Urine Collection: Routine Voided Urine Specimen

CLINICAL GUIDELINES

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.
Routine voided specimens are collected for routine urinalysis and can be used to examine the urine for color, specific gravity, pH, protein level, glucose level, acetone level, bilirubin level, or the presence of blood.
A routine voided specimen is usually collected on the child’s admission to the hospital, before surgery, or during a visit to the healthcare provider’s office for a well-child visit.
Methods of collection include a clean bedpan, urinal, or toilet specimen container for the toilet-trained child. For the child who is not toilet trained, collect urine by using an adhesive urine collection bag, urine collection pad, or cotton balls.
A routine voided specimen can be used to check for bacteria in the urine; however, it is not used to make a final determination of the presence of bacteria.
Collect the urine specimen at the child’s first void of the morning, if possible. Such a specimen is more likely to reveal abnormalities than a later voiding.

EQUIPMENT

Nonsterile gloves
Basin with liquid soap and warm water, washcloth, and towel or perineal wipe
Waterproof pad
Age-appropriate urine collection device:
- Bedpan
- Urinal
- Toilet specimen container
- Sterile foil bowl
- Adhesive urine collection bag
- Urine collection pad
- Cotton balls
Chemical adhesive (e.g., tincture of benzoin)
Urine specimen container
Adhesive label or marker
Biohazard bag for transporting the specimen to the laboratory
4 × 4 gauze pads or tampon, if needed, for pubescent girls during menses

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Assess the cognitive level, readiness, and the ability to process information of the child and the family. The readiness to learn and process information may be impaired as a result of age, stress, or anxiety.
Assess the history for toilet training, if age appropriate.
For a young or cognitively delayed child, ask the family what word the child uses for urine and use that word when talking with the child about the procedure.
Reinforce the need for the urine specimen collection, as appropriate, to both the child and the family.
Offer the child something to drink before the procedure to encourage voiding.
Provide the opportunity to ask questions and alleviate fears.
Explain the procedure, as appropriate, to both the child and the family.

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 child, regardless of age, during the procedure, and handle specimen discreetly.

PROCEDURE
Routine Voided Urine Specimen Collection

Steps	Rationale/Points of Emphasis
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 precaution to reduce transmission of microorganisms
4 As age appropriate, have the child urinate in a clean bedpan, urinal, or toilet specimen container or use a urine collection device to collect urine from the child who is not yet toilet trained.	Adapt the procedure to the child’s developmental ability to understand request and to child’s physical maturation. Infants and toddlers will be unable to void upon request until myelinization of the spinal cord is complete and potty training practices have been fully mastered.
	caREminder
	If the child is having difficulty voiding, run water in the sink to trigger voiding.
5 For specimen collected in a bedpan or urinal:
• Position the child on the back with the head of the bed slightly elevated.	This position makes it easier to void and allows gravity to aid in elimination.
• Place a waterproof pad under the child’s buttocks.	Prevents the bed linens from being soiled
• Wash the child’s genital area with warm water and soap. Rinse and dry the area.	Cleanses perineal area
	caREminder
	The child and the family can be instructed in performing this step themselves.
• Place the bedpan under the child or place the urinal such that the penis is inserted in the opening.	Having the bedpan or urinal in the proper position prevent spills on the bed.
• Once the child has voided, remove the bedpan or urinal, offer toilet paper, and assist the child to place underwear back on. Assist the child to perform hand hygiene.	Cleaning the perineal area prevents odors and irritations to the skin. Hand hygiene prevents transmission of microorganisms.
6 For the child using a toilet specimen container:
• Explain to the child and the family how to clean the genitalia area. Instruct the child not to defecate at the same time and not to contaminate the specimen with toilet paper.	Use age-appropriate terminology. Feces and toilet paper can alter the results of urinalysis.
• A menstruating female should place a tampon or a gauze pad in her vaginal orifice after cleansing the perineal area with warm soap and water.	Menses may cause a false-positive result when testing for blood in the urine.
• Give the container to the child and explain how to hold the container while voiding.	Proper handling reduces transmission of microorganisms.
• Ask the child to leave the sample in the bathroom after the specimen is obtained.	Prompt transfer to an appropriate specimen container optimizes accuracy of results.
• Ask the child to perform hand hygiene after the specimen has been obtained.	Reduces transmission of microorganisms.
• Once specimen has been obtained, don gloves. Pour the fresh urine in the specimen container and put the lid on the container.	Standard precaution to reduce transmission of microorganisms. Prepares urine for transfer to laboratory.
7 For the specimen collected by using a urine collection bag:
• Position the child on the back with the legs in a frog-like position.	This position exposes the genitalia to facilitate cleansing of the area and proper placement of the collection bag.
• Remove the diaper and clean the perineum or prepuce of the child.	Prevents contamination of the urine specimen.
• Apply a chemical adhesive (e.g., tincture of benzoin). Do not use chemical adhesive on premature infants or neonates because this will cause transdermal tearing.	Helps maintain seal between the bag and the child’s skin.
• Attach a urine collection bag to the child by removing the protective backing from the adhesive. Make sure the bag does not cover the anus.	Proper placement of the bag avoids having to repeat the procedure.
• For a male, insert the penis and the scrotum into the bag opening; the adhesive adheres to the perineum and the symphysis (Figure 113-1).
• For a female, position the lower half of the adhesive on the bag on the perineum first and then press on the adhesive up toward the symphysis (Figure 113-2).

