Collecting a urine specimen: Clinical skills notes

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Notes

Genitourinary

Collecting a Urine Specimen

INTRODUCTION

Urinalysis includes physical examination of the urine, testing of urine, and examination of the urine under a microscope. It can be used to diagnose and monitor various conditions, including kidney disorders; urinary tract infections; and systemic diseases, such as diabetes.

Figure 1: The three steps of urinalysis, which include a physical examination of the urine, testing the urine, and examining the urine under a microscope.

RANDOM AND CLEAN CATCH URINE SPECIMENS

For routine urinalysis, a random urine specimen is required, which means that urine can be collected any time during the day without any special measures. When the client is suspected to have a UTI, or urinary tract infection, it’s important to do a clean catch specimen. “Clean catch” refers to cleaning the perineum and the skin on the genitalia to clear away any microbes on the skin that could contaminate the urine sample. The sample should be taken midstream, meaning it should be collected from the middle of the urine flow. This way, the first and last portion of the urine that are more likely to contain bacteria from skin are not collected. A properly collected clean catch specimen will help make sure any bacteria found in the urine specimen came from inside the urinary tract.

COMMON CARE TIPS

Confirm the client’s identity to make sure the procedure is performed on the right person.
Make sure that the specimen container is labeled with the client’s name and room number, as well as the date and time the specimen was collected.
At all times, respect the client’s privacy and modesty by remembering to close the doors and window covers, and ensuring the client is properly covered.

Figure 2: Common care tips include confirming the client's identity, making sure the specimen container is labeled, and respecting the client's privacy.

COLLECTING A RANDOM/MIDSTREAM URINE SPECIMEN

Supplies

First, gather the supplies you’ll need, including:

gloves
paper towels
a specimen container
a collection device
toilet tissue
a biohazard transport bag

You may also need:

a bedside commode
a urinal or a bedpan

For a midstream urine specimen, you will also need:

sterile gloves
a “clean catch” kit

Figure 3: Supplies you will or may need when collecting a random / midstream urine specimen.

Procedure

Put on gloves and cover the bathroom counter with a paper towel.
Open the specimen container and place the lid on the paper towel with the inside facing up.
If the client can use a regular toilet, place a clean collection device, or specimen “hat,” inside the toilet. For people who can’t use the toilet, a bedside commode, a bedpan, or a urinal can be used.
- It’s important to remember that stool can alter the results, so ask the client if they need to have a bowel movement before collecting the urine.
If a midstream urine specimen is required, open the “clean catch” kit. Provide the client with special cleansing wipes from the kit if they’re able to clean the perineum by themselves. Otherwise, assist as necessary.
- Wrap the wipe around one hand.
- If the client has phenotypically female genitalia, use your other hand to separate the labia. Then, use the wipe to wipe downwards from the top of the vulva and towards the anus.
- If the client has a circumcised penis, start by placing the wipe on the tip of the penis, while if the client has an uncircumcised penis, first retract the foreskin by gently pushing the skin downwards towards the base of the penis. Wash downwards towards the base of the penis in a circular motion.
Give the client time to urinate and assist as necessary.
- Remind them not to throw toilet tissue into the collection device, the bedside commode, the bedpan, or the urinal because this can alter the results.
- If a midstream urine specimen is required, remind them to start the flow of urine, then stop it, and then restart it. The sample should be collected from the restarted flow.
- When collecting a midstream specimen, clients with phenotypically female genitalia should keep the labia separated and clients with uncircumcised penises should keep the foreskin retracted.
- For most clients, you can leave the room until they finish.
- Be sure that the call light is close to the client.
- Remember to remove your gloves when you leave, dispose of them safely, and put on a new pair when you come back.
- Knock before entering.
Provide tissue paper, a moist cloth, or pre-moistened wipes if they are able to clean themselves; otherwise, you should assist in perineal care. Also, assist the client with handwashing as necessary.
If the client used the toilet or a bedside commode, help them return to bed. Take the collection device from the bedside commode to the bathroom. If the client used a bedpan or a urinal, place the cover on and take it to the bathroom.
Note the general quality, the amount, the color, and the odor of the urine. You may also be asked to measure the urine.
To collect the urine specimen,
- raise the toilet seat and, while holding the specimen container over the toilet, pour about 90–120 mL of urine from the collection device, the bedpan, or the urinal into the container. The container should be about three-quarters full with urine.
- Empty the rest of the urine into the toilet.
- Close the specimen container tightly and place it back on the paper towel on the bathroom counter. Be careful not to touch the inside of the lid or the container, especially if when collecting a midstream urine specimen.
Dispose of one glove and use the ungloved hand to hold the biohazard transport bag. Then, with your gloved hand, put the specimen container into the bag. Make sure not to touch the outside of the transport bag with the glove. Dispose of the other glove safely and wash your hands.
The urine specimen has to be taken to the laboratory within 20 minutes. Otherwise, it must be refrigerated until the scheduled pick up time.
Clean and return the equipment to the right place.

