Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [165], C).
2. 2.Show
   Position the patient upright in a chair or in a high semi‐Fowler position, supported as necessary with pillows.
   For comfort and to facilitate optimum specimen collection. E
3. 3.Show
   Wash hands with bactericidal soap, or decontaminate physically clean hands with alcohol rub. Put on apron, gloves and eye protection.
   To reduce the risk of cross‐infection and splash injury to the practitioner (NHS England and NHSI [155], C).

Procedure

1. 4.Show
   Fill syringe with 3–5 mL of 0.9% sodium chloride and attach tubing to syringe tip.
   To facilitate instillation of 0.9% sodium chloride high into the patient's nostril. E
2. 5.Show
   Ask the patient to tilt their head backwards slightly while sitting upright.
   To promote the flow of 0.9% sodium chloride into the nostril. E
3. 6.Show
   Dip the end of the catheter into the water‐soluble lubricant.
   To facilitate comfortable passing of the catheter. E
4. 7.Show
   Carefully insert the tubing into the nostril and quickly instil 0.9% sodium chloride into one nostril while holding the second nostril closed.
   To facilitate optimal recovery of epithelial cells. E
5. 8.Show
   Aspirate the fluid while withdrawing and rotating the tube to dislodge cells and secretions. Note: recovery must occur rapidly or instilled fluid will drain down the throat.
   To obtain the desired nasopharyngeal specimen. E
6. 9.Show
   Either:

   Where appropriate, the patient may tilt their head forward and gently push the fluid out of the nostril into a sterile container.
   Patients may find this method more comfortable. E
   Or:

   If aspirated: inject aspirated specimen from the syringe into suitable dry, sterile container or one containing viral transport medium, according to virology laboratory requirements.
   To ensure a good‐quality specimen and to prevent cross‐contamination. E
7. 10.Show
   Repeat procedure with the other nostril and inject the specimen into the same container (Action figure 13.26).
   A combined specimen will promote optimal yield of micro‐organisms. E

Post‐procedure

1. 11.Show
   Dispose of waste; remove apron, gloves and eye protection; and wash and/or decontaminate hands.
   To ensure correct clinical waste management and reduce the risk of cross‐infection (DH [48], C).
2. 12.Show
   Label the sample immediately and complete the microbiology request form (including relevant information such as indication for sample and current or recent antimicrobial therapy).
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
3. 13.Show
   Dispatch the sample to the laboratory as soon as possible (within 4 hours).
   To increase the chance of accurate organism identification (Higgins [84], E).
4. 14.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).