This article, the second in a four-part series, describes the procedure for collecting a catheter specimen of urine
Citation:Shepherd E (2017) Specimen collection 2: obtaining a catheter specimen of urine. Nursing Times [online]; 113, 8, 29-31.
Author:Eileen Shepherd is clinicaleditor at Nursing Times.
- This article has been double-blind peer reviewed
- Scroll down to read the article ordownload a print-friendly PDF here
- Click here to see other articles in this series
Introduction
Obtaining a specimen involves collecting tissue or fluids for laboratory analysis or near-patient testing, and may be a first step in determining a diagnosis and treatment (Dougherty and Lister, 2015). Specimens must be collected at the right time, using the correct technique and equipment, and be delivered to the laboratory in a timely manner (Dougherty and Lister, 2015). Box 1 provides a reminder of the general principles of specimen collection, which were discussed in more detail in part 1 (Shepherd, 2017).
Box 1. Professional issues and good practice principles
Nurses must:
- Be aware of their organisation’s policies and procedures for specimen collection
- Be able to explain the purpose of the specimen to the patient and the implicationsfor treatment, and to obtain informed consent
- Be competent to undertake the procedure (NMC, 2015). This includes knowledgeof correct procedure for collection, handling and transportation of the sample(Dougherty and Lister, 2015)
- Be aware of infection prevention and control principles involved in collection oftissue and body fluids (Loveday et al, 2015)
- Understand the importance of accurate record keeping. Documentation shouldinclude time the specimen was collected, results and changes to treatment thatoccur in response to the results (Dougherty and Lister, 2015)
The specimen must be:
- Appropriate to the patient’s clinical presentation
- Collected at the right time
- Collected in a way that minimises the risk of contamination
- Collected in a manner that reduces risk to all staff (including laboratory staff)
- Collected using the correct equipment
- Documented clearly
- Stored/transported appropriately (Higgins, 2008)
The collection of any tissue/fluid carries a risk to staff from splash or inoculationinjury, so standard precautions should be followed (Loveday, 2015).
Indwelling urinary catheters
Indwelling urinary catheterisation involves the insertion of a tube into the bladder using aseptic technique (Dougherty and Lister, 2015).
The procedure is carried out on patients for a variety of reasons, including to:
- Manage acute and chronicurinary retention;
- Accurately measure urine outputin acutely ill patients;
- Bypass an obstruction such asan enlarged prostate gland in men;
- Administer drugs directly into the bladder and carry out bladder function tests (Yates, 2017a).
Catheters can also be used to manage incontinence and maintain skin integrity when all other conservative management strategies have been attempted and failed (Dougherty and Lister, 2015; Royal College of Nursing, 2012).
Indwelling urinary catheterisation is associated with a number of complications, including:
- Catheter-associated urinary tract infection (CAUTI);
- Tissue damage;
- Bypassing and blockage (Yates, 2017a).
As there is a risk of complications, catheters should be used only when no alternatives are appropriate. Catheters should also be removed as soon as clinically appropriate (Loveday et al, 2014).
Catheter specimen of urine
Catheter specimens of urine (CSU) are usually collected for microscopy, culture and sensitivity (MC&S) testing when an infection has been suspected. The urine is tested to identify the organisms causing the infection as well as their sensitivities to antibiotics.
A CSU should only be collected when a patient has clinical signs of a CAUTI (Box 2). The decision should not be based solely on the sight or smell of urine in the drainage bag as these are not good indicators of infection in catheterised patients (Scottish Intercollegiate Guidelines Network, 2015).
Box 2. Clinical signs of CAUTI
- Fever
- Rigor, shivering, shaking
- New onset or worseningconfusion/delirium
- Lethargy with no other identified cause
- Back pain/pelvic pain
- Acute haematuria
Source: SIGN, 2015
Principles of specimen collection
Indwelling urinary catheters are usually attached to a drainage bag to create a closed drainage system. Breaking this closed system – for example by disconnecting the catheter from the drainage device or emptying the drainage bag,can increase the risk of CAUTI (Lovedayet al, 2014).
