Specimen Collection Containers/Swabs a program for nurses Which one to use for Urine? Stool? Bacteriology Cultures? Virology Cultures? 7/09

Directions Carefully read through this program, paying close attention to the pictures of the specimen containers on each slide. When done, proceed to the quiz, by clicking on the next button at the bottom of the screen. If you are connected to a color printer, print a copy to use as a reference. 7/09

Purpose This program is designed to provide the nurse with information about, and descriptions of, the correct containers to use when collecting urine or stool specimens as well as bacteriology and virology cultures. 7/09

Urine Containers Which one to use? 7/09

For U/A Chem-(Urinalysis) This U/A straw transfer kit has a red/yellow marble top tube and straw type adapter. Use this tube for U/A Chem (Urinalysis) testing only, as it contains a urine preservative. It cannot be used for any other test. This tube comes in a kit with a straw type adapter that allows you to draw the urine up from a container such as a urine cup. NOTE: This kit is NOT to be used for Urine Cultures. The urine is not sterile. 7/09

BE CAREFUL!!—the outside packaging of these 2 kits (U/A Chem (Urinalysis) and Urine Culture & Sensitivity) are very similar….and it is easy to pick the wrong one!! BE CAREFULl—the outside packaging of these 2 kits (U/A Chem and Urine Culture & Sensitivity) are very similar….and it is easy to pick the wrong one!! Be very careful-the outside packaging of these 2 kits (U/A Chem and Urine Culture & Sensitivity) are very similar…and it is easy to pick the wrong one. 7/09

BE VERY CAREFUL WHEN SELECTING A URINE KIT! For Voided U/A Chem (Urinalysis) For Urine C/S from Catheter BE VERY CAREFUL WHEN SELECTING A URINE KIT! 7/09

For Urine Culture & Sensitivity (C&S) There are different types of Urine Culture kits: Clean Catch Kit It comes with a small gray top tube, a cup, and 2 cleansing towelettes for patient cleansing. Use this kit if you are having your patient collect a mid-stream sample while urinating into the sterile cup. Transfer the urine to the gray top vacutainer tube using the port on the top of the urine cup cap. If less than 3mL of urine is collected, keep the urine in the large screw cap container and refrigerate. The gray culture tube cannot be used if less than 3mLs of urine are collected. 7/09

Urine Culture & Sensitivity continued…. 2. Transfer Straw Kit It comes with a small gray top tube and a straw type adapter. Use the tube from this kit if you are collecting from an indwelling urinary catheter (Foley). To get the urine into the tube you must use a vacutainer holder & adapter* in order to draw the sterile urine into the tube from the port on the catheter tubing. * kept with blood drawing supplies The straw type adapter that comes with the kit can be used with any type of STERILE cup or container. Remember to use vacutainer holder to transfer urine from foley to this tube. 7/09

Urine Culture & Sensitivity (C&S) continued…. 3. Non-Indwelling Urinary Catheter ‘Straight Cath’ Collection Kit This is a kit that is specifically used for urine collection from a non- indwelling urinary catheter. There is a collection tube (pictured below) that comes with the kit that is sterile and can be used for Urine Culture and Sensitivity. 7/09

Urine Culture & Sensitivity (C&S) continued…. Urine Cultures can only be taken from sterile environments or from cups that are sterile. If you open a kit, but for some reason do not use all of the parts - discard the unused parts in the garbage, so no one inappropriately uses the left over pieces. 7/09

Collecting Urine for a GC/Chlamydia Amplified Antigen detection (Genprobe) Used for the detection of GC/Chlamydia Antigen from urine specimens. Not to be confused with the swab kits used for the amplified antigen detection from genital specimens. Kit includes a plastic pipette and specimen container Use the plastic pipette to transfer urine from a collection container into the tube provided in the kit and fill between the black lines only. Make sure to follow the instructions on the kit for proper collection 7/09

Do not use a serum (blood) gray top tube for urine specimens Serum gray top tubes are 6.0mL and have a WHITE label. They are for BLOOD specimens only Urine culture tubes are 4.0mL and have a YELLOW label. They are for URINE specimens only 7/09

For All Other Urine Tests (not Urine C&S, or U/A Chem (Urinalysis)) Used for all other Urine tests: Lytes Osmolarities Protein Creatinine Urea Nitrogen Legionella Antigen HCG (Pregnancy) Toxicologies Emergency Stat Routine 7/09

