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Patient brings own urine sample for preoperative pregnancy testing

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DineenC DineenC (New) New

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.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Yeah no way would I use a home sample

Zyprexa

Has 2 years experience.

Reminds me of the random jar of urine (aka "Granny's Peach Tea") in Batman V Superman :D

dirtyhippiegirl, BSN, RN

Specializes in PDN; Burn; Phone triage. Has 8 years experience.

My brain automatically wanders to the patient who absolutely thinks that you're going to drug test them and they care more about getting out of THAT than whether they are going to receive sedation while pregnant. :p

Is there a credible organization that addresses this?

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Would you test a blood sample a patient brought in from outside? It's better to have a waiver documented than information that is patently false and manipulated.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Proper urine hCG testing is performed on the first sample after waking and the sample remains stable for a while, so unless the person can hold that first morning pee until they get to the clinic it's usually preferred to have them bring their morning sample in with them. If you want to determine is someone is pregnant at other times of day then a blood test should be done.

If the pregnancy test is optional, as described, then I'm not sure why people think someone would go through the trouble of cheating the test.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

I would certainly rather test their home urine than not test them at all.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

If you want to determine is someone is pregnant at other times of day then a blood test should be done..

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

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

After going thru a pre-op for a big surgery, my blood work was done 5 days prior, I wish they could just draw a test then. After being NPO for hours, it was like squeezing a rock for liquid lol ��

But a urine from home, probably not. Although I was like, hook my IV up for a bit, then I can pee lol

DowntheRiver

Specializes in Urgent Care, Oncology. Has 7 years experience.

Not always true. I've had patients that have tested positive that morning and then when they come to the clinic they test negative. And yes, we require the specimen on site, but I work in a clinical setting. If you can't produce then we draw blood and you wait for the results. In a clinic setting, this means results next day typically.

And yes, many people do think you are testing them for drugs even if you're testing for glucose, ketones, WBCs, etc. I used to do DOT physicals which required a urine specimen and people would be very weary of providing a specimen because they really thought it was another drug test.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

After going thru a pre-op for a big surgery, my blood work was done 5 days prior, I wish they could just draw a test then. After being NPO for hours, it was like squeezing a rock for liquid lol ��

But a urine from home, probably not. Although I was like, hook my IV up for a bit, then I can pee lol

I had preop labs once that included an HCG. Two days later they did a urine HCG at the facility. I thankfully hadn't become pregnant in those two days.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

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

Point of order!

You count pregnancy days and weeks from the first day of the last period, so someone two days "pregnant" hasn't even had the sex that will cause conception. By the time a woman misses a period she is at least four weeks pregnant, by the magic circle of OB that determines dates and EDC.

Even the pregnancy test companies talk about testing at two weeks pregnant, but if you look at the package, the accuracy of the test rapidly declines if you test earlier than the first missed period. They say it will be accurate 50% of the time...well you may as well flip a coin.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

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

Oddly this is true for the "pee-stick" you'll find at the grocery story which have gotten to be very sensitive, but those used in hospitals and clinics are subject to a more extensive process to get changed and updated to more sensitive tests, many still use tests that are only reliable with a more concentrated sample (first morning pee), which is why we more commonly test blood.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

Point of order!

You count pregnancy days and weeks from the first day of the last period, so someone two days "pregnant" hasn't even had the sex that will cause conception. By the time a woman misses a period she is at least four weeks pregnant, by the magic circle of OB that determines dates and EDC.

Even the pregnancy test companies talk about testing at two weeks pregnant, but if you look at the package, the accuracy of the test rapidly declines if you test earlier than the first missed period. They say it will be accurate 50% of the time...well you may as well flip a coin.

By two days, I meant 2 days past missed period.

Look at it this way - hcg doubles every 24-48 hours. Most clinics use a not-very-sensitive test, that measures bHCG of about 50. A super sensitive home pregnancy test will measure bHCG in urine of 15-20. Blood tests will measure amounts as >5 as positive.

Within a few days after it's present IN ANY QUANTITY in the urine or bloodstream, it will be doubled and tripled enough that it will most likely get picked up even in tests that are not very sensitive.

Edited by klone

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

Oddly this is true for the "pee-stick" you'll find at the grocery story which have gotten to be very sensitive, but those used in hospitals and clinics are subject to a more extensive process to get changed and updated to more sensitive tests, many still use tests that are only reliable with a more concentrated sample (first morning pee), which is why we more commonly test blood.

See my post above.

Some people might use it but I wouldn't, to me it's not worth the professional risk.

foggnm

Has 8 years experience.

I wouldn't think someone would bring fake urine knowing the purpose of the test is for operative safety. I see nothing wrong with it, but of course ideally they would do it in the office. No one is that excited about getting surgery to fake a pregnancy test. And like you said they could just as easily bring someone else's urine and put it in a cup at your office if they really wanted to. It is a nice courtesy to let someone do it at home. Probably the best policy is just to tell people they will have a urine test prior to surgery and so no to void just before arriving so that you will be able to do so upon arrival. Another option would be for them to do it the day before the surgery.

Edited by foggnm