Urine is a type of specimen that can be easily and non-invasively collected from patients, making it a convenient option for diagnostic testing. Urine specimen analysis can provide physicians with useful information regarding the presence of infections in the urinary tract, including identifying the specific microorganisms responsible. The physician can also use the information from urine testing to diagnose and treat other diseases.
This guide will cover the types of urine specimens, preparation, collection methods, and best practices to ensure accurate and reliable results.
Table of Contents
- What is a Urine Specimen Collection?
- Types of Urine Specimen
- Methods of Urine Collection
- How to Collect Urine Specimen?
- Nursing Consideration
- Sources and References
What is a Urine Specimen Collection?
Collecting urine specimens is a common and basic procedure in medical practice, providing valuable information for diagnosing and monitoring various health conditions. Urine tests can detect infections, kidney disease, metabolic disorders, and many other conditions.
Types of Urine Specimen
There are various urine specimen types, each serving specific diagnostic purposes. Random specimens are for general screening, first morning specimens are highly concentrated, midstream clean-catch specimens reduce contamination, and timed specimens measure substances over a set period.
1. Random Urine Specimen.
Collected at any time of the day without any specific preparation. This type of specimen is commonly used for routine screening and general health assessments because it can be obtained quickly and easily.
2. First-Morning Urine Specimen
Collected immediately after waking up, this sample is more concentrated, providing a higher level of detectable substances such as proteins, making it useful for pregnancy tests, bacterial cultures, and other diagnostic evaluations.
3. Midstream Specimen Clean-Catch
Collected midstream during urination after thoroughly cleaning the genital area. This method reduces contamination from bacteria and cells in the urethra, making it ideal for detecting urinary tract infections (UTIs).
4. Timed Urine Collection
It involves collecting all urine over a specified period, such as 24 hours. This type of specimen helps measure substances that fluctuate throughout the day, providing a comprehensive analysis of kidney function and hormone levels.
5. Catheterized Urine Specimen
Obtained using a catheter inserted into the bladder, this method is used when patients cannot provide a sample naturally or when a sterile sample is necessary. It ensures the collection of urine directly from the bladder without external contamination.
Methods of Urine Collection
Various urine collection methods are used to obtain accurate samples for different diagnostic tests, tailored to specific patient needs and clinical requirements. These methods ensure minimal contamination and accurate analysis.
1. Random Urine Collection
- Provide the patient with a sterile container.
- Instruct the patient to urinate directly into the container.
- Ensure the container is properly labeled with the patient’s information and time of collection.
2. First-Morning Urine Collection
- Instruct the patient to collect the first urine of the day.
- Provide a sterile container and ensure it is labeled correctly.
3. Midstream Clean-Catch Collection
- Provide cleansing wipes and a sterile container.
- Instruct the patient to clean the genital area thoroughly with the wipes.
- Instruct the patient to begin urinating, then collect the midstream portion in the container, avoiding the initial and final parts of the stream.
4. Timed Urine Collection
- Provide a large container, sometimes with a preservative, to collect urine over the specified period.
- Instruct the patient to discard the first urine sample and note the time.
- Collect all subsequent urine in the container, including the final sample at the end of the collection period.
- Store the container in a cool place or refrigerate if required.
5. Catheterized Urine Collection
- Performed by healthcare professionals in a sterile environment.
- Insert a catheter into the bladder and collect urine directly into a sterile container.
- Ensure strict aseptic technique to prevent infection.
How to Collect Urine Specimen?
Collecting a urine specimen for culture and sensitivity by clean catch involves obtaining a midstream urine sample after thoroughly cleaning the genital area to minimize contamination. This method ensures that the sample accurately reflects the presence of any pathogens, allowing for precise identification and antibiotic sensitivity testing. Here are the following steps:
Assessment
1. Assess if the patient can independently provide a urine sample.
Assessing the patient’s ability to provide a sample helps plan for any necessary assistance, enhancing the accuracy of the collection. It also promotes patient comfort and reduces the likelihood of contamination.
2. Assess the patient’s understanding of the procedure.
Determines if the patient knows the procedure and the importance of obtaining an uncontaminated sample.
3. Check the patient’s allergies.
Patients may have allergies to certain cleansing agents or materials, such as latex or iodine, which can cause skin irritation or allergic reactions during the urine collection process.
Planning
The planning process for collecting a urine specimen involves selecting the appropriate collection method, preparing the necessary equipment, and ensuring the patient understands the procedure. It also includes coordinating timing and conditions to obtain a valid and uncontaminated sample.
Delegation
While Unlicensed assistive personnel (UAPs) can collect a clean-catch or midstream urine specimen, the nurse must guide the UAP on how to give the patient proper instructions about the collection process. Emphasizing the importance of thorough urethral cleansing is necessary to prevent contamination of the urine sample.
Preparation
Preparation for urine collection involves explaining the procedure, providing materials, and instructing on hygiene to avoid contamination. Clear instructions are vital for an accurate and reliable sample.
