Collecting a urine specimen/ urine specimen from indwelled catheter

The nurse is instructing a client in proper technique for collecting a midstream urine sample. The client reports having voided only a short while ago and is concerned there may not be a sufficient volume of urine. Which amount of urine would the nurse instruct the client is necessary for testing to be performed?

Approximately 1.5 tablespoons (10 to 20 mL) The nurse would instruct the client that approximately 1.5 tablespoons (10 to 20 mL) is a sufficient amount to use for testing. For the collection, the nurse would instruct the client to void approximately 2 tablespoons (30 mL) into the toilet, stop voiding briefly, void 1.5 tablespoons (10 to 20 mL) into the collection device, and complete voiding into the toilet. If the client were to void more than 10 to 20 mL into the collection device it would not be a problem, but this volume is more than the minimum necessary.

The nurse is preparing to collect a urine specimen from a client's indwelling urinary catheter. Which technique should the nurse plan to use?

Attach a sterile syringe to the luer-lock sampling port on the catheter drainage tubing and withdraw urine. Indwelling catheter drainage tubes have special sampling ports in the tubing for removal of urine for testing. Most sampling ports are needleless systems. However, some ports require the use of a needle or blunt cannula to access the sampling port. Never take urine specimens from the catheter drainage bag because the urine is not fresh and bacteria may be present on the bag. The integrity of a closed urinary drainage system should not be disrupted. Therefore, do not open the drainage system to obtain urine specimens to avoid contamination of the system and bladder infection. Piercing the drainage tubing would contaminate it and render it unusable.

The nurse is collecting a urine sample from an indwelling urinary catheter. Prior to cleaning the aspiration port, what would be the appropriate nursing action?

Bend the drainage tubing back on itself distal to the port. Clamping the catheter drainage tubing or bending it back on itself, distal to the port, ensures the collection of an adequate amount of fresh urine. There is not a drainage system that has a knob to turn it off and clamping the tubing above the port would not allow urine into the port for collection. Making sure the tubing is not kinked may help the flow of urine, but it does not ensure the collection of enough fresh urine for a sample.

The nurse is explaining the procedure for collecting a midstream urine specimen to a female client capable of performing the procedure without assistance. How should the nurse instruct the client to cleanse the perineal area prior to collecting the sample?

Clean each side of the urinary meatus then cleanse over it. Female clients would use antiseptic wipes (towelettes) or a wet washcloth to clean each side of the urinary meatus, and then center over the meatus and clean from front to back. The client would use a new wipe or clean area of the washcloth for each stroke. The nurse would instruct the client to keep the clean labia separated after the cleaning and during collection. Hand hygiene is always the first step to reduce contamination, but it is not part of the perineal cleaning process. Cleaning the perineum only does not cleanse the area around the urinary meatus.

When obtaining a urine specimen from an indwelling urinary catheter, the nurse places a label on the specimen container. How should the nurse check the information on the specimen label?

Compare it to the client identification band. When collecting a urine specimen from a client, the nurse would compare the specimen label to the client identification band. This ensures the specimen is labeled correctly for the right client. The nurse would not rely upon the client's confirmation of the label or check the label with the health care provider prescription or lab at this point in the procedure.

The nurse has finished collecting a urine specimen from the client's indwelling urinary catheter. What would the nurse do with the collected specimen to prepare it to be sent to the lab?

Empty the urine from the syringe into a specimen cup with a lid. After collecting a urine specimen from an indwelling urinary catheter, the nurse would remove the syringe from the port, slowly inject the urine from the syringe into the specimen container, replace the lid on the container, and place the syringe in the sharps container. The specimen container would be labeled and placed in a biohazard bag for transport to the lab.

The nurse is reviewing a urinalysis laboratory report of a client. The nurse notes there are nitrates and white blood cells present in the urine. Based on these results, what intervention(s) would be necessary? Select all that apply.

Prepare to obtain a urine culture., Notify the health care provider., Prepare to obtain a specimen by catheterization. If the urinalysis results show nitrates and white blood cells, it indicates that there could be an infection present. These results would warrant further testing. The health care provider should be notified. The nurse would anticipate receiving a prescription to obtain a sterile urine specimen by catheterization and the specimen should be sent to the laboratory to be cultured. Once the organisms are identified on the culture, the correct type of antibiotic can be prescribed by the health care provider. Neither obtaining another voided specimen nor collecting a midstream urine would provide a sterile specimen.

When collecting a urine sample from the port of the client's catheter drainage tubing, the nurse inserts the syringe into the aspiration port, slowly aspirates enough urine for the specimen, and removes the syringe. What would be the nurse's next step?

Unclamp the drainage tubing. After collecting the urine specimen, the nurse would remove the syringe from the port and unclamp the drainage tubing. This prevents overextension of the client's bladder and injury to the bladder. The tubing would not be disconnected, the aspiration port is cleansed prior to inserting the needle, and documentation is completed at the end of the procedure.

The nurse clamps the catheter drainage tubing to collect a urine specimen from a client's indwelling urinary catheter. How long can the nurse leave the tubing clamped to obtain a sufficient amount of urine?

Up to 30 minutes. The nurse can clamp the catheter drainage tubing or bend it back on itself, distal to the port, for up to 30 minutes to obtain a sufficient amount of urine, unless contraindicated. Clamping for an extended period of time can lead to overdistention of the bladder.

The nurse is teaching a client how to collect a midstream urine sample. After the client has cleaned the perineal area or penis, what instruction would the nurse give to the client?

Void a small amount of urine into the toilet, bedpan, or commode prior to collecting the sample. The nurse would instruct the client to void a small amount of urine into the toilet, bedpan, or commode. The client should then stop urinating briefly, then void into the collection container. The client should collect the specimen and then finish voiding into the toilet, bedpan, or commode. The inside of the collection container or the lid should not be touched. Collecting a midstream specimen ensures that fresh urine is analyzed. Some urine may have collected in the urethra from the last void. By voiding a little before collecting the specimen, it will contain only fresh urine. If the client attempts to save only the final amount for the collection container, the client may complete voiding without providing a sufficient volume of urine for the sample.

When obtaining a urine specimen from an indwelling urinary catheter, how would the nurse clean the aspiration port?

With an alcohol wipe. The nurse would cleanse the aspiration port with an alcohol wipe and allow the port to air dry prior to inserting the needle into the port. Cleaning the port with alcohol deters entry of microorganisms when the needle punctures the port.

The nurse has placed a urine collection bag on an infant. How often should the nurse check the bag to see if the infant has voided?

every 15 minutes The nurse should check the bag every 15 minutes. An infant does not have voluntary control over the bladder, so voiding occurs when the bladder is full. Checking the bag too frequently is not necessary. If the length of time is too long, the bag may overfill with urine and become unattached. The nurse should make sure the bag is secured in place.