Stool Collection Stool (solid and liquid) should be collected and placed in a screw cap type container and screwed shut tightly. These collection cups are used for any type of bacterial culturing and for viral testing of Rotavirus and/or Adenovirus Antigen. Either of these cups is acceptable for use ! NEVER place stool of any kind in a denture cup and send to the lab. 7/09

Culture Swabs Which One to Use? 7/09

Bacterial or Viral?? The next few slides will cover the various types of culture swabs, media and containers for bacterial and viral culturing. There are many different types of cultures/swabs and it can be confusing. When considering what swab/culture to use for viral testing it may be easier to consider what virus is being tested for and how (PCR* or NON-PCR) as many viruses can be cultured using the same media. A chart of the various types of Specimen Collection containers/swabs for Virology testing is available and has been included in this presentation. *Polymerase Chain Reaction-isolates DNA for certain viruses As always, if you are unsure of what to use, you can always call the lab and ask. Microbiology – 626-7965 Virology – 878-7515 7/09

Red Top Culture Swab – Bacterial Testing Used for most types of culturing (except GC/Chlamydia) These are most commonly used for bacterial culturing such as wounds, genitals, throats and nares. 7/09

Green Top Culture Swab – Bacterial Testing These mini-tip culturettes are used for eye, and urethral cultures or when a small area is being cultured for bacteria 7/09

Use for GC/Chlamydia (Genital Specimens) GenProbe Culture Swab Kit for Amplified Antigen Detection of GC/Chlamydia Use for GC/Chlamydia (Genital Specimens) Kit contains swabs for cleansing area to be cultured (Red, Black & White package) and Swabs for the collection of the specimen (Green & White package) 7/09

This is an example of the Virology Chart that can be referenced to determine what culture swab you should use. If your department does not have one of these, you can call the Virology Lab and request one. 7/09

Green Top Culture Swab Used for Non-Culture Viral PCR* Testing Only *Polymerase Chain Reaction-isolates DNA from certain viruses 7/09

M4/UTM Media Culture Swab Use for Viral Cultures, Respiratory Screen, RSV, Influenza A&B and IFA 7/09

Spinal Fluid (CSF) in the clear tube Viral Culturing The containers to the left are used for culturing of the following viruses: Chlamydia (VIRAL) Herpes Simplex – (HSV) Varicella Zoster Viral Misc. Culture Respiratory Virus Enterovirus (CSF) Respiratory Screen (influenza A&B, Parainfluenza 1/2/3, Adenovirus, RSV Ag IFA, and Human Meta Pneumovirus (hMPV)) Influenza A&B Ag IFA (influenza A&B Ag) Adenovirus Ag IFA Paraflu 1/2/3 Ag IFA RSV Ag IFA UTM media (Pink Fluid) Spinal Fluid (CSF) in the clear tube 7/09

Viral Culturing (cont) The containers to the left are used for culturing of the following virus: Cytomegalovirus (CMV) – NON PCR Urine would be placed in the blue cup Blood (serum) in the Green Top Tube Bronchial Wash, throat swab in the Pink UTM Media 7/09

Non Culture Viral PCR Testing The containers to the left are used for collection for the following test: Bordetella pertussis DNA PCR The Green Swab would be used for Nasopharyngeal culturing Nasopharyngeal suction secretions can be poured into the Pink UTM Media 7/09

Non Culture Viral PCR Testing (cont) The containers to the left are used for collection for the following tests: Enterovirus RNA PCR Nasopharyngeal secretions using the culturette placed in Pink UTM media or using the Green Culture Swab Spinal Fluid (CSF) – placed in clear plastic tube Herpes Simplex Virus (HSV) DNA PCR Varicella Zoster Virus (VZV) PCR Direct swab from a lesion, placed in Pink UTM media or using the Green Culture Swab 7/09

Non Culture Viral PCR Testing (cont) The containers to the left are used for collection for the following tests: Cytomegalovirus (CMV) DNA PCR Whole Blood in either tube to the left Yellow top MUST be ACD not an SPS or SST Epstein Barr Virus (EBV) DNA PCR CSF in Clear plastic tube (not pictured) Purple Top EDTA Tube Yellow ACD Tube 7/09