Urinalysis OSCE guide

geekymedics.com/urinalysis-osce-guide/

Lewis Potter 31/03/2015

Urinalysis (urine dipstick testing) frequently appears as an OSCE station, so you need to get familiar with the
process to look smooth in the exam. Its actually a very simple process, but people often fail to revise this station
and lose marks unnecessarily. With a little practice, you can ensure you get full marks every time! Check out the
urinalysis OSCE mark scheme here.

Gather equipment
Alcohol gel
Gloves
Apron
Urine dipsticks
Urine sample
Paper towels

Gather equipment

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Inspect urine
1. Wash hands, don gloves and apron

2. Confirm patient details are correct on the sample bottle name / DOB / hospital number

3. Inspect the colour of the urine:

Straw coloured normal

Dark concentrated urine dehydration
Red macroscopic haematuria / rifampicin / porphyria / beetroot
Brown bile pigments / myoglobin / antimalarials

4. Inspect the clarity of the urine:

Clear normal
Cloudy / debris urinary tract infection (UTI)
Frothy nephrotic syndrome

5. Remove the sample bottles cap and assess urine odour:

Offensive urine UTI

Sweet glycosuria

Wash hands

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Don apron

Don gloves

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Confirm patient details on the sample bottle are correct

Inspect colour of urine

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 Inspect clarity of urine

Assess odour of urine

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Perform dipstick testing
1. Check urine dipsticks expiry date

2. Remove a testing strip from the container (avoiding touching the testing zones)

3. Insert test strip into urine sample (ensuring all test zones are immersed)

4. Remove the strip, ensuring to tap off residual urine before removing from the sample bottle

5. Ensure test strip remains in a horizontal orientation (to avoid cross contamination of testing zones)

6. Use the dipstick analysis guide on the side of the testing strip container to interpret the findings

7. Different tests on the strip are required to be read at different times, so ensure you interpret the
appropriate test at the correct time interval e.g. 60 seconds for protein

8. Once you have interpreted all of the tests, discard the strip into the clinical waste bin along with your
gloves and apron

9. Wash hands

Check urine dipstick expiry date

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Remove testing strip from container

Fully submerge test strip in the urine sample

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Remove the test strip & wipe away any excess urine

Ensure the test strip remains horizontal to avoid cross contamination

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Interpret each test at the appropriate time using the dipstick analysis chart

Dispose of clinical waste

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 Wash hands

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To complete the procedure

Summarise findings

Document urinalysis results

Indicate that depending on the results, further investigations may be required:

WCC / Leukocytes ?UTI send urine for culture (MSU/CSU)

Glucose ?Diabetes capillary blood glucose

Urine dipstick tests explained

pH indicates acidity of urine e.g. pH in systemic acidosis

Specific gravity indicates amount of solute dissolved in urine in diabetes insipidus

Blood indicates number of red blood cells in urine in haematuria

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Protein indicates level of protein in the urine nephrotic syndrome

Leukocyte esterase enzyme produced by neutrophils (WCC in urine) in UTI

Nitrites breakdown products caused by Gram -ve organisms Gram -ve UTI e.g. Ecoli

Ketones breakdown product of fatty acid metabolism starvation / DKA

Glucose hyperglycaemia e.g. poorly controlled diabetes

Bilirubin Indicates conjugated bilirubin (water soluble) biliary tract obstruction

Urobilinogen if raised indicates bilirubin turnover malaria / haemolytic anaemia

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