Ministry Saint Michael s Hospital Laboratory LABORATORY POLICY AND PROCEDURE

Transcription

1 Ministry Saint Michael s Hospital Laboratory LABORATORY POLICY AND PROCEDURE TITLE/SUBJECT: FILE NUMBER: ASSIGNED MANUAL: ORIGINATION DATE: 5/1/1989 EFFECTIVE DATE: 11/11/14 DISTRIBUTION: All SMH Laboratories Urine Specimen Collection Via First-stream for CTGCU and Clean-catch Midstream Collection Method for UA & Urine Cultures PH Phlebotomy Policies and Procedures PRINCIPLE/PURPOSE: A urine culture is a test to find and identify germs (usually bacteria) that may be causing a urinary tract infection (UTI). Urine in the bladder normally is sterile it does not contain any bacteria or other organisms (such as fungi). But bacteria can enter the urethra and cause an infection. The clean-catch midstream urine collection method helps protect the urine sample from germs that are normally found on the body that may contaminate the urine sample and thereby create a less than accurate picture of the patient s specimen. Chlamydia trachomatis and Neisseria gonorrhoeae are sexually transmitted diseases which can be tested for by an Amplified RNA Assay using a first-stream urine collection. Therefore it is important to collect this specimen before collecting a midstream urine for a UA and/or Urine Culture. SPECIMEN/HANDLING: 1.0 Clean-catch midstream urine is to be obtained. OPTIMAL VOLUME: ml (see chart in Criteria For Unacceptable Results) It is allowable to accept smaller volumes on infants, small children, renal patients and patients with urethral obstruction. Please note any volume less than 10 ml by using the canned text "LVOL" in the External Comment field. 2.0 First-stream urine is to be obtained. OPTIMAL VOLUME: ml (see chart in Criteria For Unacceptable Results) MATERIALS:

2 PH Urine Specimen Collection Supplies Equipment Reagents NA NA o 1 specimen container with cover o 1 foil packet containing 3 premoistened benzalkonium chloride cleaning towelettes CALIBRATION: No calibration necessary. QUALITY CONTROL: No quality control necessary. PROCEDURE: CLEAN CATCH 1.0 Label container with patient's name, using either label or magic marker. Steps 1 and 2 are usually performed by lab personnel. 2.0 Wash hands thoroughly. 3.0 Remove screw cap from specimen container, being careful not to touch inner surfaces of container or cap. 4.0 Remove towelettes from foil packet. 5.0 Cleanse perineal area with all towelettes, using them one at a time. 5.1 FEMALES: Separate fold of urinary opening, with first towelette, using one downward stroke, clean one side of the inner fold. With the second towelette, using the downward stroke, clean opposite side. With the last towelette, using one downward stroke, clean the center area. 5.2 MALES: Clean head of penis; if not circumcised, pull foreskin back during cleansing and urination. 6.0 Void first into either toilet or bed pan. 7.0 Collect midstream sample in specimen container by moving the container into "midstream" to interrupt flow. Fill specimen container only half way. 8.0 Finish voiding into toilet or bedpan. 9.0 Replace lid on specimen and screw tightly into place Transport sample ASAP to the laboratory following collection and storage guidelines as outlined in each individual procedure. PROCEDURE: CTGCU Page 2 of 7

3 PH Urine Specimen Collection Synonym: Chlamydia/GC Amplified RNA, urine; CTGC Probe, Mnemonic: CTGCU Included Tests: Chlamydia trachomatis amplified RNA; Neisseria gonorrhoeae amplified RNA.Availability: M-F 1.0 Collect specimen in plastic, preservative-free, STERILE urine specimen collection cup from patients who have not urinated within one hour of collection. 2.0 Label container with patient's name, using either label or magic marker. If collecting a CTGC urine and an UA/UC, you need to label two urine containers. Label CTGC urine as #1 with markings at 10 ml and 30 ml., and label the UA/UC urine container as #2. Steps 1 and 2 are usually performed by lab personnel. 3.0 Wash hands thoroughly. 4.0 Remove screw cap from specimen container, being careful not to touch inner surfaces of container or cap. 5.0 Remove towelettes from foil packet. 6.0 Cleanse perineal area with all towelettes, using them one at a time. 6.1 FEMALES: Separate fold of urinary opening, with first towelette, using one downward stroke, clean one side of the inner fold. With the second towelette, using the downward stroke, clean opposite side. With the last towelette, using one downward stroke, clean the center area. 6.2 MALES: Clean head of penis; if not circumcised, pull foreskin back during cleansing and urination. 7.0 Allow perineal area to air dry 8.0 Collect the first ml of voided urine (the FIRST part of the stream). 9.0 Urine can be stored at room or refrigerated temperature Minimum Volume: 10 ml urine -- NO MORE than 30 ml urine 11.0 Rejection: Urine specimens with a volume less than 10 ml or greater than 30 ml are unacceptable 12.0 Processing Comments: Cap container tightly and label the urine collection cup with patient identification and date/time of collection. DERIVATION OF RESULTS: No calculations necessary. REPORTING: No results to report. Page 3 of 7

