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Do not attempt to collect a throat swab specimen if acute epiglottitis is suspected because trauma from the swab may cause increased edema, resulting in airway occlusion.undefined#ref7">7
Collect oropharyngeal and nasopharyngeal specimens within 3 days of symptom onset if possible but no later than 7 days of symptom onset and before the start of antimicrobial therapy.1
Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
A nose-throat swab specimen is used to detect pathogenic microorganisms in the nose and throat. To determine the degree of infection, laboratory personnel place the specimen in a transport media and determine if pathogenic organisms grow.
Pathogenic organisms that may be identified by culture include group A beta-hemolytic streptococci, Bordetella pertussis, Corynebacterium diphtheriae, and Staphylococcus aureus. Other organisms, including Haemophilus influenzae, Streptococcus pneumoniae, and Candida albicans, are considered abnormal if found in large amounts. The test results help determine which antibiotic therapy or treatment is appropriate.
Several techniques are used depending on the type of specimen obtained. Incorrect technique may result in an inaccurate result.3 The length of the swab stick and the material used in manufacturing vary. Ensure the correct swab is used depending on the technique applied and the type of specimen ordered.
An anterior nasal swab specimen is obtained by inserting the swab stick into the nostril no more than 1.5 cm (approximately 0.6 inch). The swab is rotated for a total of 15 seconds.3 The same swab is then used in the same manner in the other nostril. A nasal midturbinate specimen is obtained by inserting the specimen swab straight back into the nostril approximately 2 cm (0.8 inch), or until resistance is felt.3 The same swab is then used in the same manner in the other nostril.
Obtaining a simple nasopharyngeal swab is completed by inserting the specimen swab into the nostril approximately half the distance between the patient’s nostril and ear.4 The swab should be left in the nostril for several seconds to absorb as much moisture as possible. A nasopharyngeal specimen may also be obtained using a wash method. Several drops of sterile 0.9% sodium chloride are placed into the nostril. A sterile suction catheter is attached to a specimen container and light suction is applied while rotating and removing the catheter.4 Nasal washing may provide an effective, more comfortable alternative to swabbing, when necessary.
A nose-throat swab may cause discomfort to sensitive mucosal membranes. Collecting a throat specimen sometimes causes gagging. The patient’s clear understanding of the specimen collection technique may minimize anxiety or discomfort.
Rationale: Having the swab and sterile culture tube ready allows the nurse to grasp the swab easily without danger of contamination.
Rationale: Depressing the tongue permits exposure of the pharynx, relaxes throat muscles, and minimizes the gag reflex. The area to be swabbed should be clearly seen.
Do not place the tongue blade along the back of the tongue; doing so is likely to initiate the gag reflex. If the patient gags, remove the tongue blade and allow the patient to relax before reinserting it.
Rationale: Touching the lips, teeth, tongue, cheeks, or uvula with the swab may cause contamination with organisms from the oral cavity.
Rationale: The inflamed or purulent sites in the tonsillar area contain the most microorganisms.
Rationale: Mixing the swab tip with the culture or transport medium helps ensure live bacteria or virus for testing.
Rationale: As the patient breathes through each open nostril, the nurse determines the nostril with the greater patency.
Rationale: The swab should remain sterile until it reaches the area to be tested. Rotating the swab ensures that it touches all surfaces where exudate is present.
Rationale: Avoiding contact with the sides of the nose prevents contaminating the swab with resident bacteria.
Rationale: Having the swab and sterile culture tube ready allows the nurse to grasp the swab easily without danger of contamination. Only the handle is touched, not the tip.
Rationale: As the patient breathes through each open nostril, the health care team member determines that both nostrils have patency.
Rationale: Having the swab and sterile culture tube ready allows the nurse to grasp the swab easily without danger of contamination. Use of a specially designed nasopharyngeal swab allows access to the difficult-to-reach nasopharyngeal area.
Rationale: Leaving the swab tip in contact with the nasopharynx facilitates absorption of fluid into the swab.
Audere. (2020). Swab instructions: Mid-turbinate self-swab nasal specimen collection. Retrieved September 10, 2021, from https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/Self-SwabMid-turbinateCollectionInstructions.pdf
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier.
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