Some patients have a catheter valve in place instead of a drainage bag, which allows the bladder to fill and then requires the patient (or a health professional or carer) to release the valve and allow the bladder to empty. Using the catheter valve helps maintain bladder tone and can be the method of choice for some patients. For further information on catheter valves see Yates (2017b).
A fresh sample of urine is required for a CSU and this must be obtained from the sampling port on the catheter bag or in the case of a catheter valve, directly from the valve. The sampling ports are designed to be accessed directly using a syringe and do not require a needle, therefore removing the risk of sharps injury (Dougherty and Lister, 2015).
Samples should not be collected from the drainage bag tap as the urine specimen may be contaminated (Brekle, 2014) and inaccurate results may lead to inappropriate treatment. Ideally, samples should be collected before antibiotics are commenced as they may affect the result of the laboratory investigation.
Equipment
The following equipment is required:
- Clean tray to hold equipment;
- Non-sterile gloves;
- Apron;
- Sterile 10ml syringe (not required if taking a specimen from a catheter valve);
- Non-traumatic clamp (notrequired if taking a specimen froma catheter valve);
- Specimen container;
- Alcohol-impregnated swabs(2% chlorhexidine in 70% isopropyl alcohol);
- Sterile jug (if taking a CSU from a catheter valve);
- Documentation and forms.
The procedure
Collecting from a sampling port
An aseptic non-touch technique (ANTT) must be used to obtain a CSU as this reduces the risk of cross infection (Rowley, 2011).
- Decontaminate hands and prepare the equipment.
- Explain the procedure to the patient and gain informed consent to obtain the specimen. It is important to explain why the specimen is being collected, when the results will be available and implications for treatment (Dougherty and Lister, 2015).
- Ensure the patient is comfortable and that their privacy and dignity is maintained throughout the procedure.
- Decontaminate your hands and put on an apron.
- If taking a specimen from a sampling port (Fig 1a), check first whether there is urine in the catheter tubing. If the tubing is empty apply a clamp below the level of the sampling port (Fig 1b). This allows urine to collect above the clamp so that a sample can be obtained.
- Decontaminate your hands and apply non-sterile gloves. Clean the sampling port with an alcohol-impregnated swab according to local policy and allow to dry (Fig 1c). This reduces the risk of cross infection or contamination of the specimen (Rowley, 2011).
- Stabilise the tubing by holding it below the level of the sampling port.
- Insert the syringe tip into the sampling port (following manufacturer’s instructions) (Fig 1d). Be careful to protect the sterile syringe tip and disinfected sample port from contamination.
- Aspirate at least 10ml of urine and withdraw the syringe.
- Put the urine into a sterile universal container, avoiding contact between the syringe and the pot (Fig 1e). Ensure the top of the specimen container is secured to prevent leakage and contamination of the specimen.
- Wipe the sampling port with an alcohol-impregnated swab and allow to dry. This reduces the risk of cross infection and contamination (Dougherty and Lister, 2015).
- If a clamp was used, release it to allow urine drainage freely. Failure to do this will cause the bladder to fill and can result in discomfort and bypassing of urine around the catheter, which can be distressing for the patient.
- Remove and dispose of gloves and apron, and wash hands with soap and water.
- Complete the request form, label the specimen and place in a specimen bag following local policies.
- Send the sample to the laboratory immediately or refrigerate until it can be transported to ensure accurate results are obtained (Dougherty and Lister, 2015).
- Document the date and time the sample was collected in the patient’s notes.
Collecting from a catheter valve
First, follow steps 1-4 above and then:
- Ensure the patient has a full bladder.
- Apply non-sterile gloves and clean the catheter valve port with an alcohol-impregnated swab according to local policy and allow to dry. This reduces the risk of cross infection (Fig 1f).
- Open the valve and release a small amount of urine to flush the valve.
- Open the valve again and empty the remaining urine into a sterile jug, ensuring the valve does not come into direct contact with the jug.