4 CRITERIA FOR UNACCEPTABLE RESULTS AND CORRECTIVE ACTION: 1.0 Quantity Not Sufficient. (See Attachment.) 2.0 Collection method incorrect. (See Attachment.) PH Urine Specimen Collection LIMITATIONS: Contamination of collection container or cap by touching with hands or other methods, eliminates specimen from bacteriologic culture consideration and may alter laboratory analysis. PROCEDURE NOTES: 1.0 For Clean-catch, patients must be thoroughly instructed in the methods for cleansing the genitalia and for collecting only the midstream portion of the urine. 2.0 For first-stream, patients must be thoroughly instructed in the methods for cleansing the genitalia and for collecting only the first-stream portion of the urine. 3.0 If a clean-catch midstream urine is used for bacteriologic culture, is should be cultured immediately. If this is not possible, the specimen must be refrigerated at 4 degrees Celsius until cultured. The length of time of refrigeration is not to exceed 24 hours. ATTACHMENTS: 1. CTGC Urine Collection Instructions 2. Collection Method and Preferred Volumes Chart SAFETY PRECAUTIONS: Follow procedures and precautions described in the Saint Michael's Hospital Infection Control and Hazard Communication manuals, as well as the Saint Michael's Hospital Chemical Hygiene Plan. Refer to the MSDS for reagent-specific handling guidelines. ```````````````````````````````` 1.0 Clinical Diagnosis and Management, 17th edition, by John B.Henry, M.D., W. B. Saunders Company, Philadelphia, PA, 1984, p Urinalysis and Body Fluids, by Susan King Strasinger, F. A. Davis Company, Philadelphia, PA, 1985, pp Product Instructions, Curity Mid Stream Catch Kit, The Kendall Company, Boston, MA 02101, Aptima Urine Specimen Collection Kit for Male and Female Urine Specimens, Gen Probe Rev. B ORIGINATING DEPARTMENT/SECTION: Ministry Saint Michael s Hospital Laboratory, Microbiology Department Page 4 of 7

5 PH Urine Specimen Collection AUTHOR AND DATE: Pat Barden MT (ASCP) 5/1/1989 REVISED BY AND DATE: Chad Moertl, Phlebotomy Coordinator, 1/19/09 Gail Benzine 11/20/2012 Becky Brooks November 2014, changed urine volume requirements for Aptima CTGC. APPROVAL: Dawn Finch, MT (ASPC) Laboratory Director Jason Heese, MD Medical Director of Laboratory Services H:\Lab\Lab Manuals\Phlebotomy\PH Urine Specimen Collection.doc Page 5 of 7

6 If collecting urine only for CTGC: 1. Patient preparation: CTGC Urine Collection Instructions a. Patient must NOT have urinated within the last 60 minutes. 2. Write your initials on the header label and on the small (aliquot) sticker. 3. Place the small (aliquot) patient sticker on the specimen cup. 4. Using a permanent marker, make two lines on the specimen cup denoting the minimum volume (=10cc) and the maximum volume (=30cc). 5. Instruct patient in correct collection method: a. Urinate directly into the specimen cup. b. Patient should NOT perform a midstream collection. c. Sample volume must stay within the two lines the lab person has drawn on the cup. d. If the patient collects too little or too much urine, the sample will be rejected. If collecting urine for CTGC and urine for other testing: 1. Patient preparation: a. Patient must NOT have urinated within the last 60 minutes. 2. Write your initials on the header label and on the small (aliquot) stickers for each specimen. 3. You will need two specimen cups. Place a small (aliquot) specimen sticker on each specimen cup. 4. Write #1 on the CTGC cup and #2 on the other cup. 5. Using a permanent marker, make two lines on specimen cup #1 denoting the minimum volume (=10cc) and the maximum volume (=30cc). 6. Instruct patient in correct collection method for CTGC: a. Begin with cup #1 (CTGC). Urinate directly into the specimen cup. b. Patient should NOT perform a midstream collection. c. Sample volume must stay within the two lines the lab person has drawn on the cup. d. If the patient collects too little or too much urine, the sample will be rejected. e. Stop urinating after collecting CTGC sample. Use specimen cup #2 and resume urinating. H:\Lab\Lab Manuals\Phlebotomy\FORMS\CTGC urine collection instructions.doc Urine Specimen Collection Via First-stream for CTGCU and Clean-catch Midstream Collection Method for UA & Urine Cultures PH Phlebotomy Policies and Procedures Effective Date: 11/20/2012 All SMH Laboratories

7 UA/UC/CTGCU COLLECTION Collection Method and Preferred Volumes Chart Test Collection method Preferred Volume Minimum Volume Preservative/ handling Other instructions Urinalysis Fresh midstream clean catch 15 ml 2 ml Refrigerate Must be tested within 8 hours of collection. Urine Culture Midstream clean catch NA 0.5 ml Refrigerate Sterile container/collection Urine for Chlamydia GC CTGCU First, use clean catch method and void directly into cup. Finish in toilet or use second cup if other testing ordered ml 10 ml Room Temp Or Refrigerate Sample will be rejected if volume greater than 30 mls. Microalbumin Clean catch 8 ml 1 ml Refrigerate NTX Urine Morning, SECOND void of the day 10 ml 4 ml Refrigerate Toxicology Screen Clean catch 30 ml 30 ml Refrigerate Patient history sheet completed Urine Drug Screens Clean catch 30 ml 30 ml Refrigerate Patient history sheet completed Urine For Cytology AFTER first void of day (no other restrictions) 10 ml 5 ml (do not Cytology request slip (in cabinet # 5). reject if less) Refrigerate Bring to Cytology within 1 hour of collection. Urine Pregnancy Clean catch NA 1 ml Refrigerate Protein/Creatinine Ratio Clean catch NA 1 ml Refrigerate Urine Na, Cl Clean catch NA 1 ml Refrigerate Urine Osmolarity Clean catch NA 1 ml Refrigerate Creatinine Clearance See 24 urine instructions Creatine level drawn preferably during 24 collection, but must be within 24 hours of the beginning or end of urine collection. 12 or 24 Hour Urines See 24 urine instructions Check for preservatives and container type Urine Specimen Collection Via First-stream for CTGCU and Clean-catch Midstream Collection Method for UA & Urine Cultures PH Phlebotomy Policies and Procedures Effective Date: 11/20/2012 All SMH Laboratories