Urinalysis and other Body Fluids Lab - 01 Specimen Collection

ANALYSIS OF URINE AND OTHER BODY FLUIDS LABORATORY SPECIMEN COLLECTION AND TYPES OF URINE SPECIMEN OUTLINE • Introduction • Procedure: Random Specimen • Procedure: First Morning Specimen • Procedure: Glucose Tolerance Specimen • Procedure: 24-hour/Timed Specimen • Procedure: Catheterized Specimen • Midstream Clean Catch Specimen • Procedure: Midstream Clean Catch Specimen (Female) • Procedure: Midstream Clean Catch Specimen (Male) • Procedure: Suprapubic Aspiration • Procedure: Prostatitis Specimen • Procedure: Pediatric Specimen • Procedure: Drug Specimen Collection o Procedure • Specimen Rejection Criteria • Changes in Unpreserved Urine SPECIMEN COLLECTION AND TYPES OF URINE SPECIMEN INTRODUCTION • Specific information on specimen collection and handling should be stated at the beginning of each procedure listed in the manual. • Requisition forms and computerized entry forms should designate the type of urine specimen to be collected and the date and time of collection. • The form should include space for recording: o the actual date and time of specimen collection, o whether the specimen was refrigerated before transporting, o the time the specimen was received in the laboratory and the time the test was performed, o tests requested, o an area for specific instructions that might affect the results of the analysis, and o patient identification information. (The patient’s sex, age or date of birth, and, when appropriate, the source of the specimen and the time it was collected must be documented.) • Notes o Improper labeling is a mortal sin in laboratory o Detergent an alter specimen o Maintain clean and dry specimen containers o Do not alter the urine routine of the patient, adjust the collection to the routine of the patient • Principle o Microscopic Examination o Macroscopic Examination • Materials o Microscope o Glass slide o Cover slip o Centrifuge o 10 mL test tiube o Urine strip o Specimen container PROCEDURE: RANDOM SPECIMEN • Routine screening specimen. • Most commonly received specimen because of its ease of collection and convenience for the patient. • May be collected at any time , but the actual time of voiding should be recorded on the container. PROCEDURE: FIRST MORNING SPECIMEN • Ideal screening specimen. • Preferred for pregnancy tests • Essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria . • Patient should be instructed to collect the specimen immediately on arising and to deliver it to the laboratory within 2 hours or keep it refrigerated. • First morning midstream catch - preferrable PROCEDURE: GLUCOSE TOLERANCE SPECIMEN • Sometimes collected to correspond with the blood samples drawn during a glucose tolerance test (GTT). • OGTT - test to determine of the capacity to use glucose o Multiple specimens o Fasting, 1-hour, 2-hour, 3-hour o After fasting, patient is asked to drink juice (50-100mL) • Number of specimens varies with the length of the test. o Fasting o Half-hour o 1-hour o 2-hour o 3-hour o Possibly 4-hour, 5-hour, and 6-hour specimens • OGCT - reduced collection (fasting & 2 nd hour) PROCEDURE: 24-HOUR / TIMED SPECIMEN • Provide the patient with written instructions, and explain the collection procedure. • Provide the patient with the proper collection container and preservative. o Day 1: 7 a.m.: patient voids and discards specimen; collects all urine for the next 24 hours. o Day 2: 7 a.m.: patient voids and adds this urine to previously collected urine. • On arrival at laboratory, the entire 24-hour specimen is thoroughly mixed, and the volume is measured and recorded PROCEDURE: CATHETERIZED SPECIMEN • Collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder. • The most commonly requested test on a catheterized specimen is a bacterial culture . • Done by other health professionals (nurse) MIDSTREAM CLEAN CATCH SPECIMEN • During sleep, there can be bacterial contamination of urethra so midstream is preferred