- Put a sample of urine in a sterile universal container. Ensure the top of the specimen container is secured to prevent leakage and any contamination of the specimen.
- Close off the valve and wipe the port with an alcohol-impregnated swab.
- Dispose of any remaining urine according to local policy.
- Follow steps 13-16 above to completethe procedure.
Also in this series
- Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen
- Specimen collection 3: obtaining a faecal specimen from a patient with diarrhoea
- Specimen collection 4: procedure for obtaining a sputum specimen
Professional responsibilities
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
Brekle B (2014) Specimen collection - microbiology and virology.
Dougherty L, Lister S (2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell.
Higgins D (2008) Specimen collection 1.obtaining a midstream specimen of urine.Nursing Times; 104: 5, 26-27.
Loveday HP et al (2014) epic3: national evidence-based guidelines for preventing healthcare-2associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, S1–S70.
Rowley S (2011) ANTT: A standard approach to aseptic technique. Nursing Times; 107: 36, 12-14.
Scottish Intercollegiate Guidelines Network (2015) Management of Suspected Bacterial Urinary Tract Infection in Adults.
Shepherd E (2017) Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen. Nursing Times; 113; 7, 45-47.
Yates A (2017a) Urinary catheters 5: teaching patients how to use a catheter valve. Nursing Times; 113: 5, 25-27.
Yates A (2017b) Urinary catheters 1: male catheterisation. Nursing Times; 113: 1, 32-34.
FAQs
May also be used withdraw the plunger and aspirate the urine. Divide the urine between the two pots.
What are the 4 types of urine collection tests? ›
Red blood cell urine test. Glucose urine test. Protein urine test. Urine pH level test.
What are 3 ways to collect a urine specimen? ›
Diagnosis requires collection of urine generally by 1 of 4 methods: sterile urine bag, urethral catheterization (CATH), suprapubic aspiration (SPA), or clean-catch (CC). Both CATH and SPA are thought to yield the most reliable results by minimizing false-positive results, but these methods are invasive and painful.
What is the catheter? ›
A catheter is a tube that is inserted into your bladder, allowing your urine to drain freely. The most common reasons for using a catheter are: to rest the bladder following an episode of urinary retention. to rest the bladder after surgery – most commonly bladder, bowel or urinary tract surgery.
What is the procedure of catheterization? ›
One end of the catheter is either left open-ended to allow drainage into a toilet or attached to a bag to collect the urine. The other end is guided through your urethra until it enters your bladder and urine starts to flow. When the flow of urine stops, the catheter can be removed. A new catheter is used each time.
What are the 5 types of urine collections? ›
Types of urine specimens:
- First morning specimen.
- Single random specimen.
- Timed short-term specimens.
- Timed long term specimens: 12 or 24 hours.
- Catheterized specimen or specimen from an indwelling catheter.
- Double voided specimens (test for sugar and acetone)
The types of biological samples accepted in most clinical laboratories are: serum samples, virology swab samples, biopsy and necropsy tissue, cerebrospinal fluid, whole blood for PCR, and urine samples. These are collected in specific containers for successful processing in the laboratory.
What is the most common type of urine specimen? ›
Midstream (clean-catch) urine collection is the most common method of obtaining urine specimens from adults, particularly men. This method allows a specimen, which is not contaminated from external sources to be obtained without catheterization.
What is the best sample for urine collection? ›
First voided specimen: Sample also referred to as a first morning specimen. This sample is collected the first time the patient urinates in the morning. A first voided specimen is the most concentrated and is the preferred specimen for pregnancy testing, bacterial cultures and microscopic examinations.
Why are there different types of collections methods for urine? ›
Urine specimen collection methods vary according to the type of specimen required, which can influence results. The normal make-up of urine varies considerably throughout any twenty-four-hour period. Specimens that are randomly collected are not considered specimens of choice.
