| Purpose |
| To obtain sputum specimens for AFB smear microscopy and culture from a patient who has a dry, non-productive cough. Ensure that the patient is placed in an appropriate negative air pressure room with the door shut. The air in the negative air pressure room should be drawn out of the room and vented outside of the building. |
| Materials and equipment required |
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| Procedure |
| Preparation |
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If at risk for aspiration, assure that the patient is NPO for three hours prior to sputum induction. -
Instruct the patient to gently brush his/her teeth, gingival margins, tongue, and buccal surfaces using sterile, filtered water or normal saline to rinse. Do not use toothpaste, commercial mouth wash preparations, nose drops, or any medications containing alcohol, or oil. Instruct the patient to avoid taking oral antibiotics immediately before the sputum collection procedure. -
Instruct the patient to rinse and gargle several times with sterile, filtered water or normal saline after brushing. Do not use tap water or bottled water, as it may contain nontuberculous mycobacteria that may alter findings. |
| Sputum collection |
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Observe standard airborne isolation protection precautions at all times. NOTE: N95 masks must worn by healthcare personnel for AFB cough-producing procedures. - The patient must be in an appropriate negative air pressure room or outdoors.
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Place approximately 5 mL of 3% saline into the hand-held nebulizer. Set the flow at 6 to 8 L/min and nebulize saline for 7 to 10 minutes or until sputum is expectorated. The maximum nebulization time is 20 minutes. NOTE: More saline may be added to the nebulizer if more than 10 minutes is needed to produce an adequate cough. -
At the end of this time, ask the patient to inhale the nebulized 3% saline deeply 2 to 3 times followed by a vigorous cough. This will assist in expectorating quality sputum. Collect the sputum into a sterile specimen container. NOTE: Coaching the patient is very important in order to get quality results in a timely manner. NOTE: High-quality sputum is required for smear, culture, and NAA testing. For AFB NAA testing alone, a minimum of 1 mL of raw sputum (or 0.5 mL of sputum sediment) is needed. It is preferred to collect 5 to 10 mL of raw sputum. - Label the specimen with time and date of its collection and place it in a specimen bag. Attach a laboratory request form, if applicable.
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Document the procedure in the appropriate flow sheet or medical record. NOTE: Documentation also is required for unsuccessful procedures. |
