CLASS PRESENTATION ON PAEDIATRIC NURSING SPECIMEN COLLECTION

SPECIMEN COLLECTION

INTRODUCTION

          After admission of a child to the hospital, the nurse may carry out or assist with certain diagnostic procedures, including collection of specimen i.e. urine, stool, blood, CSF, throat and sputum specimens.

          Infants and young children may not be able to cooperate when specimens are needed since they may not be able to understand the instructions given by the nurse or to handle the equipment.

          It is collaborative nursing function essential to complete the assessment of a child.

          They help to diagnose an illness evaluate the progress of particular condition.

DEFINITION

          It is the collection of body fluids, secretions and excretions.

TYPES

1. Urine Specimen
2. Stool Specimen
3. Blood Specimen
4. Throat, Nasopharyngeal
5. Sputum

NURSES RESPONSIBILITIES

1. Explain the procedure to the child if he can understand and to his/her parents so that they can convince him/her to cooperate.
2. For effective communication be certain to know the word the child uses for stool, urine etc
3. Explain the older children how much and when to collect urine specimen.
4. Maintain strict aseptic techniques the specimen needed is sterile.
5. Observe for any special instructions
6. Ask the child to drink water prior to urine collection
7. Provide privacy for younger clients
8.  The specimen should be labeled correctly and accompanied by the appropriate slip containing name of the client, IP nos., age, sex, type of specimen, time of collection
9. All specimen should be sent to the laboratory for immediate processing

BLOOD SPECIMENS

          Blood specimens may be collected by lab technicians, physicians or nurses.

PURPOSE

Ø      Determine the illness

Ø      For diagnosis

Ø      Evolution

Ø      For blood grouping

Ø      To rule out infections

Ø      For blood culture

Ø      For complete blood analysis

PROCEDURE

          The procedure is same for the children (older children) as that of adult, whose veins are large enough and who are able to cooperate.

VEINPUNCTURE

          The superficial veins of the dorsal surface of the hand or the anticubital fossa as that of adults.

Ø      In infants and young children whose veins are small, only the larger i.e. femoral, external jugular veins may be used.

Ø      After the needle has been removed from the jugular and femoral vein firm pressure should be applied for 3-5 minutes to prevent the leakage of blood into subcutenous tissue.

PHERIPHERAL CAPILLARY BLOOD

          In young children it is taken by ear lobe stab or finger stick method. In infants it is collected by a heel stick.

HEEL STICK IN INFANTS

          The blood vessels (in the heel) are dilated by warm, moist compress for  5-10 minutes. The infants foot is held firmly in the nurse’s hand the area is cleaned with alcohol and the heel punctured on the outer aspect to prevent injury to the medial plantar artery. Apply pressure with guaze after collecting the specimen to arrest bleeding.

THROAT, NASOPHARYNGEAL SPUTUM SPECIMENS

PURPOSES

1. For diagnosis of RT infections
2. To rule out causative organism
3. For diagnosis of TB

THROAT

          A sterile swab is used to obtain a throat culture. The swab should not touch the lips or tongue on entering or being removed from the mouth and it should touch the only most purulent areas of throat. The nurse may use tongue blade or depressor so that the throat can be swabbed. The swab is placed in a sterile container and is sent to lab.

NASOPHARYNX

          A sterile swab on a flexible wire is used which the nurse inserts the swab through a nostril, bending the wire downward through the nasal passage until it reaches the nasopharynx. When the swab is removed, it is handled as just described.

SPUTUM

          A suction device called a mucus trap is used to obtain a sputum specimen from a child who is too young to cough productively. While the nurse provides suction orally on the mouth piece of one catheter the end of other catheter is inserted into the trachea, stimulating the cough reflex. The mucus is trapped in the mucus chamber.

          Children who are old enough to cough deeply and productively may be instructed to do so in order to obtain a specimen. The nose should be present when this is done so that sputum is collected and not saliva. Sputum can be collected most easily in the morning before the child has had an opportunity to cough and swallow what was produced overnight.

CSF SPECIMENS

          Lumbar puncture (spinal tap) is done to obtain CSF fluid.

PURPOSE

1. For culture and sensitivity.
2. For cell count, globulins, proteins or sugar in CSF
3. To determine the level of intracranial pressure.
4. To reduce intracranial pressure.
5. To identify hemorrhage in CNS

CAUTION/IMPORTANT

          This procedure is not done in children who have a space occupying lesion that increases ICP, because the rapid release of pressure by the removal of CSF may result in drawing down of the brain stem into the bony spinal column producing compression of the medulla or cardio-respiratory center.

PROCEDURE

          Explain the procedure to the parents and prepare the child for LP. The nurse will assist the child to tie on the side with the knees bent. The child can be told about remaining absolutely still throughout the procedure. Parents are usually not present.

          Prior to the procedure, local anesthesia may be given SC at the inj site. An infant may be given a pacifier and older adult should be sedated.

