Instructions Patients may find the procedure embarrassing and it is important to protect their privacy and dignity while offering or providing support. It is important that the urine sample is not contaminated by germs from the skin when it is collected as this may lead to a wrong diagnosis. If immediate transportation is not possible, it is important to consult local guidelines about storage of specimens. To collect a 24-hour urine specimen: Follow your physician’s directions regarding intake of food, drink, or drugs before and during collection. Box 3. Instructions to help patients with their test preparations or specimen collections. Measure and record this volume on the test request form and on the urine transport vial (see Pediatric Specimen Tubes below). The procedure used to collect a specimen must minimise the risk of introducing error and protect the health and safety of both the patient and the staff who handle the sample. Principle. When collecting a 24-hour urine specimen:Where must the urine for a 24-hour specimen be stored? Date of the last urine specimen collected (MM/DD/YYYY) Time of the last urine specimen collected (please include A.M. or P.M.) NCH Clinics: Clinicians can use an EPIC registration label before giving the container(s) to the patient. There are a couple of ways to collect the specimen. You … Test name. A clean-catch specimen is a way of collecting urine that does not contain a lot of bacteria from the skin. A: Have the patient urinate a small amount of urine before starting the collection. Think about this. A vast assortment of collection and transport containers for urine specimens are available. For healthcare personnel collecting specimens or working within 6 feet of patients suspected to be infected with SARS-CoV-2, maintain proper infection control and use recommended personal protective equipment (PPE), which includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown, when collecting specimens. This test can be used to diagnose a kidney condition or see if a treatment is working. Visit our, Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, Specimen collection 2: obtaining a catheter specimen of urine, Specimen collection 3: obtaining a faecal specimen from a patient with diarrhoea, Specimen collection 4: procedure for obtaining a sputum specimen, Specimen Collection: Microbiology and Virology, Urinary Tract Infection Surveillance for Use in Health and Social Care Facilities, Safe Working and the Prevention of Infection in Clinical Laboratories and Similar Facilities, The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives, Wipe it out: One change to get it right – Essential Practice for Infection Prevention and Control, Newly qualified nurses: practical procedures, Winners of the Nursing Times Workforce Awards 2020 unveiled, Don’t miss your latest monthly issue of Nursing Times, Announcing our Student Nursing Times editors for 2020-21, How best to meet the complex needs of people with interstitial lung disease, Creating an electronic solution for early warning scores, New blended learning nursing degree offers real flexibility, Expert nurses share their knowledge of pressure ulcers in free-to-watch videos, CNOs lead seasonal tributes to nurses after year of Covid-19, Hancock reveals 2021-22 pay rise for nurses will be ‘unfortunately delayed’, University gets approval for ‘ground-breaking’ online nursing degree, Concern for nurses in Wales as Covid-19 cases rise at ‘alarming rate’, Investigation into NG tube errors calls for ‘standardised staff training’, Scotland announces appointment of new chief nursing officer, Survey reveals pressures faced by health visitors since Covid-19, Disruption from no-deal Brexit ‘last thing NHS needs’, PM warned, New resource for community nurses on responding to ‘long Covid’, Healthcare heroes, we need your voice now more than ever, This content is for health professionals only, This article has been double-blind peer reviewed, Appropriate to the patient’s clinical presentation, Collected in a way that minimises contamination, Collected in a way that reduces health and safety risk to all staff handling the specimen (including laboratory staff), Documented clearly using appropriate forms. Record date and time under “start” and begin the test (e.g., 5/12/10, 7:00 a.m.). Which of the following actions should the nurse take when obtaining a wound culture specimen from the pressure ulcer? You can insert a sterile needle attached to a sterile syringe and withdraw a specimen from a port in the drainage tubing after swabbing with alcohol. Explain the steps of the procedure and how to avoid contaminating the specimen. Box 1. ‘Employers must do their utmost to support their nursing staff’, This article, the first in a four-part series, describes the general principles of specimen collection and how to collect a midstream specimen of urine. How to collect a clean urine specimen You have been given a container to collect a sample of urine from your child to test for a urinary tract infection. 24hr urine in a PLAIN container. Show More about Collecting a Sterile Urine Specimen Residual urine, urine left in the bladder after voiding, can be measured at the time of catheterization. Urine Cytology Your health care provider has requested a urine specimen. These convenient online drug test specimen collection training modules consist of instruction and demonstrations, each followed by a quiz that will take approximately 15 minutes. Wash your hands and put on gloves and an apron if you are accompanying the patient or handling the specimen. A nurse is collecting a blood specimen for culture from a patient hospitalized for pneumonia. For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Bring the specimen to the lab within 1 hour or collection or store refrigerated for up to 24 hours. Urine in the bladder is sterile and, in the absence of a UTI, it should not be contaminated with bacteria. Decide on a day