Collection of Clean Catch Urine Specimen

Dione Blas Rey R. Abogadie MAN, RN

Collection of Urine Specimen

A. Routine CollectionPurpose: To screen the client’s urine for abnormal constituents.EQUIPMENT:• Cleansing materials• Wide-mouthed specimen container• Identification label• Completed laboratory request• Clean bedpan/urinal or commode for client’s who are unable

to void directly into specimen container• Non-sterile gloves as needed

PROCEDURESUGGESTED ACTION WITH RATIONALE 1. Wash hands and gather all needed equipment.

Eliminates microorganisms. Proper arrangement of needed equipment ensures working in an orderly manner.

2. Identify the client properly.3. In an ambulatory client with urinary control, give the

following instructions:• Explain the purpose of urine specimen and how the

client can assist.• Explain that all specimens must be free of fecal

contamination or voiding needs to occur after defecation or at different times from defecation.

• Instruct the client to clean the genitalia before urinating by washing it with water and soap properly.

• The female client should wipe from meatus toward the rectum.

• The male client should clean the meatus in a circular motion moving from the meatus up the glans penis. – Ensures that the specimen collected is somehow free form microorganisms. Cleaning in these manner follows the principle of cleaning from the least contaminated to the more contaminated area.

• Give the client the specimen container and tell him/ her to go the bathroom and avoid 120ml nto it. (The amount usually varies depending on agency policy. In some instances 30 – 60 ml is recommended)

• Tell the client to put tightly the lid on the container. If spillage occurred outside the container, instruct the client to wash it with soap and water – This prevent spillage of the urine and contamination of other objects.

4. Ensure that the specimen labels and laboratory request have been filled up with correct information. Attach them securely to the specimen container. – Inappropriate identification of the specimen can lead to errors of diagnosis or therapy for the client.

5. Arrange for the specimen to be sent to the laboratory immediately. – Urine deteriorates relatively rapidly from bacterial contamination when left at room temperature. Specimen should be analyzed within 1 hour after collection.

6. Document the time of collection; kind amount and

characteristic of specimen: time sent to lab; and exam desired.

Note: For seriously ill, physically incapacitated or disoriented clients, the following changes should be followed in the collection of the specimen.

1. Provide required assistance in the bathroom, or help the client to use bedpan or urinal.

2. Wear gloves when assisting the client to void into clean bedpan or urinal or when transferring the urine form the bedpan to the specimen container.

3. Empty bedpan or urinal properly.4. Remove gloves and wash hands before

labeling and transporting the urine.

B. CULTURE ANS SENSITIVITY BY CLEAN CATCH METHODPURPOSE: To determine the presence of microorganisms,

the type of microorganisms and the antibiotics to which the microorganism are sensitive.

EQUIPMENT:• Cotton balls with antiseptic solution• Sterile specimen container• Identification label• Laboratory request form• Disposable gloves (optional)• Bath blanket and urine receptacle (bedpan) if the

patient is not ambulatory

PROCEDURESUGGESTED ACTION WITH RATIONALE 1. Wash hands properly and gather all equipment

needed. – Ensures working in an orderly and organized manner.

2. Identify the client properly. 3. Inform the client that the urine specimen is

required; give the reason and explain the method to collect it. - Ensures cooperation of the client if he is an active member of his care.

4. Instruct the client to clean the urinary meatus and obtain urine specimen – Cleaning with antiseptic reduces the number of bacteria and minimizes contamination of urine specimen.

For a male client:• Wash hands and open container aseptically• Cleanse end penis with cleansing swab using

circular motion form middle toward outside. – Always swab from clean to dirty area to decrease bacteria levels.

• Initiate urine stream.• After single stream achieved, pass specimen

bottle into stream and obtain sample 30-60ml. – The microorganism, which have accumulated at the lower urethra and urinary meatus, have been flushed out with the original stream of urine and will not be collected in the specimen.

