Although P&P say otherwise in my facility, I have only seen people (and I do the same) collect urine specimens out of the foley BAG and not use a syringe in the port. Personally, I empty the bag, then collect the specimen from the urine that collects after. I/others do this for Culture and Sensitivity also. I learned in school it should be collected from the port. I float to 5 different hospitals and I have always seen it this way. I am just curious what the norm is in other facilities...
(I am aware that I should not do something just because it is the "norm" or because "that is the way it's always been done"...I am merely just curious and for some reason never really gave this much thought until now...)
Unless the Foley is new w/the sterile bag, any UA after that is going to be contaminated.
Most bags are only changed weekly- so even though the urine is sterile if the Foley is inserted w/o a UTI, the mucosa the catheter travels along into the bladder does have cells that get sloughed off. When the bag is emptied, air and airborne goodies CAN go into the bag...if someone is transported, and the bag put in their lap for even a few seconds until all is adjusted, a few bugs can travel along the catheter via the fluid lining the tubing....
Also, if you know you have to get a specimen, get all visible urine out of the tubing, coil it correctly, and then wait for some urine to recollect near the port.
From what I understand, colonization of foley catheters happens within 24-48h post insertion. The only time I collect urine from the bag is upon insertion of the foley. Any time after that I will clamp just below the port, allow a small amount of urine to collect, clean the port for 30 seconds, then collect my sample. Always wear gloves when handling FCs.
Thouse bags are dirty and in most cases have been reused over and over the one I have here is a month old and the dirty urien sits in there forever as you can not get every drop out when you empty it . You would never want anything that you are going to sample touching the bags as it would always come back as a uti ( I would think )
the bag can be contaminated (this is why you never let the bag and drainage tubing be above the surface of the bed). you can scrub the port for sampling to minimize the chance that you will be introducing bacteria into the system.
we collect from the port for this reason. just scrub the port with alcohol, take a 10cc syringe and withdraw your sample. just make sure you're using the actual port and not connecting the syringe to the balloon port
The theory that allowing time of the bacteria to "cook" in the bag (ie, proliferate to make the bacteria "show up" better on a C&S) fails to recognize that the microbiology lab counts on you to provide uniform, consistent samples to them. The lab does the job of culturing the bacteria under very controlled conditions and growth timing in order to arrive at meaningful results (they are counting the # of colonies visible under a microscopic field). There are so many uncontrolled variables involved if you take a sample from an already established foley bag that the lab results will be virtually meaningless. Remember that there is a certain amount of "allowable" bacteria in urine before the threshhold of UTI diagnosis. I wouldn't want to have a pt misdiagnosed and put on ABT because I sent a contaminated sample to the lab. This may also lead to a delay in the correct diagnosis for the pt's presenting s/s (eg, decreased LOC).
a microscopic film of urine on the inside of the bag would probably lead to a dirty sample. there's no way to get EVERY drop out of the bag, every time. I always use the port when collecting, it's good practice. I will be asking my CNAs next shift if they use the port, or if they're just getting it out of the bag.
NeoPediRN
945 Posts
In the ER we collect from the bag, but the Foley has always just been placed.