Have specimens collected and in the storage area by the pick-up time. If a specimen is not collected, results are delayed at least 1 day. This can harm the person. If not collected in time, a specimen may need to be discarded. Another is collected the next day. This also results in a delay and can harm the person. Using more supplies and equipment costs more money.

Promoting Safety and Comfort

Collecting and Testing Specimens

Safety

Correct identification is important when collecting and testing specimens. To identify the person, check the ID bracelet against all information on the requisition slip. Agency policy may require that you ask the person to identify himself or herself by both of the following.

• Stating or spelling his or her first and last name

• Stating his or her birthdate

Blood, body fluids, secretions, and excretions may contain microbes and blood. This includes urine, stool, and sputum specimens. Follow Standard Precautions and the Bloodborne Pathogen Standard when collecting, testing, and handling specimens.

Urine Specimens

Urine specimens are collected for urine tests. Follow the rules in Box 34-1.

See Delegation Guidelines: Urine Specimens.

See Promoting Safety and Comfort: Urine Specimens.

Delegation Guidelines

Urine Specimens

To collect a urine specimen, you need this information from the nurse and the care plan.

Promoting Safety and Comfort

Urine Specimens

Comfort

Urine specimens may embarrass some people, including children. They do not like clear specimen containers that show urine. It may be helpful to place the specimen container in a paper bag. Or provide a paper towel or washcloth to wrap around the container.

The Random Urine Specimen

The random urine specimen is used for a routine urinalysis (U/A). No special measures are needed. It is collected any time in a 24-hour period. Many people can collect the specimen themselves. Weak and very ill persons need help.

See procedure: Collecting a Random Urine Specimen.

Collecting a Random Urine Specimen

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines: Urine Specimens. See Promoting Safety and Comfort:

a Collecting and Testing Specimens

b Urine Specimens

2. Practice hand hygiene.

3. Collect the following before going to the person’s room.

• Laboratory requisition slip

• Specimen container and lid

• Voiding device—bedpan and cover, urinal, commode, or specimen pan (Fig. 34-1)

FIGURE 34-1 The specimen pan is placed at the front of the toilet on the toilet rim. This pan has a color chart for urine. (Courtesy Weldon, Inc., Fort Worth, Tex.)

• Specimen label

• Plastic bag

• BIOHAZARD label (if needed)

• Gloves

4. Arrange collected items in the person’s bathroom.

5. Practice hand hygiene.

6. Identify the person. Check the ID bracelet against the requisition slip. Compare all information. Also call the person by name. Ask the person to state his or her first and last name and state his or her birthdate.

7. Label the container in the person’s presence.

8. Put on gloves

9. Collect a graduate to measure output.

10. Provide for privacy.

Procedure

11. Ask the person to void into the device. Remind him or her to put toilet tissue into the wastebasket or toilet. Toilet tissue is not put in the bedpan or specimen pan.

12. Take the voiding device to the bathroom.

13. Pour about 120 mL (milliliters) (4 oz [ounces]) into the specimen container.

14. Place the lid on the specimen container. Put the container in the plastic bag. Do not let the container touch the outside of the bag. Apply a BIOHAZARD label.

15. Measure urine if I&O are ordered. Include the specimen amount.

16. Empty, rinse, clean, disinfect, and dry equipment. Return equipment to its proper place.

17. Remove and discard the gloves. Practice hand hygiene. Put on clean gloves.

18. Assist with hand-washing.

19. Remove and discard the gloves. Practice hand hygiene.

Post-Procedure

20. Provide for comfort. (See the inside of the front cover.)

21. Place the call light and other needed items within reach.

22. Raise or lower bed rails. Follow the care plan.

23. Unscreen the person.

24. Complete a safety check of the room. (See the inside of the front cover.)

25. Practice hand hygiene.

26. Take the specimen and requisition slip to the laboratory or storage area. Wear gloves if that is agency policy.

27. Remove and discard the gloves. Practice hand hygiene.

28. Report and record your observations.

The Midstream Specimen

The midstream specimen is also called a clean-voided specimen or clean-catch specimen. The perineal area is cleaned first to reduce the number of microbes in the urethral area. The person starts to void into a device. Then the person stops the urine stream and a sterile specimen container is positioned. The person voids into the container until the specimen is obtained.

Stopping the urine stream is hard for many people. You may need to position and hold the specimen container in place after the person starts to void (Fig. 34-2).

FIGURE 34-2 The labia are separated to collect a midstream specimen.

See Focus on Communication: The Midstream Specimen.

See Promoting Safety and Comfort: The Midstream Specimen.

See procedure: Collecting a Midstream Specimen.

