# Oro/Nasopharyngeal Swabbing

## Overview

This module describes how to swab the oropharynx or nasopharynx.

## Indications

1. Testing for upper respiratory tract infections

## Contraindications

1. None

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to check for infections in your nose or throat by taking a swab of the back of your throat through your mouth/nose. We will send this swab to the lab for testing.”

### What can my patient expect?

“The swab looks like a long earbud. I will touch it to your tonsils and the back of your throat, OR the back of your nose. You may feel like gagging, OR it may burn a bit, but it will be more uncomfortable than painful.”

### What is my patient’s role?

“Keep your mouth open and relax your tongue. Try not to move while I take the specimen.”

## Preparation

###

### Documentation

1. Patient notes

2. Patient labels

3. Laboratory request form

### Equipment

1. Any PPE required

2. Alcohol-based hand rub

3. Sterile pharyngeal swab

4. Tongue depressor

## Site & Positioning

Position the patient seated, preferably with their head against a headrest and tilted slightly backwards.

## Procedure

Follow medical asepsis with appropriate PPE.

1. Perform hand hygiene.

2. Label the swabs with patient labels.

### Oropharyngeal swab

1. Push down the tongue gently with the tongue depressor.

2. Take care not to touch the teeth, tongue, or palate with the swab.

3. Roll the swab on the tonsils and oropharynx.

4. Withdraw the swab.

### Nasopharyngeal swab

1. Ask the patient to blow out any excess secretions from the nose.

2. Choose the more open nostril.

3. Estimate the insertion depth by placing the unopened swab against the cheek to measure from the corner of the nose to the tip of the ear. You will insert the swab half to two-thirds of this distance.

4. Insert the swab

   horizontally
   horizontally

   Do not insert 'upwards'.

   along the floor of the nasal cavity and along the medial septum until you meet resistance, about 8 cm deep.

5. Roll the swab gently and leave it for a few seconds to absorb secretions.

6. Withdraw the swab. It is not necessary to swab both nostrils if the swab is well soaked.

7. Dispose of medical waste safely.

8. Label and complete the laboratory request forms. Document whether oropharyngeal or nasopharyngeal swab.

9. Record the completion of the procedure in patient notes.

## Troubleshooting

I am meeting resistance before my swab is inserted to the estimated depth.

Make sure you are advancing in the horizontal plane and not upwards. Rotate the swab and try to advance again. If unsuccessful, try the other nostril.

## Risks

1. Gagging or vomiting

2. Splash injury or exposure to infectious substances

## References

1. Kenny P. How to Examine the Mouth and Throat. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 145-146.

2. Mehta V. How To Swab a Throat for Testing. In: MSD Manual. 2020. Available from: https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/how-to-do-throat-procedures/how-to-swab-a-throat-for-testing

3. Pondaven-Letourmy S, Alvin F, Boumghit Y, Simon F. How to perform a nasopharyngeal swab in adults and children in the COVID-19 era. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(4):325-327. doi:10.1016/j.anorl.2020.06.001.

4. Petruzzi G, De Virgilio A, Pichi B, et al. COVID-19: Nasal and oropharyngeal swab. Head Neck. 2020;42(6):1303-1304. doi:10.1002/hed.26212.