Special Instructions

Question 1

Superficial abscess

Answer 1

Aspirate if possible, swab along leading edge of wound.

Question 2

Deep abscess

Answer 2

Aspirate material from wall or excise tissue.

Question 3

Blood or Bone Marrow aspirate

Answer 3

Draw blood at time of febrile episode; draw two sets from right and left arms; do not draw more than three sets in a 24-hr period; draw ≥20 mL/set (adults) or 1-20 mL/set (pediatric) depending on patient’s weight; or per manufacturer’s instructions.

Question 4

Amniotic, abdominal, ascites (peritoneal), bile, joint (synovial), pericardial, pleural

Answer 4

Needle aspiration

Question 5

Bone

Answer 5

Take sample from affected area for biopsy.

Question 6

CSF

Answer 6

Consider rapid testing (e.g., Gram stain; cryptococcal antigen).

Question 7

Inner ear

Answer 7

Aspirate material behind drum with syringe if ear drum intact; use flexible shaft swab to collect material from ruptured ear drum.

Question 8

Outer ear

Answer 8

Firmly rotate swab in outer canal.

Question 9

Conjunctiva

Answer 9

Sample both eyes;
use separate swabs premoist-ened with sterile saline.

Question 10

Aqueous/vitreous fluid

Answer 10

None

Question 11

Corneal scrapings

Answer 11

None

Question 12

IUD

Answer 12

None

Question 13

IV catheters pins

Answer 13

Do not culture Foley catheters;
IV catheters are cultured quantitatively by rolling the segment back and forth across agar with sterile forceps four times: =15 colonies are associated with clinical significance.

Question 14

Gastric aspirates

Answer 14

Most gastric aspirates are on infants or for AFB.

Question 15

Gastric biopsy

Answer 15

Rapid urease test or culture for
Helicobacter pylori.

Question 16

Rectal swab

Answer 16

Insert swab ~ 1-1.5 cm past anal sphincter; feces should be visible on swab.

Question 17

Stool (feces) routine culture

Answer 17

Routine culture should include Salmonella, Shigella, and Campylo-bacter: specify Vibrio, Aeromonas, Plesiomonas, Yersinia, Escherichia coli 0157:H7, if needed.

Follow-up may include Shiga toxin assay as recommended by CDC.

Question 18

O&P

Answer 18

Wait 5-10 days minimum (up to 2 weeks) if patient has received anti-parasitic compounds, barium, iron, Kaopectate, metronidazole, Milk of Magnesia, Pepto-Bismol, or tetracycline.

Question 19

Bartholin cyst

Answer 19

Aspirate fluid: consider chlamydia and GC culture.

Question 20

Cervix

Answer 20

Do not use lubricant on speculum;

use viral/chlamydial transport medium, if necessary;

swab deeply into endocervical canal.

Question 21

Cul-de-sac

Answer 21

Submit aspirate.

Question 22

Endometrium

Answer 22

Surgical biopsy or transcervical aspirate via sheathed catheter

Question 23

Urethra

Answer 23

Collect discharge by massaging urethra against pubic symphysis or insert flexible swab 2-4 cm into urethra and rotate swab for 2 seconds; collect at least 1 hr after patient has urinated.

Question 24

Vagina

Answer 24

Swab secretions and mucous membrane of vagina.
If a smear is also required, use a second swab.

Question 25

Prostate

Answer 25

Collect secretions on swab or in tube.

Question 26

Urethra

Answer 26

Insert flexible swab 2-4 cm into urethra and rotate for 2 seconds or collect discharge on JEMBEC transport system.

Question 27

Hair, Nails, or Skin Scrapings (for fungal culture)

Answer 27

Hair: collect hairs with intact shaft Nails: send clippings of affected area Skin: scrape skin at leading edge of lesion

Question 28

BAL, BB, BW

Answer 28

Anaerobic culture appropriate only if sheathed (protected) catheter used

Question 29

Sputum, tracheal aspirate (suction)

Answer 29

Have patient collect from deep cough; specimen should be examined for suitability for culture by Gram stain; induced sputa on pediatric or uncooperative patients may be watery because of saline nebulization.

Question 30

Nasopharynx nose

Answer 30

Insert flexible swab through nose into posterior nasopharynx and rotate for 5 seconds; specimen of choice for Bordetella pertussis.

Question 31

Pharynx (throat)

Answer 31

Swab posterior pharynx and tonsils; routine culture for group A streptococcus (S. pyogenes) only.

Question 32

Tissue

Answer 32

Do not allow specimen to dry out; moisten with sterile, distilled water if not bloody.

Question 33

Clean-voided midstream (CVS)

Answer 33

None

Question 34

Straight catheter (in and out)

Answer 34

Insert catheter into bladder; allow first 15 mL to pass; then collect remainder.

Question 35

Suprapubic aspirate

Answer 35

Needle aspiration above the symphysis pubis through the abdominal wall into the full bladder.