Focus on Communication

The Midstream Specimen

Some persons can collect the midstream specimen without help. When explaining the procedure, use words the person understands. Show what supplies to use and how to use them. Also, ask if the person has any questions. For example:

Ms. Jacobs, I need a midstream urine specimen from you. This means I need urine from the middle of your urine stream. First, wipe well with this towelette (show the towelette). Wipe from the front to back. The specimen goes in this cup (show the specimen cup). Please do not touch the inside of the cup. Start your urine stream and then stop. Position the cup to catch urine and begin your stream again. If you cannot stop your stream, just position the cup during the middle of the stream. I need at least this much urine in the cup if possible (point to the 30 mL measure on the cup). Remove the cup when it is about that full. Finish urinating. Secure the lid on top of the cup. Please do not touch the inside of the lid. I will take the specimen when you are done.

After explaining the procedure, ask if the person has questions. Also make sure the person understands what to do. You can say: “Ms. Jacobs, please tell me what you are going to do so I know that you understand what I said.”

Promoting Safety and Comfort

The Midstream Specimen

Safety

You will open sterile packages and wear sterile gloves to collect a midstream specimen. You must guard against contamination. Review “Surgical Asepsis” in Chapter 16 before you handle sterile packages and items and don sterile gloves.

Collecting a Midstream Specimen

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines: Urine Specimens, p. 568. See Promoting Safety and Comfort:

a Collecting and Testing Specimens, p. 568

b Urine Specimens, p. 568

c The Midstream Specimen

2. Practice hand hygiene.

3. Collect the following before going to the person’s room.

• Laboratory requisition slip

• Midstream specimen kit—specimen container, label, towelettes, sterile gloves

• Plastic bag

• Sterile gloves, if not part of the kit

• Disposable gloves

• BIOHAZARD label (if needed)

4. Arrange your work area.

5. Practice hand hygiene.

7. Put on disposable gloves.

8. Collect the following.

• Voiding device—bedpan and cover, urinal, commode, or specimen pan if needed

• Supplies for perineal care (Chapter 22)

• Graduate to measure output

• Paper towels

9. Provide for privacy.

Procedure

10. Provide perineal care (Chapter 22). (Wear gloves for this step. Practice hand hygiene after removing and discarding them.)

11. Open the sterile kit.

12. Put on the sterile gloves.

13. Open the packet of towelettes.

14. Open the sterile specimen container. Do not touch the inside of the container or lid. Set the lid down so the inside is up.

15. For a female—clean the perineal area with towelettes.

a Spread the labia with your thumb and index finger. Use your non-dominant hand. (This hand is now contaminated. It must not touch anything sterile.)

b Clean down the urethral area from front to back (top to bottom). Use a clean towelette for each stroke.

c Keep the labia separated to collect the urine specimen (steps 17 through 20).

16. For a male—clean the penis with towelettes.

a Hold the penis with your non-dominant hand. (This hand is now contaminated. It must not touch anything sterile.)

b Clean the penis starting at the meatus. (Retract the foreskin if the male is uncircumcised.) Clean in a circular motion. Start at the center and work outward.

c Hold the penis (and keep the foreskin retracted in the uncircumcised male) until the specimen is collected (steps 17 through 20).

17. Ask the person to void into a device.

18. Pass the specimen container into the urine stream. Keep the labia separated (see Fig. 34-2).

19. Collect about 30 to 60 mL (1 to 2 oz) of urine.

20. Remove the specimen container before the person stops voiding. Release the foreskin of the uncircumcised male.

21. Release the labia or penis. Let the person finish voiding into the device.

22. Put the lid on the specimen container. Touch only the outside of the container and lid. Wipe the outside of the container. Set the container on a paper towel.

23. Provide toilet tissue when the person is done voiding.

24. Take the voiding device to the bathroom.

25. Measure urine if I&O are ordered. Include the specimen amount.

26. Empty, rinse, clean, disinfect, and dry equipment. Return equipment to its proper place.

27. Remove and discard the gloves. Practice hand hygiene. Put on clean disposable gloves.

28. Label the specimen container in the person’s presence. Place the container in the plastic bag. Do not let the container touch the outside of the bag. Apply a BIOHAZARD label.

29. Assist with hand-washing.

30. Remove and discard the gloves. Practice hand hygiene.

Post-Procedure

31. Provide for comfort. (See the inside of the front cover.)

32. Place the call light and other needed items within reach.

33. Raise or lower the bed rails. Follow the care plan.

34. Unscreen the person.

35. Complete a safety check of the room. (See the inside of the front cover.)

36. Practice hand hygiene.

37. Take the specimen and requisition slip to the laboratory or storage area. Wear gloves if that is agency policy.

38. Remove and discard the gloves. Practice hand hygiene.

39. Report and record your observations.

The 24-Hour Urine Specimen

All urine voided during 24 hours is collected for a 24-hour urine specimen. To prevent the growth of microbes, the urine is chilled on ice or refrigerated. Sometimes a preservative is added to the collection container.

The person voids to start the test with an empty bladder. Discard this voiding. Save all voidings for the next 24 hours. The person and staff must clearly understand the procedure and the test period. This test is re-started if:

• A voiding was not saved.

