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Collecting a stool specimen: Clinical skills notes

Notes

Notes

Gastrointestinal

Collecting a stool specimen

Introduction

A stool specimen is a sample of the client’s feces. It can be analyzed for the presence of blood; mucus; fat; microbes, such as bacteria and parasites; or other abnormal findings. Collecting a stool specimen can be helpful in diagnosing various conditions of the gastrointestinal system, such as ulcers and cancers. 

Common care tips

  • Make sure to notify the client in advance.
  • At all times, respect the client's privacy and modesty by remembering to close the room's door, all window covers, and ensuring the client is properly covered.

Supplies & Procedure

When collecting a stool specimen, first gather the supplies you’ll need, including:
  • gloves
  • paper towels
  • a specimen container
  • a collection device
  • toilet tissue
  • a tongue depressor
  • a biohazard transport bag

You may also need:
  • a bedside commode
  • a bedpan
  • an occult blood test kit

Figure 1: Supplies for collecting a stool specimen.

Procedure

  1. Always double-check the client’s identity to make sure the procedure is performed on the right person. Make sure that the specimen container is labeled with the client’s name, room number, as well as the correct date and time.
  2. Put on gloves and cover the bathroom counter with a paper towel.
  3. Open the specimen container and place the lid on the paper towel with the inside facing up.
  4. If the client can use a regular toilet, place a collection device at the back of the toilet bowl. For people who can’t use the toilet, a bedside commode or a bedpan can be used.
    • It’s important to remember that urine can alter the results, so ask the client to empty their bladder before collecting the stools. If the client can’t use the toilet, provide them with a voiding device.
  5. Give the client time to defecate and assist as necessary.
    • Remind them not to throw toilet tissue into the collection device, the bedside commode, or the bedpan because this can alter the results.
    • For most clients, you can leave the room until they finish.
    • Be sure that the call light is close to the client.
    • Remember to remove gloves when you leave, dispose of them safely, and put on a new pair when you come back.
    • Knock before entering.
  6. Provide tissue paper, a moist cloth, or pre-moistened wipes if they are able to clean themselves; otherwise, you should assist in perineal care. Also, assist the client with handwashing as necessary.
  7. If the client didn’t use the toilet, take the collection device or the bedpan to the bathroom. Note the general quality, the amount, the color, and the odor of the stool.
  8. To collect the stool specimen, you can use the spoon attached to the lid of the specimen container or a tongue depressor. Take two tablespoons of feces and place them onto the specimen container.
    • If the stool is formed, the specimen should be taken from the middle of the stool.
    • Make sure to take a sample from areas with blood, mucus, or any areas that seem more watery.
    • If the stool is hard, take a sample from the middle and the two ends of the stool.
    • If you use a tongue depressor, wrap it in paper towels or toilet tissue and dispose of it safely.
  9. Close the specimen container tightly and place it back on the paper towel on the bathroom counter. Now, dispose of one glove and use the ungloved hand to hold the transport bag. Then, with your gloved hand, put the specimen container into the bag. Make sure not to touch the outside of the transport bag with the glove. Dispose of the other glove safely and wash your hands.
    • Sometimes the stool has to be warm when analyzed, so they have to be delivered to the laboratory right away. Otherwise, place them in the storage area until they’re picked up.

Figure 2: Collecting the stool specimen.

You may be asked to test the stool for occult blood, where “occult” means that there’s no visible evidence of bleeding. This can be done using an occult blood test.
  1. Put on clean gloves. Open the flap of the test slide. Using a tongue depressor, take a small portion of stool and apply a thin smear on the test paper in the first box, or box A, of the slide.
  2. Using a different tongue depressor, take a stool specimen from a different part of the stool. Apply a thin smear on the second box, or box B.
  3. Close the slide cover and turn it to the other side.
  4. Open the cardboard flap and apply two drops of the developing solution that comes with the test kit on boxes A and B.
  5. Wait 10–60 seconds as specified by the manufacturer. Document the color changes.
    • A blue color indicates a positive test for occult blood in the stool.
  6. Dispose of the test packet safely. Wrap the tongue depressors in paper towels or toilet tissue and dispose of them. Empty the rest of the stool into the toilet. Wash your hands. Finally, make sure to clean and return the equipment to the right place.

Figure 3: Performing an occult blood test. A. Apply a smear to test paper, B. turn the slide to the other side and apply developing solution, C. and wait for results.

Documentation

When collecting a stool specimen, there are some things you should report to the healthcare provider, like:
  • if the client reports difficulty passing stool
  • excessive flatus or bloating
  • fecal incontinence between bowel movements
  • any other change in their bowel habits, like constipation or diarrhea
  • any abnormalities in the stool, like blood or mucus

These findings need to be documented after reporting. Also document:
  • date and time you collected the stool specimen
  • general quality, the amount, and the color of the stool
  • occult blood test results, if this test was performed
  • whether the specimen was transported to the laboratory right away or stored until the scheduled pickup time