Year 1 MBChB

Clinical Skills Session

Urinalysis

Reviewed & ratified by:

Dr V Taylor-Jones & Ms C Tierney.

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Urinalysis

Aims and Objectives

Aim: For the student to be able to safely conduct a urinalysis on a sample of urine.

Objective: The student will know the indications for urinalysis.

Objective: The student will know how to obtain urine samples and perform urinalysis.

Objective: The student will know how to document the urinalysis result.

Theory and background

Urinalysis can be used as a screening test to aid detection of abnormalities and aid

diagnosis, also for monitoring and management of a patient’s condition.

This may be performed routinely as part of health check, well woman / well man clinic

or if indicated by patient history and presentation.

Urine Dipstick Analysis

There are a large range of strips available, some are very specific eg. screen for

glycosuria (the excretion of glucose in the urine..

Many have multiple tests on each strip, please check the test strips selected have the

specific tests on that you require. Check that the container has not been left open and

that the strips are in date. Ensure that you are clear about the timings required for each

test and that you know how to read the strip accurately. You must be familiar with the

strips that you are using.

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What can you test for:

Glucose is not normally present in the urine. Presence may be due to elevated blood

glucose levels or reduced renal threshold.

Protein (Albumin) albumin and globulin is normally in too low a concentration to give a

positive reaction. False positive results occur in strongly alkaline urine. Abnormal

proteinuria (the presence of an excess of serum proteins in the urine. is usually due to

glomerular disease, which may be caused by a variety of conditions, including diabetes

mellitus and hypertension.

Blood suggests urological disease and/or urinary tract infection (UTI.. Results may be

false positive if the container is contaminated with bleach, perianal skin, povidone

iodine, stale urine or menstruation.

pH Value is usually slightly acidic within pH 5-6 (range 4.8 to 8.5.. Lowest after overnight

fast, highest after meals. Can be helpful when screening for renal disease, respiratory

disease, certain metabolic disorders and specific therapeutic regimens, such as sodium

bicarbonate.

Nitrites are not normally present; produced by gram negative bacteria converting

nitrates to nitrites. Ideally specimen should be obtained about 4 hours after last passing

urine (voiding.. Indicates a UTI and the sample should be sent for further testing.

Ketones are abnormal urinary constituents, being breakdown products of fatty acid

metabolism.

Bilirubin indicates hepatic or biliary disease.

Urobilinogen is normally present in urine, elevated levels may indicate liver

abnormalities or excessive destruction of red blood cells. Urobilinogen tests should be

considered with the bilirubin result to provide a differential diagnosis. A false negative

result may be obtained from a stale sample.

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Leucocytes a positive result suggests pyuria (pus in the urine. associated with a UTI.

Isolated results may not be significant. Repeated positives should not be ignored – but

be aware of possible sources of contamination or other factors which may limit

sensitivity to this test.

Specific Gravity (SG) sometimes called ‘density’. It is a laboratory test that measures the

concentration of all chemical particles in the urine. Normal ranges given do vary

between 1.001 -1.035 – so do check your product instructions carefully. Increased SG is

seen in conditions causing dehydration, glycosuria, renal failure, heart failure or

inappropriate antidiuretic hormone secretion or proteinuria. Decreased SG may be seen

in excessive fluid intake or renal failure or pyelonephritis.

Tests can be falsely positive or falsely negative so remember to be aware of other

factors…

Consider whether –

The sample could have been contaminated?

The patient’s medication could have affected the results or the sensitivity of the test?

The patient’s condition could have affected the results or sensitivity of the test?

Urine Collection

Listed below are a few examples of different collection types;

Routine sample of urine

MSSU – mid stream sample of urine (most common collection method)

First Pass Urine – first few drops of urine, eg; in Chlamydia screening

CSU – catheter specimen of urine

EMU – early morning urine

24 hour urine

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Some methods of collection;

Paediatrics – Urine bag

Catheterised patients-

Images above supplied and permission granted by B. Braun Medical Ltd

There are also many further types of devices that can be fitted to urine bottles to aid collection or urine can be collected in a sterile pot before transfer to a specimen bottle

There are various ways of collecting urine – find out what is recommended by your Trust. If the sample is to go for laboratory analysis/ culture then the process should be aseptic.