Specimen collection is a common component of routine checkups for your health. It goes hand-in-hand with lab tests, allowing medical professionals to obtain tissue or fluids to look for any changes in your health. In addition, they help physicians diagnose medical conditions, plan treatments, and monitor diseases.
How do you use a catheter? ›
Use firm, gentle pressure to insert the lubricated end of the catheter into the urethra. Hold the other end of the catheter over the toilet bowl or container. Slowly slide the catheter until it reaches the bladder and urine starts to flow out of the tube. Continue inserting the catheter another inch or two.
Where is urinary catheter inserted? ›
It's usually inserted into your bladder through the urethra (the tube that carries urine out of your body). The sterile catheter is usually pre-lubricated, to reduce the risk of any discomfort when you insert it.
When collecting a catheter specimen of urine urine must be taken via the sampling port to Minimise contamination the port should be cleaned with? ›
Wipe the sampling port with an alcohol-impregnated swab and allow to dry. This reduces the risk of cross infection and contamination (Dougherty and Lister, 2015).
What are the 4 types of catheters? ›
Catheters come in many sizes, materials (latex, silicone, Teflon), and types (straight or coude tip).
What are the 3 main types of catheters? ›
There are three main types of catheters: indwelling catheters. external catheters. short-term catheters.
Why urinary catheters are used? ›
A urinary catheter is usually used when people have difficulty peeing (urinating) naturally. It can also be used to empty the bladder before or after surgery and to help perform certain tests.
Which catheter is used in female? ›
Also, today's female catheters come in advanced options like pre-lubricated female catheters, hydrophilic female catheters, and closed system catheter kits. They may offer a more smooth and comfortable catheterization. Plus, many new female catheter products are more discreet and pocket-size than ever before.
What are the steps for catheterization of a female patient? ›
Grasp the sterile catheter 2 to 3 inches (5 to 7.5 cm) from the tip and keep it from touching anything. Ask the patient to take a deep breath and slowly exhale while you insert the catheter tip. Advance it 2 to 3 inches until urine flow starts. Advance it another 1 to 2 inches to make sure it's in the bladder.
How is a catheter inserted in a female? ›
Insert the catheter:
Hold the labia apart with one hand. Slowly put the catheter into the meatus with your other hand. Gently push the catheter about 3 inches into the urethra until urine begins to come out. Once urine starts to flow, push the catheter up 1 inch more and hold it in place until the urine stops.
A 24-hour urine collection is done by collecting your urine in a special container over a full 24-hour period. The container must be kept cool until the urine is returned to the lab. Urine is made up of water and dissolved chemicals, such as sodium and potassium. It also contains urea.
How is urine collected and stored? ›
Storing a urine sample until you hand it in
If you can't hand your urine sample in within an hour, you should keep it in the fridge at around 4C (39F) for no longer than 24 hours. Put the container of urine in a sealed plastic bag first. If the urine sample isn't kept in a fridge, the bacteria in it can multiply.
What is normal urine test report? ›
Normal values, depending on diet, range from about 5 to 7, where values under 5 are too acidic, and values over 7 are not acidic enough) Protein (not usually found in urine) Sugar (glucose, not usually found in urine) Nitrite (not usually found in urine)
What is the procedure for collecting specimen? ›
There are four steps involved in obtaining a good quality specimen for testing: (1) preparation of the patient, (2) collection of the specimen, (3) processing the specimen, and (4) storing and/or transporting the specimen.
What are specimen samples examples? ›
Common examples include throat swabs, sputum, urine, blood, surgical drain fluids, and tissue biopsies.
What is the name of the specimen? ›
A specimen is a sample of something, like a specimen of blood or body tissue that is taken for medical testing. The noun specimen comes from the Latin word specere, meaning “to look.” Biologists collect specimens so they can get a better look at something to study it.
What is a urine sample called? ›
A urinalysis is a simple test that looks at a small sample of your urine. It can help find problems that need treatment, including infections or kidney problems. It can also help find serious diseases in the early stages, like kidney disease, diabetes, or liver disease.
What is catheterized specimen? ›
Catheterized specimen urine culture is a laboratory test that looks for germs in a urine sample.