to do the test when your child will be at home all day. When there is an immediate need to collect a specimen (e.g., a post -accident Test Name Urine Steroid Profile Test Code USP1: USPT (Timed), USPR (Random) Specimen Type. Specimen Preparation and Collection Section 3 Reviewed March 2010 - 1 - Urine Specimen Collection General Guidelines for collection of Urine Specimens (For specific urine specimen collection, refer to TEST MENU) ♦ All urine specimens should be clearly labeled and delivered to … 2. Please state commencement and completion time of sample duration on collection … Before you start, you should have been provided with a sterile container for the collection of the urine. The collected urine should be added to the appropriate urine preservative tube or refrigerated immediately to retard growth of bacteria until the test is performed. This procedure should be undertaken only after approved training, supervised practice and competency assessment, and should be carried out in accordance with local policies and protocols. Patient’s name, date of birth, ward/department and patient identification number or NHS number; Type of specimen and the site from which it was obtained; Diagnosis, history and reasons for request – for example, diarrhoea and vomiting, rash, pyrexia; History of antimicrobial drugs prescribed and administered if possible – specimens should be collected before antibiotics are prescribed as they may affect the result; Contact details of the health professional ordering the investigation (Dougherty and Lister, 2015; Brekle and Hartley, 2014). A: Rub the patient's arm at the selected site prior to venipuncture. This article, the first in a four-part series, describes the general principles of specimen collection and how to collect a midstream specimen of urine Citation: Shepherd E (2017) Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen. For which of the following tests is a random sample voided into a clean cup appropriate? A nurse is instructing the patient regarding collection of stool specimens for fecal occult blood testing. Uncircumcised men should retract their foreskin to clean around their urethral meatus. The specimen needs to be sterile. Specimens are an important part of a holistic assessment and can help to: Nurses frequently collect specimens including urine, stool and sputum. An accurate specimen collection technique is essential to reduce the risk of contamination, which can lead to inaccurate results and inappropriate treatment (Brekle and Hartley, 2014), and can result in a longer length of hospital stay (Dougherty and Lister, 2015). It is necessary when your health care provider wants to test your urine for bacteria, which may be causing an infection in your urinary tract. During this procedure, the nurse should. Maintain sterility in collecting the specimen. Professional responsibilities Specimen collection training . The patient should collect the middle part of the stream in a wide-neck sterile container without interrupting micturition (Dougherty and Lister, 2015) (Fig 2c). When a clean-catch urine specimen is required, follow the directions given under Urine for Culture in the Microbiology Specimens: Bacteriology and Mycobacteriology Specimens section. Determining which urine collection method and container should be used depends on the type of laboratory test ordered. The preferred specimen is the next urine specimen produced that day (second void). A: The patient just told me that he forgot to put the urine in the container. 3. Author: Eileen Shepherd is clinical editor at Nursing Times. Add 5 mL of diazolidinyl urea (Germall) as a preservative at start of collection or refrigerate specimen during and after collection. Which of the following should the nurse instruct the patient to avoid a few days before and during the testing period to reduce the risk of false-positive results? You should still pass the first part of your urine stream into the toilet. Timed urine collections may require the use of a chemical preservative or kept on ice or refrigerated during the duration of the collection. If the patient needs help, follow standard infection prevention and control precautions, and wear gloves and an apron (as a minimum) when collecting and handling the MSU. A nurse caring for a group of patients in an ambulatory care clinic is collecting urine for several prescribed diagnostic tests. Complete the documentation on the specimen pot, request form and in the patient’s notes (2d). Check whether the patient needs any help. Urine samples are collected over a 24-hour period and sent to a lab for analysis. Collect all urine for the next 24 hours so that the morning urine void on the second day is the final collection. Urine specimens and children. A clean-catch urine specimen is a sample of urine. The result of an MSU takes 2-7 days. ). The patient can then void the remaining urine into the toilet. Type. At 7:00 am the next morning, void and add the urine to the collection container. An MSU may also be obtained for near-patient urine testing and other tests, such as toxicology screening to identify causes of poisoning or drug overdose. Label the container with the patient's full name exactly as it appears on the test requisition. High concentrations of gadolinium and iodine are known to interfere with most metals tests. When a urinary tract infection is suspected, an MSU may be required for microscopy, culture and sensitivities. 2. However MSUs can become contaminated by: The aim of collecting MSUs is to reduce the effects of urethral contamination by taking a sample of urine while the bladder is emptying, avoiding the initial and end stages of micturition. