Nursing Fundamentals: Specimen Collection and Point-of-Care Basics for Accurate Results

Why specimen collection accuracy matters

Specimen quality directly affects test accuracy. Most “bad results” are caused by pre-analytic issues: contamination, wrong container, wrong timing, delayed transport, or missing identifiers. Your priorities are: collect the right specimen the right way, prevent contamination, label at the bedside, and get it to the lab within required time/temperature limits.

Core principles across all specimen types

• Verify the order: correct patient, test, specimen source, and timing (routine vs. timed vs. STAT).
• Use the correct container: sterile cup, preservative vial, transport medium, sterile swab tube, etc. If unsure, check facility policy or lab guide before collecting.
• Prevent contamination: clean technique vs. sterile technique as required; avoid touching inside lids/containers; keep specimen away from non-sterile surfaces.
• Label at the bedside: immediately after collection, before leaving the patient. Include required identifiers (commonly two), date/time, source, and collector initials per policy.
• Timing and transport: send promptly; follow temperature requirements (room temp vs. refrigerated vs. on ice) and time limits.
• Biohazard handling: place in biohazard bag with requisition in outer pocket; remove gloves and perform hand hygiene after handling.

Bedside labeling: minimum safe workflow

1. Collect specimen and secure lid/cap.
2. At bedside, compare patient identifiers with label/requisition (per policy: wristband + verbal confirmation if able).
3. Apply label to container (not the lid), ensuring it is flat and readable.
4. Document collection time, source, patient tolerance, and any collection issues (e.g., contamination risk, low volume).

Urine specimens: clean-catch (midstream) education

When used

Commonly ordered for urinalysis and urine culture. Culture is especially sensitive to contamination, so technique matters.

Supplies

• Sterile urine collection cup (and sterile lid)
• Cleaning wipes (per kit; often antiseptic towelettes)
• Gloves; additional PPE per isolation status
• Label and biohazard transport bag

Patient coaching script (preserves dignity and improves quality)

Intro: “I need a urine sample that’s as clean as possible so the test is accurate. I’ll explain each step, and you can ask questions anytime.”

Key instruction: “Please clean first, start peeing into the toilet, then without stopping, catch the urine in the cup midstream, and finish in the toilet.”

Dignity: “I’ll step out and give you privacy. If you need help holding the cup or have mobility concerns, tell me and we’ll do it safely.”

Continue in our app.

• Listen to the audio with the screen off.
• Earn a certificate upon completion.
• Over 5000 courses for you to explore!

Or continue reading below...

Download the app

Step-by-step: clean-catch midstream (female anatomy)

1. Verify order and confirm patient identifiers.
2. Hand hygiene; don gloves.
3. Open kit without contaminating the inside of the cup/lid. Place lid face-up on a clean surface if needed (avoid touching inner surface).
4. Explain cleansing: “Separate the labia with one hand and keep them separated while you clean and while you start urinating.”
5. Cleanse front to back using each wipe once: one side, the other side, then center (follow kit instructions).
6. Begin urinating into toilet for a few seconds.
7. Move cup into stream without touching skin; collect required amount (often 30–60 mL unless otherwise specified).
8. Remove cup and finish voiding into toilet.
9. Cap tightly without touching inside of lid/cup.
10. Label at bedside; bag and send promptly.
11. Document collection time, method (clean-catch), and patient tolerance.

Step-by-step: clean-catch midstream (male anatomy)

1. Verify order and identifiers; hand hygiene; gloves.
2. Open kit; maintain sterility of cup interior.
3. Explain cleansing: “If you’re uncircumcised, retract the foreskin and keep it back while cleaning and collecting.”
4. Cleanse the glans using wipes per kit directions (typically circular motion from urethral opening outward; use each wipe once).
5. Begin urinating into toilet for a few seconds.
6. Collect midstream urine without touching cup to skin.
7. Cap tightly; label at bedside; transport promptly.
8. Document method and tolerance.

Common errors and fixes (clean-catch)

Urine from an indwelling catheter: collection port awareness (do not break the closed system)

Key safety concept

Never collect urine for testing from the drainage bag unless specifically allowed by policy for certain tests (often it is not). Do not disconnect tubing to obtain a sample. Use the designated sampling port to maintain a closed system and reduce infection risk.

