Our notes are now found under OSCE Learning! Click here
image
Clinical ProceduresSwabs and smears
·1 min read

ENT and skin/wound swabs

Introduction

  • Wash hands; Introduce self; ask Patient’s name and DOB; Explain procedure and obtain consent 

Gather equipment

  • Swabs – CHECK EXPIRY
    • Blue = bacterial   
    • Green = viral

NB: colours may vary between hospitals.

  • Sterile saline (to moisten swab if swabbing dry area, e.g. nose, skin)
  • Tongue depressor and torch (if taking throat swab)
  • Clean tray and place swab inside in partially open packet
  • Put on gloves and apron (and surgical mask depending on patient’s isolation status)

Performing the swabs

  • Throat swab
    • Patient should sit with their head tilted backwards with light shining into their open mouth
    • Ask the patient to protrude their tongue, while you depress it with a tongue depressor if required to visualise tonsils
    • Quickly but lightly rub the swab over both tonsils and the posterior pharyngeal wall

NB: warn the patient they may gag during the procedure. Viral nose and throat swabs are usually combined; in this case, collect the throat swab first, then use the same swab to take the nasal sample. Some kits have two swabs which go in the same container – a thin one for the nose and a thick one for the throat.

  • Nasal swab
    • Wipe the nose if excess secretions are present
    • Gently insert a swab horizontally into one of the patient’s nostrils by 2-5cm until you feel resistance, aiming posteriorly along the floor of the nasal cavity
    • Gently rotate the swab for 5 seconds
  • Ear swab
    • Place swab in outer ear
    • Rotate to collect secretions
  • Wound/skin swab
    • Expose site
    • Moisten end of a swab with sterile saline if the area is dry
    • Roll the swab along moist or purulent area
  • MRSA screening 
    • Nasal: insert a moistened swab vertically into the anterior nare (approximately 2cm) and rotate swab against anterior nasal mucosa for 5 seconds (repeat on the other nostril using the same swab)
    • Groin: gently roll a moistened swab back and forth against skin on both sides of groin

To complete 

  • Place swab into container without touching anything else (some kits may require you to snap the swab in half; some may require you to rub the swab on the collection tube wall and then discard it)
  • Close the container
  • Thank patient 
  • Discard waste and clean tray; then discard gloves and apron; wash hands
  • Fill in the samples and request form details
    • Name, DOB, hospital/clinic number, address, GP name and address
    • Specimen site
    • Clinical details
  • Send to lab

Document in patient’s notes

image