COLLECTING A URINE SPECIMEN FROM A URINARY CATHETER

Supplies

Keep in mind that the specimen cannot be obtained from the drainage bag.

First, gather the supplies you will need:

gloves
a clamp or a rubber band
a disinfectant swab
a needleless syringe
a specimen container
a biohazard transport bag

Figure 4: Supplies you will need when collecting a urine specimen from a urinary catheter.

Procedure

Start by putting on the gloves.

Clamp the catheter drainage tubing with a clamp or a rubber band for approximately 15 minutes below the level of the urine drainage port.
Use the disinfectant swab to clean the port for 15 seconds and allow it to dry.
Attach the needless syringe to the port. Draw 20 mL of urine if the specimen is required for a routine urinalysis or three mL for culture.
Empty the urine from the syringe into the specimen container.
- Use sterile equipment and urine containers if collecting the urine for culture and do not contaminate them.
- Close the container tightly.
Unclamp the catheter and make sure that the urine flows normally.
Dispose of one glove and use the ungloved hand to hold the biohazard transport bag. Then, with your gloved hand, put the specimen container into the bag. Make sure not to touch the outside of the transport bag with the glove. Dispose of the other glove safely and wash your hands.
Take the urine specimen to the laboratory within 20 minutes.
Clean and return the equipment to the right place.

24-HOUR URINE COLLECTION

Some clients may have a 24-hour urine collection order, where all the urine the client produces in a 24-hour period will be collected for testing. Because you’ll be collecting urine for an extended period of time, the urine specimen needs to be chilled by being placed on ice or in the refrigerator to prevent excessive microbial growth. The urine collection usually starts first thing in the morning with an empty bladder. That means that the client will need to urinate first, which won’t be collected as part of the specimen. After that, all the urine the client produces over the next 24 hours will be collected. So, be sure to indicate the time and date you begin and when to stop. The client should urinate into a bedside commode, urinal, bedpan, or “hat.” This way, you can collect and observe the urine and even measure it, if required, before transferring it into the special container.

You’ll need all the same supplies as you’d use in a random urine collection, but instead of a collection cup, you’ll use a 24-hour urine container, funnel, and a bucket of ice if you don’t have access to an appropriate fridge. These special containers might have preservatives in them, so be careful when you transfer the urine into them. Using a funnel can make this easier and prevent splashes.

It’s important to remind the client that all the urine they produce in this 24-hour period must be collected. If one is missed, the test will need to start over. It can be helpful to place signs in the room as a reminder to the client, visitors, and the entire healthcare team. Also, they should be reminded not to place toilet paper in the container and not to have a bowel movement while voiding. Both of these things can contaminate the specimen. When you’ve collected all the urine for testing, it should be transported to the lab accordingly.

Figure 5: Supplies you will need when collecting a urine specimen for a 24-hour urine collection order.

DOCUMENTATION

When collecting a urine specimen, the following should be reported to the healthcare provider:

if the client has any new or worsening pain or difficulty urinating
if the urine is discolored, cloudy, or has an abnormal odor
the urine output
any difficulties obtaining the urine specimen

For clients with a urinary catheter, also report:

complaints of pain, burning, or irritation related to the catheter
redness, swelling, or discharge from the catheter insertion site

Document:

the date and time
the type of urine specimen
any observations regarding the quantity and quality of urine
where the specimen was taken or stored until the scheduled pick up time