Supplies

• Clean gloves; additional PPE per isolation
• Alcohol/antiseptic swab for the sampling port
• Sterile syringe/needleless access device per facility policy
• Appropriate specimen container (sterile for culture)
• Label and biohazard bag

Patient communication script

“I’m going to take a urine sample from the catheter’s sampling port. This keeps the system closed to reduce infection risk. You may feel me handling the tubing, but it shouldn’t be painful.”

Step-by-step: sampling from catheter port (general workflow; follow facility policy)

1. Verify order, specimen type (UA vs. culture), and container requirements.
2. Hand hygiene; don gloves and PPE as indicated.
3. Ensure urine is present in tubing. If policy allows, clamp the catheter tubing below the sampling port for a short period to allow fresh urine to collect in the tubing (avoid prolonged clamping; follow time limits in policy).
4. Scrub the sampling port vigorously with antiseptic for the required contact time; allow to dry.
5. Using a sterile syringe/needleless device per policy, access the port and withdraw the required volume.
6. Unclamp tubing if clamped.
7. Transfer urine into the correct container without contaminating the rim; cap securely.
8. Label at bedside with source clearly indicated (e.g., “urine, catheter port”).
9. Bag and transport promptly; document time, source, and patient tolerance.

Common errors and fixes (catheter specimens)

• Error: Collecting from drainage bag. Fix: Recollect from sampling port; reinforce closed-system practice.
• Error: Not disinfecting port long enough. Fix: Re-scrub with correct contact time; recollect if contamination suspected.
• Error: Breaking the system by disconnecting tubing. Fix: Stop, re-establish closed system per policy, notify RN/provider as appropriate, and recollect correctly.

Stool specimens: basics and contamination prevention

Common tests and collection considerations

• Occult blood: often small sample on test card; avoid contamination with urine or toilet water.
• Culture / PCR panels: requires clean container; prompt transport; some tests require preservative media.
• Ova and parasites: may require specific vials/preservatives and multiple samples on different days.
• C. difficile: typically requires unformed/liquid stool and rapid transport; follow policy.

Patient communication script

“This stool sample helps us identify what’s causing your symptoms. To keep it accurate, it can’t be mixed with urine or toilet water. I’ll show you the container and how to collect it as privately as possible.”

Step-by-step: stool collection (general)

1. Verify order and required container/preservative.
2. Hand hygiene; don gloves and PPE (consider splash risk).
3. Provide collection method per patient situation: collection hat in toilet, clean bedpan, or commode insert (per policy).
4. Instruct patient to urinate first (if possible) to prevent urine contamination.
5. Have patient pass stool into collection device (not directly into toilet water).
6. Using provided scoop/spatula, transfer required amount into specimen container; avoid contaminating outside of container.
7. Cap tightly; clean exterior if soiled; remove gloves and perform hand hygiene.
8. Label at bedside; place in biohazard bag; transport per time/temperature requirements.
9. Document time, stool characteristics relevant to order (e.g., “liquid”), and patient tolerance.

Common errors and fixes (stool)

Sputum specimens: coaching for a true lower-respiratory sample

Key concept

Sputum is mucus from the lungs, not saliva. Saliva-contaminated samples are commonly rejected or produce misleading results.

Patient communication script (coaching)

“This test needs mucus from deep in your chest, not spit from your mouth. We’ll do a few deep breaths, then a strong cough to bring it up. If you feel short of breath, we’ll pause.”

Step-by-step: sputum collection (general)

1. Verify order (routine culture, AFB, cytology) and correct container (often sterile; some tests require special containers and rapid delivery).
2. Hand hygiene; don gloves and PPE; consider eye/face protection due to cough/splash risk; follow isolation requirements.
3. Best timing is often early morning before eating/drinking (if ordered), or at least before oral care/mouthwash unless policy specifies otherwise.
4. Have patient rinse mouth with water (no toothpaste/mouthwash unless policy allows) to reduce oral contamination.
5. Instruct: sit upright, take 2–3 deep breaths, then cough deeply from the chest.
6. Have patient expectorate sputum directly into sterile container without touching inside; aim for thick mucus rather than thin saliva.
7. Cap tightly; label at bedside; transport promptly (some tests are time-critical).
8. Document time, appearance/amount, and patient tolerance (e.g., fatigue, dyspnea).

Common errors and fixes (sputum)

• Error: Sample is mostly saliva/foam. Fix: Re-coach deep breathing and chest cough; consider timing (morning) and mouth rinse; recollect.
• Error: Wrong container for AFB/cytology. Fix: Verify specific test requirements before collection; recollect in correct container.
• Error: Lid left loose or exterior contaminated. Fix: Re-cap securely; clean exterior; re-bag; recollect if integrity compromised.