For a female client:• Wash hands and open container aseptically.• Cleanse the labia with non-dominant hand.• Cleanse the area with disinfectant swab

beginning above the urethral orifice and moving posteriorly. – swabbing from fron to back cleans from the area of least contamination to the area of greatest contamination, thus preventing introduction of microorganisms to the urinary meatus.

• Initiate urine stream has been achieved, pass specimen bottle into the stream and obtain 30 – 60 ml sample.

Note: To prevent contamination of specimen with the skin flora, instruct the patient to remove the bottle before flow of urine stops and before releasing the labia or penis.

5. Wipe off outside of container after replacing the

cap. Handle only the outside of the container and its cap throughout the entire procedure. – Capping the container prevents spillage of urine and contamination of other objects. Touching only the outside of thecap retains the sterility of the inside of the cap.

6. Wash hands. 7. label the specimen and take it to the laboratory within 15

minutes. – Bacterial cultures must be started immediately before any contaminating organisms can grow, multiply and produce false results.

8. Document pertinent data. Record the collection of specimen, any pertinent observations of the urine in terms of color, odor or consistency, and any difficulty in voiding that the client experienced.

Note: In some instances, collection of urine specimen for culture and sensitivity requires use of sterile gloves. This is usually worn prior to the cleansing of the vulva or penis with an antiseptic swab.

For a non –ambulatory client, the same principle applies except for the following:

1. Assist the client to an upright sitting position on a urine receptacle. Provide appropriate cover by draping the client properly, exposing only the genital area.

2. Assist the female client to spread her legs enough to ensure that the urine does not touch the legs.

3. Put on sterile gloves.4. Clean the area of the external urinary meatus using

sterile technique with an antiseptic swab.

5. Ask the client to start voiding, then after the initial urine has been passed out; place the specimen container under the stream of urine near to but not touching the meatus.

6. Collect 30 – 60 ml urine and replace sterile cap tightly on the specimen container touching only the outside of the cap.

7. Remove gloves and wash hands.

COLLECTING A TIMED URINE SPECIEMEN (24 HOUR URINE SPECIMEN)

Purposes: 1. To assess the ability of the kidney to

concentrate or dilute urine.2. to determine diorders of glucose metabolism e.g. diabetes mellitus.3. To determine levels of specific constituents e.g. albumin, amylase, creatinine, urobilinogen and certain hormones in urine.

SPECIAL CONSIDERATIONS:For timed urine specimens, appropriate specimen containers with or without preservative in accordance with specific test are generally obtained form the laboratory and placed in the client’s bathroom or in the utility room. To remind the staff of the test in progress, an alert sign is placed outside the room of the client. Specimen identification labels need to indicate the time and date of each voiding and may be numbered sequentially as 1st specimen, 2nd specimen, etc.

EQUIPMENT:• Urine specimen container with or without

preservative• Completed specimen identification labels• Completed laboratory requisition• Bedpan or urinal• Alert card on or near the bed indicating the

specific times for urine collection• Antiseptic

PROCEDURE SUGGESTED ACTION WITH RATIONALE 1. Identify the client properly.2. Give the client the following information and instructions. – Ensures

client cooperation through knowledge of what will happen and what to expect.

• The purpose of the test and how the client can assist • When the specimen collection will begin and end.• That all urine must be stored and saved in the specimen container

once the test starts.• That the urine specimen must be given to the nursing staff

immediately so that it can be placed in the appropriate specimen bottle.

3. Place a sign in the client’s bathroom or any place where it can easily be seen that 24 – hour urine collection is in the appropriate specimen bottle.

4. Collect the first urine specimen and discard it. Document the time the test starts with this discarded specimen. – The first specimen is considered “old urine” or urine that was in the bladder before the test began.

5. Collect all subsequent urine specimens, including one at the end of the period. Depending on hospital policy, specimens may be refrigerated or left in the client’s bathroom. – Refrigeration or other form of cooling prevents bacterial decomposition of the urine.

6. Request the client to void exactly 24 hours after the first specimen was obtained. Include voided urine in the container. – This urine output would still be included since it was produced and stored with the allotted 24 hour.

7. After the last voided specimen is placed in the container, cover and send entire

End