Introduction: A number of diagnostic tests are available to evaluate the status of the urinary system.

During diagnostic testing, the nurse has many roles. The nurse maybe directly involved in collecting and testing specimens and in assisting the examiner during certain procedures. And as a nurse, we must be able to use test results appropriately in the patients care plan. Nurses are responsible for collecting urine specimens for a variety of tests. Some tests require clean voided specimens, some require sterile specimens. When handling body fluid, the nurse should wear gloves and take care not to contaminate other objects with the specimen. Care should also be exercised to see that the specimen is not contaminated with feces, menstrual blood, and so forth during the collection. OBJECTIVES At the end of this lecture the student be able: To identify different methods of urine collection. To effectively perform/follow the procedure when obtaining a urine sample.

Methods of Urine Collection 1. First Morning Specimen most concentrated bladder is incubated Best for nitrate, protein, pregnancy tests, microscopic examination and routine screening. 2. Random Specimen most convenient collected anytime good for chemical screening, routine screening, microscopic examination.

3. Midstream (Clean-Catch) the external meatus is first cleansed with soap and water
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Caution the client to hold the specimen container near, but not touching, the meatus

Client voids and discard a little urine ( e.g., voids about 30ml into the toilet); then the client voids into the specimen container

the last urine in the bladder is also discarded. If the client cannot void into the container, use a sterilized bedpan to collect the specimen.

4. Post-Prandial used for glucose determination, diabetic monitoring collected 2 hours after meal.

5. TIMED requires collection of a certain time. a. Timed 2-hour volume used for urobilinogen determination

b. Timed 24-hour volume known also as 24-urine collection / 24 hours creatinine clearance all urine saved for 24-hour period it evaluates kidney function accurately. for measurement of total urine protein, creatinine and electrolytes over a 24-hour period. PROCEDURE: 1. Ask the patient to void at the beginning of urine specimen collection. 2. Discard the first void, and note the time. 3. Mark the time the test begins and the time the collection should end in the container. 4. Collect all urine voided over the 24 hours into a large container and label it with the patients name, the time frame collection, the test ordered and other pertinent information. 5. Ask the patient to void for 24 hours after the first voiding, to conclude the collection. Add the urine from this last voiding to the specimen in the container.
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6. Storage: Refrigerate the collection bottle immediately after the patient has voided or place it on iced container. NOTE: Because patient may not always be able to void on request, the last specimen should be obtained as closely as possible to the stated end-timed of the test. 6. Catheter Specimen a. Straight Catheterization client is catheterized only to obtain sample of urine for testing

sterile catheterization technique is used and the catheter is removed immediately least likely to be contaminated by bacteria from the perineum.

b. Sterile Specimen from Indwelling Catheter the specimen should be withdrawn from the catheter, not the collecting bag, using the special port for withdrawing urine Wear disposable gloves and use a sterile 21-25 gauge needle and syringe specimen container If no urine is found in the tube below the collection port, clamp the tube briefly (for <30 minutes) Clean the port with an antiseptic swab, insert the sterile needle, aspirate the urine, and transfer the specimen in the container. a. A urine culture requires about 3ml of urine b. A routine urinalysis requires at least 10ml Clinical Alert: 1. Inform the patient about the collection. 2. Use sterile disposable container. 3. Women should always have a clean catch specimen if microscopic examination is to be done. 4. Cover all specimens tightly, label properly and send immediately to the laboratory. 5. Observe standard precautions when handling urine specimen.

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6. If specimen cannot be delivered immediately to the laboratory or tested within 1 hour, it should be refrigerated or have an appropriate preservative added.

Assess for interfering factors like: a. urine contaminated with feces. b. vaginal discharge c. menstrual blood flow d. failure to follow instructions in urine collection.

PROCEDURE AND TECHNIQUES FOR COLLECTING URINE SPECIMENS 1. Urine specimen must be free of fecal contamination. Advise clients to void in the urine receptacle and defacate in the toilet, or to collect the urine specimen at a time when they dot also need to defecate. 2. Laboratory analysis is difficut if there is paper in the specimen. Tell the client to discard toilet tissue in the toilet or a waste bag rather than in the bedpan. 3. Take care not to contaminate other objects with urine. (e.g., wear gloves; place lids tightly on containersto prevent spilling and contamination of other objects). If the outside of a container has been contaminated with urine,clean it with a disinfectant. 4. Take care that the specimen is properly identified. Be sure that the specimen label and the laboratory requisition have the correct and identical information; attach them securely to the container before leaving the clients room, or at least place a piece of tape on the container and write the clients name; never take a specimen from the clients room without first labeling it. 5. Urine decompose when left at room temperature over time. Transport specimens to the lab promptly,or refrigerate them. Find out from the laboratory whether a preservative is needed for 24-hour specimens.

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