Swab collections: basic approach per facility policy

Common swab types

• Nasal/nasopharyngeal (respiratory viruses): requires correct swab type and transport medium.
• Throat (e.g., strep): avoid tongue/cheeks; swab tonsillar pillars/posterior pharynx per policy.
• Wound: follow policy on superficial vs. deep collection; avoid swabbing dried drainage when a deeper sample is needed.
• Perineal/rectal screening swabs: follow privacy and consent practices; correct transport medium is essential.

General contamination prevention

• Use only the swab provided for the test (some are flocked; some contain specific media).
• Do not touch the swab tip to hands, bed linens, or non-target surfaces.
• Place swab immediately into transport tube; snap/secure as designed; tighten cap.

Patient communication scripts (brief, respectful)

Nasal: “This swab may feel uncomfortable and make your eyes water, but it’s quick. I’ll count to three, and you can breathe slowly through your mouth.”

Throat: “Open wide and say ‘ah.’ I’ll avoid your tongue, and it will be over in a few seconds. If you gag, that’s normal—raise your hand and we’ll pause.”

Wound: “I’m going to swab the area that best represents what’s happening in the wound. I’ll be gentle; tell me if you need a break.”

Step-by-step: swab collection (general)

1. Verify order and required swab/transport medium.
2. Hand hygiene; don gloves and PPE per isolation and splash risk.
3. Position patient for access while maintaining privacy (drape appropriately).
4. Collect specimen per site-specific policy (depth, rotation time, number of swabs).
5. Insert swab into transport tube immediately; secure cap.
6. Label at bedside with source/site (e.g., “left nare,” “throat,” “wound R shin”).
7. Bag and transport per policy; document time, site, and patient tolerance.

Transport, storage, and biohazard workflow

Transport checklist

• Container closed tightly; exterior clean and dry.
• Correct label applied at bedside; identifiers match requisition/order.
• Specimen placed in biohazard bag; paperwork in outer pocket (not inside with specimen).
• Time-sensitive specimens sent immediately; STAT flagged per policy.
• Temperature requirements followed (room temp/refrigerated/on ice) per test.

When to call the lab (or check the lab guide) before collecting

• Unclear container/preservative requirements.
• Timed collections or special handling (ice, light protection, immediate delivery).
• Low-volume situations (pediatric, oliguria) to confirm minimum volume.
• Questions about rejection criteria (e.g., formed stool for C. difficile testing).

Common specimen problems: quick troubleshooting

Competency check: specimen collection workflow (all types)

1) Verify orders

• Correct patient, test, specimen source, and timing (routine/STAT/timed).
• Check special handling (ice, refrigeration, light protection, immediate delivery).
• Confirm correct container/kit and minimum volume.

2) Prepare patient and environment

• Explain purpose and steps in plain language; offer privacy and dignity measures (drape, door/curtain, same-gender chaperone per policy if requested).
• Assess ability to perform self-collection; plan assistance for mobility, pain, or cognitive barriers.
• Gather supplies before starting; ensure label availability at bedside.

3) Hand hygiene and PPE

• Perform hand hygiene before contact and before handling supplies.
• Don gloves; add gown/mask/eye protection based on isolation and splash/aerosol risk (especially sputum).

4) Collect specimen using contamination prevention

• Use correct technique for specimen type (clean-catch, catheter port, stool hat/bedpan, coached sputum, site-specific swab).
• Maintain sterility/cleanliness of container interior and swab tip.
• Do not break closed urinary catheter systems.

5) Seal and label immediately

• Cap/secure container; ensure no leaks.
• Label at bedside with required identifiers, date/time, source/site, and collector info per policy.

6) Document

• Collection date/time and method/source (e.g., clean-catch, catheter port).
• Specimen appearance as relevant (e.g., cloudy urine, liquid stool, thick sputum) without over-interpreting.
• Patient tolerance and any teaching provided.
• Any deviations/issues (low volume, contamination risk, delayed transport) and actions taken.

7) Notify and transport (lab/courier process)

• Place specimen in biohazard bag; follow unit process for lab pickup, pneumatic tube restrictions, or courier.
• For STAT or time-sensitive tests, notify lab/courier per policy and document handoff if required.
• If specimen is likely to be rejected (wrong container, unlabeled, contaminated), address immediately rather than sending and hoping.