As someone who uses an indwelling urethral catheter for bladder management, I'm exceedingly frustrated by how few nurses (and doctors who are not urologists, for that matter) know the proper procedure for collecting a urine specimen from someone with an indwelling catheter.
I've had five orders for a UA written during recent visits to the ED and an admission for abdominal surgery. Not one of the four nurses or the ED doctor who came to collect the specimen knew the correct procedure, and only one (a marvelous RN) listened to me when I explained why the way she planned to take the sample would not yield accurate results and what needed to be done to collect a valid specimen.
So I'm curious. As a nurse, were you ever specifically taught how to collect a urine sample from patients who rely on indwelling catheters? If so, what were you taught? Did this teaching occur as this part of your nursing school curriculum or did you learn on the job from another nurse, doctor, or (gasp!) a patient?
I was taught to take it from the port (clear the line, clamp below the port, draw your sample aseptically after some urine has accumulated above the clamp). Although in practice, I have found that some Docs and even ID Docs prefer to get the sample from the bag. Their rationale is that it's all the same open system between the bladder and the bag, so any bugs in the bag should still be treated regardless of where they originated; (if there aren't bugs in your bladder but they are in the bag, they'll probably be in your bladder soon so antibiotic coverage is beneficial.) The esterase and WBC levels will also give in an indication as to whether the colonization is internal or external.
Last edit by MunoRN on Jul 29, '11
Quote from GM2RN
Yeah, definitely an overreaction on the part of the OP. There is way too much to know to learn it all in nursing school, so NS teaches the basics. Much of what a nurse learns about nursing is on the job, but even after many years in the profession there is no way nurses or doctors can know everything about everything.
Agree. My wife has taught a couple of dozen nurses how to remove a below knee prosthesis. Most have no idea how or think all you have to do is give it a real hard tug.
As for the UA sample, I was taught in school the same way others have said. Drain the tube, clamp it off, draw from the port when the tube refills. Oh yeah, unclamp the tube when finished.
Last edit by belgarion on Jul 29, '11
: Reason: Clarifiation