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Obtain A Nasopharyngeal Swab

Summarized by PlexPage
Last Updated: 02 July 2021

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General | Latest Info

Nasopharyngeal swabs are specifically manufactured to have long, flexible shafts made of plastic or metal and tips made of polyester, rayon, or flock nylon. In addition to nasopharyngeal swabs, you will need personal protective equipment, including a gown, nonsterile gloves, protective mask, and face shield, as described below. Make sure that all sample tubes have been labelled and that appropriate requisition forms have been filled out before starting the procedure. It is essential that you follow pertinent respiratory and contact precautions specified by the Centers for Disease Control and Prevention and by your own institution and that you put on PPE correctly. If possible, you should put on and take off PPE in presence of an observer to make sure there are no breaks in technique that may pose risk of contamination. First, put on a protective gown, wash your hands with soap and water, and put on a pair of nonsterile gloves. Then put on protective mask with a rating of N95 or higher, as recommended by CDC. Finally, put on face shield for face and eye protection. Masks are recommended for all patients suspected of having Covid-19. Ask patient to take off her mask and blow her nose into tissue to clear excess secretions from nasal passages. Remove swab from packaging. Tilt patients head back slightly, so that nasal passages become more accessible. Ask the patient to close her eyes to lessen mild discomfort of procedure. Gently insert swab along the nasal septum, just above the floor of nasal passage, to the nasopharynx, until resistance is felt. Insert swab into nostril, parallel to palate. If you detect resistance to passage of swab, back off and try reinserting it at a different angle, closer to the floor of the nasal canal. Swab should reach a depth equal to the distance from nostrils to outer opening of ear. The CDC recommends leaving swab in place for several seconds to absorb secretions and then slowly removing swab while rotating it. Your institution may also recommend rotating swab in place several times before removing it. Ask the patient to reapply her mask. Open collection tube and insert swab into the tube. Break swab at groove and discard what remains of swab. Close labeled collection tube, wipe tube with surface-disinfectant wipe, and insert tube into open biohazard bag held by assistant. Depending on institutional practices, you may instead return the sample to its original packaging for transport. Follow CDC directions for direct processing of swab specimen or placement of swab in media with or without refrigeration.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

To the Editor

You will be asked to cough before the test begins and then tilt your head back. Sterile cotton-tipped swab is gently passes through the nostril and into the nasopharynx. This is part of the pharynx that covers the roof of the mouth. The swab is quickly rotated and remove. A sample is sent to the laboratory. There, it is place in special dish. It is then watched to see if bacteria or other disease-causing organisms grow. Melio FR. Upper respiratory tract infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9 ed. Philadelphia, PA: Elsevier; 2018: chap 65. Patel R. Clinician and microbiology laboratory: test ordering, specimen collection, and result interpretation. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9 ed. Philadelphia, PA: Elsevier; 2020: chap 16.


How is the test done?

When and how often laboratory tests are done may depend on many factors. Timing of laboratory tests may rely on results or completion of other tests, procedures, or treatments. Lab tests may be performed immediately in an emergency, or tests may be delayed as condition is treated or monitor. A test may be suggested or become necessary when certain signs or symptoms appear. Due to changes in the way your body naturally functions through the course of day, lab tests may need to be performed at a certain time of day. If you have prepared for test by changing your food or fluid intake, lab tests may be time in accordance with those changes. Timing of tests may be based on increased and decreased levels of medications, drugs or other substances in the body. The age or gender of the person being tested may affect when and how often lab test is require. Chronic or progressive conditions may need ongoing monitoring through use of lab tests. Conditions that worsen and improve may also need frequent monitoring. Certain tests may be repeated to obtain a series of results, or tests may need to be repeated to confirm or disprove results. Timing and frequency of lab tests may vary if they are performed for professional or legal reasons.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

