Coronavirus — COVID-19 Testing — Clinical Pathway

Specimen Collection Procedure for COVID-19

Patients with no Tracheostomy or ETT: Obtain Upper Airway Specimens

Bedside RN or RT performs this procedure using Modified Precautions

Patient Characteristics	Specimen	Comments
No Tracheostomy or ETT	Obtain NP aspirate via leukens OR NP swab using COVID-19 PCR testing kit Obtain RRP if patient has symptoms	Modified Precautions Do not obtain an oropharyngeal specimen or induce sputum sample Hand carry specimen to lab at room temperature immediately

Additional Information from Online Lab Services Directory

Patients with Tracheostomy, ETT

The RT performs the tracheal aspirate, RN or RT will perform the NP swab as described above

Asymptomatic Patients

Obtain an upper airway specimen only, no lower airway specimen is required

Symptomatic Patients

Obtain an upper and lower airway specimen
The RT performs the tracheal aspirate, RN or RT will perform the NP swab as described above
Having upper and lower airway specimens assists with clearance from active infection

Children with a Tracheostomy or ETT	Obtain NP aspirate via leukens OR NP swab using COVID-19 PCR testing kit Obtain RRP if patient has symptoms	Modified Precautions Do not obtain an oropharyngeal specimen or induce sputum sample Hand carry specimen to lab at room temperature immediately
Children with a Tracheostomy or ETT	Tracheal aspirate or BAL	See below for precautions

Specific Considerations to Collection of Specimens from Patients with Tracheostomy or Endotracheal Tubes

Patient Characteristics	Specimen/Comments
Patient with existing closed suction catheter AND No respiratory bacterial is required	Modified Precautions Obtain specimen in a leukens trap using the existing in-line catheter after clearing the closed suction catheter with 6 mL of saline Obtain RRP if patient has symptoms
Patient does not have closed suction catheter OR A respiratory bacterial is required	Expanded Precautions Place or replace the existing closed suction catheter Obtain the specimen in a leukens trap using the new in-line catheter Obtain RRP if patient has symptoms Hand carry specimen to lab at room temperature immediately

Additional Information from Online Lab Services Directory

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.