NCM 103 FUNDAMENTALS OF NURSING NOTES
COLLECTING SPUTUM SPECIMEN
I. DEFINITION
Sputum – is the mucous secretion from the lungs, bronchi, and trachea. It is obtained for
evaluation of gross appearance, microscopic examination, culture and sensitivity, gram stain,
acid-fast bacillus and cytology.
II. RATIONALE
1. For culture and sensitivity to identify a specific microorganism and its drug sensitivities.
2. For cytology to identify the origin, structure, function, and pathology of cells. For this purpose,
it requires serial collection of three early – morning specimens.
3. For acid – fast bacillus (AFB), which also requires serial collection, often for 3 consecutive days,
to identify the presence of tuberculosis (TB).
4. To assess the effectiveness of a therapy.
III. EQUIPMENT
A pair of Gloves
Sputum Specimen Container with label
Mouth Care Kit
Culture Swab and Tongue Depressor
IV. PLANNING AND IMPLEMENTATION
Special Considerations:
1. Patients receiving antibiotics, steroids, and immunosuppressant drugs for a prolonged time
may have periodic sputum examination because these agents may give rise to opportunistic
pulmonary infection.
2. It is important that the sputum be collected correctly preferably in the morning, and that the
specimen be sent to the laboratory immediately.
3. Allowing the specimen to stand in a warm room will result to overgrowth of microorganisms,
making identification of pathogens difficult and alter cell morphology.
4. A series of these early morning specimens is needed for acid-fast bacillus examination.
5. Cytology specimen should be collected in a container with fixative agent.
6. Sputum can be obtained through various methods:
Deep breathing and coughing
Patient in upright or sitting position (unless contraindicated). Instruct patient to take several
deep breaths, exhale and perform a series of deep coughs and expectorate the sputum in a
sterile container.
Induction through the use of ultrasonic or hypertonic saline nebulization
Nebulization increased the moisture content of air going to lower tract; particles will
condense in tracheobronchial tree and aid in expectoration.
Suctioning
Aspiration of secretions via mechanical means; through nasotracheal, endotracheal, or
tracheostomy tube.
Bronchoscopy with broncho-alveolar lavage
In which 60-100 is instilled and aspirated from various lung segments.
Gastric aspiration
Nasogastric tube is inserted; approximately 50 cc of sterile water is instilled, and swallowed
pulmonary secretions are siphoned out.
Transtracheal aspiration
Involves passing a needle and then a catheter through a percutaneous puncture of the
cricothyroid membrane, and transtracheal aspiration is done.
Generally, 15 ml of sputum sample is adequate.
Lifespan Considerations:
Infants
1. Avoid occluding an infant’s nose because normally they breathe only through the nose.
Children
2. The young child will need to be restrained gently while the throat specimen is collected. Allow
the parents to assist and explain that the procure will be over quickly.
3. Cooperative children can be asked to put their hands under their buttocks, open their mouth,
and laugh or pant like a dog.
4. Observe for signs of ear infection. A child’s short respiratory tract allows bacteria to migrate
easily to the ears.
Elders
5. Elders may need encouragement to cough because a decreased cough reflex occurs with
aging.
6. Allow time for elders to rest and recover between coughs when obtaining a sputum specimen.
ACTION RATIONALE
1. Identify the correct client. To ensure accuracy.
2. Explain the procedure to the client or to a To gain the client’s cooperation.
family member.
3. Wear gloves. Follow special precautions if To prevent contamination and droplet infection.
tuberculosis is suspected, obtaining the
specimen in a room equipped with a special
airflow system or ultraviolet light, or
outdoors. If these options are not available,
wear a mask capable of filtering droplet
nuclei.
4. Offer mouth care. To prevent the specimen from getting
contaminated with microorganisms from the
mouth.
5. Ask the client to breathe deeply and then
cough up 1 to 2 tablespoons or 15 to 30 ml of
sputum.
6. Ask the client to expectorate (spit out) the To prevent the spread of microorganisms.
sputum into the specimen container. Make
sure the specimen does not contact the
outside of the container. If the outside of the
container does become contaminated, wash it
with a disinfectant.
VARIATION: THROAT CULTURE
Let the client sit upright if health permits, To expose the pharynx and control the gag
open the mouth, extend the tongue, and say reflex.
“ah”.
Insert the swab into the oropharynx and run
the swab along the tonsils and areas on the
pharynx that are reddened or contain
exudates.
If the posterior pharynx cannot be seen, use a To help visualize the pharynx.
light and depress the tongue with a tongue
blade or depressor.
7. Following sputum collection, offer To remove any unpleasant taste.
mouthwash.
8. Label and transport the specimen to the To prevent inaccurate results.
laboratory immediately. Ensure that the
specimen label and the laboratory requisition
contain the correct information.
V. EVALUATION AND DOCUMENTATION
1. Color, odor, consistency of the specimen collected
2. Presence of hemoptysis
3. Any measure needed to obtain the specimen
4. Any discomfort experienced by the client