POSITION

          Lateral recumbent

          In this procedure a needle is inserted into the lumbar area (L3-4) of the sub arachonoid space. The CSF is collected in tubes that are accurately labeled and numbered.

AFTER CARE

Ø      The child should lie flat

Ø      Check vital sings for 15 minutes for an hour and then 30 minutes for another hour

Ø      If the signs remain stable the usual care can be resumed

URINE SPECIMENS

          Various procedures for collecting urine from children may be used depending on the purpose of the examination and the age of the child. Children who are not toilet trained pose the greatest problem for the nurse seeking to obtain a urine specimen.

TYPES

1. Routine Urine Specimen
2. 24 Hours Urine Specimen
3. Clean Catch Specimen
4. Catheterized Specimen for Culture

ROUTINE URINE SPECIMEN

FROM THE INFANT OR TODDLERS

          A child who has not been toilet trained cannot be expected to urinate on command, so it is necessary to attach a collecting device to girly perineum or a boy’s  penis and scrotum, then wait for the infant to void. If the infants attempts to loosen the collector, cover the device with a diaper to keep it out of reach offer the child some thing to drink and after which the infants void. Remove the collector as soon as possible and transfer the it the specimen bottle and send it to the lab.

FROM PRESCHOOLER OR SCHOOL AGE CHILD

          It may be difficult to obtain a routine urine specimen from preschooler because they can only void when they feel a definite urge to do so, not on command. Offer a child a glass of water or other fluid and ask to reinforce the request to void.

FROM ADOLESCENT

          Since they are knowledgeable and cooperative about providing urine specimens. As with adults give them a clean specimen container and tell them what is needed.

Provide Privacy

          Adolescent girls are embraced to mention that they are menstruating. To avoid having a urine specimen contaminated by menstrual blood, ask the girl to wash her perineum well with soap and water. Mark the specimen “possibly contaminated by menstrual blood”.

24 HOUR URINE SPECIMENS

          It is needed to determine the quantitative amount of many substances or how much of a substance is excreted during a day.

          To begin a 24 hour urine collection ask the child to void and diseased this urine so that a specific time can be established. If the collection (urine) is started in the morning, diseased the first voiding because these urine is formed in the night. Record the time and save all urine voided for next 24 hours and place it in one collection bottle.

OBTAINING 24 HOUR SPECIMEN FROM INFANT AND TODDLER

          For infant, use a 24 hour urine collector.  A collector will adhere for this length of time only if the child’s perineum is thoroughly dry at the time of application. Place the infant in semi fowlers position if possible with active infants, fitting them with a colostomy bag applied to cover the urinary meatus for this attach a small feeding tube through this when the child voids aspirate the urine with syringe and transfer to the urine collector. This type of urine collector has advantage in that it allows the child to be ambulatory.

          In older children and adolescents are capable of collecting 24 hour urine specimen if the equipment is explained to them and they are given instructions about how to measure, store and record their urinary output.

CLEAN CATCH SPECIMENS

          It is ordered when a urine culture for bacteria is desired. The objective of the specimen is to obtain urine that is uncontaminated by external organisms, by cleaning the external meatus and the surrounding structures before voiding.

          The technique for obtaining a clean catch urine specimen from older child is same as that from an adult. Midstream urine can easily collected from older children but it is not possible to collect from infants.

          To collect a specimen from a young child, ask the child to void into a sterile container, after voiding send it to the lab immediately.

          To collect from infant wash the genitalia and a apply a sterile urine collector.

CATHETERIZED SPECIMEN FOR CULTURE

          If bacteria are present in clean catch specimen, a catheterized specimen may be needed for culture. The equipment for catheterization is the same as for the procedure in the adult only the size of catheter various.

          For infants 8 to 10 Foley catheter may be used catheterization is rarely necessary, however, in the mole child because a sterile specimen can be obtained.

STOOL SPECIMEN

          A stool specimen is collected by using the tip of a tongue blade to transfer a freshly passed stool to a clean, covered, waxed specimen cup. It should not be contaminated by urine. If a specimen is to be obtained from an infant who has diarrhea, the tip of the tongue blade may be scrapped across the soiled area of the diaper.

          If a stool specimen cannot be obtained, a rectal swab may be done by gently inserting a swab as for into the rectum as a thermometer is placed. Stool specimens and rectal swabs must be sent to the lab promptly, especially if the stool is to be examinated for ova and parasites.

CONCLUSION

          Nurses play an important role in specimen collection. The nurse should be careful when collecting the specimen she should know which specimen, type should be collected and by which means. She/he should label the specimen correctly indicating the name of the patient, specimen, time of collection and send to the lab promptly and immediately. Delay can cause alterations in diagnosis.

BIBLIOGRAPHY

1. Drothy R. Marlow:- Text Book of Paediatric Nursing

      J.P. Publications, 6^th Edition,

      Unit – IV,

      Pg. No. 312-315

2. Adele Pillitteri:- Child Health Nursing

      Lippincott

      Pg. No. 463-466

3. Mrs. R.S. Tambulwadkar:- Paediatric Nursing

     Pg.No. 266-268