a better way to collect u/c sample from foley catheter?

amoLucia · May 11, 2012

This is starting to sound like a broken record that I keep singing but...did you check your Infection Control Policy & Procedure Manual for the correct technique??? Any place that I've worked, we pull specimens from the aspiration port at the end of the catheter/junction of drainage tubing (that's why they designed the port!). And re: the tubing loop you want to use...I would consider tubing there just as 'nasty' as old urine that accumulates in the bag. Please check your technique. PS - I'm hoping you never ever ever ever ever cut the catheter as a short cut to drain it before removal (you do pull the fluid out with a syringe just like you did to inflate it?).

canesdukegirl, BSN, RN · May 11, 2012

There is no way that this method could be considered a sterile sample. Your scissors alone would contaminate the sample. ALWAYS use the aspiration port.

sbostonRN · May 11, 2012

We don't have an aspiration port on the foley catheters we use. I use the same method you described, removing the bag, swabbing the end of the catheter tubing, and waiting for it to drain into the cup. It would give the same results to clamp the end of the tubing with a kelly clamp and then drain it after 15 minutes or so.

unsaint77 · May 11, 2012

Yes, I forgot to mention that the foley we use don't have the port canesdukegirl is referring to.

So, I have to do either of these two. (for the sake of discussion let's use the term "catheter" as the rubber part goes into patient, and "tube" for the clear plastic tubing connected to the collection bag) I disconnect the catheter and tube and collect urine from catheter opening. Or do as I mentioned above (of course I alcohol-clean the scissors and the part of the tube being cut, just like I alcohol-clean the catheter opening after I disconnect the tube from catheter. Same degree of sterility achieved.).

SbostonRN, when you say you kelly clamp the tubing, you mean you kelly clamp the catheter, not the clear plastic tubing, right?

sbostonRN · May 11, 2012

SbostonRN, when you say you kelly clamp the tubing, you mean you kelly clamp the catheter, not the clear plastic tubing, right?

Yes, kelly clamp the catheter part, close to insertion site, preferably above the balloon port. That's how I've done it in the past, although we don't do this often.

Good Morning, Gil · May 11, 2012

Your foleys don't have that blue lab sample port? Ask your manager to switch to Bard then. I didn't even realize they made foleys without one. So, of course getting a sample will be more of a pain then lol. If it doesn't cost that much more, they might consider it, especially if you tell them the CAUTI rate is falsely elevated from nurses contaminating the samples...that'll get 'em moving to a new product lol.

CoffeeRTC, BSN, RN · May 11, 2012

If your bags don't have the port on the tubing, what about changing the bag? We had a bag that didn't have the tubing and what we would do would be to change the bag and connect a brand new one. The a bag and tubing is sterile for that first collection. Let urine drain into the bag then collect the specimin from that.

amoLucia · May 11, 2012

Just to be clear --- the aspiration port is on the tubing end of the collection bag. Sorry if I confused anyone. Check with your Inf Control person (or Central Supply person, who does the supply orders) to ensure that you have the correct bags. Also just to replace an old bag with a new bag (and then you pull it) is a waste of available equipment and is costly (altho I can see how it could work). In many LTC facilities, we don't have the luxury - I've had to charge out supplies and it would be questioned why a new bag was used if only to subsequently be pulled. Isn't it sad that high costs, insurances and reimbursements can so influence such a simply task!?!? Sad, but true!

CompleteUnknown · May 11, 2012

If the catheters used in your facility don't have an aspiration port (ours don't either), just clamp the catheter for 20 or 30 minutes, then wipe over the join with an alcohol wipe, disconnect and drain the urine into your specimen jar.

Letting some urine collect in a dependent loop of the bag tubing and then cutting the tubing is not a good idea - you may as well just take the urine out of the bag if you're going to do that.

As others have mentioned, putting a new bag on just to get a sample is expensive and unnecessary, and you have to 'break' the system to put that new bag on anyway so there's no point.

canesdukegirl, BSN, RN · May 11, 2012

One of the National Patient Safety goals set by the Joint Commission this year was prevention of infection.

http://www.jointcommission.org/assets/1/6/2012_NPSG_HAP.pdf

I would ask your NM if your facility could get the foley kits that have the aspiration port. I would hate for the pts in your facility to be bombarded with ABX because of a false + bacterial growth from a specimen. It would be more cost effective for your facility to use the Bard Foley kits with an aspiration port to collect a sterile specimen rather than treat false +.

sauconyrunner · May 12, 2012

as an infection control nurse (new, but i am one.) i am kind of cringing reading this. one thing that is emphasized in reducing catheter related uti's is to not break the system.

some of the new foley bags have stuff impregnated in the bags, so even the first collection of urine from the bag could yield false results if you are using one of the bags with antibiotics impregnated in them. (cdc does not recommend these but i think some places are using them anyway.)

the best option you have here if you do not have a sampling port is to use the kelly clamp.