Patient brings own urine sample for preoperative pregnancy testing

Nurses General Nursing

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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.

Specializes in ER.
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.

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Specializes in Critical Care.
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.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
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.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
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.

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

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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.

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I would not test a sample from home, ever. I would tell them if they can't pee at the facility, an expensive blood test will have to be performed. It's amazing how people will respond to that. All the sudden, the pee will start flowing.

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Check with your Lab for more information, OP.

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Does a nurse, or an anesthesiologist give the sedation in your endoscopy center? If it is an anesthesiologist I would ask them what they think.

I assume the general public, women of child bearing age, would not have that many visits to an endoscopy center. How would they even know they would be asked for a urine sample for pregnancy testing prior to their procedure? Do you get a lot of "frequent flyers"?

I absolutely believe what you are saying, just hard to believe it would happen that often? I would be suspicious of a woman bringing in her own sample just because it is kind of weird. As others mentioned maybe they think they will be tested for drugs?

Our urine pregnancy kits can take blood or urine. When women can't pee we get a small amount of blood when we start their IV and use that.

Blondi2061, We, on "auto pilot", tell women of child bearing age we need a urine specimen as we bring them back. Afterwards when they are changing and we look over their chart we see "DOH" they have a lab drawn HCG in their chart. I've even done the urine HCG, look over their chart, and find out they had a BTL or hysterectomy. Yes, I feel stupid.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
How would they even know they would be asked for a urine sample for pregnancy testing prior to their procedure? .

I would guess through the preop teaching done before the appointment.

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You might try American Association of ambulatory care nursing or G.I. nursing Cytie website G I nursing insi G I nursing society sorry Siri auto type makes up its own words

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

At my last ER, our lab had a policy for urine HCGs that the sample couldn't be more than 4 hours old. Check with your lab, OP. Or if you are doing POC testing, there might be an "age" limit there as well.

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