- Patient Instructions: Clearly explain the procedure and provide instructions for proper collection to avoid contamination.
- Hygiene: Emphasize the importance of cleaning the genital area thoroughly to reduce the risk of contamination.
- Materials: Provide the necessary materials, including:
- Sterile specimen container
- Cleansing wipes or towelettes
- Gloves (non-sterile or sterile, depending on protocol)
- Labels for specimen container
- Biohazard bag
- Hand sanitizer or access to handwashing facilities
- Instruction sheet (if needed for patient education)
- Documentation forms or electronic health record access for recording the procedure and patient information
Implementation
Here are the steps for collecting a midstream urine sample for culture and sensitivity (Clean Catch):
1. Gather supplies. Perform hand hygiene and wear gloves. Verify patient identity using two identifiers.
Ensures readiness, lessens infection risk, and confirms the correct patient.
2. Assist the patient in the bathroom.
Female patient: Ask the patient to sit on the toilet with legs spread apart to expose the genital area.
Male patient: Ask the patient to stand or sit on the toilet.
3. Teach the patient how to clean the genital area.
Decreases contamination risk from bacteria on the skin.
Female patient: Instruct the patient to clean the vulva by wiping from front to back using cleansing wipes. Use a new wipe for each stroke (one for each side of the labia and one down the middle).
Male patient: If uncircumcised, instruct the patient to retract the foreskin. Clean the head of the penis with a cleansing wipe, moving from the urethral opening outward in a circular motion.
4. Instruct the patient to begin urinating in the toilet. After a few seconds, place the sterile container midstream to collect the urine. (for female patients: continue holding the folds open while urinating).
Avoids initial flow which may contain contaminants, ensuring a cleaner sample.
5. Make sure the container does not come into contact with the genital area or any surface. Collect the required amount of urine, typically 30-60 ml.
Prevents contamination and collects an adequate sample for testing.
6. Instruct the patient to finish urinating in the toilet. Securely cap the specimen container without touching the inside. Label the container with patient’s name, DOB, requesting physician, date, and time of collection.
Securing the specimen container prevents contamination, maintaining the urine sample’s integrity for accurate testing. Proper labeling ensures clear identification for reliable results.
7. Perform hand hygiene. Place the specimen in a biohazard bag for transport to the lab. Document the procedure in the patient’s chart and report any issues to the supervising nurse.
Ensures safety and proper documentation for follow-up.
Nursing Consideration
Nursing considerations in urine collection focus on ensuring sample integrity and patient comfort while following proper protocols to avoid contamination and ensure accurate diagnostic results.
1. Always label the specimen container with the patient’s name, date, and time of collection.
Proper labeling guarantees the correct specimen identification, preventing mix-ups and accurately matching test results to the correct patient.
2. When collecting urine from an infant, use a clean catch kit consisting of a plastic bag with an adhesive strip to cover the infant’s genital area.
Instruct the mother to offer the child a drink (cup, bottle, breastfeed), as this often prompts urination within an hour, facilitating a clean-catch sample.
3. For infants aged <90 days, apply Quick-Wee method by applying gentle suprapubic stimulation with a cold, wet gauze.
This technique stimulates urine production in infants, facilitating the quick and easy collection of urine samples. It is particularly useful for obtaining clean-catch specimens in young children who are not yet toilet trained.
4. Record all relevant information, including collection method, time, and any patient-reported issues during collection.
This ensures the lab has all the necessary details to accurately interpret the results and maintain comprehensive medical records.
5. Transport the specimen to the laboratory immediately to prevent degradation or contamination.
Prompt transportation to the laboratory minimizes the risk of degradation or contamination, keeping the specimen’s components unchanged for accurate analysis.
6. If immediate transport is not possible, specimens can be stored in refrigerators at 2 to 8° C for up to two (2) days (48 hours) or frozen at 0° C.
This helps preserve its integrity, preventing the growth of bacteria and the breakdown of substances within the urine.
7. Note on the laboratory slip if the patient is on antibiotics or menstruating.
These factors can affect the urine culture results, potentially leading to inaccurate interpretations and ensuring proper analysis by the lab.
Sources and References
- Bae, C., & Del Portal, D. A. (2018). News: The Myth of Midstream Clean-Catch Urine Samples.
- Kaufman, J., Fitzpatrick, P., Tosif, S., Hopper, S. M., Donath, S. M., Bryant, P. A., & Babl, F. E. (2017). Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. bmj, 357.
- Jacob, M. S., Kulie, P., Benedict, C., Ordoobadi, A. J., Sikka, N., Steinmetz, E., & McCarthy, M. L. (2018). Use of a midstream clean catch mobile application did not lower urine contamination rates in an ED. The American Journal of Emergency Medicine, 36(1), 61-65.
- Lough, M. E., Shradar, E., Hsieh, C., & Hedlin, H. (2019). Contamination in adult midstream clean-catch urine cultures in the emergency department: a randomized controlled trial. Journal of Emergency Nursing, 45(5), 488-501.