PROCEDURE: MID-STREAM CLEAN CATCH SPECIMEN (FEMALE) 1. Wash hands. 2. Remove the lid from the container without touching the inside of the container or lid. 3. Separate the skin folds (labia). 4. Cleanse from front to back on either side of the urinary opening with an antiseptic towelette, using a clean one for each side. 5. Hold the skin folds apart and begin to void into the toilet. 6. Bring the urine container into the stream of urine and collect an adequate amount of urine. Do not touch the inside of the container or allow the container to touch the genital area. 7. Finish voiding into the toilet. 8. Cover the specimen with the lid. Touch only the outside of the lid and container. 9. Label the container with the name and time of collection and place in the specified area or follow institutional policy. PROCEDURE: MID-STREAM CLEAN CATCH SPECIMEN (MALE) 1. Wash hands. 2. Remove the lid from the sterile container without touching the inside of the container or lid. 3. Cleanse the tip of the penis with antiseptic towelette and let dry. Retract the foreskin if uncircumcised. 4. Void into the toilet. Hold back foreskin if necessary. 5. Bring the sterile urine container into the stream of urine and collect an adequate amount of urine. Do not touch the inside of the container or allow the container to touch the genital area. 6. Finish voiding into the toilet. 7. Cover the specimen with the lid. Touch only the outside of the lid and container. 8. Label the container with the name and time of collection and place in the specified area or follow institutional policy PROCEDURE: SUPRAPUBIC ASPIRATION • Collected by external introduction of a needle through the abdomen into the bladder. • Because the bladder is sterile under normal conditions, suprapubic aspiration provides a s a mple for bacterial culture that is completely free of extraneous contamination. o One of the best specimen for bacterial culture • The specimen can also be used for cytologic examination PROCEDURE: PROSTATITIS SPECIMEN • Three Glass Collection o Prior to collection the area is cleansed using the male midstream clean-catch procedure. o Then instead of discarding the first urine passed, it is collected in a sterile container. (Specimen 1) o Next, the midstream portion is collected in another sterile container. (Specimen 2) o The prostate is then massaged so that prostate fluid will be passed with the remaining urine into a third sterile container. (Specimen 3) o All Specimens : Quantitative cultures o 1st & 3rd Specimen : Examined microscopically o 2nd Specimen : Used as control for bladder and kidney infection • PRE- and POST- Massage Test (PPMT) o A clean-catch midstream urine specimen is collected. o A second urine sample is collected after the prostate is massaged. o A positive result is significant bacteriuria in the post-massage specimen of greater than 10 times the premassage count. PROCEDURE: PEDIATRIC SPECIMEN • Soft, clear plastic bags with hypoallergenic skin adhesive to attach to the genital area of both boys and girls are available for collecting routine specimens. • Routine Specimen – Ensure the are is free of contamination. Attach the bag firmly over the genital area avoiding the anus. When enough specimen has been collected, remove the bag and label it or pour the specimen into container and label the container following institutional policy • Microbiology Specimen - Clean the area with soap and water and sterilely dry the area, removing any residual soap residue. Firmly apply a sterile bag. Sterilely transfer collected specimen into a sterile container & label container. PROCEDURE: DRUG SPECIMEN COLLECTION • Urine specimen collections may be “witnessed” or “unwitnessed.” • 30-45mL of urine collected must be observed • Urine temperature must be taken within 4 minutes from the time of collection to confirm the specimen has not been adulterated. • The temperature should read within range of 32.5°-37.7°C. PROCEDURE 1. The collector washes hands and wears gloves. 2. The collector adds bluing agent (dye) to the toilet water reservoir to prevent an adulterated specimen. 3. The collector eliminates any source of water other than toilet by taping the toilet lid and faucet handles. 4. The donor provides photo identification or positive identification from employer representative. 5. The collector completes step 1 of the chain-of-custody (COC) form and has the donor sign the form. 6. The donor leaves his or her coat, briefcase, and/or purse outside the collection area to avoid the possibility of concealed substances contaminating the urine. 7. The donor washes his or her hands and receives a specimen cup. 8. The collector remains in the restroom but outside the stall, listening for unauthorized water use, unless a witnessed collection is requested. 9. The donor hands specimen cup to the collector. Transfer is documented. 10. The collector checks the urine for abnormal color and for the required amount (30 to 45 mL). 11. The collector checks that the temperature strip on the specimen cup reads 32.5°C to 37.7°C. The collector records the in-range temperature on the COC form (COC step 2). If the specimen temperature is out of range or the specimen is suspected of having been diluted or adulterated, a new specimen must be collected and a supervisor notified.

12. The specimen must remain in the sight of the donor and collector at all times. 13. With the donor watching, the collector peels off the specimen identification strips from the COC form (COC step 3) and puts them on the capped bottle, covering both sides of the cap. 14. The donor initials the specimen bottle seals. 15. The date and time are written on the seals. 16. The donor completes step 4 on the COC form. 17. The collector completes step 5 on the COC form. 18. Each time the specimen is handled, transferred, or placed in storage, every individual must be identified and the date and purpose of the change recorded. 19. The collector follows laboratory-specific instructions for packaging the specimen bottles and laboratory copies of the COC form. 20. The collector distributes the COC copies to appropriate personnel. SPECIMEN REJECTION CRITERIA • Specimens in unlabeled containers • Nonmatching labels and requisition forms • Specimens contaminated with feces or toilet paper • Containers with contaminated exteriors • Specimens of insufficient quantity (<10 mL) • Specimens that have been improperly transported CHANGES IN UNPRESERVED URINE Analyte Change Cause Color Modified / Darkened Oxidation or reduction of metabolites Clarity Decrease Bacterial growth and precipitation of amorphous material Glucose Glycolysis and bacterial use Ketones Volatilization and bacterial metabolism Bilirubin Exposure to light/photo oxidation to biliverdin Urobilinogen Oxidation to urobilin RBCs / WBCs / Casts Disintegration in dilute alkaline urine Trichomonas Loss of motility, death Odor Increase Bacterial multiplication causing breakdown of urea to ammonia pH Breakdown of urea to ammonia by urease-producing bacteria/loss of CO2 Nitrite Multiplication of nitrate-reducing bacteria Bacteria Multiplication • P. aeruginosa - main bacteria