8. Patients may find the procedure embarrassing and it is important to protect their privacy and dignity while offering or providing support. Specimen Volume: 4 mL. The preferred specimen is the next urine specimen produced that day (second void). 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. You … Measure and record this volume on the test request form and on the urine transport vial (see Pediatric Specimen Tubes below). A nurse is collecting a blood specimen for culture from a patient hospitalized for pneumonia. 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). Random Urine Collection for Routine Urinalysis or Urine Culture All urine specimens should be collected as clean catch urine specimens, unless otherwise indicated. 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. Identify a suitable location to collect the specimen, for example a clean toilet, and ensure the patient’s privacy and dignity are maintained. 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). Urine Cytology Your health care provider has requested a urine specimen. Urinary tract infection: signs and symptoms, Source: Health Protection Scotland (2013). A: Have the patient urinate a small amount of urine before starting the collection. 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). Specimen pH should be between 4.5 and 8 and will stay in this range if kept refrigerated. Please state commencement and completion time of sample duration on collection … 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 … A: Obtain specimens from three different stools. For which of the following tests is a random sample voided into a clean cup appropriate? Determining which urine collection method and container should be used depends on the type of laboratory test ordered. 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. When collecting a 24-hour urine specimen:What is done with the urine collected at 7 a.m. the last day? 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 specimen needs to be sterile. 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). 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. A nurse is caring for a female patient who needs to collect a midstream urine specimen. 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. It is not easy to obtain a pure midstream specimen of urine (MSU) in young children and babies. Type. Hospital environmental hygiene principles. An assistive personnel (AP) is collecting a 24-hour urine specimen from a patient. The patient can then void the remaining urine into the toilet. Wash your hands and put on gloves and an apron if you are accompanying the patient or handling the specimen. ‘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. Do not collect the first urine produced in the morning (first void). Collection Instructions: 1. 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. During this procedure, the nurse should. 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. The first voided morning specimen is preferred. Which of the following instructions should the nurse provide? Specimens are an important part of a holistic assessment and can help to: Nurses frequently collect specimens including urine, stool and sputum. 3. Collect urine for 24 hours. A: Rotate a sterile swab in the area of drainage. 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). 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. The 24-hour urine protein test checks the function of the kidneys and detects disease. Tagged with: Assessment skills: specimen collection Newly qualified nurses: practical procedures. At 0700, a nurse obtains a capillary blood glucose result of 180 mg/dL from a patient who has diabetes mellitus. Before you start, you should have been provided with a sterile container for the collection of the urine. Test Name Urine Steroid Profile Test Code USP1: USPT (Timed), USPR (Random) Specimen Type. Specimens should be sent to the laboratory as soon as possible after collection as a delay may adversely affect the results. 2. 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). 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). Collecting your sample. 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. Transfer the requested volume into the labeled urine transport vial. When collecting a 24-hour urine specimen:Where must the urine for a 24-hour specimen be stored? Women should part their labia with their fingers while passing the first 15-30ml of urine into the toilet (Dougherty and Lister, 2015). Author: Eileen Shepherd is clinical editor at Nursing Times. 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. 2. 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). 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). 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. There are a couple of ways to collect the specimen. Box 3. Collecting urine specimens is a job function of the Nursing Assistant. Part 2 will cover sources of preanalytical artifact arising during urine collection, handling and transportation. 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? 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. A nurse is teaching a patient about home collection of a stool specimen for fecal occult blood testing. Think about this. 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. Professional responsibilities Which of the following actions should the nurse take when obtaining a wound culture specimen from the pressure ulcer? A nurse caring for a group of patients in an ambulatory care clinic is collecting urine for several prescribed diagnostic tests. 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. In this way, you are collecting the urine from the bladder. The final section is an exam. Send the sample to the laboratory immediately (or within four hours) (Dougherty and Lister, 2015) or refer to organisational policy if storage is required. The types of urine sample you might be asked for include a random specimen, first morning specimen or timed collection. Record date and time under “start” and begin the test (e.g., 5/12/10, 7:00 a.m.). 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). Explain the steps of the procedure and how to avoid contaminating the specimen. This test can be used to diagnose a kidney condition or see if a treatment is working. ). While collecting the sample, it is important not to contaminate it or the container. 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. Collection 1. Minimum Volume Minimum 10mL Comments. The result of an MSU takes 2-7 days. 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). Check whether the patient needs any help. 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). 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. To collect a 24-hour urine specimen: Follow your physician’s directions regarding intake of food, drink, or drugs before and during collection. 24hr urine in a PLAIN container. Wash it well and rinse it with boiling water. 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. When there is an immediate need to collect a specimen (e.g., a post -accident D. Female urine culture collection instructions: These are general instructions.BVH periodically changes the company which provides the mid-stream collection kits. Good-practice principles for specimen collection are outlined in Box 1. Specimen collection training . Label the container with the patient's full name exactly as it appears on the test requisition. Appropriate containers include plastic disposable cups or bags (for infants) with a capacity of 50 ml. At the end of the procedure, decontaminate your hands with either alcohol hand rub or soap and water. These include adhering to: The equipment required will vary according to the specimen so nurses should consult local policies about which container to use. Principle. Decide on a day to do the test when your child will be at home all day. How to Collect the 24-hour Urine Specimen. This helps to identify the causative organism and select appropriate antibiotics to treat the infection. If immediate transportation is not possible, it is important to consult local guidelines about storage of specimens. 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. 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. Uncircumcised men should retract their foreskin to clean around their urethral meatus. Timed urine collections may require the use of a chemical preservative or kept on ice or refrigerated during the duration of the collection. 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. A: Rub the patient's arm at the selected site prior to venipuncture. https://www.hopkinsmedicine.org/.../24hour-urine-collection In order to produce a meaningful laboratory test result, follow these instructions exactly. Instructions to help patients with their test preparations or specimen collections. Bacteria around the distal urethra are washed away by the initial urine flow (Dougherty and Lister, 2015). A nurse is caring for a patient who has a suspected UTI. To collect the urine sample: Keeping your labia spread open, urinate a small amount into the toilet bowl, then stop the flow of urine. Which of the following is a correct action for the nurse to take? 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