• Toilet tissue was discarded into the specimen.

• The specimen contains stools.

See Promoting Safety and Comfort: The 24-Hour Urine Specimen.

See procedure: Collecting a 24-Hour Urine Specimen, p. 572.

Promoting Safety and Comfort

The 24-Hour Urine Specimen

Safety

The urine container or preservative may contain an acid. Pour urine into the container carefully and avoid splashes and splatters. Do not get the preservative or urine from the container on your skin or in your eyes. If you do, flush your skin or eyes with a large amount of water. Tell the nurse what happened and check the safety data sheet (SDS) (Chapter 13). Also complete an incident report.

Keep the specimen chilled to prevent the growth of microbes. If not refrigerated, place the urine container in a bucket with ice. Add ice to the bucket as needed.

Assist the person with hand-washing after every voiding. This prevents the spread of microbes that may be in the urine.

Collecting a 24-Hour Urine Specimen

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines: Urine Specimens, p. 568. See Promoting Safety and Comfort:

a Collecting and Testing Specimens, p. 568

b Urine Specimens, p. 568

c The 24-Hour Urine Specimen, p. 571

2. Practice hand hygiene.

3. Collect the following before going to the person’s room.

• Laboratory requisition slip

• Urine container for a 24-hour collection

• Specimen label

• Preservative if needed

• Bucket with ice if needed

• Two 24-HOUR URINE labels

• Funnel

• BIOHAZARD label

• Gloves

4. Arrange collected items in the person’s bathroom.

5. Place one 24-HOUR URINE label in the bathroom. Place the other near the bed.

6. Practice hand hygiene.

7. Identify the person. Check the ID bracelet against the requisition slip. Compare all information. Also call the person by name. Ask the person to state his or her first and last name and state his or her birthdate.

8. Label the urine container in the person’s presence. Apply the BIOHAZARD label. Place the labeled container in the bathroom.

9. Put on gloves.

10. Collect the following.

• Voiding device—bedpan and cover, urinal, commode, or specimen pan

• Graduate to measure output

11. Provide for privacy.

Procedure

12. Ask the person to void. Provide a voiding device.

13. Measure and discard the urine. Note the time. This starts the 24-hour period.

14. Mark the time on the urine container.

15. Empty, rinse, clean, disinfect, and dry equipment. Return equipment to its proper place.

16. Remove and discard the gloves. Practice hand hygiene. Put on clean gloves.

17. Assist with hand-washing.

18. Remove and discard the gloves. Practice hand hygiene.

19. Mark the time the test began and the time it ends on the room and bathroom labels.

20. Remind the person to:

a Use the voiding device during the next 24 hours.

b Not have a BM when voiding.

c Put toilet tissue in the toilet or wastebasket.

d Put on the call light after voiding.

21. Return to the room when the person signals for you. Knock before entering the room.

22. Do the following after every voiding.

a Practice hand hygiene. Put on clean gloves.

b Measure urine if I&O are ordered.

c Use the funnel to pour urine into the urine container. Do not spill any urine. Re-start the test if you spill or discard the urine.

d Empty, rinse, clean, disinfect, and dry equipment. Return equipment to its proper place.

e Remove and discard the gloves. Practice hand hygiene. Put on clean gloves.

f Assist with hand-washing.

g Remove and discard the gloves. Practice hand hygiene.

h Follow “Post-Procedure” steps except for steps 28 and 33.

23. Ask the person to void at the end of the 24-hour period. Follow steps 22, a–g.

Post-Procedure

24. Provide for comfort. (See the inside of the front cover.)

25. Place the call light and other needed items within reach.

26. Raise or lower bed rails. Follow the care plan.

27. Put on gloves.

28. Remove the labels from the room and bathroom.

29. Clean, rinse, dry, and return equipment to its proper place. Discard disposable items.

30. Remove and discard the gloves. Practice hand hygiene.

31. Unscreen the person.

32. Complete a safety check of the room. (See the inside of the front cover.)

33. Take the specimen (labeled urine container) and requisition slip to the laboratory or storage area. Wear gloves if that is agency policy.

34. Remove and discard the gloves. Practice hand hygiene.

35. Report and record your observations.

Collecting a Urine Specimen From an Infant or Child

Sometimes urine specimens are needed from infants and children who are not toilet-trained. A collection bag (“wee bag”) is applied over the urethra (Fig. 34-3). A parent or another staff member assists if the child is upset.

FIGURE 34-3 A urine collection bag applied to a baby girl’s perineum.

Voiding on request is hard for toilet-trained toddlers and young children. Potty chairs and specimen pans are useful. Remember to use terms the child understands. “Pee pee,” “wee wee,” “potty,” and “tinkle” are examples. Or ask the parent what term the child uses and understands.

The nurse may have you give the child water or other fluids when a urine specimen is needed. Usually the child can void about 30 minutes after drinking fluids.