Urine collection for diagnostic analysis is ordered by a healthcare prescriber.
A registered nurse (RN), a licensed practical nurse (LPN), or an unlicensed assistive personnel (UAP) may collect urine for diagnostic analysis.
A clean-catch urine (CCU) or midstream urine (MSU) specimen is collected when a urinary tract infection is suspected and uncontaminated urine is needed for a urine culture and sensitivity. Confirmation of a diagnosis of a urinary tract infection is completed by using transurethral bladder catheterization or suprapubic aspiration.
The CCU and MSU are the methods of choice for obtaining a urine sample in infants and older children who do not require immediate antibiotic treatment.
caREminder
The diagnosis of urinary tract infection cannot be established by a culture of urine collected in a bag.
Specimens needed from infants must be collected by using an adhesive urine collection bag or urine collection pad as outlined in Chapter 113.
If possible, collect the child’s first voiding in the morning because bacterial counts are the highest in this voiding.
EQUIPMENT
Nonsterile gloves
Basin with liquid soap and warm water, washcloth, and towel
Sterile specimen container
Adhesive label or marker
Antimicrobial perineal wipes, swabs, or sponges
Biohazard bag for transporting the specimen to the laboratory
4 × 4 gauze pads or tampon, if needed, for pubescent girls
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess the cognitive level, readiness, and the ability to process information by the child and the family. The readiness to learn and process information may be impaired as a result of age, stress, or anxiety.
KidKare The child may have difficulty understanding the request. The adolescent may be reluctant to have the test completed or may be unable to void on request. The nurse should use simplistic terms and age-appropriate words that the child uses, such as “pee-pee,” to make the request. Provide privacy for the older child.
Assess the present history for toilet training, if age appropriate.
Before use, assess for allergies to antimicrobial agents.
Reinforce the need for the urine specimen collection, as appropriate, to both the child and the family.
Provide the opportunity to ask questions and alleviate fears.
Explain the procedure, as appropriate, to both the child and the family.
1 Perform hand hygiene. Gather the necessary supplies.
Reduces transmission of microorganisms. Promotes efficient time management and provides an organized approach to the procedure.
2 Close the door to the child’s room and draw the curtains around the bed to provide privacy, as appropriate. Assist the child to the bathroom.
Provides privacy during the procedure.
3 Don gloves.
Standard precautions to reduce transmission of microorganisms.
4 Remove the lid of the sterile specimen container and place it with the inside of the lid facing up, on a clean surface within easy reach.
Touching the inside of the lid causes contamination.
5 If a family member is assisting or the child is performing self-care, he or she should perform hand hygiene and don gloves (optional).
Standard precautions to prevent contamination of specimen from microorganisms.
6a Clean around the child’s urethral opening with liquid soap and water, antimicrobial wipes, swabs, or sponges and discard them in a nearby open waste receptacle. Allow the area to dry.
Prevents contamination of the specimen by microorganisms on the skin. Research indicates that urine contamination rates are higher in midstream urine that is collected without perineal/genital cleansing before obtaining the specimen. Cleansing may reduce the need for repeat cultures and/or receiving unnecessary antibiotic treatment due to misdiagnosis of urinary tract infection.
6b For a female use a separate antimicrobial swab for each stroke, open the child’s labia and cleanse both the right and left side of the inner labia with one downward stroke. Then clean midline, from the clitoris down to the rectum, with one stroke. The nurse may need to assist the child in keeping the labia open while voiding. If the child is old enough, she may be able to do this herself, although she may then need assistance holding the specimen cup.
Prevents contamination of the sterile field. The labia should not be allowed to close during the entire procedure. If the labia do close, stop the procedure, don new sterile gloves, and start over at this step.
6c A menstruating female should place a tampon or a gauze pad in her vaginal orifice after cleansing the perineal area with soap and warm water.
Menses may cause a false-positive result when testing for blood in the urine.
6d For a male, retract the foreskin (if present). Cleanse the penis in an outgoing circular motion, from the urethral opening to the base of the penis, using a new antimicrobial wipe, swab, or sponge each time.
Removes secretions and smegma and reduces microorganisms.
7 If possible, instruct the child to void a small amount of urine into the toilet or urinal. For infants and young children, use an adhesive urine collection bag or urine collection pad as outlined in Chapter 113 to collect the specimen.
This cleanses the meatus of any remaining bacteria.
caREminder
Run water in the sink to trigger voiding.
8 Have the child urinate 10-20 mL directly into a sterile specimen container; the child can then finish urinating in the toilet or urinal.
Urinating directly into the specimen container decreases the possibility of contaminating the specimen.
9 Place the lid back on the specimen container. Avoid touching the inside of the lid or of the container. Wipe off the outside of the container.
If hands or any other body part or nonsterile object touches the lid or the inside of the container, the specimen is contaminated by outside bacteria.
10 Assist the child with wiping/cleansing the perineal area after voiding is complete, as needed.
Promotes cleanliness.
11 Assist the child to return to bed, or other activity, after disposing of gloves and performing hand hygiene.
Reduces transmission of microorganisms.
12 Label the specimen, and place it in a biohazard bag.
Standard precautions.
13 Send the specimen to the laboratory immediately.
Urinalysis results may be altered if the specimen is more than 1-hour old. If the specimen is not fresh, bacteria may enter the urine, and other components can break up and disintegrate.
14 Dispose of equipment and waste in appropriate receptacle. Remove gloves. Perform hand hygiene.
Standard precautions. Reduces transmission of microorganisms.
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KidKare The child may have difficulty understanding the request. The adolescent may be reluctant to have the test completed or may be unable to void on request. The nurse should use simplistic terms and age-appropriate words that the child uses, such as “pee-pee,” to make the request. Provide privacy for the older child.
PROCEDURE
