• Nasopharyngeal wash in sterile container or nasopharyngeal swab
• Collect nasopharyngeal swab with Amies, Charcoal, Dacron or cotton swab. (B. Pertussis culture must be submitted on separate Charcoal swab if ordered.) DO NOT USE swabs made with wooden sticks.
• Swabs are available from NPHL. See following collection procedure.
• Transport to lab dry, refrigerated.

Washing:

• Cut off the distal end of the butterfly catheter (needle and butterfly) catheter extension set so that about 2-3 inches of tubing are left attached to the hub.
• Draw up 2-3 mL of saline into a syringe.
• Attach syringe to hub of butterfly catheter. Purge tubing with saline.
• Put on gloves, gown, mask and eye protection.
• Gently remove excess mucous from patient's nose. (If patient is an adult, ask the patient to gently blow nose. For pediatrics, a bulb syringe may be used to remove excess mucous.)
• Position patient in supine position with the head of bed up 30°. The head should be turned to one side and tilted slightly backward.
• Stabilize the patient's head and gently place the catheter into the nare. Placement should be in the nare (nasal wall), not the nasopharynx. Depending on the size of the patient, this should be about 1-2 cm in adults and 0.5 cm to 1.0 cm in children (0.5 cm in neonates). See Figure 1.

      Figure1.

• Instill .5 - 2 mls saline (.5 - 1 mls for infants and children, 1 - 2 mls for adults) into the nare and aspirate back mucous, saline and epithelial cells.
• Repeat this process using the same syringe until the sample is cloudy or appears to hold cellular debris. (If the sample is inadequate, the process may be repeated on the opposite nare, using a second sterile syringe and tubing. Usually one nare is sufficient.)
  • NOTE: There may be some blood streaks in the mucous. This is normal and patients/parents should be told this is expected and will stop in a few minutes.
• Transfer contents of tubing and syringe into transport media using the following process: Depress syringe plunger and express fluid from syringe and tubing into transport media. Then withdraw media/fluid back into syringe and tubing. Depress syringe plunger again, expressing fluid from syringe and tubing back into transport media.
  • NOTE: This is necessary to recover any cells adhering to the tubing or syringe.

Nasal Swab:

• Insert a mini-tip culturette swab into the same nares from which the wash was performed approximately 3 cm and gently rub the mucosa.
• Place the swab back into transport media containing aspirated material.
• See Figure 2.
• NOTE: Combining the aspirate and the swab enhances recovery and reduces cost to the patient.
• Deliver entire specimen to the lab immediately.