Nursing How To’s: Urine Specimen and Culture

Random Urine Sample

A sample of urine collected at any time of the day. This type of specimen is most convenient to obtain.

Supplies and Equipment

  • Clean, dry container with lid
  • Cotton ball or towelette
  • Laboratory request form

Procedure

  1. Instruct the patient to use the cotton ball or towelette to clean urethral area thoroughly to prevent external bacteria from entering the specimen.
  2. Let the patient void into the container.
  3. Label the specimen container with patient identifying information, and send to the lab immediately. A delay in examining the specimen may cause a false result when bacterial determinations are to be made.
  4. Wash your hands and instruct the patient to do it as well.
  5. Note that the sample was collected.

Midstream “Clean-Catch” 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. It is important to follow the “clean-catch” protocol in order to have accurate results from an uncontaminated sample.

Supplies and Equipment

  • Sterile specimen cup
  • Zephiran, a soap solution, or three antiseptic towelettes
  • Three cotton balls (to use with zephiran or soap solution)
  • Laboratory request form

Preparation

Explain to the patient that this kind of urine collection involves first voiding approximately one half of the urine into the toilet, urinal, or bedpan, then collecting a portion of midstream urine in a sterile container, and allowing the rest to be pass into the toilet. Discuss that this is done to detect the presence or absence of infecting organisms and, therefore, must be free from contaminating matter that may be present on the external genital areas.

Procedure

For female patients:

  1. Wash hands with soap and water.
  2. Instruct the patient to clean perineal area with towelettes or cotton balls.
  3. Tell the patient to separate folds of urinary opening with thumb and forefinger and clean inside with towelettes or cotton balls, using downward strokes only; keep labia separated during urination.
  4. Instruct the patient to void a small amount of urine into the toilet to rinse out the urethra, void the midstream urine into the specimen cup, and the last of the stream into the toilet. The midstream urine is considered to be bladder and kidney washings; the portion that the physician wants tested.
  5. Fill out the laboratory request form completely, label the specimen container with patient identifying information, and send to the lab immediately. A delay in examining the specimen may cause a false result when bacterial determinations are to be made.
  6. Wash your hands and instruct the patient to do it as well.
  7. Note that the specimen was collected. Record any difficulties the patient had or if the urine had an abnormal appearance.

For male patients:

  1. Wash hands with soap and water.
  2. Instruct the patient to completely retract foreskin and cleanse penis with towelettes or cotton balls.
  3. Instruct the patient to void a small amount of urine into the toilet to rinse out the urethra, void the midstream urine into the specimen cup, and the last of the stream into the toilet. The midstream urine is considered to be bladder and kidney washings; the portion that the physician wants tested.
  4. Fill out the laboratory request form completely, label the specimen container with patient identifying information, and send to the lab immediately. A delay in examining the specimen may cause a false result when bacterial determinations are to be made.
  5. Wash your hands and instruct the patient to do it as well.
  6. Note that the specimen was collected. Record any difficulties the patient had or if the urine had an abnormal appearance.

Timed Urine Specimens (2-Hour, 4-Hour, 24-Hour)

For many urine chemistry procedures the specimen of choice is 24-hour urine. A 24-hour urine collection is performed by collecting a person’s urine in a special container over a 24-hour period. It always begins with an empty bladder so that the urine collected is not “left over” from previous hours. This specimen shows the total amounts of wastes the kidneys are eliminating and the amount of each.

Supplies and Equipment

  • Large, clean bottle with cap or stopper
  • Measuring graduate
  • Bedpan or urinal
  • Refrigerated storage area
  • Gloves

Preparation

The test does not require anything other than normal urination. There are no risks involved. Generally, the patient will be given one or more containers to collect and store urine over a 24-hour time period.

Procedure

  1. Label the bottle with patient identifying information, the date, and time the collection begins and ends.
  2. Instruct the patient to urinate, flush down the urine down the toilet when he gets up in the morning.
  3. Afterward, tell the patient to collect the rest of his urine in the special bottle for the next 24 hours, storing it in a cool environment. It can be kept cool in the refrigerator or on ice in a cooler.
  4. Instruct the patient to drink adequate fluids during the collection period.
  5. Emphasize proper hand hygiene before and after each collection. Record each amount on the intake and output (I&O) sheet.
  6. Exactly 24-hours after beginning the collection, ask the patient to void. This will complete the specimen collection.
  7. Instruct the patient to continue to keep the collection container refrigerated until transfer to laboratory.
  8. Send the bottle and laboratory request form to the lab.

Pregnancy Urine Test

A pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG), a hormone produced during pregnancy. This hormone can be detected in small amounts in both the urine and the blood of a pregnant woman as early as 10 days after conception.

Supplies and Equipment

  • Only a urine specimen cup is required.

Preparation

Allow patient to wait one to two weeks after her first missed period to get the most accurate results. Note: Irregular periods or miscalculations of when a period is due can affect the test. According to the FDA, 10 to 20 percent of pregnant women may not detect their pregnancy by testing on what they believe to be the first day of their first missed period.

Procedure

  1. Advise the patient to use the test the first time she urinate after waking up. As this urine is the most concentrated, it will contain the highest hCG levels of the day. Urine will become more diluted as the patient drink liquids, so hCG levels may be harder to measure later in the day.
  2. Label the specimen cup with the patient’s identifying information, complete a laboratory request form requesting an HCG test and send both to the lab.
  3. Only the physician or a registered nurse should tell the patient the results of the test.

 

Sources:

https://sites.google.com/site/nursingstudentsnote/family-blog/diagnostictestandspecimencollection

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

What Do You Think?