How to obtain a tracheal aspirate

[quirkystar]

The infectious disease doctor put an order in for a sputum culture: tracheal aspirate and I didn't know how to obtain this(patient has a tracheostomy). No one else on my floor knew either. I thought maybe it required suctioning?

[JustBeachyNurse, LPN]

Did you try contacting the lab or nurse education department to find out facility protocol? Also consult respiratory therapy as this is their area of expertise. Some facilities restrict these specimens to critical care nurses and certified RTs per P&P.

If you are not sure don't do it. But suctioning with clean technique would be necessary. Prep may vary by lab technique (such as administer a warmed saline neb to loosen secretions prior to obtaining sample with a sterile suction set up )

[blondy2061h, MSN, RN]

Yeah, respiratory therapy does this in my facility. We have sputum traps and they instill a bit of saline into the trach then suction and the sample gets stuck in the trap.

[NicuGal, MSN, RN]

Actually, if you put saline down the tube or trach it can contaminate the specimen with colonized flora. This is our procedure:

place sterile catheter on trap, go down tube without suctioning, suction when at right length for tube, do not suction on your way up. Rinse cath with sterile NS to get all

of specimen in trap. This will give you a true culture. We use this for patients that are ventilated. On the floors, if they are trached and can cough they obtain the specimen that way.

[Here.I.Stand, BSN, RN]

My procedure goes something like this: "Hey Joe, RRT. Team ordered a QBAL; can you get it when you have a sec?"

In all seriousness, yes our RRTs collect them.

[CelticGoddess, BSN, RN]

My procedure goes something like this: "Hey Joe, RRT. Team ordered a QBAL; can you get it when you have a sec?"

In all seriousness, yes our RRTs collect them.

That's how we do it also. RRT's just love us!

[nurseprnRN, BSN, RN]

We used to do these all the time. The little traps come sterile and you put them on the end of your suction line, and handle the part that goes into the tracheostomy with sterile, not clean, gloves. If you do it and use sterile saline to flush the returns into the collection vial/jar, be sure the saline you use does not have preservatives in it.

As to instilling saline first, there is research that says this should never, ever be done. I know, I know, we used to do it all the time, but finally somebody did a study that shows it doesn't increase yield and it does increase patient distress and hypoxia. Sputum induction with nebulized saline is different.