42. CCA Study Notes: Stool Specimen Collection and Testing for Blood

The Big Picture

A stool specimen is a small sample of bowel waste collected for testing. Stool tests help check for blood and other abnormal contents.

The sample must stay free from urine and toilet tissue because these can affect test results. Some stool specimens must also reach the laboratory right away.

Testing may look for blood that you can see or blood that is hidden. Careful collection, correct handling, privacy, safety, and accurate reporting all matter.

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Course Notes: Key Ideas You Need to Know

What Is a Stool Specimen?

Feces are the semi-solid waste products found in the colon. Stool means feces after the body excretes them.

A stool specimen is collected so the stool can be analyzed. Testing may look for:

• blood
• fat
• microbes
• parasites, including worms
• other abnormal contents

When internal bleeding is suspected, stool may be checked for blood.

The general guidelines for collecting stool specimens are the same as those used for urine specimens. Follow Standard Practices.

Protect the Specimen From Contamination

The stool specimen must not contain urine.

Some tests require a warm, fresh stool. For these tests, take the specimen to the laboratory immediately.

Toilet tissue must also stay out of the stool collection container, bedpan, commode, or specimen pan because tissue can change specimen results.

Blood in Stool

Blood may appear in stool for several reasons, including:

• ulcers
• colon cancer
• hemorrhoids

Hemorrhoids are swollen veins in the anal canal.

Sometimes blood is easy to see. The colour of the blood or stool is important when reporting what you observe.

Bright Red Blood

Bright red blood can occur with hemorrhoids or cuts and abrasions around the anal area.

Bright red blood can usually be seen when bleeding occurs low in the gastrointestinal, or GI, tract.

Melena

Melena means dark, tarry stool containing decomposing blood.

Stool becomes black and tarry when bleeding occurs in the stomach or upper GI tract.

When reporting blood in stool, describe its colour. The colour may help when the source of the bleeding is being investigated.

Occult Blood

Some bleeding happens in amounts too small to see by looking at the stool.

Occult blood means hidden or unseen blood.

Stool testing can detect occult blood. This type of testing is often used to screen for colon cancer.

Factors That Affect Blood Test Results

Many different stool blood tests are available.

Follow:

• the manufacturer’s directions for the ordered test
• Standard Practices
• the care plan
• the assignment sheet

The care plan and assignment sheet tell you when to collect the specimen.

Some factors can affect test results. For example, the client cannot eat red meat for 3 days before the test.

Bleeding from hemorrhoids can also affect the result. Menstrual bleeding can affect the result as well.

Client-Centred Care During Collection

Support the client’s quality of life throughout the procedure by promoting:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Collecting a Stool Specimen

The order of the procedure matters. Follow each step carefully.

Pre-Procedure

1. Identify the client according to employer policy. Correct identification prevents one client from being mistaken for another.
2. Explain the procedure to the client.
3. Perform hand hygiene.
4. Gather the required supplies:
   • bedpan and cover or bedside commode
   • urinal, or a bedpan with a cover, for voiding
   • specimen pan for the toilet or commode
   • correct specimen container and lid for the ordered test
   • stabilizing fluid ⓘ when the ordered test requires it
   • tongue blade
   • disposable bag
   • gloves
   • toilet tissue
   • laboratory requisition slip
   • plastic bag

   Gathering supplies before starting helps prevent leaving the client to retrieve forgotten equipment.

5. Label the specimen container.
6. Provide privacy.

Procedure

7. If the client uses the bathroom, make sure the client wears a robe and nonskid footwear. If the client does not use the bathroom, assist the client onto a bedpan or commode.
8. Ask the client to void ⓘ first. Provide a bedpan, commode, or urinal when needed. Empty and clean the device. Wear gloves. Urine can interfere with test results, and feces can spread pathogens.
9. If the client uses the bathroom, place the specimen pan under the toilet seat. The stool will be collected from this pan.
10. Tell the client not to put toilet tissue into the bedpan, commode, or specimen pan. Give the client a disposable bag for used toilet tissue.
11. In facilities, place the call bell and toilet tissue within the client’s reach. Raise or lower bed rails according to the care plan.
12. Perform hand hygiene. Leave the room if it is safe to do so, but stay within hearing distance so you can hear if the client asks for help.
13. Return when the client calls. Knock before entering. Perform hand hygiene.
14. Lower the bed rail nearest you if it is raised. This reduces your risk of back strain.
15. Put on gloves. Provide perineal care if needed.
16. Use a tongue blade to collect about 30 mL, or 2 tablespoons, of feces. Place the stool into the specimen container.
    • For formed stool, take the sample from the middle.
    • If employer policy requires it, collect stool from two different areas of the specimen.
17. Put the lid on the specimen container. Do not touch the inside of the container or lid. Place the closed container inside the plastic bag to help prevent accidental spills.
18. Wrap the tongue blade in toilet tissue. Dispose of it according to employer policy. Proper disposal decreases the risk of spreading pathogens.
19. Empty, clean, and disinfect the equipment according to agency policies.
20. Remove your gloves. Perform hand hygiene.
21. Return equipment to its proper place.
22. Assist the client with handwashing. Wear gloves if needed.

Post-Procedure

23. Make sure the client is safe and comfortable.
24. Place the call bell within reach when applicable.
25. Return the bed to its lowest position. Follow the care plan for bed rail use.
26. Remove the privacy measures.
27. Follow your supervisor’s instructions for storing and transporting the specimen.
28. Perform hand hygiene.

Report and Record

Report and record your actions and observations according to employer policy.

Reporting and recording are required for legal reasons and help keep the rest of the health care team informed.

Some steps marked for facility use, including certain call-bell and bed-rail steps, may not apply in community settings.