How to Conduct a Rape Kit Exam

Although they vary in content based on jurisdiction, rape kits typically contain items required to collect and preserve evidence from a sexual assault victim. To conduct a rape kit exam, medical personnel should be highly trained and qualified in collecting forensic evidence. A rape kit is a legal procedure and the crime lab's forensic scientists thoroughly analyze its contents for use during trial.

Difficulty: Challenging

Instructions

Things You'll Need:

• Rape kit
• Examining table paper
• Latex gloves
• Paper bags
• Camera
• Documentation forms
• Wood's lamp
• Cotton swabs
• Saline
• Comb
• Speculum
• Aspirator
• Slides
• Microscope
• Cotton-tip swabs

1. Ask your patient to disrobe over a large piece of examination table paper. This paper catches all falling hair, fibers or debris. Make sure only the patient handles her clothing to avoid contamination. With latex gloves on, place all clothes in paper bags, seal and label.

2. Evaluate your patient for any bruises, lacerations or abrasions. You must photograph any findings and describe in detail on rape kit forms.

3. Examine with a Wood's lamp the inner thigh and perineal area to detect semen stains. Swab fluorescent areas with cotton swabs moistened with saline and then comb your patient's pubic hair over a clean sheet of paper to collect any trace evidence. Most rape kits include a sterile comb. Place the comb, sheet and pubic hair clippings in a paper bag before sealing and labeling the bag.

4. Perform a vaginal examination with a water-lubricated speculum. Other lubricants could taint evidence. Note the condition of the hymen, cervix and vaginal walls for any abrasions. Aspirate or collect on cotton swabs vaginal secretions.

5. Suspend some of your aspiration in warm saline for a wet-mount sperm exam. Document any motile sperm on the slide, noting their motility and number per microscopic high power field.

6. Preserve on slides the remaining vaginal aspirate, which forensic scientists use to determine the presence of acid phosphatase. If present, this enzyme indicates recent coitus. Detect the presence of p30, a semen-specific marker, if seminal fluid is scarce. A plasma glycoprotein produced in the prostate gland, p30 indicates coitus within 48 hours.

7. Obtain swabs, using long cotton tip applicators, from your patient's mouth and anus if oral or anal penetration occurred. These detect the presence of sperm or acid phosphatase.

Tips & Warnings

• You must have consent from the victim to conduct a rape kit exam. You should conduct the rape kit exam within 72 hours of sexual assault to preserve evidence.
• Always use sterile equipment and collection items.
• You must keep the rape kit secure at all times to preserve the chain of evidence. You must constantly supervise the kit, so that any evidence goes from the victim to you to law enforcement.
• The physician, nurse, lab technician and law enforcement officer must document every step of evidence collection and handling to ensure proper legal procedures for trial.
• Be sure to scrape under your patient's fingernails for any traces of the attacker's skin or blood.
• Never place clothing or other evidence in plastic bags, as plastic encourages bacteria growth on blood stains and seminal fluid.

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