Specimen Collection: Urine, Stool, and Sputum

Scope and Standard 14 boundary

Under Indiana's 410 IAC 16.2 Standard 14, the CNA may collect routine (non-sterile and clean-catch) specimens — clean-catch urine, 24-hour urine (with the nurse starting and stopping the collection), stool, and expectorated sputum. The CNA does not collect specimens by sterile invasive technique (straight-catheter urine, wound cultures, nasopharyngeal swabs, blood draws). Those are licensed-nurse or higher tasks. Knowing this boundary is testable and protects the CNA's registry status.

Clean-catch midstream urine

The clean-catch (midstream) specimen reduces contamination by skin and urethral flora so the laboratory can accurately culture any true urinary pathogens. The procedure balances cleanliness with sterility of the container.

Resident preparation

1. Explain the procedure. Offer the perineal-care supplies (antiseptic towelettes or soap and water washcloths) and the labeled sterile specimen cup. The cup stays sealed until the moment of collection.
2. Instruct the resident to clean the meatus with the supplied wipes: for females, separate the labia and wipe front-to-back with a single stroke per wipe (use all three wipes if supplied); for males, retract the foreskin if present, wipe the glans in a circular motion outward from the meatus, one stroke per wipe.
3. Instruct the resident to begin voiding into the toilet, then catch the midstream in the sterile cup, then finish voiding into the toilet. The first urine flushes urethral organisms; the last urine washes skin at the meatus. Only the midstream goes in the cup.
4. The resident caps the cup without touching the inside of the lid or the rim. The CNA may assist physically dependent residents but must avoid touching the sterile interior.

For residents who cannot perform their own clean-catch

The CNA performs the perineal cleaning per the 4-inch/cleaning rule in Section 3.1, then holds the sterile cup to catch the midstream. Keep the cup interior sterile; do not set an open cup on any surface. For bedbound residents, a bedpan or urinal may be used to collect the specimen, then the specimen is transferred to the sterile cup if the laboratory allows (some labs reject specimens transferred from a bedpan — confirm facility policy).

Labeling and transport

Label the specimen at the bedside before leaving the room with the resident's full name, room number, date, time of collection, and source (e.g., "urine, clean-catch midstream"). Document the collection time and type in the chart, and transport the specimen to the laboratory promptly or place it in the designated refrigerator. Specimens left at room temperature for hours overgrow contaminant bacteria and produce misleading culture results.

24-hour urine collection

A 24-hour urine collection measures everything the kidneys excrete over a full day, used for creatinine clearance, protein, hormones, and electrolyte balance. The nurse starts and stops the collection; the CNA is responsible for keeping every void in the container over the 24 hours.

The procedure:

1. The nurse begins the test by having the resident void and discard that first specimen (this sets the start time; the bladder is now empty).
2. Every void after the start time goes into the 24-hour container — including nighttime voids and the final void at exactly the 24-hour mark.
3. The container is kept refrigerated or on ice per facility policy and laboratory instruction (some tests require a preservative already in the container; never discard the preservative).
4. If a void is missed and goes into the toilet or bedpan, the test is invalid and must be restarted — report immediately to the nurse.
5. At the 24-hour mark the resident voids one last time; this final void is added to the container. The total volume is measured and recorded, the container is labeled, and it is sent to the laboratory.

Trap callout: A common test question asks what to do with the first void when starting a 24-hour collection — discard it. The first void sets the clock by emptying the bladder; everything after that goes in the container. Conversely, the final void at the 24-hour mark goes into the container.

Stool specimen

Stool specimens are collected for occult (hidden) blood, culture, ova and parasites, and fat malabsorption. The CNA's role is to obtain a small sample from a clean, urine-free stool.

Technique

1. Have the resident void urine first and discard it (urine contaminates stool specimens and kills trophozoites in ova-and-parasite tests).
2. Have the resident defecate into a clean bedpan, commode specimen hat, or bedside commode — never into toilet water, because toilet water and bowl cleaners contaminate and dilute the specimen.
3. Using the supplied collection device (a small scoop or tongue blade), transfer a sample about the size of a walnut, including any blood, mucus, or abnormal-looking portions, into the specimen container.
4. Cap the container. Label at the bedside with resident name, date, time, source ("stool"), and the test ordered (e.g., "stool for occult blood").
5. Document the stool character (color, consistency, odor, presence of blood or mucus) and the collection.
6. Transport promptly. Ova-and-parasite specimens often must be sent immediately warm to the laboratory because trophozoites degrade quickly; follow facility policy.

Sputum specimen

Sputum (mucus coughed up from the lower airways, not saliva) is collected for culture, acid-fast bacilli (TB), and cytology. The best time to collect is first thing in the morning, before the resident has eaten, because secretions pool overnight and the bacterial load is highest.

Technique

1. Offer water for the resident to rinse the mouth (do not use mouthwash or antiseptic rinse — they suppress the bacteria the test is looking for).
2. Have the resident sit upright or in high Fowler's position to expand the lungs.
3. Instruct the resident to take several deep breaths, then cough deeply from the chest (not a throat clear) and expectorate into the sterile sputum cup.
4. Cap the cup without touching the inside. A specimen of about 1–2 teaspoons (5–10 mL) is usually sufficient.
5. Label at the bedside with name, date, time, source ("sputum"), and test ordered. Document amount, color, consistency (e.g., "thick, yellow-green, blood-tinged").

If the resident cannot produce sputum, the CNA reports this to the nurse; the nurse may order aerosol nebulization or suction collection — the CNA does not perform those procedures.

What to report

Report rust-colored, blood-tinged, or foul-smelling sputum; black or tarry (melena) stool; bright-red blood in stool; clay-colored stool (possible biliary obstruction); urine that is bloody, cloudy, or foul-smelling; and any resident who is unable to produce an ordered specimen so the nurse can adjust the plan.