How to Obtain a Nasopharyngeal Swab Specimen

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Salient features:

This video focuses on:

  • Overview
  • Preparation and equipment
  • Procedure
  • Handling the specimen
  • Removing Personal Protective Equipment
  • Summary

Detailed summary:

Overview :

  • Collection of specimens from the surface of the respiratory mucosa with nasopharyngeal swabs is a procedure used for the diagnosis of Covid-19 in adults and children.
  • The procedure is commonly used to evaluate patients with suspected respiratory infection caused by other viruses and some bacteria.
  • This video describes the collection of nasopharyngeal specimens for detection of Covid-19, the illness caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
  • There are no specific contraindications for collecting specimens with nasopharyngeal swabs.
  • However, clinicians should be cautious if the patient has had recent nasal trauma or surgery, has a markedly deviated nasal septum, or has a history of chronically blocked nasal passages or severe coagulopathy.

Preparation and equipment :

  • Nasopharyngeal swabs have long, flexible shafts made of plastic or metal and tips made of polyester, rayon, or flocked nylon.
  • Personal protective equipment (PPE), including a gown, nonsterile gloves, a protective mask, and a face shield is needed.
  • All sample tubes should be labeled and that the appropriate requisition forms should be filled out before starting the procedure.
  • It is essential to follow the pertinent respiratory and contact precautions specified by the Centers for Disease Control and Prevention (CDC) to put on the PPE correctly.
  • If possible, you should put on and take off the PPE in the presence of an observer to make sure there are no breaks in technique that may pose a risk of contamination.
  • First, put on a protective gown, wash your hands with soap and water (or use an alcohol-based solution), and put on a pair of nonsterile gloves.
  • Then put on a protective mask with a rating of N95 or higher, as recommended by the CDC.
  • Finally, put on a face shield for face and eye protection.

Procedure :

  • Masks are recommended for all patients suspected of having Covid-19
  • Ask the patient to take off her mask and blow her nose into a tissue to clear excess secretions from the nasal passages.
  • Remove the swab from the packaging.
  • Tilt the patient’s head back slightly, so that the nasal passages become more accessible.
  • Ask the patient to close her eyes to lessen the mild discomfort of the procedure.
  • Gently insert the swab along the nasal septum, just above the floor of the nasal passage, to the nasopharynx, until resistance is felt .
  • Insert the swab into the nostril, parallel to the palate. If resistance to the passage of the swab is felt, back off and try reinserting it at a different angle, closer to the floor of the nasal canal.
  • The swab should reach a depth equal to the distance from the nostrils to the outer opening of the ear.
  • The CDC recommends leaving the swab in place for several seconds to absorb secretions and then slowly removing the swab while rotating it.

Handling the specimen

  • Open the collection tube and insert the swab into the tube.
  • Break the swab at the groove and discard what remains of the swab.
  • Close the labeled collection tube, wipe the tube with a surface-disinfectant wipe, and insert the tube into an open biohazard bag held by an assistant
  • Follow the CDC directions for direct processing of the swab specimen or placement of the swab in media with or without refrigeration.

Removing Personal Protective Equipment

  • First, remove your gown and gloves.
  • Clean your hands with an alcohol-based solution or soap and water.
  • Put on a new pair of gloves, and then remove your face shield and either dispose of it or clean and store it in accordance with the guidelines.
  • Remove your gloves, rewash your hands, and put on another pair of gloves; then remove your mask and follow guidelines for disposal or reuse.
  • Finally, remove the last pair of gloves and wash your hands.

Summary :

  • This video demonstrates the collection of specimens from the surface of the respiratory mucosa with nasopharyngeal swabs for the diagnosis of Covid-19 in adults and in children.
  • It is important to use approved PPE and the appropriate technique to minimize the possibility of spreading the virus.

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