URINE III-38
URINE COLLECTION, PREPARATION AND HANDLING I. SPECIMEN COLLECTION A. Introduction Laboratory tests requiring urine specimens involve a wide variety of procedures. A basic urinalysis is almost always included in the routine workup of patients. When a urine culture or a more esoteric urine test is ordered, the clinical usefulness of the test results can be ensured only if the patient receives explicit written instructions. B. Preparation Prior to each collection, review the laboratory s specimen requirement. Note the proper specimen to be collected, and the storage and handling requirements. Provide a patient in advance with appropriate collection instructions and information on fasting, diet, and medication restrictions when necessary. Confirm identification in the presence of the patient. Process and store the specimen as required. During specimen collection, preparation and submission, there is a much greater possibility of critical error than during actual testing or examination of the specimen. Errors in storage and handling compromise the integrity of the specimen and, thus, the test results. Test results are only as good as the specimen collected. C. Patient Instructions and Preparation Random urine collection for routine analysis Patients should be provided with both written and spoken clean-catch instruction. See Microbiology Section for specific instructions. Routine 24 hour urine collection III-39
Many of the chemical analyses performed on urine specimens must be carried out on 24 hour urine collections. Collection of this specimen requires the utmost cooperation of the patient, nursing staff and laboratory. The 24 hour urine specimen should be submitted in a chemically clean, properly labeled urine container. (Patients should not be allowed to submit urine specimens in their own clean jars). The laboratory will add required preservatives or will supply the proper preservative with the container. Please refer to test directory section to note any specific requirements or special restrictions for the ordered test. Written and verbal instructions should be clearly explained in the follow manner: 1. A normal intake of fluids during the collection period is desirable unless otherwise indicated by the physician or test requirements. 2. Upon arising in the morning urinate into the toilet, emptying your bladder completely. DO NOT COLLECT THIS SPECIMEN. Note the exact time and date on the container label. 3. All urine specimens passed (day or night) is collected in an appropriate container. Urine passed during bowel movements must also be collected. 4. At the end of the 24 hour collecting period the bladder is emptied and this urine specimen added to those already collected. Note the date and time collection is completed. 5. The entire specimen should be refrigerated at 4 degrees centigrade during collection, or kept in a cool place, since urine is an excellent culture medium for bacteria. Also, the constituents decompose quickly. 6. Take the 24 hour urine specimen to the physician s office or laboratory as soon as possible, maintaining the cool temperature in transit by placing the specimen in a portable cooler or insulated bag. D. Urine Collection Containers Specimen Identification The accuracy of any result depends upon the quality of the specimen. Materials for proper specimen collection and transport are supplied by the Altoona Hospital. III-40
Proper identification of specimens is extremely important. Unidentified samples will not be tested; therefore, clearly label each specimen with the patient s full name, date and time collected, test name and nurses initials if applicable. Information on preprinted labels should be verified. Selecting Appropriate Specimen Containers Sterile Container: Provided by laboratory. Use: Urine Cultures and clean-catch specimens must be refrigerated immediately and maintained until delivered to lab. Clean Disposable Cup: Provided by laboratory. Use: Random urinalysis, certain chemistry tests, etc. Refrigerate specimens until delivered to lab. 24 Hour Urine Container: Provided by laboratory. If specimen requires special preservative this will also be provided by laboratory. Use: Needed for tests which require 24 hour specimen. 24 Hour Pee-Splitter Container: Provided by laboratory. Use: Needed for tests which require multiple preservatives. E. Collection Errors Careful attention to routine procedures can eliminate most of the errors outlined in this section. General Collection Errors 1. Inadequate preservation and/or refrigeration 2. Loss of voided specimens 3. Inclusion of two morning specimens II. URINE SPECIMEN PREPARATION AND HANDLING A. Preparing and Handling Urine In preparing and submitting specimen adhere to the following critical points: III-41
1. If only a portion of the 24 hour collection is submitted to the lab, be sure to measure the entire 24 hour volume and record the total amount in milliliters (ml.) on the test form for lab use. 2. When aliquots are required with preservatives use only the preservative requested. One preservative cannot be substituted for another. 3. The total daily urine volume is dependent on many factors. Be sure to provide the patient with a container of adequate size. B. Preparation Errors 1. Failure to refrigerate specimen. 2. Failure to adhere to specific dietary restrictions as stated in the testing directory. 3. If submitting a portion of 24 hour urine, failure to note the total volume of the urine on the lab test form. III. CRITERIA FOR URINE SPECIMEN REJECTION 1. Improperly identified or unidentified specimens. 2. Specimen too old for accurate testing (refer to specific test for such time requirements). 3. Improper preservative for urine specimen. 4. Patient did not follow specific instructions associated with certain test procedures. Special instructions may be obtained by calling Altoona Regional Health System Department of Laboratory Services at (814) 889-2161. 5. No plasma or serum creatinine drawn within 24 hour collection of the 24 hour creatinine clearance collection. III-42
24 Hour Urine Instructions Patient Information Sheet Test Description Your physician has ordered a test that requires the collection of all voided urine over a 24 hour period. You will be provided with a container that may contain a preservative. The preservative may be a small amount of liquid, powder or tablet and must not be removed. If you come in contact with the preservative, please flush with plenty of water. Patient Preparation Please make sure you have followed the specific instructions provided to you by your physician, as well as this patient information sheet. Testing Process 1. Please label the container with your name and date of birth. 2. Empty your bladder upon awakening and flush the urine down the toilet. 3. Document this Date and Time on the sample label. This will mark the beginning of the 24-hour collection period. 4. Collect all subsequent specimens during the remainder of the 24-hour period. DO NOT exceed the 24 hour period. Timing is critical and you must stop the collection exactly at the 24 hour mark. [Example First morning sample was voided at 07:00 and flushed, (do not save this sample). All urine samples are collected in the container until 07:00 the following day.] 5. The sample must be kept refrigerated or in a container of melting ice at all times unless specified by your physician. 6. After the collection process is complete, please return the collection container(s) to the hospital Outpatient Laboratory. You must stop and register in Patient Access prior to dropping off your sample. 7. You may or may not be required to have blood samples collected on the return visit to the Outpatient Laboratory. Please speak to the laboratory personnel when you drop off your sample. Do Not simply drop off the sample and leave. We may need to obtain additional information at this time. What to Expect Blood samples will be collected from a vein. This may result in bruising at the puncture site. This can be reduced by keeping pressure on the site for several minutes after the needle is withdrawn. If you do not feel well, please contact your physician. Sop\24 hour urine instructions