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for at least 96 hours. At 0700, a nurse obtains a capillary blood glucose result of 180 mg/dL from a patient who has diabetes mellitus. Random Urine Collection for Routine Urinalysis or Urine Culture All urine specimens should be collected as clean catch urine specimens, unless otherwise indicated. The types of urine sample you might be asked for include a random specimen, first morning specimen or timed collection. Specimen collection: good-practice principles, Box 2. Obtaining a specimen involves the collection of tissue or fluids for laboratory analysis or near-patient testing, and may be the first step in determining a diagnosis and treatment (Dougherty and Lister, 2015). The collection of any tissue/fluid carries a risk to staff from splash or inoculation injury, so standard infection prevention and control precautions should be followed. Which of the following instructions should the nurse provide? Do not collect the first urine produced in the morning (first void). 4.4. The validity of urine drug screen results is dependent on specimen integrity. Specimens must be collected at the right time, using the correct technique and equipment, and be delivered to the laboratory as quickly as possible (Dougherty and Lister, 2015). Good-practice principles for specimen collection are outlined in Box 1. Urine Specimen Collection. They may also perform venepuncture to collect blood samples and support patients through complex procedures to collect specimens, such as biopsies. Nursing Times [online]; 113: 7, 45-47. Transfer the specimen into a sterile container and seal the lid. A midstream urine sample provides a better specimen for analysis than first urine passed. Keep the collection container refrigerated until delivery to the laboratory. Aware of their organisation’s policies and procedures for specimen collection; Able to explain the purpose of the specimen to the patient and the implication for treatment, and be able to obtain informed consent; Competent to undertake the procedure (Nursing and Midwifery Council, 2015) – this includes knowing the correct procedure for the collection, handling and transportation of the sample (Dougherty and Lister, 2015; RCN, 2012); Aware of standard infection prevention and control principles involved in the collection of tissue and body fluids (Box 2) (Loveday et al, 2014); Aware and understand the importance of accurate record keeping (NMC, 2015). The final section is an exam. Collect all urine voided during the next 24 hours. A: Rotate a sterile swab in the area of drainage. The 24-hour urine protein test checks the function of the kidneys and detects disease. Transfer the requested volume into the labeled urine transport vial. Hold the urine cup a few inches (or a few centimeters) from the urethra and urinate until the cup is about half full. Place the specimen and request form in the specimen bag. Collecting your sample. Women should separate their labia with their fingers and clean around the urethral meatus, ensuring they wipe away from the urethra towards the anus using a clean swab each time (Dougherty and Lister, 2015) (Fig 2a). LTR27570 3 6. A: Routine urinalysis R: Routine urinalysis can be done on a random clean voided specimen collected … Which of the following actions should the nurse take? To collect the urine sample: Keeping your labia spread open, urinate a small amount into the toilet bowl, then stop the flow of urine. Patient should not eat seafood for a 48-hour period prior to start of collection. Hospital environmental hygiene principles. While collecting the sample, it is important not to contaminate it or the container. The clinical information obtained from a urine specimen is influenced by the collection method, timing and handling making it important for the Nursing Assistant to know correct procedures and follow them when collecting specimens. Empty bladder completely on awakening in the morning and discard this urine specimen. The easiest and most common type of preservation is refrigeration of the urine specimen at 4-6 degrees Celsius within 2 hours of collection if the specimen is not able to be tested right away. Collecting urine specimens is a job function of the Nursing Assistant. Pyrexia (38°C or above skin temperature) or chills, Worsening of mental or functional status, particularly in older people, New flank or suprapubic pain or tenderness, Change in character of urine (such as new bloody urine, foul smell or sediment). This helps to identify the causative organism and select appropriate antibiotics to treat the infection. Which of the following statements by the AP indicates that the specimen collection will have to be restarted? Collection Instructions: 1. Which of the following is a correct action for the nurse to take? Collecting tissue/body fluids: precautions to take. How to Collect the 24-hour Urine Specimen. In order to produce a meaningful laboratory test result, follow these instructions exactly. Bacteria that colonise the distal urethra; Sterile container with a wide top to collect the urine, which can then be transferred into a specimen pot; Soap and water, 0.9% sodium chloride solution or a disinfectant-free solution for genital hygiene; Obtain informed consent and explain the procedure to optimise the quality of the specimen. A: Obtain specimens from three different stools. Urine Specimens – an overview of collection methods, collection devices, specimen handling and transportation This Focus Topic is the first of a two part series on urine specimen collection. Women should part their labia with their fingers while passing the first 15-30ml of urine into the toilet (Dougherty and Lister, 2015). Patients who are able to do so should perform genital hygiene with soap and water, 0.9% sodium chloride solution or a disinfectant-free solution (Dougherty and Lister, 2015). Bacteria around the distal urethra are washed away by the initial urine flow (Dougherty and Lister, 2015). Collection 1. It is not easy to obtain a pure midstream specimen of urine (MSU) in young children and babies. The collection of an MSU must be performed as part of a holistic assessment and must be considered alongside the