The patient should be informed that improper collection, storage, and transport are the primary reasons for specimen rejection and subsequent requests for recollection. If the specimen is to be collected at home, it should be collected in a clean plastic container (preferably a container from the testing laboratory). Many studies require refrigeration after collection. If the collection container includes a preservative, the patient should be made aware of the contents and advised as to what the precaution labels mean (caution labels such as caustic, corrosive, acid, and base should be affixed to the container as appropriate). When a preservative or fixative is included in the container, the patient should be advised not to remove it. The patient also should be told not to void directly into the container. The patient should be given a collection device, if indicated, and instructed to void into the collection device. The specimen should be carefully transferred into the collection container. Urinary output should be recorded throughout the collection time if the specimen is being collected over a specified time interval. Some laboratories provide preprinted collection instructions tailored to their methods. The specimen should be transported promptly to the laboratory after collection.
Wear gloves and any other additional personal protective equipment indicated by the patient’s condition. See Standard Precautions for a more detailed description of standard precautions. Assess whether the patient has allergies to the disinfectant or anesthetic, or to latex if latex gloves or catheter will be used in the procedure.
These samples are mainly used for routine screening and can be collected at any time of the day. The patient should be instructed to void either directly into the collection container (if there is no preservative) or into a collection device for transfer into the specimen container.
Urine on rising in the morning is very concentrated. These specimens are indicated when screening for substances that may not be detectable in a more dilute random sample. These specimens are also necessary for testing conditions such as orthostatic proteinuria, in which levels vary with changes in posture.
In some cases, it is desirable to test freshly produced urine to evaluate the patient’s current status, as with glucose and ketones. Explain to the patient that he or she should first void and then drink a glass of water. The patient should be instructed to wait 30 min and then void either directly into the collection container or into a collection device for transfer into the collection container.
These midstream specimens are generally used for microbiological or cytological studies. They also may be requested for routine urinalysis to provide a specimen that is least contaminated with urethral cells, microorganisms, mucus, or other substances that may affect the interpretation of results. Instruct the male patient first to wash hands thoroughly, then cleanse the meatus, void a small amount into the toilet, and void either directly into the specimen container or into a collection device for transfer into the specimen container. Instruct the female patient first to wash hands thoroughly, and then to cleanse the labia from front to back. While keeping the labia separated, the patient should void a small amount into the toilet, and then, without interrupting the urine stream, void either directly into the specimen container or into a collection device for transfer into the specimen container.
Catheterized Random or Clean Catch
“Straight catheterization” is indicated when the patient is unable to void, when the patient is unable to prepare properly for clean-catch specimen collection, or when the patient has an indwelling catheter in place from which a urine sample may be obtained. Before collecting a specimen from the catheter, observe the drainage tube to ensure that it is empty, and then clamp the tube distal to the collection port 15 min before specimen collection. Cleanse the port with an antiseptic swab such as 70% alcohol and allow the port to dry. Use a needle and syringe (sterile if indicated) to withdraw the required amount of specimen. Unclamp the tube.
To quantify substances in urine, 24-hr urine collections are used. They are also used to measure substances whose level of excretion varies over time. The use of preservatives and the handling of specimens during the timed collection may be subject to variability among laboratories. The testing laboratory should be consulted regarding specific instructions before starting the test. Many times the specimen must be refrigerated or kept on ice throughout the entire collection period. Explain to the patient that it is crucial for all urine to be included in the collection. Urinary output should be recorded throughout the collection time if the specimen is being collected over a specified time interval. The test should begin between 6 and 8 a.m. if possible. Instruct the patient to collect the first void of the day and discard it. The start time of the collection period begins at the time the first voided specimen was discarded and should be recorded along with the date on the collection container. The patient should be instructed to void at the same time the following morning and to add this last voiding to the container. This is the end time of the collection and should be recorded along with the date on the container. For patients who are in the hospital, the urinary output should be compared with the volume measured in the completed collection container. Discrepancies between the two volumes indicate that a collection might have been discarded. A creatinine level often is requested along with the study of interest to evaluate the completeness of the collection.
Instructions for this type of collection are basically the same as those for timed specimen collection. The test should begin by changing the tubing and drainage bag. If a preservative is required, it can be placed directly in the drainage bag, or the specimen can be removed at frequent intervals (every 2 hr) and transferred to the collection container to which the preservative has been added. The drainage bag must be kept on ice or emptied periodically into the collection container during the entire collection period if indicated by the testing laboratory. The tubing should be monitored throughout the collection period to ensure continued drainage.
This procedure is performed by inserting a needle directly into the bladder. Because the bladder is normally sterile, the urine collected should also be free from any contamination caused by the presence of microorganisms. Place the patient in a supine position. Cleanse the area with antiseptic and drape with sterile drapes. A local anesthetic may be administered before insertion of the needle. A needle is inserted through the skin into the bladder. A syringe attached to the needle is used to aspirate the urine sample. The needle is then removed and a sterile dressing is applied to the site. Place the sterile sample in a sterile specimen container. The site must be observed for signs of inflammation or infection.
Specimen collection can be achieved by any of the above-described methods using collection devices specifically designed for pediatric patients. Appropriately cleanse the genital area and allow the area to dry. For a random collection, remove the covering of the adhesive strips on the collector bag and apply over the genital area. Diaper the child. When the specimen is obtained, place the entire collection bag in the specimen container (use a sterile container as appropriate for the requested study). Some laboratories may have specific preferences for the submission of urine specimens for culture. Consult the laboratory before collection to avoid specimen rejection.
Patient Preparation and Specimen Collection has been found in Davis's Lab & Diagnostic Tests
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