Chapter 2: Urine Collection Flashcards
Urine Collection Techniques
Routine void
Midstream clean catch
Catheterized, urethral
Catheterized, ureteral
Suprapubic aspiration
Pediatric collection bag
requires no patient preparation and is collected by having the patient urinate into an appropriate container.
Normally the patient requires no assistance other than clear instructions.
routine voided urine specimen
If the possibility of contamination (e.g., from vaginal dis-charge) exists, or if a bacterial culture is desired, a _______should be obtained.
midstream “clean catch” specimen
Collection of these specimens requires additional patient instruc-tions, cleaning supplies, and perhaps assistance for elderly patients or young children.
midstream “clean catch” specimen
______ provides instruction details for male and female patients in the document titled Urinalysis:Approved Guideline.’
The Clinical and Laboratory Standards Institute (CLSI)
In brief, before collection of a midstream clean catch specimen, the _____of the male or the ______of the female is thoroughly cleansed and rinsed.
After the cleansing procedure, a midstream specimen is obtained when the patient first passes some urine into the toilet and then stops and urinates the midportion into the specimen container. Any remaining urine is passed into the toilet.
glans penis, urethral meatus
To prevent contamination of the container and specimen, the interior of the container must not come in contact with the______ or _____.
patient’s hands or perineal area
This________ technique allows passage of the initial urine that contains any urethral washings (e.g., normal bacterial flora of the distal urethra) into the toilet and allows collection of a specimen that represents elements and analytes from the bladder, ureters, and kidneys.
midstream
two collection techniques require medical personnel
catheterized specimen
suprapubic aspiration
is obtained after catheterization of the patient-that is, insertion of a sterile catheter through the urethra into the bladder.
Urine flows directly from the bladder through the indwelling catheter and accumulates in a plastic reservoir bag.
A urine specimen can be collected at any time from this reservoir.
catheterized specimen
Because urinary tract infections are common in catheterized patients, these urine specimens are often used for______
When a single catheterized urine specimen is received for multiple tests (e.g., routine urinalysis, bacterial culture, urine total protein, urine drug tests) and the culture cannot be performed first, steps must be taken to prevent contamination of the urine specimen.
This usually involves transferring aliquots of the urine specimen using sterile technique into additional containers for the other tests requested.
bacterial culture.
The normally sterile bladder urine is aspirated into the syringe and sent for analysis.
This procedure is used principally for bacterial cultures, especially for anaerobic microbes, and in infants, in whom specimen contamination is often unavoidable.
suprapubic aspiration
involves collecting urine directly from the bladder by puncturing the abdominal wall and the distended bladder using a needle and syringe.
suprapubic aspiration
Newborns, infants, and other pediatric patients pose a challenge in collecting an appropriate urine specimen. Because these patients are unable to urinate voluntarily, commercially available________________ are used.
plastic urine collection bags with a hypoallergenie skin adhesive
Pediatric collections
The patient’s_____ area is cleansed and dried before the specimen bag is placed onto the skin.
The bag is placed over the penis in the male and around the vagina (excluding the anus) in the female, and the adhesive is firmly attached to the perineum.
Once the bag is in place, the patient is checked every____ minutes to see if an adequate volume of urine has been collected.
The urine specimen should be removed as soon as possible after collection, labeled, and transported to the laboratory.
perineal
15mins
Disposable diapers can sometimes be used to collect urine for specific tests, like measuring substances in the urine.
However, urine absorbed into a diaper or any absorbent material cannot be used for _______during routine urinalysis. This is because the absorbed urine cannot provide clear and accurate results for analyzing cells, crystals, or other elements under the microscope.
microscopic examination
(2) are probably the two most common reasons for specimen rejection.
Unlabeled
improperly labeled urine specimens (e.g., name or ID number on container label and order slip do not match)
Some institutions allow urine absorbed into a_____ or _____ to be used for chemical analysis; the urine is recovered by expressing it into a specimen cup.
However, this urine is not acceptable for_______ or ______ portions of a routine urinalysis because epithelial cells, blood cells, and formed elements (e.g., casts, mucus) will be trapped in the absorbent material causing erroneous results.
diaper or other absorbent material (e.g., cotton balls)
bacterial culture or for the physical and microscopic examination
Reasons for Urine Specimen Rejection (6)
• Unlabeled urine specimen container
• Mislabeled urine specimen
• Inappropriate urine collection technique or specimen type for test requested (e.g., urine in diaper)
• Specimen not properly preserved during a time delay or inappropriate urine preservative used
• Visibly contaminated urine (e.g., fecal material, toilet tissue)
• Insufficient volume of urine for test(s) requested
Routine urinalysis protocols typically require _______of urine, but collection of a larger volume is encouraged to ensure sufficient urine for additional or repeat testing.
10 mL to 15 ml
Smaller volumes of urine (_____) hinder performance of the microscopic examination when the urinalysis is performed manually and can limit the chemical tests performed.
However, if a fully automated urinalysis system is used, a complete urinalysis can be performed with______ of urine.
< 12 mL
3 to 5 mL
With 24-hour urine collections, despite the large volume of urine submitted to the laboratory, only a small amount (____) of well-mixed urine is actually required for quantitative urine tests (e.g., creatinine, hormones, electrolytes).
A portion of the urine collection (_____) is usually retained to ensure sufficient specimen in case repeat or additional testing is required later.
~1 mL
20 to 50mL
• No preparation before collection
• Routine screening
Routine void
• Genital area cleansed before collection
• Patient passes initial urine into toilet, stops and collects urine in container, then empties any remaining urine into toilet
Midstream clean catch
Midstream clean catch USES
• Bacterial and fungal cultures (sterile container required)
• Routine screening
• Cytology
• A catheter is inserted into the bladder via the urethra
• Urine flows directly from bladder through catheter into plastic bag
Catheterized, urethral
Catheterized, urethral USES
• Bacterial and fungal cultures
• Routine screening
• A catheter is inserted through the urethra and bladder and into the left and right ureter; urine is collected from each ureter before it reaches the bladder
Catheterized, ureteral
Catheterized, ureteral USES
• To determine and differentiate kidney infections
• Using sterile needle and syringe, the abdominal wall is punctured, and urine is directly aspirated from the bladder
Suprapubic aspiration
Suprapubic aspiration USES
• Bacterial and fungal cultures
• Used with patients unable to urinate voluntarily
• Plastic collection bag is adhered to the skin surrounding the genital area
• Urine accumulates in plastic bag
Pediatric collection bag
Pediatric collection bag USES
• Routine screening
• Quantitative assays
