Specimen Collection Nose and Throat (Pediatric)
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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
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#ref5">5
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.2
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 numbers. In children, Streptococcus pyogenes (strep throat), respiratory syncytial virus, and Bordetella pertussis are common pathogens. The test results help determine which antibiotic therapy or treatment is appropriate.
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. Nasal washing may provide an effective alternative to swabbing, when necessary.
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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.
At the completion of the procedure, ensure that all choking hazards (e.g., culture tube cap) are removed from the patient’s linens and placed in the appropriate receptacle.
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.3
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.2
Rationale: As the patient breathes through each open nostril, the nurse determines whether both nostrils have patency.
At the completion of the procedure, ensure that all choking hazards (e.g., culture tube caps) are removed from the patient’s linens and placed in the appropriate receptacle.
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.
At the completion of the procedure, ensure that all choking hazards are removed from the patient’s linens and placed in the appropriate receptacle.
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