If a routine urinalysis and a culture are requested on a catheterized specimen, then

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If a routine urinalysis and a culture are requested on a catheterized specimen, then

Urine Collection Procedure

URINE SPECIMENS
TYPES AND COLLECTION PROCEDURES

I. PRINCIPLE

Collection and transportation of urine specimens to the clinical laboratory are important because variables such as collection method, container, transportation, and storage affect the analysis outcome and consequently diagnostic and therapeutic decisions based on the results. Clinical staff are responsible for patient instruction, collection and labeling of urine specimens and timely

transportation of specimens to the Laboratory.

II. SPECIMEN REQUIREMENTS

A. Specimen types

1. Random specimen For chemical and microscopic examination, a voided specimen is usually more suitable. A randomly collected specimen may be collected at unspecified times and is often more convenient for the patient. A random specimen is suitable for

most screening purposes.

2. First morning specimen or 8-hour specimen The patient should be instructed to collect the specimen immediately upon rising from a night’s sleep. Other 8-hour periods may be used to accommodate insomniacs, night-shift workers, and in certain pediatric situations. The bladder is emptied before lying down and the specimen is collected on arising so that the urine collected only reflects the recumbent position. Any urine voided during

the night should be collected and pooled with the first morning voided specimen.

3. Fasting specimen This differs from a first morning specimen by being the second voided specimen

after a period of fasting.

4. 2-Hour postprandial specimen The patient should be instructed to void shortly before consuming a routine meal

and to collect a specimen 2 hours after eating.

5. 24-hour (or timed) specimen To obtain an accurately timed specimen, it is necessary to begin and end the collection period with an empty bladder. The following instructions for collecting a 24-hour specimen can be applied to any timed collection (consult test requirements to determine if a special preservative is required):

Day 1 – 7 AM: Patient voids and discards specimen. Patient collects all urine

for the next 24 hours.

Day 2 – 7 AM: Patient voids and adds this urine to the previously collected


urine.

6. Catheterized specimen This specimen is collected under sterile conditions by passing a hollow tube

through the urethra into the bladder.

7. Midstream “clean catch” specimen This specimen provides a safer, less traumatic method for obtaining urine for bacterial culture. It also offers a more representative and less contaminated specimen for microscopic analysis than the random specimen. Adequate cleansing materials and a sterile container must be provided for the patient. The procedure for the collection of a “clean catch” urine is described below in

section VI of this policy.

8. Suprapubic aspiration Urine may be collected by external introduction of a needle into the bladder. It

is free of extraneous contamination and may be used for cytologic examination.

9. Pediatric specimens This may be a sterile specimen obtained by catheterization or by suprapubic aspiration. The random specimen may be collected by attaching a soft, clear

plastic bag with adhesive to the general area of both boys and girls.

B. Transportation of specimens

Urine specimens should be delivered to the within 2 hours of collection or refrigerated
and transported to the lab as soon as possible.

III. REAGENTS AND SUPPLIES (for collection of “clean catch” specimens)

A. Disposable, clean, dry, leak-proof container (sterile container with lid required for
microbiological cultures)

B. Screw top specimen tube

C. Disposable gloves

D. Betadine swabs (Hibiclens if allergic to betadine)

E. Dry, clean gauze

F. Patient’s bedpan or urinal, if patient is unable to go the bathroom.

IV. CALIBRATION

No calibration is required for this procedure.

V. QUALITY CONTROL

Identification of the patient must be performed by asking a conscious patient his or her full name
and birthdate. Verify by checking the identification band if available.

VI. PROCEDURE

A. Patient preparation:

For FEMALE patients:

1. Wash hands thoroughly before beginning the procedure and put on disposable
gloves.

2. Use betadine swabs or Hibiclens to cleanse the perineal area.

a. Separate the folds of the labia and wipe the betadine swab or Hibiclens from front to back (anterior to posterior) on one side, then discard swab or towelette. b. Using a second betadine swab or Hibiclens, wipe the other side from front to back, then discard. c. Using a third betadine swab or Hibiclens, wipe down the middle from front to back, then discard. d. Pat dry periurethral area with clean dry gauze to remove excessive betadine

while keeping the labia separated.

For MALE patients:

1. Wash hands thoroughly before beginning the procedure and put on disposable
gloves.

2. If the patient is not circumcised, pull the foreskin back (retract the foreskin) on
the penis to clean and hold it back during urination.

3. Using a circular motion, clean the head of the penis with betadine swabs or
Hibiclens. Discard the swab or towelette.

B. Urination should begin, passing the first portion into the bedpan, urinal, or toilet.

C. After the flow of urine has started, the urine specimen container should be placed under the patient collecting the midportion (midstream “clean catch”) without contaminating the

container.

D. Any excess urine can pass into the bedpan, urinal, or toilet.

E. Cover the urine container immediately with the lid being careful not to touch the inside of
the container or the inside of the lid.