Needle free

collection port

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Specimen bottles may contain boric acid, please gently agitate bottle to mix contents MSU is the recommended routine collection method. Periurethral cleaning is only recommended if the sample is to go for analysis (water is considered sufficient.. The first part of voided urine is discarded and, without interrupting the flow, approximately 10mL is collected into a CE marked leak proof container, or a sterile pot and transferred to a sample bottle. The remaining urine is discarded. (Standards unit, PHE June 2017, pg 24.

National guidance on this is below;

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/618126/B_41i8.2.pdf

Patient Safety

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Procedure

Consider the tests that are required and ensure that you know how to read the strip.

Prepare your equipment before you begin

You should be bare below the elbows, and hair off your collar.

You must put on a pair of gloves and a plastic apron prior to opening the sample container and wash your hands when you finish.

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Take a moment to consider the colour and turbidity (cloudiness of the urine. as these may be significant - and be linked to pathology or dietary and drug causes.

There are many variations in practice, you may write the results on a scrap piece of paper to transfer to the patient notes in a clean environment. Some clinical placements will have a machine that will analyse the dipstick and print the results, please check procedures in your working environment.

Open the test strip container and remove a strip.

Replace the top immediately

Exposed strips absorb atmospheric moisture and renders the test zones inaccurate.

Do not contaminate the strips by placing them on a table, use a clean surface or clean blue roll.

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Briefly (no longer than one second) dip the

test strip into the urine to wet all the test

zones.

There may be a control zone at the bottom

of the strip- this should not be dipped

Withdraw strip, dragging the edge along the

rim of the container to remove excess fluid.

Use the second hand of a watch to time the

period since dipping. Take care as different

tests require different times.

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Place the strip on a piece of clean

blue roll.

Compare test zones with the colour

scale on the side of the strip

container at the time indicated by the

manufacturer.

The colours are stable for at least

another minute allowing plenty of

time for reading. NOTE your results.

Documenting Results

There are different methods for documenting the results, as mentioned

previously;

1. After dipping the urine compare the strip with the scale and remember the

results

2. Prepare your documentation sheet with as much information as possible, prior

to dipping the strip. After dipping it, remove the glove from your dominant

hand and document the results.

3. You may write the results on a scrap piece of paper to transfer to the patient

notes (electronic or paper. in a clean environment.

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Documenting Results

Please report abnormal results immediately to a senior member of staff, and

document clearly.

Some Do’s and Don’ts

Some Do’s of urinalysis ….DO

Check expiry date on container before use

Replace cap & store strips in a cool, dry place

Read instruction on pack insert

Time accurately for each test on the strip

The University of Liverpool Clinical Skills Teaching and Learning Centre

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Dispose of ALL waste appropriately AND WASH YOUR HANDS AGAIN

Document in full in black pen - including negative findings

Report abnormal results

IF it isn’t recorded IT wasn’t DONE

And …some Don’ts of urinalysis

DO NOT - Transfer strips to another pack

DO NOT - Prolong dipping of test strip (1 second is enough.

DO NOT - Hold the stick vertically after dipping

DO NOT - Touch the test zone with fingers

DO NOT – Contaminate your pen or the patient notes with urine.

References and other Useful Resources

Sources and useful resources –

Public Health England

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/618

126/B_41i8.2.pdf

Siemens Multistix 8 SG

www.patient.co.uk

B.Braun at https://www.bbraun.co.uk/

Urine Analysis App – Siemens U.A app

Urine Dipstick Analysis – Patient PLUS article

http://www.whnt.nhs.uk/document_uploads/PatientInfo_Urology/mssurv.pdf

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Underlying anatomy and Physiology

Peer Feedback

05 Y1 Urinalysis

peer feedback.docx

Video

Glossary