How do you collect first morning urine? ›
Giving a first morning urine sample
Urinate directly into the container. It is not allowed to pour urine from one container into another. Use the first urine in the morning (first-void urine) for the sample. Do not eat or drink 10–14 hours before giving a urine sample.
How do you get a urine sample from an incontinent patient? ›
If the person is incontinent and wears incontinence pads, a urine collection pack can be used to draw a sample of urine from the pad. These are usually made up of two urine collection pads, a 5ml syringe and a urine specimen container. Contact your GP or local NHS continence service for advice on how to obtain these.
Wipe the sampling port with an alcohol-impregnated swab and allow to dry. This reduces the risk of cross infection and contamination (Dougherty and Lister, 2015).
Which type of catheter is used to collect specimens or to instill medications? ›
Triple-lumen catheters are used for continuous bladder irrigation and for instilling medications into the bladder; the additional lumen delivers the irrigation fluid into the bladder.
How do you collect a 24 hour urine with a Foley? ›
Collect urine in a clean, dry vessel and carefully pour the urine into the 24-hour collection container.
- Follow your physician's advice regarding any food, drink or drugs before and during collection.
- Empty your bladder completely upon awakening and discard this urine. ...
- Collect all urine for the next 24 hours.
Collecting a urine sample
- label the container with your name, date of birth and the date.
- wash your hands.
- start to urinate, but don't collect the first part of urine that comes out.
- collect a sample of urine "mid-stream" (see below) in a sterile screw-top container.
- screw the lid of the container shut.
Storing a urine sample until you hand it in
If you can't hand your urine sample in within an hour, you should keep it in the fridge at around 4C (39F) for no longer than 24 hours. Put the container of urine in a sealed plastic bag first. If the urine sample isn't kept in a fridge, the bacteria in it can multiply.
How much urine do you need for a urine test? ›
One to two ounces of urine is collected in a clean container. A sufficient sample is required for accurate results. Urine for a urinalysis can be collected at any time. In some cases, a first morning sample may be requested because it is more concentrated and more likely to detect abnormalities.
What precautions must be taken when a patient has a urinary catheter in place? ›
Do perform hand hygiene immediately before and after handling the catheter or drainage system, and use clean gloves while handling the catheter or drainage system. Do perform peri-care using only soap and water or a similarly gentle cleaning agent. Do keep the catheter and tubing from kinking and becoming obstructed.
What solution should be used for cleaning in preparation for urinary catheterisation? ›
The use of chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion reduces the incidence of catheter associated asymptotic bacteriuria and catheter associated urinary tract infection, compared to normal saline.
What is the most common type of urine specimen collected? ›
First voided specimen: Sample also referred to as a first morning specimen. This sample is collected the first time the patient urinates in the morning. A first voided specimen is the most concentrated and is the preferred specimen for pregnancy testing, bacterial cultures and microscopic examinations.
What are the different types of catheters? ›
There are 3 main types of catheters: Indwelling catheter. Condom catheter. Intermittent self-catheter.
It's usually inserted into your bladder through the urethra (the tube that carries urine out of your body). The sterile catheter is usually pre-lubricated, to reduce the risk of any discomfort when you insert it.
What is the recommended procedure for collecting a 24-hour urine sample? ›
A 24-hour urine sample is needed: On day 1, urinate into the toilet when you get up in the morning. Afterward, collect all urine in a special container for the next 24 hours. On day 2, urinate into the container when you get up in the morning.
What test requires 24-hour urine collection? ›
A 24-hour urine collection helps diagnose kidney problems. It is often done to see how much creatinine clears through the kidneys. It's also done to measure protein, hormones, minerals, and other chemical compounds.
How do you transport a 24-hour urine collection? ›
Collect all urine passed during the rest of the day and night for the next 24 hours. Do not urinate directly into the container. Collect in another clean container and then carefully pour into the 24-hour collection container. Note: If possible, keep container refrigerated during collection.