5. Discussion

Youve probably heard few friends describe their experiences receiving nasal swab. Some friends may go on about some discomfort while others dismissively say it was no big deal. Theyre both telling the truth. These samples can be collected from varying depths of the nose, says Dr. Mochon. Some swabs are designed to collect samples from the nasal walls of your nostril while others are collected from deeper in your nasal cavity. Samples can also be collected from the back of the throat, otherwise know as oropharyngeal swab. All swabs are looking for the same thing-respiratory secretions and infected cells. So why isnt everyone just choosing the most comfortable method? Dr. Mochon explained that samples pulled from deeper in nasopharynx have proven to have higher viral concentration or titer. In other words, you are more likely to obtain more accurate diagnosis when sampling with nasopharyngeal swabs than you are with nasal or throat swab. For this reason, nasopharyngeal swab has been standard for reliable testing. Of course, there is still a place for collecting samples from the nose or throat, says Dr. Mochon. Obviously, they are more comfortable, but they can also be a safer method for patients who have nasal conditions, such as chronic nose bleeds and nasal polyps. If you suffer from one of these conditions, you should speak with your provider about what sample type will best meet your needs, but, when possible, nasopharyngeal samples should be the primary method of collection.


How is the test done?

Nasopharyngeal swab, aspirate, or wash is done to collect cell samples from the upper part of your nose and throat. For nasopharyngeal swab, you will be asked to tilt your head back. The person doing the test will use a special kind of swab and insert it into one of your nostrils. The swab will rotate gently and then remain still for a few seconds before it is remove. This is to allow swab to collect large enough samples to be test. This process will be repeated in the second nostril. For aspirate or wash, healthcare worker will use a syringe to push a small amount of sterile saline into your nose, then either apply gentle suction or use gravity to collect the resulting fluid into a cup. The sample is then sent to the lab for testing.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Introduction

SARS-CoV-2, virus that cause COVID-19, represents a once-in-alifetime global threat. In a matter of 4 months, virus spread from Wuhan, China, to nearly 95% of all countries in the world. As of mid-April, there were more than 2 million confirmed cases with more than 134 000 deaths worldwide. 1 This exponential growth is partially explained by its transmission during presymptomatic or mildly symptomatic phases of illness. 2 this rapid unknown transmission threatens to overwhelm health systems as has already been seen in locations within China, Italy, Spain, and the United States. Currently there are no known effective pharmaceutical treatments for illness, forcing hospitals to rely on routine supportive care. Governments across the globe have instituted a number of limitations on movement and encouraged social distancing to help limit spread. Countries, after crossing peak transmission of virus, are beginning to slowly lift these restrictions; However, to do this safely there is a need for widespread testing. Unfortunately, dominant method of testing, reverse transcription polymerase chain reaction, has been shown to only have specificity as low as 70%. 3 Additionally, anatomical site with the highest yield for testing is the nasopharynx. 4 swabbing nasopharynx is performed by palpation alone without any direct visualization. From the perspective of otolaryngologists who perform multiple nasal endoscopies on a daily basis, we would contend this is the most challenging aspect of procedure. Incorrectly performing nasopharyngeal swab can lead to increased false-negative rate, giving patients and clinicians a false sense of security. In light of the tremendous number of health care workers who will need to be involved in deployment of these tests and their varying degrees of familiarity with nasal anatomy, we believe it is useful to provide guidelines on proper technique and common challenges. To our knowledge, none of the current articles or videos describe actual landmarks, measurements, challenges, and solutions in passing swab through nasal cavity to reach the nasopharynx. Our objective is to not only provide this information but also unique graphic handout, which can serve as quick reference when performing procedure.


Results

We processed 163 samples for 16S rRNA gene amplicon sequencing. We were able to recover on average > 16 000 sequences per sample, accounting for a total of 2 646 OTUs. When rarefied to10 000 sequences per sample in order to capture most of samples and normalize depth of coverage, rarefaction curves indicate that NP swabs and sequencing depth adequately sample microbial species richness. As expect, when more sequences are analyzed per sample, lines start to plateau. This indicates that even though more sequences were analyze, few new species were detect. Furthermore, no significant difference was observed in species richness after the partition protocol was adopt.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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