Action	Rationale
Review and carry out the standard steps in Appendix 1
The bladder is emptied completely and the urine discarded. Note the time of collection	Collection begins with the bladder empty. Only urine secreted during the time allocated is collected
From the starting time of collection onwards, each specimen of urine voided in the time requested is added to the container	All urine voided in that period is collected to ensure an accurate test result
The container of urine is refrigerated until the collection is complete	Keeping the urine cold helps prevent decomposition
At the end of 24 hours the bladder is emptied and the urine added to the container	The last voiding empties the bladder and completes the 24-hour collection
Encourage client to drink two glasses of water an hour before timed urine collection ends. Ensure that the client is not on restricted fluids	Facilitates client’s ability to void at the end of the period
Ensure that the label on the container has all the relevant information. Despatch specimen to the laboratory as soon as possible with the request form, or store specimen in refrigerator	Accurate documentation is necessary to avoid errors
If any of the urine is inadvertently discarded, the collection may need to be abandoned and the procedure restarted	Inaccurate results will be obtained if all urine excreted over the 24-hour period is not acquired

Action	Rationale
Review and carry out the standard steps in Appendix 1
Explain to client and/or family member reason specimen is needed, how client can assist (when applicable), and how to obtain a specimen that is free of tissue and stool	Promotes cooperation and client participation. In some cases client can collect clean-voided specimen independently
Give client or family member towel, wash-cloth and soap to cleanse perineum, or assist client (after application of clean gloves) with cleansing perineum	Clients usually prefer to wash their own perineal area when possible. Prevents external microorganisms from contaminating the specimen
Using surgical asepsis, open outer package of commercial specimen kit	Maintains sterility of specimen container
Apply sterile gloves	Prevents introduction of microorganisms into urine specimen from nurse’s hands
Client voids 30–60 mL of urine into the toilet or toilet utensil	Flushes any residual microorganisms out of the urethra
Collect the next 20–30 mL of urine in a sterile container, e.g. sterile kidney dish	This is the middle stream of urine and is the portion sent for analysis
The person completes voiding into the toilet or toilet utensil	The remainder of the urine is not required for collection
Pour collected urine specimen into labelled sterile specimen container and remove gloves	Prevents cross-infection
Despatch specimen to the laboratory as soon as possible with the request form, or store specimen in refrigerator	Decomposition and cell growth occur if urine is left standing, and may provide a false result
The procedure should be documented	Appropriate care can be planned and implemented
Special note: Indicate on laboratory slip if client is menstruating

Action	Rationale
Review and carry out the standard steps in Appendix 1
Place the person in a supine position if possible	Facilitates application of the bag
Cleanse the perineal area, swabbing towards the anus. Ensure that the urethral meatus is clean and dry	Prevents contamination of the urine by microorganisms from the surrounding skin
Remove the covering from the bag’s adhesive surfaces and apply the bag. The bag should enclose the urethral meatus, but not the anus	The bag must be correctly positioned and firmly secured to avoid leakage
Press the adhesive surfaces onto the skin (if necessary, the surrounding skin is shaved before applying the bag)	Promotes adherence of the bag to the skin
Check frequently and gently remove the bag when sufficient urine has been collected	Avoids damage to the skin
Transfer the urine into the specimen container	Prepares specimen for testing or despatch to the laboratory
Reposition the client and adjust the bedclothes to meet needs	Promotes comfort
Despatch specimen to the laboratory as soon as possible with the request form, or store specimen in refrigerator	Decomposition and cell growth occur if urine is left standing
Wash and dry hands	Prevents cross-infection

A catheter specimen of urine is obtained from a client who has an indwelling catheter (Figure 22.1). The insertion of a catheter for the sole purpose of obtaining a urine specimen is generally avoided because of the risk of introducing microorganisms into the urinary tract. To reduce this risk when obtaining a specimen of urine from an indwelling catheter, it is important to maintain a closed urinary drainage system. For this reason, collecting a specimen from the end of the catheter connected to the drainage tubing should be avoided. Instead, the urine should be aspirated through the sampling port using a sterile syringe and needle. A urine specimen for culture tests should not be collected from a urinary drainage bag unless it is the first urine to drain into a new sterile bag. Bacteria can ascend up into the drainage bag from surfaces it makes contact with, and grow rapidly. This can give a false measurement of bacteria in the urine.

Figure 22.1 Obtaining a sample of urine from a catheter

The equipment necessary consists of a sterile syringe and needle, alcohol swabs or disinfectant swabs, sterile labelled specimen container, completed laboratory request form, clean disposable gloves and a clamp. The recommended method for obtaining a urine specimen from a catheter is outlined in Table 22.4.

TABLE 22.4 COLLECTING URINE FROM AN INDWELLING URINARY CATHETER

Action	Rationale
Review and carry out the standard steps in Appendix 1
Explain procedure to client	Minimises anxiety when nurse manipulates catheter and aspirates urine with needle and syringe
Clamp the catheter about 30 minutes before the specimen is to be collected	Allows urine to accumulate in the bladder so that a specimen can be obtained
Wash and dry hands and put on disposable gloves and goggles	Prevents risk of transferring microorganisms
Position client so catheter port is easily accessible. Wipe the sampling port with an alcohol swab	Prevents entry of microorganisms into catheter
Attach the needle to the syringe and insert the needle at 45 degree angle just above where catheter is attached to drainage tube at built-in sampling port in silastic, silicone or plastic catheter into the port. Aspirate the specimen of urine into the syringe and transfer it into the specimen container	The needle should not be inserted into the shaft of the catheter, as this may result in subsequent leakage of urine
Wipe the puncture area on the catheter with an alcohol swab	Prevents entry of microorganisms into catheter
Unclamp the catheter	Allows urine to flow again
Dispose of the used swabs, gloves, syringe and needle safely	Prevents risk of transferring microorganisms and injury
Wash and dry hands	Prevents cross-infection
Despatch specimen to the laboratory as soon as possible with the request form, or store specimen in refrigerator	Prevents decomposition of urine or cell growth