presenting signs and symptoms (Box 3). An assistive personnel (AP) is collecting a 24-hour urine specimen from a patient. Patients should give informed consent for specimen collection and, as part of the process, the nurse should: All specimen containers must be transported in a self-sealing polythene bag with two compartments: one for the laboratory request form and one for the specimen (Brekle and Hartley, 2014). You can collect a urine sample at any time of day, unless your GP or practice nurse advises you otherwise. Example: Begin collecting the 24-hour urine specimen by voiding at 7:00 am and discarding the urine. Please refer to the Test Directory for specific tests. Part 2 will cover sources of preanalytical artifact arising during urine collection, handling and transportation. Specimen pH should be between 4.5 and 8 and will stay in this range if kept refrigerated. Urine from the dependent drainage bag should not be used for a specimen, since it is not fresh and would not reflect accurate test results. In this way, you are collecting the urine from the bladder. Pregnancy Urine Test Collect the specimen in a clean, dry urine container. Wash it well and rinse it with boiling water. D. Female urine culture collection instructions: These are general instructions.BVH periodically changes the company which provides the mid-stream collection kits. A nurse is caring for a patient who has a suspected UTI. Send the sample to the laboratory immediately (or within four hours) (Dougherty and Lister, 2015) or refer to organisational policy if storage is required. Collect urine for 24 hours. Sign in or Register a new account to join the discussion. A urinalysis is the examination of urine to obtain information about body health and disease. Ask the patient to wash their hands with soap and water and dry them, to reduce the risk of the specimen being contaminated. A nurse is caring for a female patient who needs to collect a midstream urine specimen. The first voided morning specimen is preferred. Disposable gloves and apron – additional  personal protective equipment (gown, mask/respirator, visor) may be required depending on the specimen; Sterile container appropriate for the specimen (consult local policies); Biohazard (high-risk) label indicating the danger of infection (Brekle and Hartley, 2014) if the patient is known or  suspected to have a Hazard Group 3 pathogen such as hepatitis B, hepatitis  C or HIV (Health and Safety Executive, 2003). Patients should wash and dry their hands before collecting an MSU; Dougherty and Lister (2015) also recommend that the urethral meatus is cleaned to further reduce the risk of contamination, although they acknowledge that the effectiveness of this intervention has been questioned. Specimen Volume: 4 mL. Identify a suitable location to collect the specimen, for example a clean toilet, and ensure the patient’s privacy and dignity are maintained. Appropriate containers include plastic disposable cups or bags (for infants) with a capacity of 50 ml. This article, the first in a four-part series, explores the general principles of specimen collection and describes how to collect a midstream specimen of urine (MSU). While direct-observation collections provide specimens of the greatest credibility, non-witnessed collections can be effective if safeguards are in place to ensure the donor does not have access to substances which may affect test results (water, chemicals, substitute urine, etc. Urinary tract infection: signs and symptoms, Source: Health Protection Scotland (2013). A nurse caring for a patient who has diabetes mellitus is having difficulty obtaining a capillary fingerstick blood sample for point-of-care blood glucose testing. These include adhering to: The equipment required will vary according to the specimen so nurses should consult local policies about which container to use. Instruct male patients to keep the foreskin retracted and direct the first part of the urine void (15-30ml) into the toilet to wash away any bacteria colonising the distal end of the urethra (Dougherty and Lister, 2015) (Fig 2b). 8. Citation: Shepherd E (2017) Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen. A nurse is teaching a patient about home collection of a stool specimen for fecal occult blood testing. Tagged with: Assessment skills: specimen collection Newly qualified nurses: practical procedures. When collecting a 24-hour urine specimen:What is done with the urine collected at 7 a.m. the last day? A urine protein test measures the amount of protein in urine. To help increase blood flow to the finger, the nurse should. 2. Which of the following results should indicate to the nurse the presence of a UTI? Specimens should be sent to the laboratory as soon as possible after collection as a delay may adversely affect the results. A nurse is caring for a patient who has a stage III pressure ulcer in the sacral area. SPASU : Patient Preparation: 1. At the end of the procedure, decontaminate your hands with either alcohol hand rub or soap and water. Minimum Volume Minimum 10mL Comments. Using an incorrect container can affect the accuracy of results; for example, bacterial swabs contain a transport medium that is incompatible with viruses (Dougherty and Lister, 2015). The clinical information obtained from a urine specimen is influenced by the collection method, timing and handling. To obtain an MSU, patients need to be continent and able to empty their bladder on request. Inform the patient of the reason for specimen collection; Explain how long it will take for the results to be available and how the patient will receive them; Implications for care (Dougherty and Lister, 2015). A: Administer insulin according to the patient's sliding scale orders. A collection site may be a permanent or temporary facility , located either at the work site or at a remote site, where donors present themselves for the purpose of providing a specimen for a drug test.