During the Test

How do I collect breath samples?

Take a normal breath in (not a deep breath). Blow out through the mouthpiece attached to the blue bag. During your exhale, push the vacuum-sealed test-tube onto the needle collection device. Leave it on for about 1-2 seconds. Pull the tube off of the needle while still exhaling. When the tube is off the needle, you can stop breathing out into the mouthpiece.

Common sample collection errors and their corrections

• Putting the tube on the needle before breathing into the collection device.
  This is the most common sampling error leading to QNS samples.
  Reason: Room air has contaminated the sample.
  Correct collection method: Make sure you are breathing out before you puncture the tube with the collection device needle. Once you put the tube on mid-exhalation, hold the tube in place for two seconds and then remove it before your breath is complete.

• Taking a very big inhalation before the sample.
  Reason: Room air has contaminated the sample.
  Correct collection method: Make sure to take a normal breath in, as you would in normal breathing.

• Putting the tube on the needle at the beginning of the exhalation instead of mid-exhalation.
  Reason: If you put the tube on early, the air in the tube will be air from your trachea, but we want to wait until mid-exhalation to capture the air from your lungs.
  Correct collection method: Put the tube on mid-exhalation, hold the tube in place for two seconds, and then remove it before your breath is complete.

• Puncturing the tube more than once.
  Reason: This may cause the sample to leak out of the tube before it can be analyzed.
  Correct collection method: Only puncture the tube once. If a tube is mistakenly punctured twice, please still submit the tube for analysis as the sample may still be valid.

This test is for someone who weighs less than 100 pounds. Any special instructions?

The blue collection bag has marks on it where people who weigh less than 100 pounds can roll the bag to their weight and staple it in place. This is to make sure that we are collecting air from the appropriate part of the patient’s lungs, even on smaller patients.

The blue collection bag has some little holes in it. Is that normal?

If there are small holes in the bag, they are supposed to be there. Do not try to cover them with tape or poke other holes in it. This is part of how the test materials are supposed to be.

Why do some tubes look punctured or have a bump on the top?

The manufacturing of the tubes makes it so some look like the rubber stopper goes inward, and some look like it bubbles outward. Both are normal and are completely based on the way the tube is made. Also, it can sometimes look like the tube has been punctured. This is part of how it is created as a vacuum (so it will draw in the air you breathe out through the needle collection device) and does not alter your test at all.

The plastic thing with the needle inside came off the mouthpiece. What do I do?

Just press it back into place. If it continues to be an issue, you can hold it in place during the tube collections.

Do I take the grey rubber sheath off the needle?

No. The grey sheath is there for 2 reasons. The first is that it prevents an open needle from contacting the tubes and possibly poking anyone who accidentally touches it. The second is that the rubber sheath is compressed down when the tube is placed on, and the needle stabs through both it and the rubber of the tube. This creates a type of seal so the air being drawn into the vacuum-sealed tube does not try to leak out around the puncture site. If the grey sheath is removed, the sample may be invalidated, which may mean the patient must do the test all over again.

Can I see my breath inside the tube?

No. A tube with collected air inside of it will look just like the ones that have not been used. Be sure to label tubes carefully to not mix them up.

How do I mix the drink?

Pour the liquid solution from the kit into 8 ounces of water. Either shake or stir. Patients who weigh more than 25 pounds will use all 15 mL of the liquid (10 grams of lactulose). The test was not intended for use by patients weighing less than 25 pounds. (For patients less than 25 pounds, contact your physician to discuss what kind of test is appropriate for you).

How long should I take to drink the solution?

It should take less than 5 minutes to drink the lactulose solution. Once you are done with the last drop, write the time on the Patient Record. Start a 20 minute timer.

I think I messed up the first sample. Is the test ruined?

No. If you somehow messed up the first test tube, and you have not begun to drink the lactulose solution, just discard the messed up tube and start a new one. Write on the patient record what happened and skip the 10th tube in the kit. The last tube is less important than the first few.

I did my second sample right after drinking the solution. Is the test ruined?

No. Write on the patient record what happened and discard the tube taken right after drinking the solution. This will end up skipping the 10th tube in the kit, which is not a problem. The last tube is less important than the first few.

I think I messed up a later sample. What do I do?

If you somehow messed up a test tube, just discard the messed up tube and start a new one. Write on the patient record what happened and skip the 10th tube in the kit. The last tube is less important than the first few.

I drank the solution before taking the baseline, then remembered and took the first tube right away. Is the test ruined?

No. Write on the patient record what happened when sending us back the kit. If the sample is taken right after drinking the solution, it likely hasn’t hit your digestive system yet. We will run the sample and just note what occurred on the final report. Your doctor has to be the one to interpret the results appropriately.

I missed an alarm and have a sample that is 24 minutes from the previous sample. Is the next one 20 minutes from that?

No. The samples are every 20 minutes from when the solution was finished, not from the previous sample. So if you end up running late for a sample, do not continue lengthening the time between samples. For example, if the the fourth tube is at 65 minutes, make sure the sixth tube is still at 80 minutes, not 85 minutes. This can change the whole outcome of your test. Sometimes it can help to set the alarms ahead of time so it is one less thing to worry about during the test itself.

The lactulose solution is making me feel terrible. Is that normal?

If SIBO bacteria are present, they will be fermenting the lactulose that you drank. Sometimes, they can cause the same kind of symptoms that would make you need to take a SIBO test in the first place (like bloating, gas), but some people do not experience anything at all. Lactulose is also used as a laxative, so some people may experience effects of needing to use the restroom during the test.

Is vomiting after drinking the lactulose solution a common occurrence?

No, vomiting is unlikely to occur after consuming the lactulose. Young children may be more apt to vomit, but vomiting isn’t a reaction in all children.

I vomited after drinking the solution. What do I do now?

If vomiting occurs early in the test, there may not be enough lactulose solution passed into the small intestine. This may cause a false-negative result. You should contact your ordering physician right away to tell them of your symptoms and see if they want to repeat the test. This would have to be decided by your physician and not the lab staff.

If vomiting happens later in the test (beyond 60 minutes), please note that on the Patient Record. At this point, there should be enough of the solution in your small intestine to create a reaction if the SIBO bacteria are present.

What do I need on the label?

After each sample is taken, make sure the tube is labeled with your name, the date of the test, the time the sample was taken, and the tube number that corresponds to the number on the Patient Record sheet included in the kit.

What do I write on the Patient Record?

On the form that is included in your kit, make sure that your name and date of birth are on it. Write the date the test was taken and the times each sample was taken. You only need to mark on the bottom of the sheet if you vomited after drinking the lactulose solution, so we know what time it occurred during your test. Any symptoms you experience during the test should be reported to the ordering physician. Please DO NOT write in the white squares next to the time the samples were taken. This area is for lab use only.

I have finished the test. How do I send it back in?

Each kit contains 2 bubble wrapped pouches to put tubes in to send them back to us. In the lab, we only need the bubble-wrapped tubes and the Patient Record form. There is no need to send in your collection device. If your kit was shipped to you from NUNM, it contains a label to ship it back to us using any USPS post box. If your kit came from another source, you can use either USPS or any other shipping company to send it to us. The address is listed on the Patient Record Form, (NUNM SIBO Lab, 3025 SW Corbett Ave, Portland, OR 97201). If you live in the Portland Oregon area and would like to drop off your finished test at our lab, you are welcome to leave it at the clinic laboratory (same address) any time the lab is open.