What kind of container should a patient use if he/she has to collect a urine specimen at home?
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 Show
Citation: Shepherd E (2017) Specimen collection 1: general principles and procedure for obtaining a midstream urine specimen. Nursing Times [online]; 113: 7, 45-47. Author: Eileen Shepherd is clinical editor at Nursing Times.
IntroductionObtaining 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 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. 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). Specimens are an important part of a holistic assessment and can help to:
Nurses frequently collect specimens including urine, stool and sputum. They may also perform venepuncture to collect blood samples and support patients through complex procedures to collect specimens, such as biopsies. 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). 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. Box 1. Specimen collection: good-practice principles The specimen must be:
Source: Higgins (2008) Professional issuesNurses must be:
Box 2. Collecting tissue/body fluids: precautions to take 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. These include adhering to:
Source: Loveday et al (2014) EquipmentThe equipment required will vary according to the specimen so nurses should consult local policies about which container to use. 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). General equipment required includes:
ConsentPatients should give informed consent for specimen collection and, as part of the process, the nurse should:
Request formsRequest forms should include:
Sample labelThe sample should be labelled with:
Transporting specimensAll 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). Specimens should be sent to the laboratory as soon as possible after collection as a delay may adversely affect the results. If immediate transportation is not possible, it is important to consult local guidelines about storage of specimens. Collecting an MSUWhen a urinary tract infection is suspected, an MSU may be required for microscopy, culture and sensitivities. This helps to identify the causative organism and select appropriate antibiotics to treat the infection. 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. 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). Box 3. Urinary tract infection: signs and symptoms
Source: Health Protection Scotland (2013) Patient preparationTo obtain an MSU, patients need to be continent and able to empty their bladder on request. Urine in the bladder is sterile and, in the absence of a UTI, it should not be contaminated with bacteria. 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. Bacteria around the distal urethra are washed away by the initial urine flow (Dougherty and Lister, 2015). 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. EquipmentThe following equipment is required:
The procedure
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. Patients may find the procedure embarrassing and it is important to protect their privacy and dignity while offering or providing support. Also in this series
Professional
responsibilities Brekle B, Hartley J (2014) Specimen Collection: Microbiology and Virology. Dougherty L, Lister S (2015) The Royal Marsden Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell. Health Protection Scotland (2013) Urinary Tract Infection Surveillance for Use in Health and Social Care Facilities. Health and Safety Executive (2003) Safe Working and the Prevention of Infection in Clinical Laboratories and Similar Facilities. Higgins D (2008) Specimen collection 1: obtaining a midstream specimen of urine. Nursing Times; 104: 17, 26-27. Loveday HP et al (2014) epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection; 86: S1, S1-S70. Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives. Royal College of Nursing (2012) Wipe it out: One change to get it right – Essential Practice for Infection Prevention and Control. Guidance for Nursing Staff. What type of container is suitable for urine sample collection?To collect a urine sample you should: label a sterile, screw-top container with your name, date of birth and the date. wash your hands. start to pee and collect a sample of urine "mid-stream" in the container.
Can I use a plastic container for urine sample?Storing a urine sample until you hand it in
If you can't hand your urine sample in within an hour, you should keep it in the fridge at around 4C (39F) for no longer than 24 hours. Put the container of urine in a sealed plastic bag first.
What is the most common type of urine specimen?Two common methods of collecting urine are 24-hour urine collection and clean catch urine specimen .
What equipment is used for a urine test?A urine analyser is a device used in the clinical setting to perform automatic urine testing. The units can detect and quantify a number of analytes including bilirubin, protein, glucose and red blood cells.
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