Dr. Aleta Bonner of Dell Children's Hospital in Austin, TX introduces and demonstrates nasopharyngeal specimen collection using Copan's flocked swabs.
Dr. Aleta Bonner
00:44I'm Dr. Aleta Bonner. I'm a pediatric emergency medicine physician who also does a lot of point of care research and I work at the Dell Children's medical center in central Texas in Austin Texas. I specialize in pediatric emergency medicine. I also do a lot of point of care testing research in children and adults. I'm here today to help produce a video to help train people how to do correct nasopharyngeal swabs. My expertise in point of care testing has had me obtain several thousand of these so I thought I would help impart a little bit of that knowledge and expertise to you today.
01:22 There are two different swabs today that we are going to feature. The first swab, these are both made by COPAN, they are the mini-tipped flocked swabs. You can see that there's a little fine kind of bristly end. I tell people that it's kind of analogous to the fuzzy part of a pipe cleaner. Some people don't know what a pipe cleaner is anymore. The top swab has a little thicker, less flexible shaft, the lower swab has a little longer portion of the narrow shaft and is more flexible.
02:15 I actually prefer the top swab more for collection both for children and adults because the top less flexible area actually lets me have better control of the swab. When I place it in and go under the anterior turbinates you can actually feel as we do the rotation that you're actually getting better control. Sometimes with this less flexible shaft, especially in lower kids that you’re only inserting at a small distance, there’s not as much control when you tend to have a little more flex in the swab shaft causing it not to pick up cells quite as well. So I typically prefer this shaft over the long one but both work equally well as far as picking up a sample.
03:30 One of the things to note when you insert the swab, is to go in a horizontal configuration due to the patients head. You can see how, with this diagram behind me. My swab is a pointer that you’re actually going horizontally. You’re not going vertically. You don’t want to insert this straight up into the narrow slot as you would normally think. The nasal passages are going to get under the anterior turbinates. You’re actually going to start at the very base of the nose and this little fleshy area. You’re going to go gently under that skin and you will feel the swab slide right into this area. If you do it correctly like this, the swab slides straight in and is of minimal discomfort for the patient. They’ll feel more of the tickling peck sensation, sometimes having just a bit of tearing from the eye on that side. This is not painful at all and you notice the key is that this swab is horizontal and not vertically filtered as I’m showing here and that’s the key.
04:26 So we’re going to go through a couple of steps and show you exactly how this is done. So we’re going to tell you that as far as protective wear and gear, some people will deck out in everything including a gown, gloves, mask, and eye shields. Typically, in my setting, the respiratory therapists, tech, doctors, nurses, we all just put on a pair of gloves. If we have concerns with the child or adult patient and more significant illnesses, something more contagious, like TB, then full precautions with all the body gear would be appropriate. But in the setting where you’re going to be doing nasopharyngeal swabs, typically, all you need are a pair of gloves. Some people may choose to also put on a little face shield or a mask if they feel like the kid might cough on them and cause them to catch illness but that’s more to protect you than anything.
05:25 As I’ve told you, I’ve collected several thousand nasopharyngeal swabs over the past several years doing point of care research, so for me, the depth of the insertion of a nasopharyngeal swab is very intuitive and I can do it almost with my eyes closed. But, I would recommend keeping them open. The depth of insertion is actually easily measured and there is a handy guide that COPAN supplies where you can look and see the measurement from the earlobe to the base of the nose right here where the flesh is. You would take that measurement and then divide it in two. So if you had four inches on the ruler, you would take and actually mark on your swab where two inches would be. So in this case, you would mark right about the junction of the thick portion of the swab narrowing down.
05:48 In the case of the adult on this particular swab, that works out perfectly. Unless every time for this junction to be corrected at the insertion with the child or the infant, you’re going to go a little less deep. So, measuring is often very...
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