Sputum is not material from the postnasal region and is not spittle or saliva. A sputum specimen comes from deep within the bronchi. Effective coughing usually enables the patient to produce a satisfactory sputum specimen.

1. Instruct patients to provide a deep-cough specimen into a sterile container. Often, an early-morning specimen is best. Expectorated material of 1–3 mL is sufficient for most examinations. Remember that good sputum samples depend on thorough healthcare worker education and patient understanding during the collection process.

2. Label specimens with the patient’s name, date, and test(s) ordered.

3. Do not refrigerate specimens; deliver to the laboratory as soon as possible.

Pretest Patient Care

1. Assess for and document signs and symptoms of infection (coughing, productive sputum, blood in sputum).

2. Instruct the patient that this test requires tracheobronchial sputum from deep in the lungs. Instruct the patient to take two or three deep breaths and then to take another deep breath and forcefully cough with exhalation.

3. Ask respiratory therapy personnel to assist the patient in obtaining an “aerosol-induced” specimen if the cough is not productive. Patients breathe aerosolized droplets of a sodium chloride–glycerin solution until a strong cough reflex is initiated. The specimen often appears watery but is in fact the material directly from alveolar spaces. It should be noted on the requisition as being aerosol induced.

4. Remember that when pleural empyema is present, thoracentesis fluid and blood culture are excellent diagnostic specimens. Bronchial washings, BAL, and bronchial brush cultures are excellent for detecting most major pathogens of the respiratory tract.

5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Normal

Negative: normal flora