The collection of sputum is noninvasive and fairly straightforward, although, for proteomic studies, the protocol is slightly more rigorous than one that would be prescribed by a physician. As patients develop progressive bronchiectasis, other opportunistic organisms may colonize the airways including Gram-negative rods such as Burkholderia cepacia and Stenotrophomonas maltophilia, molds such as Aspergillus fumigatus, and atypical mycobacteria.

Danny A. Assess the patient’s oxygenation status. As the patient coughs, apply suction and gently withdraw the catheter. Determine the type of patient assistance needed to obtain a specimen. In these studies, patients without eosinophilia were able to reduce the dose of inhaled steroid without deterioration in lung function.10,11, A second population of subjects with asthma, either experienced or naïve to corticosteroid therapy, have significantly higher levels of neutrophils in their sputum. Get the full experience of this Clinical Skill and access thousands of other resources on Clinical Solutions. Sputum is the best specimen for the diagnosis of pulmonary tuberculosis. 0000444361 00000 n Ruptured hydatid cysts can be recognized by the presence of hooklets in the sputum. Description. For this test it is important that sputum, not saliva, is collected. Connect the suction tubing to the adapter on the sputum trap. 0000002014 00000 n

Sputum specimens are collected for three major reasons: cytologic examination, culture and sensitivity testing, and acid-fast bacilli (AFB) smear testing. Retrieved March 10, 2020, from. 0000709063 00000 n endstream endobj 145 0 obj <>/Metadata 4 0 R/Pages 3 0 R/StructTreeRoot 6 0 R/Type/Catalog/ViewerPreferences<>>> endobj 146 0 obj >/PageWidthList<0 792.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/Shading<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 147 0 obj [/Separation/PANTONE#20424#20U 159 0 R<>] endobj 148 0 obj <>stream American Association for Respiratory Care (AARC). Other biomarkers can also be measured in the sputum supernatant. Cytologic or cellular examination of sputum may identify aberrant cells or cancer.

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Once P. aeruginosa is detected in the sputum, it is very difficult to eradicate. Other organisms include Moraxella catarrhallis and Pseudomonas aeruginosa. The most common pathogens identified on sputum culture include Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae.55 Less frequently identified organisms include Staphylococcus aureus, Pseudomonas aeruginosa, and other gram-negative rods. The sputum cell pellet is further processed by dilution in PBS to 1 × 10−6 ml−1 for eosinophil counts.

To induce expectoration, a sterile hypertonic saline aerosol is inhaled for a set period of time. Explain that it will stimulate coughing and sputum expectoration. When suctioning, ensure the patient understands the importance of relaxing and breathing at a normal rate during the procedure. It is different from saliva, which is clear and colourless. 0000222835 00000 n Assess when the patient last ate a meal (nasopharyngeal suctioning). (2020).

Observe the patient for signs or symptoms of pain. Once expectorated sputum should be processed within 2 h. There is evidence that sputum can be stored for up to 9 h in a refrigerator at 4oC or that sputum can be snap frozen for longer without affecting cell counts [9], although experience with these techniques is limited. The wide-mouthed, sterile, plastic container (wax free) with a tight fitting cap containing the sputum specimen should be immediately transported to the laboratory or held at 39.2°F (4°C) until processed. Sometimes suctioning provokes violent coughing, causes vomiting and aspiration of stomach contents, and induces constriction of pharyngeal, laryngeal, and bronchial muscles. If using a regular sterile suction catheter, remove gloves, perform hand hygiene, don sterile gloves, and avoid contaminating the outside of the container.

0000705972 00000 n Keep in mind the diagnostic limitations of sputum Gram's stain and culture, including the inability to visualize atypical organisms, contamination by oral flora, and the difficulty encountered by some patients to provide adequate specimens. Chapter 36: Airway management.

0000575274 00000 n 0000702964 00000 n *In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Demonstrate the proper splinting technique for postoperative patients. 0000444133 00000 n MilnerJr., in Hunter's Tropical Medicine and Emerging Infectious Diseases (Tenth Edition), 2020. 0000059817 00000 n

0000711219 00000 n 0000700319 00000 n Assess the patient’s respiratory status, including respiratory rate, depth, pattern, and color of mucous membranes.

Instruct the patient to breathe normally during suctioning to prevent hyperventilation. Subjects are typically treated with short-acting beta-agonists before sputum induction to reduce the chances for bronchoconstriction. 0000652788 00000 n

startxref In many cases, suctioning is indicated to collect sputum from patients unable to spontaneously produce a sample for laboratory analysis. 0000458448 00000 n Often within the first few years, P. aeruginosa is detected in sputum or throat swab cultures.

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The ATS recommends that this test be used to broaden antibiotic therapy to treat unsuspected organisms not covered by the usual empiric regimen. 0000706978 00000 n The ECP in the lysate fraction provides an estimate of the eosinophil number, and the ECP supernatant/cell lysate ECP ratio provides a measure of eosinophil degranulation.

