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PRACTICAL PROCEDURES
KEYWORDS SPECIMEN COLLECTION CATHETER URINE SAMPLE
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THIS ARTICLE HAS BEEN DOUBLE-BLIND PEER-REVIEWED
Fig 1. If required, clamp the tubing a few centimetres distal to the sampling port
Fig 6. Complete the documentation form, specimen pot and nursing notes
SPECIMEN COLLECTION
AUTHOR Dan Higgins, RGN, ENB 100, ENB 998, is senior charge nurse in critical care, University Hospital Birmingham.
ASEPTIC TECHNIQUE
The process of obtaining a sample of urine from a patient with an indwelling urinary catheter must be obtained from a sampling port. The sample must be obtained using an aseptic technique (DH, 2003). This port is usually situated in the drainage tubing, proximal to the collection bag which ensures the freshest sample possible. The use of drainage systems without a sampling port should be avoided (Gilbert, 2006). Specimens should not be collected from the tap from the main collecting chamber of the catheter bag as colonisation and multiplication of bacteria within the stagnant urine or around the drainage tap may have occurred. Aspirating urine from a sampling port has traditionally been performed using a syringe and needle. However, needle-free systems are commercially available, which may reduce the risk of inoculation injury.
REFERENCES
Department of Health (2003) Essential Steps to Safe, Clean Care: Urinary Catheter Care. London: DH. Gilbert, R. (2006) Obtaining a catheter specimen of urine Nursing Times 102; 19: 2223. Pratt R.A. et al (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 65S: S1S64.
THE PROCEDURE
Obtain informed consent. Provide explanations to optimise specimen quality. Ensure the procedure is performed in a way to optimise patient dignity. Wash hands, don apron, prepare equipment. Apply alcohol handrub. If no urine is visible in the tubing, apply a non-traumatic clamp/gate clip a few centimetres distal to the sampling port (Fig 1) (Gilbert, 2006). Once sufcient urine has collected in the tube, wipe the sampling port with an alcoholimpregnated swab (Fig 2). Allow to dry. Stabilising the tube below the sampling port, insert the needle into the port at an angle of 45 (Fig 3). In a needle-free system, insert the syringe into the sampling port according to the manufacturers recommendations. Aspirate the required amount of urine (refer to microbiology department to ascertain volume required) (Fig 4). Remove syringe/needle. Dispose of sharps as appropriate. Inject urine into sterile specimen pot (Fig 5).
This article, the second in a six-part series on specimen collection, details how to collect a catheter specimen of urine. In all aspects of specimen collection the process must be one that reduces health and safety risk to all groups of staff handling the sample and one that reduces the risk of erroneous data/results. The rst part of the series on obtaining a midstream specimen of urine outlined good practice principles for specimen collection.
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PROFESSIONAL RESPONSIBILITIES
EQUIPMENT REQUIRED
The following items should be collected as preparation for collecting a catheter specimen of urine for analysis: Sterile gloves; Apron; Syringe and needle; Alcohol-saturated swab;
NT 6 May 2008 Vol 104 No 18 www.nursingtimes.net
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Catherine Hollick
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
Wipe the sampling port with an alcoholimpregnated swab, allow to dry. Unclamp the catheter tubing as required. Dispose of waste, remove apron, wash hands thoroughly. Complete documentation according to organisation guidelines (Fig 6). Dispatch the specimen to the laboratory according to organisation guidelines.
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