Patient brings own urine sample for preoperative pregnancy testing

[DineenC]

I work at an endoscopy center. Patients who are childbearing age/ability are encouraged to consent to preoperative HCG testing. On occasion, we have patients bring in their own urine sample in from home for this. When this happens, all of my co-worker are under the assumption that this sample can not be used. They say "how can you be sure that its the patients urine". I wonder how my coworkers are sure any patients urine comes specifically from any patient, as they do not follow the patients into the bathroom to watch them provide the samples that are obtained on site. I believe that we should use these provided from home samples. First of all, many of the patients who do this state that they have some kind of anxiety issue that will not allow them to produce a sample on-site, and then end up having to sign a waiver because they can not provide the sample, and the HCG test is not done at all (how on earth is this better). Secondly, in my opinion, the sample from home is more likely to yield more accurate results as it is more likely to be from the first morning void (contains more HCG). I know that the urine should be properly stored - and that is a whole separate issue. I would like to know is does anyone have somewhere that I can reference guidelines on this from a credible organization.

[Lamharr]

As a Registered Nurse I would never use a home sample. There is too much risk. My question would be - what if they are pregnant and afraid to tell thinking the procedure would be canceled? Then the procedure would be done on a false sample and then something happen to the pregnancy. Too many RED flags. The other that jumps out is a substance abuser and don't want anyone to know?

[MjHudd]

Well really, you don't have the authority to do that since you'd need an a doctor's order to change the method of testing. It not that big of a deal to test the home sample- I explained why in the main comment thread.

[Kmcourtney22]

Why not draw a stat qualitative hcg when you start the IV line?

[Joanie3]

I think you are opening yourself up to a lawsuit if a woman brings her own sample from home and it shows negative and she gets sedated - potentially harming the fetus if she is indeed pregnant. It's true that you don't know if it's her own at the center but I think it would hold up a lot better in a court if you make the patient provide the sample at the center. I manage a center and this would never fly with me.

[klone, MSN, RN]

I think you are opening yourself up to a lawsuit if a woman brings her own sample from home and it shows negative and she gets sedated - potentially harming the fetus if she is indeed pregnant. It's true that you don't know if it's her own at the center but I think it would hold up a lot better in a court if you make the patient provide the sample at the center. I manage a center and this would never fly with me.

But if the patient cannot provide a sample on site, they just DON'T DO IT. Why would not doing it at all be preferable to doing it on a home sample?

They need to either create a policy that it MUST be done (and if the patient can't pee, they run a serum test), or they should accept the home sample.

[brownbook]

I repeat, at my old job our urine pregnancy test also worked with a drop of blood. Get a drop of when you start the IV, problem solved.

[Rose_Queen, BSN, MSN, RN]

But if the patient cannot provide a sample on site, they just DON'T DO IT. Why would not doing it at all be preferable to doing it on a home sample?

They need to either create a policy that it MUST be done (and if the patient can't pee, they run a serum test), or they should accept the home sample.

This is exactly our policy. Sample provided on site, tested (includes specific gravity). If specific gravity is too low or a sample can't be provided, then we do a serum test. However, we also offer a waiver for those who choose to opt out of the pregnancy test. Then any consequences to a fetus that the staff doesn't know about are on them.

[DisneyNurseGal, BSN, RN]

The urine of someone more than 2 days pregnant will still show +, regardless of time of day.

Not true. I was 4 months pregnant with my last child before I had a positive urine test. I knew I was pregnant and did have the testing to prove it.. finally at 7 weeks we could hear the heartbeat.