4.4 Specimen Collection and Common Tests

Specimens turn a resident's symptoms into lab data the medical team can act on. A contaminated or mislabeled specimen leads to wrong results, repeat collection, and delayed treatment — so the CNA's technique and labeling matter as much as the lab's analysis.

Always follow Standard Precautions: gloves for every collection, plus mask/gown/eye protection when splashing is possible.

Urine Specimens

Routine (Random) Urine — "Clean Voided"

Used for routine urinalysis (UA), dipstick screening, and color/clarity checks.

1. Wash hands and put on gloves.
2. Provide a clean, dry container (not necessarily sterile).
3. Have the resident void directly into the container, or into a specimen hat / bedpan and then pour into the container.
4. Pour off about 120 mL (or per facility policy).
5. Cap, label at the bedside, place in biohazard bag with the lab slip.
6. Refrigerate if not transported within 30 minutes.

Midstream / Clean-Catch Urine

Used when the lab needs to rule out urinary tract infection (UTI) — the sample must be as close to sterile as possible.

1. Open a sterile specimen kit and explain to the resident.
2. Provide perineal/penile cleaning:
   • Female: clean front to back, separating the labia, using three antiseptic wipes (one each side, one down the middle).
   • Male: clean the meatus in a circular motion from center outward (retract the foreskin if uncircumcised).
3. Resident starts the urine stream into the toilet, stops, then resumes into the sterile container until 30 – 60 mL is collected.
4. Resident finishes voiding into the toilet.
5. Do not touch the inside of the container or lid.
6. Cap, label at the bedside, send with lab slip.

24-Hour Urine

Used for creatinine clearance, hormone studies, and other tests that require total daily output.

1. Post "24-HOUR URINE" signs in the bathroom and over the bed.
2. At the start time (e.g., 0700), have the resident void and discard this first specimen.
3. Collect every drop for the next 24 hours into the large refrigerated/iced collection container (often with a preservative the nurse adds).
4. At hour 24, ask the resident to void one final time and add that void to the container.
5. Keep the container on ice or in a refrigerator the entire collection (warm urine degrades).
6. If any urine is missed/spilled, the collection must restart — notify the nurse.

Stool Specimens

Common orders: occult blood (FOBT/FIT cards), ova and parasites (O&P), C. difficile toxin, culture.

1. Have the resident defecate into a clean bedpan or specimen hat in the toilet — never the toilet bowl itself (water contaminates).
2. Do not mix urine with the stool.
3. Use the wooden tongue blade in the specimen kit to transfer about 2 tbsp (or thumbnail-size) into the specimen container.
4. For FOBT cards: apply two small smears from different sites in the stool sample onto the windows; close the slide and write the date.
5. Label at the bedside and send with the lab slip.

Sputum Specimens

Sputum is mucus from the lungs, not saliva from the mouth.

• Best time: early morning, on waking, before eating or brushing teeth.
• Have the resident rinse the mouth with plain water (no toothpaste — it kills bacteria).
• Resident takes 2 – 3 deep breaths and then a deep cough to bring sputum up.
• Collect 1 – 2 tablespoons in a sterile sputum container.
• Cap, label, biohazard bag, send to the lab quickly (tuberculosis specimens are kept and transported per facility isolation policy).

Capillary Blood Glucose (Finger-Stick) and CNA Scope in NC

Capillary blood glucose monitoring is the finger-stick test that uses a glucometer to measure point-of-care blood sugar.

• In many states, blood glucose monitoring is a CNA II / Medication Aide task.
• In North Carolina, blood glucose monitoring is generally NOT within CNA I scope unless the task is specifically delegated and the CNA has been trained and competency-checked under the facility's policy and the supervising nurse's direction. Always verify your facility's job description before performing this skill. If a question on the NNAAP exam asks whether a CNA may perform a finger-stick on his or her own, the safe answer is no — notify the nurse.
• Blood pressure and weight are clearly within CNA scope.
• Drawing venous blood is never within CNA scope.

Glucometer Reference (For When It Is Delegated)

Universal Labeling and Lab Slip

Every specimen must have a label applied at the bedside (not the nurses' station) containing:

• Resident's full name
• Date of birth or facility ID number
• Date and time of collection
• Type of specimen
• Collector's initials

A matching lab requisition slip travels with the specimen in a biohazard bag. Never label a container before collecting the specimen on the wrong resident — label the right one, at the right bed.