Steps

Rationale/Points of Emphasis

1 Obtain a collection container from the laboratory to be kept at the bedside. If the child will be voiding by using a bedpan or toilet specimen container, instruct the child to place the container toward the perineum or the front of the toilet so that if the child has the urge to defecate, the feces will not mix with the urine in the collection container.

Urine must be kept and stored together in the same collection container over a 24-hour period.

caREminder

Check with the institution’s laboratory manual to determine specific handling and storage procedures. The type of container (some tests require storage in a dark container), the type of preservative in the container, and refrigeration or freezing during collection is determined by the type of urine substance being tested.

2 Post signs above the child’s bed, and in the bathroom stating that a 24-hour urine test is in progress.

Reminds all healthcare personnel and family members to save the child’s urine. A 24-hour collection of urine is needed; if any urine is discarded, test results will be invalid. The total volume of urine collected during the 24-hour period is a factor used to calculate the excretion rate of the substance. Feces and toilet tissue may alter the test results.

3 Don gloves to handle voided specimens.

Standard precautions to reduce transmission of microorganisms.

4 If the child is able, have him or her void to empty the bladder and discard the voided urine. If an indwelling catheter is in place, discard any urine already in the drainage bag (see Chapter 112 ).

Because the 24-hour urine is a timed quantitative determination, it is essential to start the test with an empty bladder.

caREminder

If the child is unable to void on command and does not require an indwelling catheter, place an adhesive urine collection bag over the perineum and discard the first voided urine.

5 Note the time that the first urine was discarded in the child’s medical record or on record kept at the bedside to track progress of the urine collection procedure.

This time is the beginning of the 24-hour collection period.

6 Pour urine from each void into the collection container, and keep the collection container on ice or refrigerate. If indwelling catheter or urine collection bag is in place, empty and add to collection container on ice at least every 2 hours. It is not necessary to measure the volume of a voiding unless specifically ordered.

Ice/refrigeration is used for preservation and to control bacterial growth. Results may be altered by urine that is not properly stored.

caREminder

Toilet paper placed in with the specimen contaminates the specimen and decreases the amount of urine for analysis. Therefore, remind the child to use toilet paper after the specimen has been transferred into the appropriate container, and dispose of the paper in the toilet.

7 Before the end of the 24-hour collection period, ask the child to void one last specimen. Pour this final specimen into the collection container.

This is necessary for all urine excreted during the 24-hour period to be collected. The last specimen should be obtained as closely as possible to the stated end time of the test.

8 Label the collection container and send it to the laboratory immediately after the 24-hour period.

Test results depend on an accurate measurement of the time and quantitative urine. Test results may be altered because the urine is no longer on ice.

9 Remove gloves and perform hand hygiene after each contact with the urine specimen. Transfer any bedside data collection notes to the child’s medical record.

Reduces transmission of microorganisms.