F. Transfer urine to specimen tube if tubes are used for transport instead of urine containers.

G. Attach label to tube or container and place specimen in the transport bag.

H. Remove gloves and wash hands.

I. Record date and time of collection and initials of the person collecting (or submitting) the specimen on the specimen container. Transport specimen to the Laboratory within 2

hours of collection or refrigerate and transport to the lab as soon as possible.

VII. CALCULATIONS

Not applicable.

VIII. REPORTING RESULTS

Not applicable.

IX. PROCEDURAL NOTES

Specimens submitted for routine urinalysis should be collected in clean, dry containers. The specimen may be random, first morning, fasting, 2-hour postprandial, 24-hour (or timed), catheterized, midstream, clean-catch, or suprapubic aspiration. The specimen should be submitted to the lab in a plastic screw-top transfer tube or specimen cup. Specimens submitted in syringes

will not be accepted by the laboratory.

The specimen containers must be properly labeled with appropriate patient identification including: name, medical record number, date of birth/age, the date and time of collection, and initials of the person collecting (or submitting) the sample Specimens should be submitted to the laboratory immediately. A specimen for urinalysis should be examined while fresh. Specimens left at room temperature will begin to decompose resulting in

chemical and microscopic changes.

A minimum of 12 ml of urine should be submitted for analysis. Smaller sample quantities will be analyzed but the statement “QNS FOR ACCURACY: < 5 ML SUBMITTED FOR ANALYSIS”

will accompany results of those specimens with volumes < 5 ml., e.g., babies or newborns.

SPECIMENS FOR PREGNANCY TESTING

First morning specimens are the best for pregnancy testing because the urine is more concentrated.

SPECIMENS FOR OSMOLALITY

No special sample preparation is required. Whole blood, serum, plasma, or urine may be used.

X. LIMITATIONS OF PROCEDURE

A. Specimens submitted in syringes will not be accepted. B. Specimens improperly labeled must be discarded and recollected. C. Urine osmolality cannot be collected with preservatives.

D. Urine samples leaking in the collection bag are unacceptable.

A routine urine culture detects the amount of germs (microorganisms like bacteria) present in the urine.

Once a urine sample is collected, a technician will keep it in conditions where microorganisms can multiply. Normally, no more than a small number of germs will be in the urine if there's no infection. If a larger number of germs are present, the technician will use a microscope or chemical tests to determine the specific types growing in the culture. The technician also may run tests to determine which medications will be most effective against the microorganism if the doctor diagnoses an infection.

Why It's Done

A urine culture is used to diagnose a urinary tract infection (UTI) and see what kinds of germs are causing it. The doctor may order a urine culture if your child:

  • complains of a painful sensation when peeing
  • feels the urge to pee frequently but doesn't produce much urine (also called urgency)
  • has a fever of without a clear reason or has abdominal pain
  • has a routine urinalysis that is abnormal, especially if it shows a high number of white blood cells
  • has completed a course of treatment for a UTI, to see if the infection is gone

Preparation

No preparation other than cleansing the area around the urinary opening is required for the urine culture. Tell your doctor if your child is taking antibiotics or has taken them recently.

The Procedure

Collecting the sample should only take a few minutes. Your child will be asked to pee into a sterile sample cup in the doctor's office. If your child isn't potty trained and can't pee into a cup, a catheter (a narrow soft tube) may need to be inserted into the bladder to obtain the urine specimen.

The skin surrounding the urinary opening has to be cleaned just before the urine is collected. In this "clean-catch" method, you or your child cleans the skin around the urinary opening with a special towelette. Your child then urinates into the toilet, stops momentarily, and then urinates again into the collection container. Catching the pee in "midstream" is the goal. The container shouldn't touch your child's skin. Be sure to wash your hands and your child's hands before and after this process.

Sometimes it's preferable to collect a sample first thing in the morning after your child wakes up. If this is the case, you may be asked to help your child with the test at home. You'll take the sample to the lab, where a technician will test it for the presence of germs. Follow any storage and transportation instructions the lab gives you.

What to Expect

Because the test involves normal urination, there shouldn't be any discomfort as long as your child can provide a urine sample. (There may be temporary discomfort if a catheter was inserted to collect the urine.) It's important to keep the area around the urinary opening clean before the test and to catch the urine sample midstream.

Getting the Results

The results of the urine culture will be available in 1-3 days. Your doctor will go over the results with you and explain what they mean.

Risks

No risks are involved when providing a sample for a urine culture. If a catheterized specimen is required, it may cause temporary discomfort. You can discuss any questions you have about this procedure with your healthcare provider.

Helping Your Child

Urinating to provide the specimen for the test is usually painless. Ease your child’s fears by explaining how the test will be conducted and why it's being done. Make sure your child understands that the urinary opening must be clean and the pee must be collected midstream.

If You Have Questions

If you have questions about the urine culture, speak with your doctor.