5A. Urine Collection

Question 1

What do we want to avoid when collecting urine?

Answer 1

injury to urinary tract system and repro system, inadvertent intro of an infection

Question 2

What is the goal of urine collection?

Answer 2

obtain a urine sample, test it, and produce diagnostic results
Collect ~5mls for SA and ~10 for LA

Question 3

What must we do when collecting urine for a culture?

Answer 3

make sure it is collected using aseptic technique and put in a sterile container
Collect sample - aseptically transfer a small amount (~1cc) to a sterile container (red tube top or transport media tube) to be saved in case of culture > run other tests on rest of sample

Question 4

What types of containers are used with urine collection and storage?

Answer 4

can be disposable or reusable
if storage is req a tight fitting lid is essential
must be dry and free of chemical residue
transparent containers help w/ the physical exam of the urine but at not essential

Question 5

What are the 4 types of urine collection methods?

Answer 5

natural micturition (free catch)
manual expression
cystocentesis
catheterization
record which you use

Question 6

What is natural micturition?

Answer 6

midstream sample
morning sample preferred w/ mid stream catch ideal
cannot be used for samples that need to be cultured but is fine for routine urinalysis - bacteria not necessarily from the bladder

Question 7

What are the advantages and disadvantages of micturition?

Answer 7

advan: no known risks, clients can collect it, provides information on urethra
disadvantages: sample likely to be contaminated w/ flora from urethra, prostate and seminal glands, vagina, vulva and prepuse
may see inc epithelia cells, mucus content, bact, other debris - cells should not be clumped in a normal sample
doesn’t always occur when needed

Question 8

What is the procedure for doing a micturition sample collection

Answer 8

1. when performing in clinic clean external genitalia first
2. try to avoid the first portion of the sample, will remove some contaminants
3. place clean dry container under pet when it urinates
4. make sure to ask owner if their pet has a pee command like “go pee”

Question 9

What do clients need to know if they are doing at home free catch

Answer 9

owners can bring home a cup or bring them in an appropriate container
sample needs to be refrigerated if not examined or dropped off at the clinic right away
nosorb (little plastic pellets) can be used in place of kitty litter to collect sample

Question 10

What are some inappropriate containers?

Answer 10

old pill vials, make up containers, vinegar jugs, tin cans

Question 11

What is manual bladdder expression

Answer 11

using external pressure to cause the bladder to release urine, used in D/C
only works under anes or had certain bladder pathology such as dec nerve control of bladder

Question 12

What are the advantages or disadvatanges of manual expression?

Answer 12

advan: low lvl of risk
disad: can damage kidney/bladder, never use on patients w/ possible blockage of urethra or fragile bladder walls cause ruptue
sample w/ contain flore from lower urinary tract (same as free catch)
may result in trauma to bladder wall causing inc RBCs and epithelia cells that are artifacts

Question 13

What is the procedure of manual expression

Answer 13

1. clean external genitalia
2. patient can be standing or in lat recumbencu
3. palpate bladder in caudal abdomen
4. apply steady gentle pressure over a large area of bladder to express urine
5. be patient it may take a few minutes for the sphincter muscles to relax
   AVOID EXCESSIVE PRESSURE

Question 14

How do we do manual expression in LA?

Answer 14

stimulate by maintaining pressure on bladder wall thru rectal palpation or washing the perianal area

Question 15

What is cystocentesis?

Answer 15

using a sterile needle to remove urine directly from the bladder through the abdominal wall
relatively common
can be performed by DVM or RVT
Gold standard is to use an ultrasound to assist in finding the bladder
the bladder must be relatively full in order to perform with least risk

Question 16

What are the advantages of cystocentesis?

Answer 16

prods a sample upon demand
less likelihood of prod an iatrogenic infection compared to cathetering
often better tolerated by patients
sterile sample
sedation is seldom required

Question 17

What are the disadvantages of cystocentesis?

Answer 17

almost always requires more than two people
may see an increase in RBC’s and hemoglobin content on analysis
if animal has a urinary obstruction or is overextended it may cause bladder to rupture or urine leak into the peritoneum
Injury can occur if bladder is too empty or the animal struggles (ultrasound guided)
may have risk of bleeding (puncture of bladder vessel)
Risk of iatrogenic infection if intestine are nicked

Question 18

When might cystocentesis be contraindicated in?

Answer 18

patients w/ bleeding disorder
Pregnant
overextended bladder, prostatic abscess
Potential pyometra
Obese
Empty bladder
Suspected bladder cancer

Question 19

What is the required equipment for cystocentesis?

Answer 19

syringe and needle - everything must stay sterile
Syringe: 3-10ml depending on side of animal
Needle: cat 22g, 11/2, Dog 22g 11/2
Skin prep -alcohol skin
Sterile collection container - red top or urine cups
ultrasound
trained personnel

Question 20

What is the procedure for cystocentesis?

Answer 20

1.patient in dorsal
2. palpate bladder - has enough urine
3. Disinfect skin w/ 70% isopropyl alcohol
4. Isolate bladder w/ non-dom hand
DO NOT SQUEEZE, only immobilize
5. Agitate blader (suspends sediment)
6. Prepare syringe: needle is attached, loosened cap, break plunger seel by PUSHING INTO syringe barrel
7. Insert needle at most cranial midline aspect of bladder - direct needal dorso-caudally at a 45-70 angle - bladder shrinks needle tip remains in lumen of bladder
8. Insert needle smoothly w/o redirecting or side ways movement
9. Transfer sample to a sterile container

Question 21

Where is the bladder located in dogs/cats?

Answer 21

Male dogs - caudal to umbilicus and lat to sheath
Female d/c - ventral midline caudal to umbilicus

Question 22

Once the needle is inside the patient, how do we collect the sample?

Answer 22

Apply negative pressure - pull back on syringe plunger in a slow, consistent manner
Make sure urine comes into syringe - anything not urine comes out, stop and withdraw needle - DO NOT REDIRECT (blood, air, fecal matter)
Get new needle and try again but not more than twice
Draw up sample w/ continuous pressure
once enough sample, stop negative pressure
let go of plunger so there is no more neg pressure and withdraw needle - remove needle in same path as insertion
Maintain aseptic technique throughout procedure

Question 23

What do we label our urine sample with?

Answer 23

patient ID, Date, Time of collection, method of collection

Question 24

How do we store urine samples?

Answer 24

ideally - samples analyzed within 30-60m
If not possible - aseptic sample to be stored in fridge (or on ice) ASAP
Urine strip and microscope exam should be conducted immediately - if not possible, store in fridge and analyze at room temp