I observed the collection of a nasal specimen for the Corona virus on television yesterday and was disturbed to see that the swab was inserted about 6 to 8 cm in the nose, causing pain. There are guidelines available on the internet that state that oro-pharyngeal specimen swabs need to be inserted approximately from the outside of the nostril to where the opening of the nose is. In this case, it would only be acceptable for a nasal swab (at this depth) on a cadava and when done by a coroner during an autopsy. Nasal swabs can be taken as a dry viral swab or with a swab which is broken off into a vial of transport medium (depending on what the laboratory requires). A nasal swab is taken by inserting it around 1.5 cm and 2.5 cm in a gentle sweeping action around the nare. The same swab can be used to repeat on the other nare, or separate swabs can be taken. The oro - pharyngeal swab is taken by gently rolling the swab down the back of the mouth (not the throat) adjacent to the molars/epiglottis and repeated on the other side. If three swabs are required, similar results can be acquired from 2 nasal and one oro-pharyngeal or one nasal and 2 oro-pharyngeal. The nasal swabs usually cause the patient to flinch because the mucous membranes are often inflamed and sensitive from the virus. It shouldn't be painful. The deep nasal swabbing technique shown on television disturbs me because it seems extreme and unnecessarily uncomfortable when patients may already be feeling ill. There is also no reason why the patient couldn't be given alcohol rub for their hands and insert the nasal swab themselves (with a glove if available). This is not the dark ages. A naso-pharyngeal swab would be performed with an endotracheal tube, and is usually collected from suctioned secretions.
