DIAGNOSTIC PROCEDURES

 CHEST RADIOGRAPHY (CHEST X-RAY) X-ray of Chest and Bony Thorax

The chest x-ray is a common procedure used to demonstrate the appearance of lungs,
mediastinum, bony thorax, diaphragm, chest wall, cardiac silhouette, and thyroid gland.

Indications
• Evaluate suspected pulmonary or cardiac disease and trauma to chest.
• Determine the location of chest tubes, feeding tubes, or subclavian catheters.
• Follow the progress of disease, such as TB.
• Check for pneumothorax after bronchoscopy and following biopsy.

Reference Values
Normal
• Normal appearing and normally positioned chest, bony thorax, soft tissues,
mediastinum, lungs, pleura, heart, and aortic arch. Interfering Factors
• Optimal chest x-ray films require the patient to be in an upright position to reveal fluid
levels. Inability to hold the breath and take a deep inspiration may affect image quality.
• Obesity, pain, congestive heart failure, and scarring of lung tissues may affect
breathing and should be considered when evaluating x-rays.

Procedure
• Clothing is removed to the waist. X-rays can penetrate through a hospital gown that
does not contain any buttons, pins, metal snaps, or jewelry.
• Generally, two views of the chest are taken with the patient in an upright position.
Sustained full inspiration is required during the x-ray procedure. The procedure takes
only a few minutes.

 BLOOD CULTURE Blood Infection

Normally, blood is considered sterile. A blood culture is done to identify the specific
aerobic or anaerobic microorganism that is causing a clinical infection. Ideally, two to three
cultures (1 hour apart) are adequate to identify bacteria causing septicemia.

Indications
• Evaluate for bacteremia, septicemia, meningitis, and endocarditis in debilitated
patients receiving antibiotics, steroids, or immunosuppressants.
• Investigate unexplained postoperative shock, chills, hyperventilation, and fever of
more than several days’duration (eg, UTIs, infected burns, sepsis).
Reference Values
Normal
• Negative cultures for pathogens; no growth after 5–7 days.
Clinical Implications
• Positive cultures and identification of pathogens, the most common of which are
Staphylococcus aureus, Escherichia coli, Enterococcus (Streptococcus D), Streptococcus
pneumoniae, Klebsiella pneumoniae, Corynebacteria group JK, and anaerobes
(Bacteroides sp., Clostridium sp., Peptostreptococcus, and Actinomyces israeli),
Streptococcus pyogenes (StreptococcusA), Pseudomonas, and Candida albicans.
Interfering Factors
• Contamination of the specimen by skin bacteria.
• Transient bacteremia caused by teeth brushing or bowel movements.

Procedure
• Using the appropriate tube, blood (20–30 mL) is obtained by venipuncture using
careful skin preparation and antiseptic techniques following the specimen collection
guidelines.
• Scrub the puncture site with Betadine (povidone-iodine solution), allow to dry, and
then clean the area with 70% alcohol.
• Collect two to three cultures at least 30 to 60 minutes apart (if possible) per 24-hour
period.
• In iodine-sensitive patients, a double-alcohol, green soap or acetonealcohol prep may
be used.

 SPUTUM CULTURE
Sputum, Infection
Sputum specimens are examined to identify organisms causing a respiratory illness.
Pertinent symptoms include cough with sputum production, fever, chest pain, and shortness of
breath.

Indications
• Diagnose disease of the lower respiratory tract.
• Determine antibiotic or drug sensitivity and course of treatment and evaluate
effectiveness of therapy or medication.

Reference Values
Normal
• Negative culture for pathogenic organisms.
Clinical Implications
• Pathogens indicative of tuberculosis, fungal infections, and causing pneumonia,
bronchitis, and bronchiectasis.
 • Possible organisms are group A Streptococcus, Streptococcus pneumoniae, species of
Enterobacteriaceae, Staphylococcus aureus, Mycobacterium sp., and Legionella sp.
Interfering Factors
• Antibiotics may cause false-negative cultures or may delay growth of organisms.
• Unsatisfactory sputum samples: contaminated specimens or “dry” specimens.

Procedure
• Instruct the patient to provide a deep-coughed specimen into a sterile container (1–3
mL is generally sufficient).
• If the patient is unable to expectorate a satisfactory specimen, ultrasonic nebulization,
chest physiotherapy, nasotracheal or tracheal suctioning, or bronchoscopy can be used.
• The best sputum specimens are collected in the early morning.