Gently insert the tip of the suction catheter through the endotracheal tube, nasopharynx, or tracheostomy tube without applying suction. trailer 0000703967 00000 n Heuer (Eds.). %%EOF Advance the catheter into the trachea gently and quickly. 0000712219 00000 n Higher output nebulizers have also been associated with the development of a sputum neutrophilia 24 h after sputum induction [7].

0000699912 00000 n The aim of suctioning is to maintain an airway by preventing the accumulation of secretions and formation of crusts. Either expectorated sputum or throat swabs during a cough are used for microbiology cultures.

0000714738 00000 n Like CF, fever and hemoptysis are uncommon in exacerbations of pediatric bronchiectasis.

Generally, the subject is asked to fast for 4 hours before sputum induction to reduce concerns over nausea and emesis; brush teeth immediately before collection to reduce oropharyngeal contamination; and rinse mouth with water immediately before collection and dry oral membranes with tissues.9, The predominant inflammatory cell present in sputum is the neutrophil.

Risk factors for bronchoconstriction include a low baseline FEV1% predicted [3], overuse of short-acting β2-agonists [4] and poor asthma control [4]. 0000714298 00000 n Sputum ECP levels can be affected by high levels of saliva contamination.48 It is recommended to measure the salivary contamination by the count of squamous cell percentage and discard the samples with a 40% of squamous cells. Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.

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1�aҞ.����e�!4�+�C�:�$ . Explain to the patient and family that coughing, gagging, or (less common) sneezing can occur as a result of the cough reflex. MilnerJr., ... Danny A. Strongyloides larvae may also be found in sputum in disseminated infections.

144 84 Oxygenate the patient before and after the procedure, and closely monitor his or her oxygenation status and heart rate. A variety of protocols for sputum induction have been published and shown to be safe provided patients are pre-treated with bronchodilators and monitored carefully [1, 2]. 0000452074 00000 n Sputum is not contaminated by saliva or oropharyngeal flora, Anxiety or discomfort from suction catheter, Sputum is contaminated by saliva or oropharyngeal flora, Unexpected outcomes and related interventions.

Sputum samples are routinely assessed for bacterial identity and antibiotic sensitivities. Bronchoscopes must be carefully cleaned and decontaminated after collecting specimens from patients.

In the presence of the patient, label the specimen per the organization’s practice.

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Sputum is produced by cells lining the respiratory tract.

Symptomatic exacerbations, assumed to be infectious in nature, are characterized by increased sputum expectoration, cough severity, and change in sputum color—with or without reduction in exercise tolerance and energy.

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Sputum eosinophilia in steroid-naïve asthmatic individuals is generally suggestive of a steroid-responsive process, and a marked reduction in eosinophil counts is typically observed after treatment with corticosteroids. Para rechazarlas o bien obtener más información, visite nuestra página de cookies. 0000652827 00000 n 0000280014 00000 n

The frequency of suction varies according to a patient’s need. 0000443900 00000 n

The sample is then mixed with an equal volume of dithiothreitol to enhance cell dispersal from the surrounding mucus before it is centrifuged at 16,000×g for 5 min.

Sputum Specimen Collection COVID-19 testing with SARS-CoV-2 RNA (COVID-19), Qualitative NAAT (test code 39448) This test has not been FDA cleared or approved.

Sputum production is a common complaint in patients with inflammatory disorders of the airways, like asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD). The endobronchial pathogens isolated during acute exacerbations have not been correlated with chronic endobronchial flora in children with bronchiectasis.

Collecting your sample. A common method used to process induced sputum is outlined in Box 42.2. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Although production is minimal in the healthy state, disease states can increase the amount or change the character of sputum. 0000706571 00000 n

0000168692 00000 n For the sputum trap, detach the suction tubing and connect the rubber tubing on the sputum trap to the plastic adapter. Monitoring of pulmonary functions during sputum induction is also recommended, either with periodic spirometry or peak flow measurements. Symptomatic bronchoconstriction is unusual in patients with COPD, even those with severe airflow obstruction [5]; sputum induction has also been carried out repeatedly and safely in patients with severe asthma [6]. 0000614031 00000 n It is generally agreed that the central airways are sampled with induced sputum.

0000703483 00000 n Some of the molecular markers of airway inflammation that have been successfully measured in sputum are shown in Table 42.2.

Pseudomonas is commonly found in adults with severe bronchiectasis, but it is uncommon in children. 0000714816 00000 n 0000715222 00000 n If the specimen requires ice for transport, place the specimen in a biohazard bag then place the bag with the specimen into a second biohazard bag filled with ice slurry. 0000113297 00000 n These subjects are less responsive to corticosteroid therapy compared with patients with an eosinophilic predominance. Continue the procedure until enough of a specimen has been collected.

Limit the aspiration time to 15 seconds or less. 0000444019 00000 n 0

Encourage questions and answer them as they arise. Examining sputum helps diagnose and treat several conditions ranging from simple bronchitis to lung cancer.

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