Figure 113-1 For a male, insert the penis and the scrotum into the bag opening; the adhesive adheres to the perineum and the symphysis.	Figure 113-2 For a female, position the lower half of the bag on the perineum first and then press adhesive up toward the symphysis.
• Cut a hole in the diaper, pulling the urine bag through the opening.	When the child voids, it is easily visible, and the urine bag can be removed immediately.
• Replace the diaper and wait for the child to void.	Child may not void immediately.
• Remove gloves and perform hand hygiene.	Reduces transmission of microorganisms.
• After the child has voided, don gloves and remove the bag from the child. Transfer urine to specimen container by holding the urine bag over open specimen container; remove the tab over the opening in the lower bag or cut off the tip of bottom corner of the bag.	Prepares specimen for submission to laboratory.
• Remove gloves and perform hand hygiene.	Reduces transmission of microorganisms.
8 For specimen collected by using a urine collection pad:
• Remove the diaper and clean the perineum or prepuce of the child.	Prevents contamination of the urine specimen.
• Place urine collection pad across the urethra or the penis in lengthwise fashion.	Urine collection pads have been found to be an effective method to retrieve urine for analysis. This method is more cost-effective than urine collection bags and is ideal as a means to rule out urinary tract infection in children in whom this is unlikely to be the focus of infection and where initiation of antibiotic therapy is not urgent. The diagnosis of urinary tract infection is best confirmed by transurethral bladder catheterization or suprapubic aspiration.
• Remove the adhesive backing from the pad and replace the diaper, ensuring the adhesive strip secures to the inside of the diaper.	Diaper assists to hold the adhesive pad in place.
• Once the child has voided, don gloves and remove the diaper with the absorbent pad in it from the infant.	Urine-saturated pad must be retrieved to obtain specimen.
• Place clean diaper on the child.	Prevents the child from voiding on bed linen.
• With gloved hands, squeeze out urine from the absorbent pad into an appropriate urine container or onto urine testing strips.	Prepares specimen for submission to laboratory.
• Dispose of the absorbent pad and the diaper in appropriate receptacle.	Standard precautions.
• Remove gloves and perform hand hygiene.	Reduces transmission of microorganisms.
9 For specimen collected by using foil bowl:
• Remove the diaper and clean the perineum or prepuce of the child.	Prevents contamination of the urine specimen.
• Have a nurse or a family member sit down with a waterproof pad placed across the lap.	Protects the lap and clothes from getting soiled.
• Place the child on the lap of the family member. The family member holds a sterile foil bowl underneath the child’s genitalia.	This method has been compared with suprapubic aspirations and has been found to yield a good association between the results found from using the two methods. Thus, this method is considered less invasive, less costly, and reliable in assessing for microorganisms in the urine. Although the method appears to be time consuming, most specimens can be collected in less than 1 hour.
• Offer the child oral fluids and await urine collection.	Additional fluids may enhance potential for voiding.
• Once a specimen is collected, don gloves, replace a diaper on the child, and proceed with preparing the specimen for the laboratory.	Standard precautions to reduce the transmission of microorganisms. Diaper contains the child’s excretions. Prepares specimen for submission to laboratory.
10 For specimen collected using cotton balls:
• Remove the diaper and clean the perineum or prepuce of the child.	Prevents contamination of the urine specimen.
• Place cotton balls near the urethra.	Use 100% cotton balls. Cotton ball aspiration is a safe and valid way to collect urine for pH, specific gravity, and latex-particle agglutination. Urine should not be aspirated from the diaper for specimen collection for testing of specific gravity, pH, or protein level. Disposable diapers with absorbent gel are difficult to aspirate from and yield inaccurate results.
• Replace diaper.	Diaper assists to hold cotton balls in place.
• Once the child has voided, don gloves and remove the diaper with the cotton balls in it from the infant.	Urine-saturated cotton balls must be retrieved to obtain specimen.
• Place clean diaper on the infant.	Prevents the child from voiding on bed linen.
• With gloved hands, squeeze out urine from the cotton balls into appropriate urine container or onto urine testing strips.	Prepares specimen for submission to laboratory.
• Dispose of cotton balls and diaper in appropriate receptacle.	Standard precautions.
• Remove gloves and perform hand hygiene.	Reduces the transmission of microorganisms.
11 Label the specimen, and place it in a biohazard bag.	Standard precautions.
12 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.
13 Dispose of equipment and waste in appropriate receptacle. Remove gloves. Perform hand hygiene.	Standard precautions. Reduces transmission of microorganisms.