Page 209 - pathology_services_handbook_5th_edition_2018

B.Lower respiratory tract

1. Expectorated sputum
i. Collect the sputum early in the morning, after rinsing the mouth and gargling
with water. MICROBIOLOGY
ii. Instruct the patient to cough deeply and expectorate only sputum and not saliva
into the sterile container.
iii. If delay is anticipated, store the specimen in a refrigerator.

2. Induced sputum

i. Explain procedure and the possible effects to the patient (eg: coughing, dry
mouth, chest tightness, nausea and excess salivation).
ii. Assemble nebuliser equipment and load 20 ml of 3 % hypertonic saline solution
into nebuliser cap.
iii. Connect the assembly to the nebuliser machine.
iv. Turn the machine on. Place the mouthpiece on the patient’s mouth and re-
emphasize on the mouth breathing. (fine mist should be seen through and
patient should experience a salty taste).
v. Allow patient to inhale the hypertonic mist for approximately 5 minutes. Then
instruct patient to take several deep breaths off the nebuliser. If patient does
not initiate coughing spontaneously, ask them to attempt a forced cough.
vi. Person doing this procedure may use gentle chest physiotherapy eg: vibration
and percussion to produce sputum.
vii. The procedure should be stopped when:
• Patient has produced 1-2 ml of sputum for each specimen.
• 15 minutes of nebulisation is reached.
• The patient complains of dyspnoea, chest tightness or wheeze.
viii. Label the sample and write the specimen as induced sputum.

Note:
Sputum induction is used as an aid to the diagnosis of TB in patients who are unable
to spontaneously expectorate adequate sputum specimens.

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