Safety

• Follow standard precautions when collecting a sputum specimen.
• Be aware that suctioning, especially for longer than 10 seconds, can damage the respiratory mucosa, lead to hypoxemia and cardiopulmonary compromise, or cause vagal overload, resulting in increased intracranial pressure.
• Obtain a sputum specimen 1 to 2 hours after or 1 hour before a meal, in order to minimize gagging, which can cause vomiting and aspiration.
• If the patient is in respiratory distress during the suctioning procedure, measure the patient’s oxygen saturation with a pulse oximeter.
• If the patient becomes hypoxic with increased respiratory rate and effort and shortness of breath while suctioning:
  • Discontinue suctioning immediately.
  • Administer oxygen (if ordered).
  • Notify the health care provider of the patient’s condition.
  • Continue to monitor the patient’s vital signs and pulse oximetry.

Equipment

(Roll cursor over items to see labels)

Sterile specimen container with label

Small biohazard specimen transport bag

Laboratory requisition form

Clean gloves

Emesis basin

Sterile suction catheter (14, 16 or 18 Fr)

Sterile water

Sterile container

Sputum trap

Oral hygiene supplies

Washcloth

Facial tissues

Delegation

The skill of collecting a sputum specimen by suction may not be delegated to nursing assistive personnel (NAP). The skill of collecting a sputum specimen by expectoration and the transporting of either kind of specimen to the laboratory may be delegated to NAP. Be sure to inform NAP of the following:

• Explain the need to immediately report if blood appears in the sputum or if the patient’s vital signs change.

Preparation

• Check the health care provider’s orders for the type of sputum analysis to be performed and for specific parameters of the test, such as the amount of sputum to be obtained, the number of specimens needed, the time at which the specimen is to be collected, and the method by which the specimen will be obtained. Specimens for an acid-fast bacillus (AFB) test for tuberculosis require collection of three consecutive morning samples.
• Assess the patient’s level of understanding of the procedure and its purpose.
• Determine when the patient last ate a meal or had a tube feeding.
• Determine the type of assistance the patient needs in order to obtain the specimen.
• Assess the patient’s respiratory status, including respiratory rate, depth, and pattern, and color of mucous membranes.

Follow-up

• Observe the patient’s respiratory status throughout the procedure, especially during suctioning. If the patient is in respiratory distress, monitor his or her oxygen saturation.
• Be alert for signs of anxiety or discomfort in the patient.
• Observe the character of the sputum: color, consistency, odor, volume, viscosity, and/or presence of blood.
• Refer to the laboratory reports for test results.
• Evaluate the patient’s ability to describe/demonstrate the sputum collection process.
• If an inadequate amount of sputum has been collected, repeat the specimen collection process after the patient takes several deep breaths.

Documentation

• Record the following:
  • Method by which the specimen was obtained
  • Date and time when the specimen was collected
  • Type of test ordered
  • Means by which the specimen was transported to the laboratory
  • Characteristics of the sputum specimen
  • Patient’s tolerance of the procedure
• Report any unusual sputum characteristics to the nurse in charge or to the health care provider.
• When the laboratory reports become available, report any abnormal findings to the health care provider. If an acid-fast bacillus (AFB) sputum culture (tuberculosis test) is positive, initiate appropriate isolation procedures.
• Most agencies require nurses to note on the specimen requisition form if the patient is receiving antibiotics.