Obtaining urine specimen from foley

[Ms.RN]

How do you obtain urine specimen from foley catheter?

My inservice/infection control nurse told us during our inservice that every time we have to obtain urine from foley, we have to insert new foley in, not just a foley drainage bag but new catheter too. I mean if patient needs urine specimen 2 or 3 times a week, we have to take old one our and insert new one, isn't that a infection issue?

When I did my clinicals in the hospital, we never had to reinsert new foley nor I was taught this way in nursing school. I was taught to clamp the foley and obtain urine specimen from the pole close to the foley catheter.

Does anyone have article or some kind of research paper that shows the proper way of doing this? Thanks

[thehipcrip]

As someone who's used a Foley 24/7 for the last six years, I was taught by two different urologists that the both the existing catheter and the tubing on the collection bag are colonized with bacteria after only minutes of being put in use and therefore should *never* be used to collect a specimen for culturing.

The only way to ensure that you are culturing bacteria that came from within the bladder and not the colonized catheter or tubing is to collect the first urine that flows through a Foley that you have just inserted. Doing anything else will not return accurate results.

When hospitalized, I insist that any urine specimens taken are done using the technique I was taught. Sadly, most nurses fight Me tooth and nail about this, and I end up being branded a difficult patient simply for trying to ensure that any treatment I receive is based on the most accurate test results possible.

[rkitty198, BSN, RN]

I understand what you are saying I really do...

But then why does the major manufacturers then include a safe sampling port?

In our institution if you insert a Foley you must take the urine sample from the first urine. If a patient develops a UTI after the catheter insertion it can be seen that the UTI was from CAUTI.

[CharmedJ7]

thehipcrip said:

As someone who's used a Foley 24/7 for the last six years, I was taught by two different urologists that the both the existing catheter and the tubing on the collection bag are colonized with bacteria after only minutes of being put in use and therefore should *never* be used to collect a specimen for culturing.

The only way to ensure that you are culturing bacteria that came from within the bladder and not the colonized catheter or tubing is to collect the first urine that flows through a Foley that you have just inserted. Doing anything else will not return accurate results.

When hospitalized, I insist that any urine specimens taken are done using the technique I was taught. Sadly, most nurses fight Me tooth and nail about this, and I end up being branded a difficult patient simply for trying to ensure that any treatment I receive is based on the most accurate test results possible.

This is interesting. I just signed on to help with a CAUTI research project and was told for the first time that best practice really does involve pulling the old foley and putting in a fresh one to get a sample. My only issue though is that in practice that would be incredibly difficult to do given the time involved and of course increased infection risk from the actual insertion process. I wonder how much of a difference it really makes, ie, I totally understand the theory, but what is the NNT (numbers needed to treat)? Is there a big rash of over-tx of "CAUTIs" that are really really just colonized foley? Have there been studies comparing cx done from a port then pulling the foley, inserting the new and drawing a sample? I will of course do a lit review, but if anyone knows of any relevant research, I'd love to read it.

[TravelinCEN]

I agree with thehipcrip. I read an research article in the early 2000 that said that an indwelling cath is colonized within 18 hours of insertion. I tried to find the article, but can't (sorry...). I will continue to look and post when I find it.

The reason that there is a sample port is to draw a sample for analysis (simple UA), not to draw a culture.

Also, if an indwelling catheter is placed using PROPER technique, there is actually very little risk of infection. So the risk of infection is not increased by removing the old cath and inserting a new one. But, the risk of getting a contaminated sample from a old cath is certainly greater.

A perfect example of EBP of this is when we teach someone who has urinary retention (SCI) to perform in and out cath rather than have continuous indwelling. In fact, at home, the in and out is done using clean technique, not sterile technique, and rates of infection are still lower than that with an indwelling.

[CharmedJ7]

TravelinCEN said:

I agree with thehipcrip. I read an research article in the early 2000 that said that an indwelling cath is colonized within 18 hours of insertion. I tried to find the article, but can't (sorry...). I will continue to look and post when I find it.

The reason that there is a sample port is to draw a sample for analysis (simple UA), not to draw a culture.

Also, if an indwelling catheter is placed using PROPER technique, there is actually very little risk of infection. So the risk of infection is not increased by removing the old cath and inserting a new one. But, the risk of getting a contaminated sample from a old cath is certainly greater.

A perfect example of EBP of this is when we teach someone who has urinary retention (SCI) to perform in and out cath rather than have continuous indwelling. In fact, at home, the in and out is done using clean technique, not sterile technique, and rates of infection are still lower than that with an indwelling.

As I say, the theory makes sense to me (biofilm and that) but I'm having a really tough time finding good articles on this topic. The best I've found is from 2000 and deals with spinal injury patients, but it doesn't look at urinalysis and the sample size is quite small so the applicability are limited. I'm all for reducing excess antimicrobial use, but I would definitely want very good evidence backing up any attempt to get all the nurses on my floor to switch a foley before drawing a urinalysis as there would be a huge uproar, and with good reason given the time it takes, frequency of UA C&S orders and foleys, and already stretched too thin staff.

[TravelinCEN]

CharmedJ7 said:

As I say, the theory makes sense to me (biofilm and that) but I'm having a really tough time finding good articles on this topic. The best I've found is from 2000 and deals with spinal injury patients, but it doesn't look at urinalysis and the sample size is quite small so the applicability are limited. I'm all for reducing excess antimicrobial use, but I would definitely want very good evidence backing up any attempt to get all the nurses on my floor to switch a foley before drawing a urinalysis as there would be a huge uproar, and with good reason given the time it takes, frequency of UA C&S orders and foleys, and already stretched too thin staff.

I just spent quite awhile looking for that article. I swear I will find it for you, but it may be a hard copy so I will scan it and send it to you.

I understand your need for evidence to change practice. But, please remember this is about the patients, preventing resistance by reducing antibiotic use, and saving healthcare resources. This should not be about staffing issues. It does not matter if the nursing staff is maxed out, if evidence shows that this is the best practice, we need to do it regardless.

Have you gone to the medical journals? I think this may have been medical, not nursing.

[dishes, BSN, RN]

I agree with hipcrip change the indwelling catheter and take the sample from the new catheter, this is the practice recommended by the Society of Urologic Nurses and Associate's (SUNA) clinical practice guidelines, care of the patient with an indwelling catheter (2005) http://www.suna.org/resources/indwellingCatheter.pdf

Charmed

Frequent urine specimens are not recommended for patients with indwelling catheters, if specimens are ordered infrequently it does not increase the nurse's workload significantly, to change the catheter in order to obtain a reliable C&S. Maybe your facility is in the habit of overordering urine specimens?

dishes

[PACU136]

I like your sheets attached to the bottom of your quotes.

Are your an instructor?

[jujuseah, RN]

I cannot imagine changing foley catheter everytime i need to collect urine, my patients and i would be damn ******. Yes you may clamp and swab the area near the Y-port and withdraw with a needle and syringe but.. i am a lazy girl i prefer to change the whole damn bag and wait for fresh urine yo!