▪ normal saline solution ▪ portable suction machine, if wall unit is unavailable ▪ oxygen therapy equipment.
Commercial suction kits have all equipment except the suction apparatus and an in-line specimen container.
Implementation
Verify the doctor’s order.
Gather the appropriate equipment.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Explain the need to collect a specimen of sputum (not saliva), and the procedure to promote cooperation. If possible, collect the specimen early in the morning, before breakfast, because secretions have accumulated overnight, aiding in the collection process.
Have all supplies within reach.
Instruct the patient to sit in a chair or at the edge of the bed. If he can’t sit up, place him in high Fowler’s position.
Perform nebulizer treatment, chest percussion, and postural drainage to assist specimen production, as needed.
Sputum Collection By Expectoration
Ask the patient to rinse his mouth with water to reduce specimen contamination. (Avoid mouthwash or toothpaste because they may affect the mobility of organisms in the sputum sample.) Then tell him to cough deeply and expectorate directly into the specimen container. Instruct the patient not to touch the inside of the cup. Ask him to produce at least 15 mL of sputum, if possible.
Cap the container and, if necessary, clean its exterior.
Nursing Alert
If the patient has asthma or chronic bronchitis, watch for aggravated bronchospasms with the use of more than a 10% concentration of sodium chloride or acetylcysteine in an aerosol.
Sputum Collection By Tracheal Suctioning
Explain the suctioning procedure to him and tell him that he may cough, gag, or feel short of breath during the procedure.
Check the suction equipment to make sure it’s functioning properly. Then place the patient in high Fowler’s or semi-Fowler’s position.
Administer oxygen to the patient before beginning the procedure.
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