Obtaining Urine Sample in the Home

[LuLu2008]

How do home health nurses obtain urine cultures when an infection is suspected? In my mind, it has to be via a clean midstream catch or a catheterized sample. Some nurses disagree and are adamant that a sample obtained from a urinal, bedpan or hat is just fine and that the lab has no problem with this. Any thoughts?

[tewdles, RN]

I get a CCMS if the patient is able to understand and cooperate...otherwise, in the home/field you get what you can, how you can.

[LuLu2008]

I get a CCMS if the patient is able to understand and cooperate...otherwise, in the home/field you get what you can, how you can.

What if the client does NOT have an infection, but based upon the contaminated urine sample our health care system uses resources to culture the bacteria that actually was in the urinal. Then the patient has to take an antibiotic for a non-existent infection.

Does obtaining a sample by using "what you can" sound like a reasonable and prudent nursing decision in this instance?

[caliotter3]

My former supervisor one time described a method for getting a sample from a male using two diapers and a specimen container(?) without a catheter. For the life of me, it made sense at the time, but I sure couldn't figure it out. She said she had been taught that way by an experienced nurse.

[sharpeimom]

when my mom was being cared for in her home by hospice nurses, this was what they did:

i knew a day ahead of the test and ran a 2qt. glass pyrex mixing bowl measuring cup/bowl with a handle through the dishwasher. just before getting the sample, the nurse would lift the bsc seat up and place the bowl just under the opening of the seat, put the seat back down, help my mom clean herself, then she'd pee into the bowl. remove bowl, pour contents into waiting container, and voila!

make sense?

[Sarahtonin]

I would get a clean catch if possible. Straight cath is probably the best method, but if a patient can urinate on their own, they're going to refuse being cathed for no reason. Not always pleasant experience. A lot of times, the family members have urine specimens waiting if they know a nurse is coming by to pick it up.

But yeah, there are problems with this, and patients probably are started on antibiotics for non-existent infections pretty often.

[tewdles, RN]

What if the client does NOT have an infection, but based upon the contaminated urine sample our health care system uses resources to culture the bacteria that actually was in the urinal. Then the patient has to take an antibiotic for a non-existent infection.

Does obtaining a sample by using "what you can" sound like a reasonable and prudent nursing decision in this instance?

Actually, in my setting we generally treat suspected UTIs empirically without obtaining either U/A or culture...how does that sound?

[LuLu2008]

Actually, in my setting we generally treat suspected UTIs empirically without obtaining either U/A or culture...how does that sound?

Honestly, it sounds like a perfect storm for superinfections.

[carwin]

I would get an order to straight cath. The patient teaching would be the benefits of straight cath versus the other methods. If they still refuse, then you can call the doctoR for a d/c order related to the cath and add clean catch

[meluhn]

Recently I tried to straight cath an obese woman for ua/c&s and was unable to. I just gave the live-in a sterile cup and a peri wipe especially for clean catches and told her to do her best and call me when she got the sample. It came up negative so it was good enough.