Definition
Collection of sputum sample for culture is a key diagnostic step in identifying infections of the lower respiratory tract, such as pneumonia, tuberculosis, or fungal infections.
When to Collect Sputum sample for Culture
- Suspected pneumonia, tuberculosis, bronchitis, or fungal infections
- Persistent cough, hemoptysis, or abnormal chest X-ray
- Monitoring treatment response or antibiotic resistance
- Immunocompromised patients with respiratory symptoms
Types of Sputum Collection Methods
- Expectorated Sputum: Most common; patient coughs deeply to produce sputum.
- Induced Sputum: Nebulized saline is inhaled to stimulate sputum production—useful in patients unable to expectorate naturally.
- Tracheal Aspirate: Collected via suction in intubated or tracheostomized patients.
- Bronchoalveolar Lavage (BAL): Invasive method using bronchoscopy to collect deep lung secretions—ideal for immunocompromised patients or when TB/fungal infection is suspected.
What Makes a Good Sample?
- Macroscopic Quality: Thick, mucoid, or purulent—not watery or saliva-like.
- Microscopic Screening: A valid sample has >25 leukocytes and <10 epithelial cells per low-power field on Gram stain.
- Labeling: Include patient name, date/time, and collection method (e.g., “induced sputum” or “BAL”).
Equipment
- Sterile specimen container.
- Sputum cup.
- Tissue paper.
- Clean gloves.
- K-basin.
- Suction catheter (optional).
- Suction apparatus (optional).
Procedure for Collection of sputum sample for culture
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Check the physician’s order. | |
| 2. | Explain to the patient that the specimen must be taken from sputum, coughed out from back of the throat or lungs. | Promotes patient’s cooperation. |
| 3. | Ask the patient to sit erect in bed, if possible. | Provides easy access for collection of specimens. |
| 4. | During procedure Wash hands and put on gloves. | Reduces transmission of microorganisms. |
| 5. | Keep a sterile specimen container ready for the sample and take a tissue paper in hand. | |
| 6. | Remove lid of container and place with inner side facing upward. | Prevents contamination. |
| 7. | Administer a nebulizer as required and instruct the patient to take breaths and then cough out deeply. | It helps to loosen the secretions and obtain adequate specimen. |
| 8. | Explain to the patient that he/she has to expectorate the sputum into sterile, labeled container without touching the inside of it. | Prevents contamination of the specimen. |
| 9. | Close the container without touching the inside of lid. | |
| 10. | Provide the patient with tissue paper and help them to a comfortable position. | Promotes patient comfort. |
| 11. | After procedure Replace articles. | |
| 12. | Wash hands. | Reduces transmission of microorganisms. |
| 13. | Provide mouth care if patient needs it or encourage patient to carry out oral hygiene. | Removes unpleasant taste in mouth. |
| 14. | Document the obtained specimen, date and time of collection, and characteristics of the specimen, and send the specimen to laboratory. | Helps in continuity of care. |
Special Considerations
- Best collected early in the morning before eating or drinking.
- If sputum is difficult to produce, steam inhalation or nebulization may help.
- Avoid contamination with saliva, food particles, or nasal secretions.
- For TB testing, multiple samples may be required over consecutive mornings.
- Note any antibiotic use on the lab form it may affect culture results.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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